2012 April 28 Saturday
Financial Return Of Medical Degree Negative For Women?

At least for primary care physicians women work so fewer hours than men that they fail to recoup the costs incurred by going thru medical school.

We find that the median female (but not male) primary-care physician would have been financially better off becoming a physician assistant. This result is partially due to a gender-wage gap in medicine. However, it is mostly driven by the fact that the median female physician simply doesn’t work enough hours to amortize her upfront investment in medical school. In contrast, the median male physician work many more hours, easily enough to amortize his up-front investment.

There's another consequence of more female doctors: the average slot in medical school taken by a woman generates much fewer hours of patient care services delivered as compared to the case where the same slot was given to a man instead. So the effective supply of doctors has gone down as a result of higher percentages of female doctors in many countries. This is a well recognized problem.

With many women seeking part-time work, new organizational challenges are emerging, including the possibility that some countries will need more doctors. France and Germany, for instance, have warned about future shortages, as older male doctors retire and are replaced by women working part-time. The German Medical Association has called it an urgent threat, particularly in rural areas. In France, some doctors are trying to set up a pilot project for a “maison médicale,” or House of Medicine, where part-time doctors can parachute in to offer different disciplines.

If all physicians were women the result would be like taking away a quarter of the doctors.

This looming shortage is forcing into the open a controversy that has been cautiously debated in hospitals and medical practices for some time: Are women doctors part of the problem? It's not the abilities of female doctors that are in question. It's that study after study has found women doctors tend to work 20% to 25% fewer hours than their male counterparts.

We need to automate much of the diagnostic work of medicine. Expert systems could do a better job in many cases. We could give blood, urine, and other samples at a pharmacy to have them sent off for lab tests. The test results could be uploaded to diagnostic systems running on servers. Visits to physicians could happen only when expert systems flagged a problem, suggested follow-up tests and produced a preliminary diagnosis.

The return on investment to the individual physician is even worse if we consider the subsidies that go into training doctors. Medical doctor Karen Sibert argues we can't afford to subsidize training of people who are only going to work part time.

Medical education is supported by federal and state tax money both at the university level — student tuition doesn’t come close to covering the schools’ costs — and at the teaching hospitals where residents are trained. So if doctors aren’t making full use of their training, taxpayers are losing their investment. With a growing shortage of doctors in America, we can no longer afford to continue training doctors who don’t spend their careers in the full-time practice of medicine.

I figure we'll continue to be unrealistic about this topic because Western nations have decided to waste a lot of resources maintaining various fictions about human nature.

Share |      By Randall Parker at 2012 April 28 08:52 PM  Economics Health


Comments
Dan Kurt said at April 29, 2012 5:37 PM:

re: We need to automate much of the diagnostic work of medicine. Expert systems could do a better job in many cases. We could give blood, urine, and other samples at a pharmacy to have them sent off for lab tests. The test results could be uploaded to diagnostic systems running on servers. Visits to physicians could happen only when expert systems flagged a problem, suggested follow-up tests and produced a preliminary diagnosis.RP

You are only 40 or so years slow on this.

Contact Arthur Robinson, Ph.D. who has been working on this since the 1970s, fighting the good fight. View a video on this here: http://www.oism.org/s32p1820.htm

Dan Kurt

Seriously said at April 29, 2012 8:12 PM:

With many women seeking part-time work..."

WTF is wrong with these dumb cunts?!?!

ivvenalis said at April 29, 2012 8:37 PM:

"WTF is wrong with these dumb cunts?!?!"

