Meritocracy No More
Stay healthy, my friends
My maternal grandfather Hienrich and his wife Matilda were dirt-poor sharecroppers in rural Texas. They never owned their own home until their six children bought one for them. I spent a week or two every summer in my early childhood with them…no air conditioning, working in the garden, walking everywhere, as they didn’t own a vehicle. Nonetheless, they were happy and content.
My other grandfather Hugo emigrated from Germany in 1904 and lived among other fellow Germans in a Bronx tenement, toiling in a foundry before moving to Texas, marrying my grandmother and buying an apothecary. It burned down in 1923 but they rebuilt and persevered. My father took over the business in 1951, shortly before Hugo passed away, long before I was born. My alter-father was my Dad's best friend, the only physician in town, of equally humble origin, who took me under his wing like his own son. He did a one-year rotating internship after a stint in Korea and then handled everything from delivering babies to abdominal surgery to sore throats and ingrown toenails. All of these people tirelessly worked for everything they had.
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I suppose part of the attraction of medicine was, for me, that it was truly a meritocracy. No matter who you were, despite your race, creed or color, if you were stupid, lazy or reprobate, you didn’t get in the club. If you somehow slithered in, you wouldn’t last. All that mattered was your dedication, performance and perseverance. I’ve always held that if I or my loved one was in a serious accident in a remote area and needed emergency intervention, all that I would care about was competence. Brown, black, yellow, red, Muslim, Christian, Hindu….I DON'T CARE. All I care about is whether or not you know what you're doing. Can you pull my, or my loved one's, chestnuts out of the fire?
There have always been great physicians, good physicians and physicians who couldn't qualify to be a dog catcher, much as in everything else. In surgery and certain other specialties, the distinctions become more acute and easily recognizable. Despite that, a dangerous , incompetent surgeon can leave quite a trail of death and destruction in their wake before they get sidelined. Neurosurgeon Christopher Duntsch, “Dr Death”,
is an extreme example, and one should note he is white. This issue has absolutely nothing to do with race. The worst surgeons in my community are white. The best neurosurgeon I have ever worked with, as a trainee, is black. It’s been said that neurosurgery is akin to sucking a 55-gallon drum of cream of wheat through a Fraser-tip suction device (quite small, about 3mm) in three minutes or less. Fred Todd could do that, and more, with grace, skill, poise, class and aplomb and then do it again and again. He’d tell you how good he was, but he backed it up. Every. Single. Time. I’d let him drill my head without hesitation.
That’s all changing, and fast. Medicine had already been reeling from the corporatization of health care, aided and abetted by the abomination of Obamacare and absolutely NOT limited to for-profit systems; not-for-profits are usually more ruthless and diabolical than their for-profit counterparts. At least with the for-profits, there are no illusions. You know what you’re getting. The giant honey pot of cash that was health care attracted a legion of carpetbaggers and grifters who now run the show, patients and their interests be damned. Then the abject debacle of the Covidiocy destroyed whatever shreds of legitimacy and honor remained.
But those daggers and arrows were apparently not enough. The perverse religion that is wokeism has as its professional screed the mantra of DEI….diversity, equity and inclusion. Equality of outcomes rather than opportunity. Every medical school and medical professional society now has DEI deans and officers. Some are raising concerns about DEI
but they are mostly falling on deaf ears. My main professional society, the American College of Surgeons, paid the race hustler Ibram X. Kendi (born Ibram Henry Rogers) a hefty sum to lecture and harangue its Board of Governors, after the College's annual October meeting last year, about how evil and racist the College has been and how it must change. In response, professional societies are hemorrhaging membership as physicians collectively say “Hell, no” and keep their annual membership dues to themselves. This will likely be my last year as a Fellow of the College. The individual societies aren’t too forthcoming regarding the numbers who have done so, but few members of the public are aware that the AMA represents only 15% or so of American physicians.
The tragedy of DEI is that its broad application tarnishes the success of the competent standouts in the demographic groups that DEI is ostensibly supposed to protect and lift up, and casts doubt in the minds of their (informed) patients.
