EHeller comments on Welcome to Less Wrong! (8th thread, July 2015) - Less Wrong

13 Post author: Sarunas 22 July 2015 04:49PM

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Comment author: Anders_H 14 September 2015 04:16:31AM *  7 points [-]

I have the Irish equivalent of an MD; "Medical Bachelor, Bachelor of Surgery, Bachelor of the Art of Obstetrics". This unwieldy degree puts me in fairly decent company on Less Wrong.

I may be generalizing from a sample of one, but my impression is that medicine selects out rationalists for the following reasons:

(1) The human body is an incompletely understood highly complex system; the consequences of manipulating any of the components can generally not be predicted from an understanding of the overall system. Medicine therefore necessarily has to rely heavily on memorization (at least until we get algorithms that take care of the memorization)

(2) A large component of successful practice of medicine is the ability to play the socially expected part of a doctor.

(3) From a financial perspective, medical school is a junk investment after you consider the opportunity costs. Consider the years in training, the number of hours worked, the high stakes and high pressure, the possibility of being sued etc. For mainstream society, this idea sounds almost contrarian, so rationalists may be more likely to recognize it.

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My story may be relevant here: I was a middling medical student; I did well in those of the pre-clinical courses that did not rely too heavily on memorization, but barely scraped by in many of the clinical rotations. I never had any real passion for medicine, and this was certainly reflected in my performance.

When I worked as an intern physician, I realized that my map of the human body was insufficiently detailed to confidently make clinical decisions; I still wonder whether my classmates were better at absorbing knowledge that I had missed out on, or if they are just better at exuding confidence under uncertainty.

I now work in a very subspecialized area of medical research that is better aligned with rational thinking; I essentially try to apply modern ideas about causal inference to comparative effectiveness research and medical decision making. I was genuinely surprised to find that I could perform at the top level at Harvard, substantially outperforming people who were in a different league from me in terms of their performance in medical school. I am not sure whether this says something about the importance of being genuinely motivated, or if it is a matter of different cognitive personalities.

In retrospect, I am happy with where this path has taken me, but I can't help but wonder if there was a shorter path to get here. If I could talk to my 18-year old self, I certainly would have told him to stay far away from medicine.

Comment author: EHeller 14 September 2015 05:43:44AM *  6 points [-]

I don't think medicine is a junk investment when you consider the opportunity cost, at least in the US.

Consider my sister, a fairly median medical school graduate in the US. After 4 years of medical school (plus her undergrad) she graduated with 150k in debt (at 6% or so). She then did a residency for 3 years making 50k a year, give or take. After that she became an attending with a starting salary of $220k. At younger than 30, she was in the top 4% of salaries in the US.

The opportunity cost is maybe ~45k*4 years, 180k + direct cost of 150k or so.. So $330k "lost to training," however 35+ years of making 100k a year more than some alternative version that didn't do medical school. Depending on investment and loan decisions by 5 years out you've recouped your investment.

Now, if you don't like medicine and hate the work, you've probably damned yourself to doing it anyway. Paying back that much loan is going to be tough working in any other job. But that is a different story than opportunity cost.