Archive for the ‘education’ Category

Why Importing Foreign Doctors may not fix the shortage.

Sunday, April 17th, 2016

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The coming doctor shortage that I have previously written about might be dealt with as Canada did with theirs some years ago, by importing foreign medical graduates. Britain has adopted a similar plan as thousands of younger doctors plan to leave Britain.

How is the plan to import foreign doctors working out ?

Not very well.

Nearly three-quarters of doctors struck off the medical register in Britain are foreign, according to shocking figures uncovered in a Mail on Sunday investigation.
Medics who trained overseas have been banned from practising for a series of shocking blunders and misdemeanours.
Cases include an Indian GP who ran an immigration scam from his surgery, a Ghanaian neurosurgeon who pretended he had removed a patient’s brain tumour, and a Malaysian doctor who used 007-style watches to secretly film intimate examinations with his female patients.

First of all, foreign medical schools are often limited in real experience and students often graduate with nothing beyond classroom lectures.

This was the case with Mexican medical schools, like that in Guadalajara where many American students attended. A program was devised to provide them with a year of clinical training before they could be licensed.

The revelations come just a week after it emerged health bosses want to lure 400 trainee GPs here from India, to help ease short-staffing in the NHS.
Last night Julie Manning, chief executive of think-tank 2020 Health, said: ‘The NHS has thrived on many international doctors coming to work in the UK – but the public needs reassuring they are all truly fit to practise in the first place.’

Of course, the foreign doctors have their defenders.

Dr Ramesh Mehta, president of the British Association of Physicians of Indian Origin, admitted ‘there is a problem’ with the high strike-off rate among foreign doctors. But he claimed racism played a part.

We have a similar problem with affirmative action medical graduates but the figures are not available about their rates of license revocation. For example, the The Alan Bakke case went to the US Supreme Court, which eventually ruled in his favor. By the time the court ruled, years had gone by and Bakke eventually did gradate from medical school and has practiced quietly ever since.

However, a black student admitted by the program that denied Bakke a place was subsequently prosecuted for gross negligence and his license removed. Affirmative Action has been vigorously defended.

An admissions process that allows for ethnicity and other special characteristics to be used heavily in admission decisions yields powerful effects on the diversity of the student population and shows no evidence of diluting the quality of the graduates.

However, the conclusion does not match the findings in the study.

Regular admission students had higher scores on Parts I and II of the National Board of Medical Examiners examination, and special consideration students were more likely to repeat the examination to receive a passing grade.

The article goes on to explain that There was no difference in completion of residency training or evaluation of performance by residency directors.

A friend of mine was the Chairman of the Department of Surgery at a UC medical school who decided to fire a black female resident for incompetence. He was advised by the UC system and the other department heads that he would lose a lawsuit if she filed one. She did, in fact, file such a lawsuit alleging racial prejudice (of course). The department chair was able to successfully defend his decision but the fact that no one else was willing to try explains the finding that There was no difference in completion of residency training or evaluation of performance by residency directors.

I have had the experience of being a Surgery Department Chair in a community hospital confronted with the application of a known incompetent surgeon. The same factors apply to those known to be dishonest. A request for a letter of reference from the department in which the applicant trained usually results in a response that states, “The applicant completed the residency from X date to Y date.” No other information is provided and a further request is usually answered by “The matter is in litigation,” or words to that effect. This applies to all such applicants but affirmative action individuals are almost impossible to find negative information on even if the “grapevine” has provided warnings.

The general concern can be found, but details are thin on the ground.

A quick scan of the documents reveals that white students applying to medical school with a GPA in the 3.40-3.59 range and with an MCAT score in the 21-23 range (a below-average score on a test with a maximal score of 45) had an 11.5% acceptance rate (total of 1,500 applicants meeting these criteria). Meanwhile, a review of minority students (black, Latino, and Native American) with the same GPA and MCAT range had a 42.6% acceptance rate (total of 745 applicants meeting these criteria). Thus, as a minority student with a GPA and MCAT in the aforementioned ranges, you are more than 30% more likely to gain acceptance to a medical school.

There are other sources of the facts, but they don’t appear in mainstream publications. Social Justice keeps most of these concerns underground.