They were told for their entire lives by everyone that they knew and loved and by every form of media that could get access to them that they should be an astronaut or a lawyer or...a doctor. Eventually they have a strange desire to marry and have children (these "part-time" doctors are almost all married, very often to other doctors). It's pretty hard to blame them, in my opinion.

dragnet said at April 30, 2012 11:48 AM:

@ ivvenalis

I quite agree---the women aren't to blame, they're justing following the ridiculous cultural cues they've been spoon fed since birth. The real problem is a culture that refuses to face up to reality: that women and men are different. Women value things like free time, quality of life, and family life more than men do. There's nothing wrong with this, in fact it's part of the reason why women live longer and are generally more mentally and physically healthy. But what this means is that a lot of money is wasted when it could have gone to a male doctor who likely would have provided a lot more value just by virtue of working many more hours. And automating diagnosis is definitely a step in right direction---but it's not a panacea. I'd wager men would STILL work far more hours than women---but on different things like research, fellowships, etc. You'd still see a service and wage gap.

And while we're at it, can we please stop this bullshit "wage gap" meme? If women work 20 percent fewer hours than men and makes decisions to pursue less grueling specialities, then OF COURE they're going to earn less.

Female doctor said at April 30, 2012 2:12 PM:

Thank God you're not smart enough to be a doctor, or hold any position of power.

Tireless said at April 30, 2012 2:44 PM:

So female doctor, you have no arguments, yet you feel the need to repeat yourself. How very feminist of you.

sestamibi said at April 30, 2012 9:30 PM:

Glad you referenced Karen Sibert's article, which I read in the NYT when it came out, and which I was going to search for and which you saved me the trouble of looking up.

As much as I loathe feminists, she was absolutely right. Girls, put up or shut up.

Black Death said at May 1, 2012 5:54 AM:

No one should should assume a massive debt burden to obtain any degree without a clearly defined plan to repay. The MD is probably the most expensive degree in terms of workload and cost requirements, but the demand for doctors is so great that essentially everybody gets a good job. But primary care doctors make only about half as much as specialists. http://www.mgma.com/blog/Key-findings-from-MGMAs-2009-physician-compensation-survey/. Even so, the primary care median of $186,000 is not too bad, but if you are only working half-time and paying $30,000 per year in loan repayment, well, it may not be so good. Anyway, most primary care can be performed by PAs and FNPs. Those who are interested in part-time work in primary care fields should probably not undertake the massive costs and time commitments it takes to get an MD.

Female doctor said at May 1, 2012 10:28 AM:

@Tireless
I don't know why it was posted twice, but it wasn't my intention. You're right, I don't see the point of refuting such a ridiculous argument. The evidence speaks for itself. I was smart enough to get into medical school. The owner of this blogpost wasn't. It's quite simple really. Perhaps the title of this post should be 'Why are men too thick to get into medical school these days?'.

Engineer-Poet said at May 1, 2012 6:29 PM:

How do you know the author of this blog wasn't smart enough to get into medical school?  Maybe he didn't like the idea of being in medicine, starting with sacrificing his twenties to school and residency.  Maybe he was smart enough to avoid something he knew he'd hate?

physphilmusic said at May 1, 2012 8:19 PM:

There's no need to engage "Female doctor". She's already started the tired old liberal-feminist tactic of "This argument is so obviously ridiculous that I won't bother to refute it". Liberals live in a bubble of groupthink.

Randall Parker said at May 1, 2012 8:49 PM:

Female doctor,

I had grades high enough to get into med school. I decided I did not want to spend my life meeting with sick people. So I went into technology instead and as a result have software executing in orbit around Saturn among other places. You seem to have the erroneous view that anyone who doesn't go into medicine isn't smart enough. But the bio majors who make up the largest fraction of med students aren't as smart as math and physics grads in my experience. The Ph.D. physics and math folks are the smartest I come across on average.

Ridiculous argument: I linked to the argument by a female MD written for the NY Times, another from Businessweek, and a journal article from the Journal of Human Capital. I'm relaying their arguments. Are these writers and economic researchers all ridiculous.

Randall Parker said at May 1, 2012 8:53 PM:

Dan Kurt,

Yes, I am aware of Mycin and other medical expert systems and that some of these expert systems can beat all but the top experts at diagnosis in some fields. It is really a shame that these systems have remained so little used. I keep bringing up medical expert systems because I'm aware of their potential. Medicine costs too much. We need to automate it.

