
Lambda School wants to teach nursing - jseliger
https://www.economist.com/business/2019/04/27/lambda-an-online-school-wants-to-teach-nursing
======
neilv
(I don't know about Lambda School specifically; just speaking of fields here.)

Any talk of transferring anything cultural from current software development
practice to somewhere else important... makes me nervous, by default.

Right now, we have huge problems in software development practice, with both
design&implementation quality, and ethics.

You don't want your medical device or bridge developed in any way like the
majority of software right now. You don't want your ER nurse to be smug about
how smart they are, while they do shoddy work with fad tools and halfwitted
cargo cult processes. You don't want your doctor or lawyer selling you out to
'analytics', for starters, like almost every dotcom startup does.

As startups try to bring the greatness of Webrogramming to other areas, are
they going to suddenly say, "Oh, but _this_ is actually an important area,
unlike the information infrastructure of humanity, so _this one_ we'll do with
more responsibility than obviously we have been."

~~~
booleandilemma
Completely agree. I don’t want medical practitioners who finished a medical
bootcamp last week googling best practices on their phones and pretending to
know what they’re talking about while I’m sedated in the OR.

~~~
mactrey
Hah, you think medical practitioners aren't already googling best practices
right after they step out of the exam room...

------
awwstn
I love Lambda's concept. I think aligning the interests of the school with the
interests of the student are a fantastic evolution, and committing to only
charge students for payback in the case that they have a positive outcome is
great too.

That said, the "only pay us back if you get a good job" commitment seems like
lip service as long as the cutoff is $50K (for software dev at least). Lambda
school's team is super vocal on Twitter and regularly shares stories of
students who walk away making 3-4x what they made previously...if the program
genuinely believes it can consistently graduate students who can earn
$80-$150K in the market, then it should align its business model to that.

The median salary for a software engineer in the US is $100K. The current
Lambda promise is "you only have to pay us back if you earn half the
nationwide median salary in the 5 years following our program"...this does not
strike me as a very bold commitment to the quality of the program.

To be very clear: I've seen successes of Lambda students and I believe that
they have created a model that graduates students who are competitive in this
job market. So, I'm not saying that Lambda is bad. On the contrary: I'm saying
Lambda is excellent and they should be bolstered by that excellence to take a
stance with a less conservative income share agreement.

From their site:

> Instead of paying tuition, students can agree to pay a percentage of their
> income after they're employed, and only if they're making more than $50k per
> year.

~~~
austenallred
Most of our students are in rural areas where $50k is actually really good
money (though this is changing). There’s not really an existing legal
framework to say “if you make x in this kind of city or y in this kind of
city.”

Certainly, in San Francisco, $50k isn’t a win. Luckily our median salary there
is well into the six figures.

Lambda School’s income share agreement is also (to my knowledge) the only in
the industry that is industry-specific. If you end up as a bartender making
$60k we make $0.

Most 3 month schools are 15% for 3 yrs with a $40k min. Lambda School is 9
months, 17% for 2 yrs with a $50k min and a cap.

So our agreement is actually very aggressive as is, and will become more
aggressive over time.

~~~
nickpsecurity
Consider using a base amount modified by cost of living, esp locational, with
a formula that adapts when it changes. Buffer does this for their transparent
salary calculations:

[https://open.buffer.com/transparent-
salaries/](https://open.buffer.com/transparent-salaries/)

Btw, love what you're doing. It might have helped me back when I was in a
rural area. We didn't have Internet, though. So, would've been whatever I
could do at libraries during narrow windows of computer use. These days it's
McDonalds' Wifi for lots of folks. Do factor that into your offerings somehow
if you don't already.

Good luck LS! Looks like awesome stuff you all are doing.

~~~
JeremyBanks
Employees shouldn't be rewarded for moving to the most expensive cities.
Buffer et al should pay whatever they're willing to pay, and if some of their
employees want to waste it on rent, so be it.

------
MispelledToyota
During my time at Lambda School, seeing people's quick arguments against it
have drastically lowered my priors on how correct "hot takes" are likely to be
in general. Sort of like reading a newspaper article about your area of
expertise for the first time, and realizing how many inaccuracies all
newspaper articles must have.

There are places for skepticism but the actual critiques made are shockingly
wide of the mark in my opinion as someone who found the value proposition
compelling.