A friend of mine, who is Cuban born and an immigrant as a child, applied to UC, San Francisco medical school. This was in the 1970s. Affirmative Action was well underway. He waited several weeks, then months, to hear if he had been accepted. Finally, he drove to San Francisco and asked someone in the Admissions Office what had happened to his application. He was told that it was in the “Hispanic Applicant Committee.” Having no idea what criteria such a committee might be using to determine who should be admitted, he asked if his application could just be considered as a “white” applicant. This was done and he received a letter approving his admission a few days later.

The pressure is now on medical education to provide the hundreds of thousands of new doctors this society believes it needs. Productivity of the present graduates is well below that of my generation. Some of that is the disappearance of fee-for-service practice which motivates work ethic. Some of it is a result of the 60% female medical school classes.

The female doctor population is acknowledged to work less.

Today, however, increasing numbers of doctors — mostly women — decide to work part time or leave the profession. Since 2005 the part-time physician workforce has expanded by 62 percent, according to recent survey data from the American Medical Group Association, with nearly 4 in 10 female doctors between the ages of 35 and 44 reporting in 2010 that they worked part time.

This was the reason why medical school admissions committees “discriminated” against female applicants in the 1960s when I was a medical student. They were concerned, even then, about a doctor shortage and assumed women would stop working to have children or practice part-time.

They were absolutely correct.

Canada is finding some productivity issues and even some explanation.

a fee for service model, and its inherent encouragement of increased productivity through increased volume of patients, a significant shift away from this single model is taking hold.

This, of course, will not deter the Social Justice types as more doctors with less productivity is somehow more efficient than paying doctors more to encourage higher work loads. Socialism is the aim, productivity will have to take care of itself.

In the meantime, PHYSICIANS WHO DID not attend medical schools in the United States or Canada, referred to as “international medical graduates (IMGs)”, play an integral role in the U.S. health care system. Such physicians now represent approximately 25 percent of practicing doctors nationwide.

It’s going to increase.

The Doctor Shortage, discovered once more.

Friday, April 1st, 2016

33 - Lister

I have previously written posts about a coming doctor shortage.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?

The health policy “experts” have been concerned to train “lesser licensed practitioners” and have pretty much ignored primary care MDs except to burden them with clumsy electronic medical record systems that take up time and make life miserable.

I repeatedly ask medical students if they would choose a career in primary care if it would completely erase their student loan debt. A few hands go up, but not many. In fact, for a while now, the federal government has dedicated millions of dollars to repaying loans for students who choose primary care. Yet residency match numbers show that the percentage of students choosing primary care is not increasing. Though loan forgiveness is a step in the right direction, medical students realize that by choosing a more lucrative specialty, they can pay off their loans just fine.

I proposed years ago, a health reform that resembled that of France where medical school is free. It could be arranged that service in primary care, low income clinics would give credit against student loans. Nothing happened. Except physician income has declined. And tuition has increased.


The Transformation of Economics.

Tuesday, March 1st, 2016

A great piece in the Wall Street Journal today about what has happened to Economics and Economics education.

I took an Economics class in college in 1957 and it changed me to a Republican. My first vote was for Richard Nixon in 1960. My family was furious as they thought we were related to the Boston Kennedys and they had always been Democrats. I wonder if an Economics class would have that effect today?

And that political economy and my assessment of it has changed over a career spanning more than half a century. Here are five developments I would emphasize:

I agree with his appraisal.

1.• Diminishing returns to research. A core economic principle is the Law of Diminishing Returns. If you add more resources, such as labor, to fixed quantities of another resource, such as land, output eventually rises by smaller and smaller amounts. That applies—with a vengeance—to academic research. Teaching loads have fallen dramatically (although the Education Department, which probably can tell you how many Hispanic female anthropologists there are teaching in Arkansas, does not publish regular teaching-load statistics), ostensibly to allow more research. But the 50th paper on a topic seldom adds as much understanding as the first or second.

This has been characteristic of Medicine, as well as other academic subjects.

Emory University’s Mark Bauerlein once showed that scholarly papers on Shakespeare averaged about 1,000 a year—three a day. Who reads them? How much does a typical paper add at the margin to the insights that Shakespeare gave us 400 years ago?

That isn’t he has shown.