T nick said at May 2, 2012 5:28 AM:

Female docs prefer socialized medicine (nanny state). Med schools slant admissions in favor of women to meet diversify goals.

Humility said at May 2, 2012 10:43 AM:

Mr. Parker,

Thanks for your great blogs and also for defending yourself against the poster who insinuated that critics of the medical industry were "not intelligent enough" to become doctors.

Physicians' salaries and their accompanying paternalism and arrogance are a historical and geographical anomaly. Their rent-extraction, haughtiness, and regulatory control has lasted for five or six generations now, but is inexorably eroding. Don't forget that industrious and fiscally-disciplined Germany, a model for the rest of the world, pays its doctors a fraction of what they are paid in the US.

We will eventually, and thankfully, have universal health coverage in this country. This will bring down the egos and salaries of doctors dramatically. The freedom for Americans to leave jobs without leaving themselves and their families open to medical bankruptcy will do wonders in unlocking the entrepreneurial potential of our population.

In fairness to our physicians, many are suffering from astronomical medical school debt, an issue that deserves it own dissertation. We will eventually come to our senses and heavily subsidize their training in return for public service. The current generation of physicians and those now in training will caught in the pincer of high debt and lower pay. Hopefully we will work out a way to relieve their debt in exchange for government service.

Female doctor said at May 7, 2012 4:29 PM:

To the people who think that women are 'kindly allowed' into medical school as a result of positive discrimination...you need to wake up! With 50/50 and sometimes 60/40 allocation of medical school places in favour of girls, there is no way that being female gets any positive discrimination points. In fact, it's more likely given to the boys. Having been an interview panelist at one of the leading medical schools in the world, the only positive discrimination we gave was to a boy whose parents were in the lowest socioeconomic class. Sorry to shatter your little delusion there.

The fact is, girls make better candidates at medical school. They are stronger academically, performing more consistently at school, they are more mature than their male peers of the same age and they give better, well rounded and coherent answers to difficult questions posed by the panel. In other words, young women are better doctor material than young men. They have better social skills, they are more honest, they are more empathetic with patients, they have better communication skills as a whole and they are very capable academically. The girls are simply outperforming the boys. Now, would you say that was the girls' fault for being capable or the boys' fault for not being able to keep up? If you or your child were in need, would you want to be seen by an excellent female doctor or a second rate male doctor?

The argument that a begrudged minority of the public think that female doctors don't contribute to society is completely false. The difference is negligible. Female doctors repay their own student loans. Female doctors are taxed just as much as male doctors, which over their careers pays for more than enough for their education. Take into account the blood, sweat and tears they've given over their time at medical school, residency, weekends, night shifts and overtime, the rapport they build with patients and the sheer emotional commitment they give to their jobs, they deserve all the benefits they get. All doctors work hard. Harder than most members of society. To calculate contribution of women in medicine purely by hours is ineffective, just as it is assessing a country purely by GDP. Since women have become doctors, there's been a complete overhaul and approach in medicine, focusing more on patients-centred consultations. If female doctors want to take maternity leave, it's completely within their right to do so, just as many of my male colleagues have decided to take sabbatical leave to train in something else or travel around the world.

How much consideration do you give to the children of female doctors? They will be go on to be valuable members of society. Countries like Singapore are actively encouraging and rewarding young professional couples to have many children. Don't you want your general population to become brighter? Therefore, you should give young, intelligent, women incentive to have families. Have you taken that kind of contribution to society into account???

Female doctor said at May 7, 2012 4:30 PM:

To the people who think that women are 'kindly allowed' into medical school as a result of positive discrimination...you need to wake up! With 50/50 and sometimes 60/40 allocation of medical school places in favour of girls, there is no way that being female gets any positive discrimination points. In fact, it's more likely given to the boys. Having been an interview panelist at one of the leading medical schools in the world, the only positive discrimination we gave was to a boy whose parents were in the lowest socioeconomic class. Sorry to shatter your little delusion there.