~~~
austenallred
How is Lambda School going for you?

~~~
MispelledToyota
I graduated two weeks ago and got a job offer, and am overjoyed by the fact.

I think if I asked myself at the beginning, what's the most you can hope for
in going to Lambda School, my expectations were met by the education quality
and the follow-through from the outcomes team. It's not perfect but the
incentive structure forces constant improvement in the factors that matter
most for getting us hired.

People point out it's not a CS degree and they're right. But the staff manages
to teach concrete skills to get students hired, and the CS, data structures,
algorithms stuff in the curriculum is taught well enough and with enough
enthusiasm that it gives students the basis to be conversant with CS concepts
and continue growing forward.

It might not work for everyone; some people are going to struggle to become
programmers. But Lambda is trying their hardest to make it work for as many
people as they can, and their heart is in the right place. And it is
structured so if it doesn't work for a student their downside is hedged. Due
to the $50k/industry-specific cutoff for repayment, the downside of going to
Lambda but not making a career transition will be least harmful to the least
advantaged students.

~~~
austenallred
What was the worst part of Lambda? What are we really bad at?

~~~
MispelledToyota
My biased view:

\- Teaching assistants and section leads play a huge role in the quality of
student experience. I think sometimes a supply/demand for filling these
positions can result in not the best people filling them, which then can
undermine the experience if your teaching assistant isn't the best.

\- The system relies on teaching assistants for reviewing student code, and
determining if students pass their tests. I worry what it means for ensuring
students aren't progressing through the curriculum without having truly
learned prior material. This goes back to having properly motivated and
talented TAs too. Maybe some sort of randomized spot-checking, QA from full-
time staff on this could help.

\- I think sometimes the startup nature, remote-aspect, and fast iteration can
mean various transitions through the curriculum aren't explained properly, but
rather communicated piecemeal and students assemble an understanding of what's
happening by discussing among themselves. There's a lot going on and
structures are evolving constantly and sometimes instructors themselves can
have trouble keeping track. I think being live in a room forces teachers to
properly add ceremony and bookending structures to classes, but that can get
dropped in the remote sphere.

Another thing, which is more a worry than a critique, is keeping the
character/values and quality level there as it scales.

~~~
SiempreViernes
That mostly sounds like it's a normal school then, or do you mean there are
aspects of these issues tied to the things Lambda does differently?

------
Eridrus
> But Ms McRae is also concerned that programmes like Lambda School, though
> well-meaning, risk undermining existing educational institutions by offering
> a quicker route to work.

If only. We all know the majority of what we learned in school was not useful.

We should be striving to cut out the wasteful education that only serves as a
signaling arms race
[https://www.theatlantic.com/magazine/archive/2018/01/whats-c...](https://www.theatlantic.com/magazine/archive/2018/01/whats-
college-good-for/546590/)

~~~
jacobobryant
Don't know why this was downvoted. Having gone through higher ed, I think
"undermining existing educational institutions" is a great thing. Now if we
could just get rid of the standard hierarchical corporate structure...

~~~
Double_a_92
Average people are already generally pretty ignorant... Removing even basic
general knowledge from society, is not going to do anything good.

We tend to underestimate that because we (engineers / people on HN) mostly
happen to have a good education and interest in general knowledge.

~~~
Eridrus
Improving general knowledge and ability is an admirable goal. But education is
pretty bad at it.

------
notbob
I am skeptical that these income sharing agreements are so great. Especially
in software.

Lambda School has a 9 month program that takes a 17% cut of your salary for
the first 24 months of employment with a cap at $30,000. Which many students
in software will hit, especially in high COL areas.

It's worth noting that this is _more expensive_ than many/most universities,
which charge less than $30,000 per year (9 months of instruction) even at the
sticker price (which no one actually pays).

In fact, I wonder whether bootcamps are even cheaper than the full cost of
university. The average student loan debt upon graduation for all US
university students is $29,400 (again, for four years of college education
with access to both applied and fundamental courses across many different
majors vs. a 9 month boot camp focused on a particular skill set).

To be concrete: by taking out a loan for what lambda school costs, you could
double major in both nursing _and_ CS at a state U for about the same amount
of post-graduation debt as you would have at bootcamps. Or CS and Econ. Or CS
and Accounting. Or CS and Mechanical Engineering. In states that still invest
in higher ed, you'll end up paying less (even with interest) than you'd pay
lambda school.

There's a natural experiment on this question at Purdue, where there's an
apples-for-apples comparison and loans are almost always cheaper than the
income sharing agreement.

To me, these income sharing agreements and bootcamps seem like not great deals
when you look at instruction time per dollar. And also when you look at the
longitudinal durability of the skill-set that's being taught. They have a
place in the market for sure, but they aren't the panacea to expensive
education. They're not even cost-competitive.

They're just a different point in the design space of educational programs
that extract as much of the added value of their product as possible.

