
Japanese Medical School Deducted Points from Exam Scores of Female Applicants - srameshc
https://www.npr.org/2018/08/02/634936967/report-japanese-medical-school-deducted-points-from-exam-scores-of-female-applic?ft=nprml&f=1001
======
zdw
From the doctors I know, there are far more women than men working less than
40 hours a week (for what passes for full/part time in the medical industry,
which can have some heinous working hours in any situation). I attribute this
to the following metric - if you're in a career where even part time work is
>100k USD a year, having free time soon becomes more valuable than extra
money. Women seem to understand this, or at least aren't stuck in the "your
job is your life" rut to burnoutville that many men get stuck in.

It seems like the solution here is "get more doctors through medical school if
some want to work part time", but instead they came up with this
discriminatory solution.

~~~
hajile
We've over-qualified doctors to a ridiculous degree. After that, 4 years med
school, then an internship, and then a few more years of residency. The
average doctor finishes with almost $200,000 in debt (around 15% finish with
$300,000+ in debt).

The biggest issue here is that the government has effectively fixed the price
to become a doctor at $200,000 (via stupid requirements) which in turn, fixes
the price they must charge patients in order to be profitable. This is in
addition to all the unnecessary requirements artificially restricting the
supply.

Consider Cuba. In 2016, they were spending $813/yr per person while the US was
spending $9,403 per person. Despite this, life expectancy was/is about equal.
They graduate loads more doctors than the US. Most of these doctor's don't
specialize, but instead become primary care physicians. When there are a lot
of them, the cost to visit your doctor for day-to-day complaints decreases and
disease is caught and treated much earlier (an ounce of prevention).

Degree inflation is a real killer here. A doctor must have a Batchelor's
because it was decided that nurses should have one (though everything past the
first 2 years makes basically zero difference on the floor). Then there's a
huge middle area, so we train nurses to be not-quite doctors in an attempt to
deal with the problem, but the schooling requirements for everyone just keep
soaring.

Eliminate the Batchelor's requirement and instead require only the classes
that are actually pre-requisites for med school. These are more than
sufficient to weed out all the really unqualified individuals, but would
reduce the cost of schooling by many tens of thousands (allowing lower charges
to patients) and reduce the time-to-market by 3-4 years.

That time to market is extremely important. That's an extra 3-4 years of work
before retirement. That's also an extra 3-4 years of experience (experience
often being the most important thing) and those years are shifted earlier to
when learning is easier. For more dexterous (eg, surgical) professions with
long residencies, that 3-4 years is a huge amount of the useful lifespan.

Finally, open a few more medical schools to allow more doctors to be trained.
With lower costs and faster time to market, costs for all medical visits (but
especially primary care).

The only potential concern here is "unqualified people", but none of the tests
have changed. Med school hasn't gotten easier either. The big change is more
people are able or willing to give it a try and the risk is much lower.

~~~
mschuster91
> In 2016, they were spending $813/yr per person while the US was spending
> $9,403 per person. Despite this, life expectancy was/is about equal.

What Cuba does not have, making this possible:

\- huge, huge administrative overhead. Both at the healthcare providers
themselves and in the insurance sector. In addition, "rich" patients are not
needed to subsidize care for patients who are uninsured/underinsured/cannot
pay in full.

\- obesity: 35% of US population is morbidly obese compared to 25% of Cuban
population. Obesity is a massive driver of medical issues.

\- "perverse incentives" where doctors are financially incentivized or, worse,
forced by administration to e.g. operate on a patient when conventional
therapy would be sufficient (this problem is also endemic in Germany, e.g.
[https://www.ndr.de/ratgeber/gesundheit/Kaputtes-Knie-
Muessen...](https://www.ndr.de/ratgeber/gesundheit/Kaputtes-Knie-Muessen-Knie-
Operationen-sein,knie109.html))

\- CYA policies, e.g. when out of fear for malpractice lawsuits, unnecessary
tests/labwork are done on the patient

\- malpractice lawsuits/damage awards driving insurance premiums through the
roof

\- a tendency, especially in elderly people, to prolong their life at immense
cost, even if it only brings them half a year in utter misery and pain (which
is fine from an ethics point of view, intensive care at that level is just
expensive as hell)

\- hard drug addictions across wide swaths of the population. Smoking and
drinking are bad enough but only the US has a huge problem with hardcore drug
addicts. They cause cost in the system due to e.g. overdose treatments or
contamination-caused complications

\- large amounts of homeless/untreated mentally ill people, who often enough

    
    
      - only come to a clinic when their health is so fucked that it's enormously expensive to nurse them back to health (aka on the brink of death)
    
      - have their illness cause injury in other persons (e.g. due to fights)
    
      - are directly affected by a lack of protection from the elements (e.g. freezing in winter, lack of shade in summer, lack of hygiene during the whole year)
    
      - "abuse" medical resources to have a warm bed (which I'm not mad about, everyone deserves a warm bed, it's just a mis-allocation of resources contributing to the high costs for everyone else)

~~~
cobbzilla
rumor I heard: Cuban prices are cheap, yes because of good supply, but also
because rates are fixed way below market. A doctor is paid some paltry rate;
it’s the same amout a teacher or mechanic or anyone else would make, because
communism.

can anyone refute this? it sounded a bit too slick to me, but I don’t know
enough to say if it’s true/false.

~~~
doombolt
Why refute this? Yes, under communism, doctors are in the same silo as
teachers salary-wise. Especially since most of them are general practice.

Source: ex-USSR experience.

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topkai22
The most surprising number in article is that the US % of female doctors in
only 34%. The percent of med school grads has been near 50% for at least 15
years. I couldn’t find numbers going back further then that, so there must be
a very large historical imbalance clearing out or a real career dropout
problem. I suspect the former, but still.

~~~
rectang
Don't underestimate structural pregnancy discrimination. One half of the
parenting pair finds the deck stacked against them when children arrive.