The fact is, girls make better candidates at medical school. They are stronger academically, performing more consistently at school, they are more mature than their male peers of the same age and they give better, well rounded and coherent answers to difficult questions posed by the panel. In other words, young women are better doctor material than young men. They have better social skills, they are more honest, they are more empathetic with patients, they have better communication skills as a whole and they are very capable academically. The girls are simply outperforming the boys. Now, would you say that was the girls' fault for being capable or the boys' fault for not being able to keep up? If you or your child were in need, would you want to be seen by an excellent female doctor or a second rate male doctor?

The argument that a begrudged minority of the public think that female doctors don't contribute to society is completely false. The difference is negligible. Female doctors repay their own student loans. Female doctors are taxed just as much as male doctors, which over their careers pays for more than enough for their education. Take into account the blood, sweat and tears they've given over their time at medical school, residency, weekends, night shifts and overtime, the rapport they build with patients and the sheer emotional commitment they give to their jobs, they deserve all the benefits they get. All doctors work hard. Harder than most members of society. To calculate contribution of women in medicine purely by hours is ineffective, just as it is assessing a country purely by GDP. Since women have become doctors, there's been a complete overhaul and approach in medicine, focusing more on patients-centred consultations. If female doctors want to take maternity leave, it's completely within their right to do so, just as many of my male colleagues have decided to take sabbatical leave to train in something else or travel around the world.

How much consideration do you give to the children of female doctors? They will be go on to be valuable members of society. Countries like Singapore are actively encouraging and rewarding young professional couples to have many children. Don't you want your general population to become brighter? Therefore, you should give young, intelligent, women incentive to have families. Have you taken that kind of contribution to society into account???

solaris said at May 8, 2012 6:50 AM:

>"..you need to wake up! With 50/50 and sometimes 60/40 allocation of medical school places in favour of girls, there is no way that being female gets any positive discrimination points."


You have a mind like a pretzel if you can write things like that without noticing the inherent problems.


>"Having been an interview panelist at one of the leading medical schools in the world ... The fact is, girls make better candidates at medical school. They are stronger academically, performing more consistently at school, they are more mature than their male peers of the same age and they give better, well rounded and coherent answers to difficult questions posed by the panel. In other words, young women are better doctor material than young men."

Certainly no evidence of discrimination in favor of women THERE! Like any bigot, you're convinced that the people you are bigoted against really ARE inferior.

solaris said at May 8, 2012 6:57 AM:

>"If female doctors want to take maternity leave, it's completely within their right to do so, just as many of my male colleagues have decided to take sabbatical leave to train in something else or travel around the world."

In the state-run healthcare system in your country, people have whatever "rights" they can extract from their boss, the government. But economically speaking that model is untenable. Government workers of the future will not have the gold-plated jobs enjoyed by you and your friends. It's just not mathematically possible.

Female doctor said at May 8, 2012 2:28 PM:

@solaris

Your arguments are incredibly vapid and flawed. I am merely quoting medical school admission statistics. They are similar across the board in medical schools in USA and western Europe. Girls have personality traits which lends them to perform better at medical school interviews - they have the edge on empathy and social skills. Similar differences are noticed in girls' and boys' schools. I'm just telling you why girls are doing slightly better. If you want to jump and shout about how medical schools choose the best candidates by academic assessment and interview, you can do, but there is no better way. Rest assured that the admission process is as fair as it can be. We have a panel of mixed male and female doctors, and I ask the same case study question to all my candidates in the same session. You can choose not to believe it if you want, but thankfully, your opinion makes no difference.

J. said at May 9, 2012 4:45 PM:

"They have better social skills, they are more honest, they are more empathetic with patients, they have better communication skills as a whole and they are very capable academically."

The question of academic capability is presumably set aside after a student is accepted into medical school, since candidates who are not capable academically will be rejected. Once the question is (as here) about doctors alone, rather than the general population, any facts about who gets into medical school versus who doesn't become irrelevant.