~~~
soneca
I am a self-taught junior web developer after a career change at 37yo.

I always have the impression that this perception that Lambda's model is not
good always come from people in more comfortable positions that are not even
close to the reality of who actually applies for Lambda.

I am from Brazil and did the career change two years ago, so there wasn't
actually the option to do Lambda School for me. But it would be a no-brainer
for me at the time and I am pretty sure I would be much better in my career
now if I had done it (in knowledge and earnings).

4 years of college? Not an option for me. USD15k upfront for a regular
bootcamp? Not an option for me. Take a loan with the risk of having to pay
with a big chance of not getting a good job soon enough? Too risky for me (and
in Brazil the high interest rates make it a ridiculous thought, but even with
US rates it is too risky).

My path was self-taught through freeCodeCamp.org (awesome project!!!) and
reading tutorials and documentation. I was able to get a frontend jr position,
but I can tell that I was lacking a lot of knowledge/skills when I started
(git, tests, agile process, design patterns, clean code, to name a few).

Now I am moving to LA and I am failing every remote technical interview
because I lack the specific skills needed for being hired in the US.

Lambda School 9 no-upfront full-time months with close mentorship and
teamwork, plus the alignment to help get me a job seems like a _" too good to
be true"_ option for me; not a _" tricking naive laypeople who don't know
better into paying their high price"_ that all "skeptical" commenters I have
ever read in HN seems to think

~~~
bitwize
> Lambda School 9 no-upfront full-time months with close mentorship and
> teamwork, plus the alignment to help get me a job seems like a "too good to
> be true" option for me;

Well, you know what they say about if something sounds too good to be true.

~~~
geofft
That's a heuristic, not an argument. The fact that you can get an entire
Windows-competitive OS for free, _and its source code_ , is too good to be
true, too.

~~~
soneca
Exactly.

------
RonnieDipple
Lambda school is a blessing for those of us born into unfortunate
circumstances with limited time, money and an urgent need to support a family
and hopefully pull them out of poverty.

I start in May wish me luck

~~~
TheSpiciestDev
Good luck!.. I've referred two people to Lambda who start later next month.
They're both excited to start and I'm looking forward to hearing how their
experience is before I go all-out and refer more people - it's a program that
has a structure and philosophy that I can easily agree with.

~~~
Ronnie_Dipple
Lambda seems to be changing a lot of lives.

------
ngngngng
I'm torn on Lambda. On one hand, it seems far superior to traditional higher
education, since the schools success depends on the success of the students.
At the same time, profit sharing is a terrible financial decision. When
compared with other bootcamps, it's basically a bet against yourself. You're
willing to risk tens of thousands of dollars more money for some risk
insurance.

I have such a hard time accepting that people can't just teach themselves
things using free online resources. It's been shown in many studies that self
directed learning doesn't work, but it worked for me. And I can't stand the
idea of smart people paying thousands to learn things they could learn for
free.

~~~
austenallred
If people can self learn they will. I think doing so is much, much more
difficult than others pretend like it is.

Given that you could earn the entire cost of Lambda School (at the cap - the
most expensive) in about three months of engineering time, it’s a rational
decision even if you just speed up the process.

~~~
notbob
_> If people can self learn they will. I think doing so is much, much more
difficult than others pretend like it is._

I'm not sure. But what's definitely true is that it's _WAY_ harder as an
adult.

Most self-taught programmers I know (including myself) learned to program as
children/teenagers. Learning at that age is easier -- if not biologically,
then at the very least because you have tons of free time.

The few I know who self-taught programming but didn't learn as youth already
had really strong backgrounds in mathematics or physics, and leaned heavily on
the skills that studying those fields teaches you.