The attitude touches the President’s favorite pastime. Tevi Troy reported in Commentary how much Obama enjoys television, particularly SportsCenter and the middlebrow series Homeland and Mad Men. The New York Times added Breaking Bad and The Wire in its article “Obama’s TV Picks: Anything Edgy, with Hints of Reality,” and while it warned of the foolishness of “psychoanalyzing” a president based on “the books he reads or the music he listens to or the television shows he watches,” the story mentions not a single book. One would expect Marxists, feminists, queer theorists, post-colonialists, anti-imperialists, and media theorists to chide Obama for his bourgeois, masculinist taste, but as far as I know they have remained silent.

Obama’s taste runs more to sports and rap music.


What the black college students are rioting about.

Monday, November 16th, 2015


Power line has a post today that seems to me to be right on the topic of what these students want, which is freedom from accountability. They are afraid they are overmatched against white colleagues. They can’t hack it and want a pass. It is called “Mismatch.”

The biggest change since Grutter, though, has nothing to do with Court membership. It is the mounting empirical evidence that race preferences are doing more harm than good?—even for their supposed beneficiaries. If this evidence is correct, we now have fewer African-American physicians, scientists, and engineers than we would have had using race-neutral admissions policies. We have fewer college professors and lawyers, too. Put more bluntly, affirmative action has backfired.

Why is this ? We know that the normal distribution of IQ is a standard deviation lower for blacks than whites.


This is the over all curve with the distribution around an average of 100, by definition.


The curve for blacks has a peak at IQ about 80. White peak at 100 to 104. Asians peak at around 106. What this means is that the average IQ is lower for blacks but this does not mean that all blacks are less intelligent than whites. At an IQ of 110 there is a large difference but the number of blacks who will do well in certain academic fields like Medicine is still significant. It would seem important to identify those blacks who will do well in fields requiring higher than average intelligence but the present system of affirmative action ignores this truth.


The Coming Shortage of Doctors.

Monday, August 3rd, 2015

33 - Lister

This Brietbart article discusses the looming doctor shortage.

Lieb notes, that the U.S. is only seeing 350 new general surgeons a year. That is not even a replacement rate, she observed.

A few years ago, I was talking to a woman general surgeon in San Francisco who told me that she did not know a general surgeon under 50 years old. The “reformers” who designed Obamacare and the other new developments in medicine are, if they are MDs, not in practice and they are almost all in primary care specialties in academic settings. They know nothing about surgical specialties.

They assume that primary care will be delivered by nurse practitioners and physician assistants. They are probably correct as we see with the new Wal Mart primary care clinics.

The company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.

This is all well and good. What happens when a patient comes in with a serious condition ?


White Privilege.

Thursday, July 2nd, 2015


The subject of “white privilege” is very much in the news there days.

Administration officials at the John F. Kennedy School of Government at Harvard University have reached an agreement with student activists to force “mandatory power and privilege training” on incoming students during orientation.

The group, which calls itself “HKS Speaks Out,” will have a meeting this week with the dean of the Kennedy School, David T. Ellwood, to discuss the funding for the compulsory training and to “make sure this training is institutionalized” throughout the school, reports Campus Reform.

Who is this group behind the “white privilege” training session ? Well, they are disgruntled students.

The movement, called HKS Speaks Out, began in October after students expressed having “really negative classroom experiences,” according to Reetu D. Mody, a first year Master in Public Policy student and an organizer of the movement. She said the group has amassed about 300 student signatures, or about a fourth of the school’s student population, on a petition that calls for mandatory privilege and power training.


She can’t breathe. She is a Congressional staffer but I can’t find out whose staff. Democrat if not Bernie Sanders.

Steve Sailor is not impressed.

Harvard U. is full of people who clawed their way into Harvard, so it’s not surprising that they often can’t stand each other. Fortunately, 21st Century Harvard students have a vocabulary of whom to blame for any and all frustrations they feel. From the Harvard Crimson:

Kennedy School Students Call for Training To Combat Privilege in Classroom

Whiteness !


Another D-Day anniversary.

Saturday, June 6th, 2015

I have posted a few photos from our trips to Normandy in years past. I haven’t been back since then but have been reading about it. Here is SLA Marshall’s description of the first wave at Normandy.

It was very nearly a disaster for the whole invasion although Utah and the British and Canadian beaches were far less dangerous for the troops. One reason was the geography.

Utah Beach was nearly flat and there was no bluff as there was at Omaha. The problem at Utah was that the country behind the beach was low and the Airborne drop was to secure the causeways that controlled access to the dry ground beyond the fields flooded by the Germans. Sante Mere-Eglise was the center of the Airborne mission.