Admission standards for medical school are being altered as well, for certain groups. Entrance and national licensure exams are under pressure to change to a kinder, gentler format where absolute scores matter less and STEM fund of knowledge is less important than sociological and cultural “literacy”
Lower standards for certain racial, gender and sexual preference demographic groups are in the works as well. Yes, I’ve heard a prospective medical student state that their scores and GPA mattered less than the fact that she was LGBTQ, and she's most likely correct. These lower standards extend into and through the curricula; the soft tyranny of low expectations has set a low bar. When I was a Chief Resident, a lifetime ago, medical students on call could go home at 11pm. Just five years prior, at the top-25 school I attended, that policy would have been derisively mocked. I had a female student, who was actually quite good, tell me on her first call night that she was headed home as we were taking an unusual emergency case to surgery. She did this every call night through her 4 week rotation. I graded her as a “B”. When she asked me why, I informed her that I didn't feel that she had sufficient interest or dedication to warrant an “A” in surgery. She protested and some Associate Dean who didn't even take care of patients changed her grade to “A”. I imagine that it’s much, much worse now. Couple behavior like that with years of these kids watching “Grey's Anatomy” and its warped portrayal of residency training, and you have contemporary medical trainees that scare the hell out of me. I don’t interact with them daily, but what I see when I do concerns me. I would strongly recommend avoiding interaction with the healthcare system. Now, not all trainees are substandard and lacking commitment, but you’d better be damned careful about choosing your doctor, if, that is, you get a choice at all.
My first years of practice after training were the most difficult years of my life. Exhausting and challenging yet exhilarating. Medical school and postgraduate training are meant to prepare one for that. Anything less places patients at risk. When no one's there to hold your hand at 2am with a crashing patient before you, no one is glad they went home at 11pm.
Remember, don’t get sick and don’t be a leaf in the stream. Create your destiny.
Late-breaking update 18 Sept…. I’m halfway through this book that Arthur referenced in this post…
It’s worth your time
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The thing is that it's worse than that. DEI is going to bring on board a lot of people who are inept and incompetent. This means that marginal and even average applicants who otherwise would have been enrolled in Med School won't be. So what will happen is that somewhere in the middle there wil be a gap between those applicants who made it on their abilities and those who made it because diversity.
But what will happen to make this worse, is that the grading standards of the institutions will have to be drastically lowered to maintain the charade and diversity, and because they won't dare fail the diversity half of the class. In addition the medical boards will also have to quickly but quietly do the same. After for the same reasons.
And it pains me to say, but when a generation of people for whom everyone gets an award is in an academic setting, even though they may be in the top tier of students that really isn't the same as it used to be. Especially when the college age population is smaller than it was before. But the need for physicians is larger because demographics.
This is all on top of a medical industry that is going to be greatly diminished in the public eye when the truth about the last few years inevitably comes out. Preventing the use of well established medications like HCQ and Ivermectin, which they dam well knew were curative in order to follow the official protocols because that's where the reimbursement money was.
My nephew's wife is a highly trained surgeon in a New York city hospital, NY Pres. And when we asked her if she would prescribe ivermectin to a covid patient if she thought it would cure them, she said no, because the hospital didn't allow it.
They even covered up the information that PepsidAC PeptoBismol and Zantac were better at dealing with covid than Remdesivier.
Which begs the question, what other low cost life saving treatments are hospitals dis allowing in order to increase revenue.
As for me, I wouldn't let her treat my dog for mange, I don't trust her and I don't respect her. Not as a medical professional.
So it's going to get worse, the good news is that the whole medical system as we know it will probably self implode before many of these new Doctors in Diversity come on board.
When one speaks about the problem with the equality of outcomes wokeism he is necessarily speaking about race. Given the intelligence distribution among the races, if equality of outcomes was the only factor in medical school admissions the numbers would reflect that distribution. It is unhelpful when we make the equality of opportunity argument without reinforcing the argument with real data about human variation. They tell us white people suck and they want less of them. We respond with we are not racist! How silly. An assertive response would be, we dominate medical schools and engineering programs because we are smart, we delay gratification, and we work hard.