~~~
warent
> Learning at that age is easier ... at the very least because you have tons
> of free time.

That isn't really a valid argument here though because Lambda School is a
full-time program to my understanding, so it's expected you somehow have 8
hours a day to put into it.

------
seancoleman
This is ironic. My girlfriend, a nurse of 10+ years, got accepted to the
Lambda School web dev track and is starting at the end of May, to get _out_ of
nursing.

~~~
austenallred
The end goal of Lambda School is to be somewhat of an economic clearing house.
Move people from where they are to where they want to be quickly, cheaply, and
taking care of the entire stack at no risk to the student.

So this is actually in line with where we want to be in the future.

~~~
RoboTeddy
What if someone wants to go somewhere where they most likely won't be paid
much? (e.g. art, music) Can Lambda School extend there?

~~~
austenallred
Yes, but would be more expensive (a higher percentage of income), although
loans are a higher percentage as well.

------
austenallred
“But Ms McRae is also concerned that programmes like Lambda School, though
well-meaning, risk undermining existing educational institutions by offering a
quicker route to work.”

~~~
Reedx
Netflix, though well-meaning, risks undermining existing video rental
companies by offering a quicker way to watch movies.

------
hhs
This is interesting. There’s also a projection of physician shortage in the
years to come. This is both for primary and specialty doctors, and I’m curious
if there will be innovative ways to work around this, too; this was released a
few days ago here: [https://news.aamc.org/press-
releases/article/2019-workforce-...](https://news.aamc.org/press-
releases/article/2019-workforce-projections-update/).

~~~
jseliger
My understanding is that the big problems are 1. existing credentialing bodies
and 2. the AMA, which wants to restrict entry into the profession and chiefly
does so through the residency system. The physician shortage is a bug to the
larger society but a feature to existing doctors, who wish to charge patients
more and raise their own salaries. But see also
[https://www.nytimes.com/2016/11/08/upshot/a-doctor-
shortage-...](https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-
lets-take-a-closer-look.html).

~~~
phren0logy
Hi, I'm a doc. Just wanted to add a few corrections: The AMA (American Medical
Association) has nothing to do with residency slots. Residency slots are
funded by CMS. I am in a shortage speciality, and we have been pushing for
more residency slots for a long time. While there are probably some physicians
who are self-interested enough to oppose this, I think it's unfair to
characterize them as even a significant minority. Even if you think of
physicians as ruthlessly self-interested, this still wouldn't serve us as the
shortage has largely led to the influx of people with a small fraction of the
clinical training (such as nurse practitioners) taking roles traditionally
filled by doctors. Interestingly, they are not generally held to the same
standard of care, so I'd hardly call that a boon to patients, either.

~~~
klipt
There are tons of highly qualified doctors in other developed countries (EU,
Australia, etc) who could earn more in the US, what stops them from practicing
here if we have a shortage?

~~~
planetburgess
They might also prefer to work in a better medical system.

------
chriselles
I’m definitely a big believer in Lambda School.

I believe it aligns the interests of: 1)student 2)school 3)employer

Far better than the existing conventional university model in teaching
tangible trade skills.

Lambda School can and will adapt to the ever changing needs of employers far
faster than universities because Lambda School’s very existence depends on it.

However, does the same apply to regulated and licensed “guilds” like nursing,
medicine, dentistry, etc?

Will “guild” like protectionism of their profession impede efforts in this
direction?

Lambda School already seems to be making enemies understandably in the
traditional university computer engineering and upfront paid bootcamp sectors.

Will it make enemies with professional regulatory bodies who may be biased to
prefer higher education hurdles and fewer licensed practitioners to protect
their income?

~~~
austenallred
Lambda School has to play by the rules of regulatory bodies. It makes it more
difficult to be innovative but makes sense in a field line nursing.

------
sandGorgon
Curious to know - is this going to be checklist centric ?

There was a recent post on how a simple thing like checklists can really cut
infection and death rate by half or something. And there were startups that
attempted to do this at the doctor level but failed to be able to drive
change.

Would you be the GitHub of nursing - drive change from bottom up. Build
checklist creation and adherence at the nurses level ?

------
gopher2
Isn't the mindset in medicine totally different from software engineering as
far as being self-taught? I'm surprised that they don't think jobs want you to
have a degree from an accredited school vs a bootcamp. Or that lambda school
thinks they won't?

