But won’t you have more bad ones? We need better mechanisms to properly deal with incompetent/careless med workers.

You -might- have a slightly higher proportion of “bad ones,” but you would also have a system with less of a capacity shortage. In turn, the harms from lesser practitioners would likely be less, and you could more readily suspend for misconduct.

Some of those we consider bad ones might even be considerably better under a little less time pressure.

Interesting. The harm that a doctor can do is very serious though. Who are the unlucky shlubs who get the bad end of the distribution?

Not having sufficient care can do some pretty serious harm. It's not like all the new doctors we'll be adding will be worse than the existing set.

Taking your argument to the extreme: if we have no doctors, they can't do any harm. Is that best? Or, we could get rid of 20% of doctors and avoid getting rid of the best, which would improve the quality of the distribution. Would that be better?

> But won’t you have more bad ones?

You absolutely will. People should be extremely careful what they wish for. Simplistic solutions like "just train more doctors" can and will have disastrous unforeseen consequences.

Are these gonna be like Soviet doctors who didn’t know how to read EKGs?

It's very likely.

The "soviet doctor" thing you mentioned is just so amusing to me. I'm brazilian, our current president is a literal communist who fancies himself the creator of a south american soviet union, he has a populist "doctors for the poor" policy which essentially consists of flooding the market with doctors via huge numbers of shitty medical schools that don't even have a hospital for the students to practice in, he's directly quoted as saying things like "we must create a new generation of leftist doctors who accept working for less"...

And now there are doctors who do not know how to identify a possible myocardial infarction on an EKG. There are doctors out there who cannot spot an ST segment elevation or depression on an EKG. Hell I've seen one doctor send a patient presenting with classic myocardial infarction symptoms home with pain meds without even running a simple, cheap, fast, non-invasive and universally available EKG. I wish I was making this up, my own goddamn lawyer made an example of this last idiot because obviously the patient died and it's just impossible to defend that conduct. I'm actually afraid of being sick and not having trusted doctors to care for me.

But of course my comment above describing this terrible situation was flagged. Welp. People here would be horrified if I described the literal quackery and charlatanism I see in this country on a daily basis. Blow smoke up people's ass tier stuff and I mean that literally. Worst part is those doctors make metric fucktons of money while the good ones are hated because they don't swindle patients with easy solutions that don't actually work.

There are already plenty of “doctor light” medical practitioners that are trained more like engineers than physicians—physicians assistants and nurse practitioners—as well as more focused practitioners like physical therapists and optometrists who aren’t required to do a residency.

When people talk about reducing the requirements to become a physician, they almost always just end up recreating physicians assistants and nurse practitioners.

I’ll also point out that my wife has an engineering degree from a top tier school and a medical degree. She says the engineering degree was a joke compared to med school. Not even close to comparable in difficulty because of the sheer amount of information you have to take in.

A big part of the basic problem in the US is the artificially limited residency system [1], which has gotten so bad that states are now explicitly letting foreign doctors skip residency requirements to work in the US [2].

[1]: https://www.aamc.org/news/medical-school-enrollments-grow-re...

[2]: https://www.medscape.com/viewarticle/993693?

Trust me, you don't actually want that. You want selection. You want highly intelligent people to make it into medical school and be highly paid. You also want dumb people to be excluded with extreme prejudice.

You should look into what's going on here in Brazil if you believe otherwise. Politicians here went wild with your "just open schools and train a huge number of doctors" idea. Gotta care for the poor and all that. The result is any moron can become a doctor these days. It was and still is an absolute horror show and it keeps getting worse. People are actually dying and I'm putting it mildly.

I hesitate to go into too much detail because the barbarity I've witnessed is just shameful. Let's just say that literally right now there are doctors working ERs who are not smart enough to diagnose and treat a myocardial infarction correctly.

It doesn't take above average intelligence to go through med school, so long as you have high discipline and motivation. Good memory helps the most, really.

There is a simple way to know that we could train more doctors - failure rates are very low, which means that either the MCAT is a better filter than the exams (unlikely!), or that it would be possible to train a lot more doctors.

The failure rate in all graduate education is low, because you’re only taking people who have already performed well for 4 years in undergrad.

For med school specifically, you’re only taking the top performers, then of those you’re filtering further based on MCAT scores.

If you’re that selective and you already have a 15-20% failure rate, I’m not sure that lowering the entry requirements is a great use of resources.

You don’t really want a 40% failure rate. That’s a lot of wasted time, effort, and money.

There are already many alternate career paths for medical practitioners who can’t make it into med school or just don’t want to spend as much time in training.

Obviously it would be possible to run more students through medical school but that wouldn't give us more practicing doctors. The real bottleneck is in residency slots at teaching hospitals. For peculiar historical reasons almost all graduate medical education is funded by the Federal government through the Medicare program and Congress has been unwilling to increase that.

https://savegme.org/

And meanwhile we select by willingness to go through basically hazing on top of inteligence. And meanwhile we routinely have doctors to perform in severely sleep deprived state too for no reason at all.

> on top of intelligence

That's enough for a minimum baseline of quality. Medical school in general is hellish enough to drive people to actual suicide and there's plenty that can be said about that but at least stupid people can't get into these schools.

It could always be worse. It could be a pointless system that inflicted hell on students and minted shitty doctors!