Your list of advantages assumes that more social skills, etc., means a better doctor. Does this apply to, in particular, surgeons? Can you support the claim that better social and communication skills and more empathy are specific advantages for a surgeon? If that is a claim you make, I don't think it's obvious. I don't say, to the contrary, that lack of them makes a better surgeon, but others do:

"I mentioned to one of the nurses that we really like that doctor. And she explains to me in her own convoluted way that the personable doctors are the bad doctors. And the ones with no personality are the ones you'd actually want operating on you. Well, in that case, I think we've got some of the best in the business."

http://www.thisamericanlife.org/radio-archives/episode/149/transcript


"The argument that a begrudged minority of the public think that female doctors don't contribute to society is completely false."

Please provide an example, taken from the articles that Randall links, of the argument that female doctors "don't contribute" to society. I only read about statistical differentials in working time and cumulative income, not a claimed absence of any contribution.


"Female doctors repay their own student loans."

English usage isn't precise enough. This statement could mean: all female doctors repay their own student loans, they typically do, or merely that some do.

Student loans can't be discharged through bankruptcy, so (theoretically) everyone with student loans has to repay them over their lifetimes. In practice, some certainly will, but certainly not everyone will, not even female doctors. The economic landscape is changing rapidly, as incomes stagnate (or decline in real terms) and tuitions soar, so we have to examine the data carefully. I don't accuse you of trafficking in mere truisms, so you'll need to give more details to explain what you mean.


"Female doctors are taxed just as much as male doctors"

From the paper by Chen and Chevalier cited (Table 7 in the Appendix):

Men Women
PA wage $1,470,861 $1,285,045
Doctor wage $2,257,628 $2,040,553
Surgeon wage $3,355,050 $2,619,645

If those figures are at all accurate, it isn't true that female doctors are taxed just as much as male doctors. Though there are certainly high-paid female doctors and low-paid male doctors, there is a statistical disparity in cumulative wages between the two populations, especially for surgeons, so that statistically the cumulative taxes obtained from the two populations will differ. You can back up your claim, and refute theirs, with more substantiated figures; since you have read the study and maintain your claim, you must have some. Please share them.


"which over their careers pays for more than enough for their education."

This claim bears thinking about. It's doubtless true that if one adds up all the tax paid by a typical female doctor over her career, the sum would match or exceed the tax-funded government expenditure needed for her medical education. But that's a contrived question. Taxpayers collectively have to pay for all government services at once, not just a particular one. Worse for us all, at the present time the total government budget so far exceeds tax receipts, and the government is so disastrously indebted and becoming more so at an accelerating rate, that the idea of comparing taxes paid by one individual to one specific service rendered to that individual is as meaningless an accounting fiction as the idea of the Social Security "lockbox".


"Take into account the blood, sweat and tears they've given over their time at medical school, residency, weekends, night shifts and overtime, the rapport they build with patients and the sheer emotional commitment they give to their jobs, they deserve all the benefits they get. All doctors work hard. Harder than most members of society."

I assume that this is equally true, as you say, for all doctors. Yet the question was a statistical disparity in working hours. A condition that is equally true for both populations can't explain the disparity, or by itself justify it.


"If female doctors want to take maternity leave, it's completely within their right to do so, just as many of my male colleagues have decided to take sabbatical leave to train in something else or travel around the world."

What are the publicly agreed-on rules determining how much of what I want to do I am within my right to do, with the condition that I won't have to pay any extra costs? I would like to take a sabbatical from my job to travel, too, and with the certainty that my job will be waiting for me when I return. I don't have that certainty. If the problem is that I don't work as hard as doctors, what is the level of intensity above which I can, *of right*, write my own ticket? And where is this written down?


"I don't know why it was posted twice, but it wasn't my intention. You're right, I don't see the point of refuting such a ridiculous argument. The evidence speaks for itself. I was smart enough to get into medical school. The owner of this blogpost wasn't. It's quite simple really. Perhaps the title of this post should be 'Why are men too thick to get into medical school these days?'."

You have left this on the table, and it contains at least two claims:

"I was smart enough to get into medical school. The owner of this blogpost wasn't."