~~~
austenallred
The nursing portion of lambda school would definitely be accredited and
licensed

~~~
gopher2
Ahh, gotcha. Thanks for clarifying! Makes sense then - I think I
misinterpreted something in the article.

------
PorterDuff
I wonder if it's cheating to sign up for Lambda School if you have no
intention of getting a job.

~~~
quickthrower2
Is it ethical? Sounds like a similar question to the person on HN who signed
up for a credit card just to transfer money 100 times a year and collect the
cashback.

------
jseliger
Good: [https://jakeseliger.com/2019/03/13/the-college-bribery-
scand...](https://jakeseliger.com/2019/03/13/the-college-bribery-scandal-vs-
lambda-school). It seems that higher-ed reform is not going to come from
within; it must start from outside the current system.

------
dj_gitmo
> If Lambda can turn a profit by offering people a stab at a decent job, that
> would be a fine lesson in capitalism.

I'm not so sure. The solution might not be to train more nurses, but to retain
the exiting nurses. Nurses have a really high turnover rate in the U.S. The
problem is nursing is demanding work and it often requires long hours.

> Nurses who work more than 12 hours in a single shift and more than 40 hours
> a week are likely to leave the nursing workforce within a year. Overtime for
> nurses should not be commonplace. Instead, hospitals and other healthcare
> organizations should reduce the length of shifts and the number of hours in
> a workweek. Hospital administrators should not push nurses into working
> extra hours.

[https://rnbsnonline.unm.edu/articles/high-cost-of-nurse-
turn...](https://rnbsnonline.unm.edu/articles/high-cost-of-nurse-
turnover.aspx)

> A study by Compdata Surveys of 11,000 healthcare employers with more than 11
> million employees found the average turnover in healthcare jobs in 2017 was
> 20.6%, up from 15.6% in 2010, putting healthcare’s turnover second only to
> hospitality’s.

[https://www.beckershospitalreview.com/finance/will-2018-be-t...](https://www.beckershospitalreview.com/finance/will-2018-be-
the-year-healthcare-addresses-its-turnover-problem.html)

> Turnover rates also varied significantly across countries with the highest
> rate reported in New Zealand (44·3%) followed by the US (26·8%), Canada
> (19·9%) and Australia (15·1%).

[https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12483](https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12483)

This might be a lesson in capitalism, but maybe not the lesson that The
Economists thinks.

------
qwerty456127
I want to learn nursing online.

------
username223
> The firm devotes about a third of its time and resources to finding jobs for
> its graduates, an unusually high share. Another third goes to recruiting
> students and the rest to teaching.

So, 2/3 of what they're paid (presumably after Austen Allred's and the VCs'
take), is marketing, leaving the leftovers to pay for actual instructors. If I
end up in the hospital, I want a nurse with an actual education, not "nursing
boot camp."

~~~
austenallred
That’s actually not how it breaks down, I told the reporter I segment the
company into three sections in my mind, he asked which is more important, and
I said they all have to work.

~~~
username223
Then the reporter seriously misled me about what you said, and I apologize.
I'm curious about the real breakdown between marketing to students and
hospitals, overhead and executive pay, and instructor pay, but I can
understand if you don't want to reveal that.

~~~
austenallred
Right now our marketing budget rounds to zero. We have a growth team that is
mostly focused on making sure the admissions funnel runs smoothly, and get
about 1,000 organic applications/week.

We have ~80 full-time employees and about 200 part-time. 40 of the full-time
and all 200 part-time are dedicated to teaching/career coaching.

~~~
username223
> We have ~80 full-time employees and about 200 part-time. 40 of the full-time
> and all 200 part-time are dedicated to teaching/career coaching.

What does this mean? I was interested in a breakdown between "people who teach
students" and "people who sell stuff," and I don't see how "marketing" and
"growth team" differ. As far as I can tell, you're saying that you hired 40
coders, 200 temps as teachers, and 40 salespeople to pitch them to employers
("career coaching").

~~~
austenallred
There are a lot of people required to run a company/school that don’t fall
into those categories. Outside of teachers and career coaches we have:

 _growth (what you call marketing)

_ student success (student support)

* engineering

* analytics

* finance

* operations/HR

The marketing team to instructor ratio is about 1:50