~~~
epicureanideal
Is it necessarily discrimination, or might there be other explanations?

For example, maybe it's discriminatory social expectations of men to be
breadwinners, so they're forced to work at really hard jobs like being doctors
while their wives can make a free choice to stay home with the kids.

I don't intend this reply to support either view. I'm just saying,
discrimination is not necessarily the reason, and even if discrimination is
the reason, there are two sides to that coin.

~~~
rectang
Harmful gender stereotypes are a negative for all of us together, for sure.

See for example, your own gendered language on who does the "hard job" and who
makes a "free choice".

~~~
epicureanideal
I specifically created a gendered counterexample to show the problem. I'm very
much aware of the gendered use of language in my intentional counterexample.

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leigha
Has any country come up with a suitable solution to the issue of maintaining a
career before, during and after pregnancy for women? I know many countries
have paid maternity leave (usually paltry) and some organizations will hold
the job while they are away. Is this good enough?

If the issue is dropout because women are forced to make a decision between
career and caring for/watching their child grow surely we can come up with a
better solution?

~~~
beisner
In my mind, the root of the problem is that companies haven’t figured out a
way (or refuse to figure out a way) to buck the 9-5pm, 5-day, butt-in-seat
workday policy. At the extreme case, if people could choose exactly which
hours in a week they wished to work, completely independently of the company
or team or anything, and perform that work anywhere they’d like, this wouldn’t
be an issue. Women could take whatever time off they need to physically
deliver a baby, and people in the family could arrange their working hours in
such a way that all adults involved could agree on a preferred work/parent
schedule that maintains whatever level of employment the adults desire.

With 9-5 this doesn’t work. Remote work helps alleviate some of these issues,
but not all. There need to be organizational innovations to make this happen.

~~~
leigha
I have noticed a trend of entrepreneurship amongst women I know that have
babies and young kids. They are essentially creating jobs for themselves that
work around these constraints you mention. They seem fulfilled and happy with
this because it works best for the work/life balance. But most of them had a
safety net that allowed them to start these endeavours in the first place.

Perhaps one solution is to offer a safety net i.e. grant, incubator,
accelerator etc. for women in this position that allows them to create the job
that works best for them? I suppose not everyone is cut out for it but this
will at least encourage some.

~~~
prawn
I've noticed the same. But I think one risk is that fulfilment and flexibility
often comes at the cost of structure that comes from the typical, corporate
world - sick days, insurance (in the US), superannuation (Australia), etc.

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todd8
Medical schools fill an important role with limited training and teaching
resources. I suspect they would be loath to admit someone that was planning to
work as an MD for only one year after graduation. Women, of course work as
doctors for more that a single year, but on average they do work less over
their lifetimes than male physicians.

For a number of reasons, female physicians don’t work as much over their
careers as men statistically. I’m guessing that this is why med schools might
practice this unsavory discrimination against women. It’s really unfair to
individuals that might or might not go on to make more important contributors
to the field than the average male doctor.

I was married to a brilliant woman that went to medical school at a time when
there was much more overt sexism in the field. Her abilities were unusual; she
was always near the top of her class, and in a field like medicine this
provided some protection from prejudice. _However, women shouldn’t have to be
better than their colleagues to simply survive medical training._

Personally, about half my doctors are now female and I’m very happy with them.

~~~
deviationblue
> Women, of course work as doctors for more that a single year, but on average
> they do work less over their lifetimes than male physicians.

What data supports this statement, or is it good old fashion common sense and
gut instinct?

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devoply
> "it was concerned that a large increase in the number of women posed a
> serious problem for the future of the university hospital, because female
> doctors tend to quit after marrying or starting families."

~~~
curiousgal
Japan does have a rapidly declining population because of the extremely low
fertility rates and the increasrd aging putting its workforce into welfare
reliance. I suppose desperate times call for desperate measures?

~~~
astura
>"Instead of worrying about women quitting jobs, they should do more to create
an environment where women can keep working," Maeda said in a statement,
according to The Associated Press. "And we need working style reform, which is
not just to prevent overwork deaths, but to create a workplace where everyone
can perform to the best of their ability regardless of gender."

~~~
kansface
Sure, but only one of the two options is available to the people who are
actually making the decision.

~~~
Sangermaine
Somehow I doubt that this medical school has already implemented or tried
every robust maternity leave, childcare, or other family support policy that
would address their concerns about female doctors being forced to choose
between quitting or having a family, and so the school simply has no other
options left but to secretly deduct points from female applicants.

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dzink
The article talks about Japanese discriminating against female candidates for
medical training. There are likely high workhour requirements and poor
childcare support systems / cultural norms against childcare done by non-
parents that can be fixed to address this problem.

Regarding US training bottlenecks. Speaking of specialties more than general
Doctor positions, it takes a certain number of cases per year to train a
doctor and to sustain the skills of doctors that require specialized hand
skills (surgeons of any kind, ortho etc). Those skills are perishable and many
hospitals get lower number of cases of certain types than needed to sustain
multiple good surgeons. For example, you wouldn’t want to go to a doc that
does less than 4 Whipples per year if you need a Whipple. The bottleneck in
training docs is the number of cases in the US in each specialty.

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koosnel
Where I live this is done based on race and it's not even a scandal, it's
government policy.

~~~
selimthegrim
And where is this?

~~~
koosnel
South Africa

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dspillett
Plain text (fast, low bandwidth, no tracking) article:
[https://text.npr.org/s.php?sId=634936967](https://text.npr.org/s.php?sId=634936967)