As you know, there are many, many medical schools with differing levels of rigor in their admissions processes. You don't say, for example, "the most elite medical schools"; you say "medical school". So your claim is that Randall was never able to get into any medical school anywhere. Randall has replied to you. You haven't answered him. Do you still maintain that claim? And is not answering him an example of the good communication skills you cite?

The second claim is not empirical. It is that the above claim you brought in extraneously -- Randall's ability to get into medical school -- is in fact the *entire* point at issue.

Randall has not composed the studies about female doctors' cumulative working hours, he has cited them. The validity or invalidity of the studies does not depend on Randall's intelligence, or anything about Randall at all. Yet you claim the question of how smart Randall is decides the entire question ("It's quite simple really.") Please explain, carefully, how dismissing someone who provides links to studies refutes the studies themselves.

Engineer-Poet said at May 9, 2012 8:42 PM:

"Female doctor" isn't bright enough to realize that the ad-hominem fallacy is a fallacy.

Talk about a very limited set of competencies.  Empathy with patients is all well and good, but when strong logical capabilities are required for e.g. doing rapid and accurate diagnostics....

Alex said at May 10, 2012 7:51 AM:

"Talk about a very limited set of competencies. Empathy with patients is all well and good, but when strong logical capabilities are required for e.g. doing rapid and accurate diagnostics...."

There is much evidence that a polite and empathetic rapport with patients supports better, rapid and more accurate diagnosis. For example, a patient is more likely to volunteer sensitive information in a medical history to a doctor they like and trust. Is this not common sense? Having a good bedside manner and clinical competency are not mutually exclusive, a male and female doctor can have both...but I wouldn't expect an Engineer to understand that.

Female docter said at May 13, 2012 5:39 AM:

J.'s points are rather pedantic and facetious. I believe I put my arguments into context which makes my sentiments very clear. Picking out odd phrases is quite banal.

Thankfully, women make good doctors and there is presently nothing which stops bright young women from being accepted into medical school and devoting themselves to what is a very rewarding career both for themselves, their family and the patients they help.

I do notice that no one has bothered to comment on my last argument - that successful, young professional couples should be encouraged to have children to aid the demographic of the next generation. Singapore offers them incentive to do so. You should be happy that children are being brought into families of clever, responsible, financially stable women who pay high taxes and make this kind of contribution to society.

Don't be a hypocrite who trashes the working class for having too many children and scrounging off the state, only to condemn families of hardworking women for taking maternity leave to have children who will one day provide for you.

J. said at May 13, 2012 7:54 PM:

"J.'s points are rather pedantic and facetious. I believe I put my arguments into context which makes my sentiments very clear. Picking out odd phrases is quite banal."

The more pedantic and banal you find my points, the easier it would be to refute them, and the more pointed the fact that you avoid answering a single one.

I appreciate your exactitude in the second sentence: a shift from "arguments" to "sentiments." Your sentiments -- i.e. feelings -- are clear enough, and just as clearly they are the substance of what you have written. But feelings are not arguments. They can't settle any question.


"Thankfully, women make good doctors and there is presently nothing which stops bright young women from being accepted into medical school and devoting themselves to what is a very rewarding career both for themselves, their family and the patients they help."

True enough, but as irrelevant as ever to the point at issue, which is the differing allocations of time among those things.


"I do notice that no one has bothered to comment on my last argument - that successful, young professional couples should be encouraged to have children to aid the demographic of the next generation. Singapore offers them incentive to do so. You should be happy that children are being brought into families of clever, responsible, financially stable women who pay high taxes and make this kind of contribution to society."

That is indeed an argument. (Note what you are doing: you are claiming the right not to defend any statement, while conversely counting it against us that nobody answered a point of your own choosing, having earlier dismissed the host as too stupid to do so. If an argument is at minimum a statement you're willing to stand by, this is your *only* one.)

Yes, it's an argument, but it does nothing against the claims of the studies. If anything, it tacitly accepts them, and says that the relative shortfall from women doctors is made up in other ways.

