Scheduling time with a doctor is difficult now. If the Affordable Care Act survives and is successful, it is likely to get harder, as 10 or 20 million newly insured citizens will be added to the patient pool. Doctors will have to churn through patients even faster than they now do, or we will need more doctors.
Is this possible? Is the number of doctors limited by the number of people who have the desire and ability to qualify for an MD? Or are we limiting the supply of MDs by constraining med school admissions and certification of foreign-trained doctors? The answer is almost surely the latter. Western European countries have per capita about 3 doctors for every 2 that practice in the US. Perhaps it's just a coincidence, but they also have better outcomes and lower costs than the US as well. Although the US public does not seem to benefit from our doctor shortage, doctors do - they are paid much more than European doctors.
The ostensible reason for limiting the supply of doctors is to maintain the quality of licensed physicians and thus protect the public. But a look at the selection process for screening applicants to medical school suggests that other factors are just as important. .
I was reminded of this by a recent essay in the New York Times in which Barbara Moran, an aspiring med student, both deplores and defends the role of organic chemistry classes in weeding out prospective pre-meds. As anyone who has taken this class knows, pre-meds are frantic to get an A in it; anything less will disqualify them from admittance to med school.
The ostensible rationale for this requirement is that doctors need a grounding in O-chem to understand biochemistry and pharmacology. This may sound good to anyone who is ignorant of both fields, as well as of the practice of medicine, but it is complete bunk. Even if doctors did remember what they transiently learned in O chem many years prior, there is simply no medical scenario in which they would put their knowledge of the principles of alkene oxidation into practice.
It's true that doctors should have a good understanding of biochemistry. But human biochemistry involves a very limited number of types of reactions (plant and microbial biochem is another story), and these are all mediated by enzymes in aqueous solution at neutral pH, not by the various catalysts and solvents one learns about in O chem.
Moran acknowledges that O-chem is pretty free of any practical applications for the practice of medicine, but defends its inclusion on the pre-med obstacle course anyway. She quotes her teacher, who claims that organic chemistry teaches "...inductive generalization from specific cases to something you’ve never seen before." A useful skill in doctors (and other human beings) to be sure, but inductive generalization is a part of just about any intellectual discipline, from philosophy to astrophysics.
Knowing some chemistry is good. Chemistry explains the transformation of one form of matter to another, and the flow of energy that drives living beings. No one would want to be treated by a doctor who didn't understand acid-base or redox chemistry, or who didn't know what a protein is, or how vitamins work.
But getting an A in organic chemistry is not necessary for any of this, nor is it a guarantee that a prospective doctor really understands the fundamentals of biochemistry. What it does signify is that a student was willing and able to memorize long lists of formulas and recite them quickly on demand. This is not a useless skill - anatomy and lists of drug contraindications require good memory skills. But there are plenty of good ways to assess this ability - such as testing prospective doctors knowledge of anatomy and drug contraindications.
O chem is in reality a signifier, in much the same way that fraternity hazing rituals are. It shows a basal level of ability, but more importantly, it shows the commitment of the candidate to becoming part of the group. Or perhaps "caste" is the more appropriate term. Doctors, like other castes, are notoriously jealous of their prerogatives. They overwhelming oppose expanded responsibilities for nurse practitioners, despite 50 years of evidence that this does not result in reduced quality of care. They strive to maintain a dress code that sets them apart from their patients.
This is not the worst example of chemistry being used for a less than noble purpose. But it does make me wonder just how many potentially good doctors we have lost because they could not quickly regurgitate reaction diagrams that they would never use again.
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