It is much more quiet today although the famous parachute still hangs from the church roof.


Why Doctors Quit.

Friday, May 29th, 2015

Today, Charles Krauthammer has an excellent column on the electronic medical record. He has not been in practice for many years but he is obviously talking to other physicians. It is a subject much discussed in medical circles these days.

It’s one thing to say we need to improve quality. But what does that really mean? Defining healthcare quality can be a challenging task, but there are frameworks out there that help us better understand the concept of healthcare quality. One of these was put forth by the Institute of Medicine in their landmark report, Crossing the Quality Chasm. The report describes six domains that encompass quality. According to them, high-quality care is:

1) Safe: Avoids injuries to patients from care intended to help them
2) Equitable: Doesn’t vary because of personal characteristics
3) Patient-centered: Is respectful of and responsive to individual patient preferences, needs and values
4) Timely: Reduces waits and potentially harmful delays
5) Efficient: Avoids waste of equipment, supplies, ideas and energy
6) Effective: Services are based on scientific knowledge to all who could benefit, and it accomplishes what it sets out to accomplish

In 1994, I moved to New Hampshire and obtained a Master’s Degree in “Evaluative Clinical Sciences” to learn how to measure, and hopefully improve, medical quality. I had been working around this for years, serving on the Medicare Peer Review Organization for California and serving in several positions in organized medicine.

I spent a few years trying to work with the system, with a medical school for example, and finally gave up. A friend of mine had set up a medical group for managed care called CAPPCare, which was to be a Preferred Provider Organization when California set up “managed care.” It is now a meaningless hospital adjunct. In 1995, he told me, “Mike you are two years too early. Nobody cares about quality.” Two years later, we had lunch again and he laughed and said “You are still too years too early.”


Scariest image of the week.

Saturday, May 2nd, 2015


Bill Nye, “The Science Guy” is one of a large number of ignoramuses talking and writing about “Global Warming.”

His background is is here and includes a BS in mechanical engineering.

He studied mechanical engineering at Cornell University (where he took an astronomy class taught by Carl Sagan)[10] and graduated with a bachelor of science degree in mechanical engineering in 1977.[11] Nye occasionally returns to Cornell as a professor to guest-lecture introductory-level astronomy and human ecology classes.

He seems to have had no training or education in ecology or weather and, aside from mechanical engineering, which I had, has no other educational credentials.

Nye began his professional entertainment career as a writer/actor on a local sketch comedy television show in Seattle, Washington, called Almost Live!. The host of the show, Ross Shafer, suggested he do some scientific demonstrations in a six-minute segment, and take on the nickname “The Science Guy”.[14] His other main recurring role on Almost Live! was as Speedwalker, a speedwalking Seattle superhero.

That certainly qualifies him to talk about global warming but I don’t know about children’s sex education.

Hillary hoves into view again.

Monday, March 9th, 2015

Hillary Clinton is another radical lefty on the same pattern as Obama. She has been around longer and is better known so she may have less success even with the automatons at HuffPo. That piece is about six levels below the top at the reliably left wing blog. Even so, it may presage trouble.

The decision to address the issue comes amid mounting criticism of her use of a personal email account, which did not comply with State Department regulations issued in 2005 governing email used for official business. Reports in the New York Times and the Associated Press detailed how Clinton used a private server, housed in her suburban New York residence, to channel her emails, which are supposed to be maintained as part of a federal agency’s historic record.

Examples of some hacked e-mails from that server are here and are interesting.

That’s pretty tame and the HuffPo attention right now is on a letter sent by Republican Senators warning Iran that an agreement that is not ratified by the Senate is not a treaty and can be reversed by the next president.

Their action is a brazen, breathtaking attempt to sabotage U.S. foreign policy and stampede America into another war in the Middle East.

While U.S. Secretary of State John Kerry is trying to negotiate the most critical elements of a deal to prevent Iran from developing nuclear weapons and avoid war, the Republicans are actively trying to undermine his efforts to get a deal.

Can you imagine the reaction if members of Congress had sent a similar letter to the Soviets urging them not to sign an arms control agreement because the United States would not keep our end of the bargain?

The heavy breathing does not include mention of numerous actions by Democrats to subvert actions by Republican Presidents.