Now, you are aware that Singapore holds down the number of female medical students to a third of every class, aren't you? They've been doing that since 1979. Exactly the demographic policy that you cite is used to prevent many women from going into full-time, demanding professions. Do you really want to invoke Singapore at the same time that you celebrate the fact that nothing prevents bright young women from going into medical school?

Singapore is famous worldwide for its authoritarian, unsentimental rule, one which is only possible because of its ethnic homogeneity and roots in Chinese Confucianism. We don't have any of that in the US. But even in the US, if family formation is a significant enough benefit to "society", why encourage young women to go to medical school in the first place? Taking "that kind of contribution to society into account" requires putting numbers to the respective contributions, and so far you've rejected numerical evidence as pedantic.

Let me make it clear that unlike you I don't make this argument, so I don't have to rescue it. For me, as for Randall, the results in the original studies are only symptomatic. The main point is to get medical costs down through automation (and eliminating cost shifting), not valorizing life/work priorities within an already overloaded system.


"Don't be a hypocrite who trashes the working class for having too many children and scrounging off the state, only to condemn families of hardworking women for taking maternity leave to have children who will one day provide for you."

First of all, an accusation of hypocrisy can be made only by a person who believes in taking responsibility for statements, rather than shrugging them off whenever it is convenient.

If you believe that readers of this blog are under the illusion that the children of today "will one day provide for" them, you haven't been reading the blog very long or very carefully. Randall has produced many posts disproving that fallacy. It is well known here that the system of state entitlements is headed for collapse. (Medical entitlement costs are growing faster than generational ones, however, and medical entitlements will collapse sooner.)

The precise point at issue is that the government supports a system -- a failing one -- in which woman doctors happen to work 20-25% less over time, on average, than male doctors, and concentrate in different areas of practice. I certainly don't say that is the worst of the problem, but it is a trend in the wrong direction. On the one hand, taxes and borrowed money for an unsustainable system; on the other, taxes and borrowed money for social entitlements. It is consistent to criticize both.

You've admitted your disbelief in a sensitive point of liberal orthodoxy, which is commendable.

Female doctor said at May 14, 2012 10:25 AM:

J. - I particularly dislike people who indulge in bullshit.

-"Now, you are aware that Singapore holds down the number of female medical students to a third of every class, aren't you?"

Having worked at Singapore General Hospital for a period as part of my international training, I can assure you that the National University of Singapore does not have any restrictions in the number of female medical students it admits. Imperial College London is about to open a new medical school with NTU - no doubt its admission stats will also likely be around half-half gender distribution. Don't lie to prove your point.

- "does nothing against the claims of the studies"

What studies? Published papers? Systematic reviews? Randomised controlled testing? Exactly where are these 'studies'? All I see are a handful of articles written by people who conveniently support the views of Mr Parker. I can cite you even more articles which contradict it. Considering the crap that anyone can publish on the internet, I wouldn't call them studies. Again, don't lie.

-"If you believe that readers of this blog are under the illusion that the children of today "will one day provide for" them, you haven't been reading the blog very long or very carefully. Randall has produced many posts disproving that fallacy."

No, I do not believe the state system will collapse within one generation. I believe that children of today will have to pay high taxes and contribute to state pension funds just as we are. I do not believe that Randall is the Oracle and whatever he predicts will be true. One day, sadly, my children might have to pay for your miserable, disease-ridden body. You might even be cared for by a female doctor. It would be a waste, really, because you've clearly not been happy since D-Day.

Randall Parker said at May 27, 2012 7:44 PM:

Los Angeles Times from 2001: Singapore's government prefers male medical students:

SINGAPORE — Men outnumber women two to one at Singapore's only medical school thanks to a government quota system that gives preference to lower-scoring males over brighter females.

National University of Singapore limits female enrollment because, officials argue, women leave the profession to have babies and this city-state cannot afford to subsidize expensive educations for those who don't make medicine a lifetime career.


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