Legal versus Medical Education and some blatant 'crowdsourcing'

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Sunday, May 27, 2012

Legal versus Medical Education and some blatant 'crowdsourcing'

In many posts on the state of legal education and the legal profession (on this blog and others) I've seen repeated references to medical education. While I imagine that there exist certain "apples and oranges" aspects to this comparison, it is intriguing. However, I am going to state something that I think might apply to a lot of people - that is, while I have a vague notion of what occurs in medical education (from TV and movies), I feel that I don't really know enough about it to make proper comparisons to legal education (something on which I have experience from both sides of the podium).

Therefore, my purpose here is to blatently 'crowdsource' this information. I have a few questions (ok, a lot of questions) posted below for folks who have experiences with medical education (preferably first-hand, but second-hand is ok too). In the best case scenario we might get some JD/MDs to weigh in on this matter.

If there is any interest, I'd be happy to share my comparative experiences as a new lawyer vs. political science PhD grad (and perhaps fellow guest prawfs blogger Bob Howard can chime in on this)? - although there may not be a great market for that discussion? ;-)

Jeff

1) How difficult is it to get into medical school? (gpa, % test scores, etc.)

2) How much does it cost to go to medical school? (per yer tuition for private/public; how many years do you pay full tuition, etc.)

3) Um, what happens in class? 1st year, 2nd year, 3rd year, etc.? How are you tested/graded? Is it very competitive (e.g. backbiting) or is it 'everyone's a winner'?

4) What are faculty teaching loads? How are they evaluated for rank/tenure (research; teaching evaluations) ? Are rank and tenure the same as in law and/or other fields (e.g. assistant, associate, full)? How are faculty recruited? What is faculty worklife like? Do they make significantly less than non-faculty doctors?

5) How important are grades for medical students in getting jobs? Is there a significant split (as there seems to be in law) between the salaries for the top 15% of the class (or top 15 law school) and the rest? What else matters?

6) How much do doctors make after they begin private practice? Five years out? Ten years out? Is there a large gap between pay for rural vs. urban areas?? (Related to question #3 please discuss salaries during the residency years - this question is about after all of that)

7) How mobile are medical degrees/licenses? How difficult is it to start a practice in another state?

8) How hard is it to get a job as a doctor as a new graduate?

?

Posted by Dingo_Pug on May 27, 2012 at 04:54 PM | Permalink

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Comments

Goodness, I set out to write an answer, but these would take me like 45 minutes or so to complete. Respondent burden is way too high!

I'd like to help, but can you trim it down to 4-5 questions (and no compound questions, please!) you'd most like to get some answers to?

(I am an attorney and a faculty member in a medical school).

Posted by: Daniel S. Goldberg | May 27, 2012 6:05:21 PM

I think that Qs 3,4, and 6 (primary questions) would probably be the most helpful - sorry for extended Qs ... once I get going ...

Posted by: Jeff Yates | May 27, 2012 6:34:11 PM

There is a ton of information available on the Association of American Medical Colleges website:
https://www.aamc.org/students/considering/gettingin/

Posted by: Jeff Lipshaw | May 27, 2012 7:00:28 PM

I know a couple of things Med and Law Schools have in common: they do not require of entering students much competency in STEM and, in the 3-4 years they pretend to teach the student, they do nothing to remedy the situation. Surprisingly, the English Language skills of the students do not seem to be that much better.

The obfuscating prose of lawyers is legendary, but try reading anything a doc or nurse writes, whether in the NYT or in a professional journal, and you will see numerous instances of "at risk for [some disease]" where "at risk of [some disease]" would be the proper form. These are folks who are missing some serious processing between ear and tongue.

It is disastrous for this country that so many of POTUS, COTUS and SCOTUS are drawn from the miserable pool of law-school grads, most of whom have taken undergrad degrees in mickey-mouse majors like History, Philosophy, English and International Affairs. That accounts for the fact that only Breyer of 9 on SCOTUS, only some 8 of 535 in COTUS, and nobody since Carter as POTUS has shown any sophistication when it comes to STEM.

Posted by: Jimbino | May 27, 2012 7:37:48 PM

(1) Medical admissions are more competitive than law school admissions. The overall acceptance rate is about 10%, and is well under 5% for the most selective schools. Median GPAs are typically between 3.5 and 3.8.

(2) Private tuition and fees are typically on the order of $50,000 a year, as are public non-resident tuition and fees. In-state students at public medical schools may pay half of that.

(3) First and second years are all-day five-day-a-week lectures, taught by a large and rotating cast of faculty. Exams are generally multiple-choice or objective (very) short answer (e.g. "name this body part."). The emphasis is strongly on memorization of large quantities of material. Depending on the school, the lectures may be intercut with simulations, small-group discussions, and shadowing affiliated doctors--but these aren't the dominant part of the curriculum. Third and fourth years are spent rotating through a wide variety of medical specialties, shadowing actual doctors, answering questions they put to you, and doing whatever smaller tasks make you most useful. (E.g., in surgery, "Hold this and don't move for the next two hours.") Grading in third and fourth years is based on some tests, but more on evaluations by the doctors with whom one works.

(4) Faculty are split between practicing doctors, laboratory researchers, and a (much) smaller contingent of lecturers. There are typically many more of them than at a law school, with much lighter individual classroom teaching loads. (E.g., it is not uncommon for a doctor's entire classroom teaching responsibilities for a year to be a week's worth of lectures.) Grading is trivial, due to the objectively graded exams. These faculty should generally be thought of as doctors and bench scientists first, and as teachers second: they just happen to have "faculty" positions that require some teaching, and they're hired for their other work. Promotion within the faculty ranks is based on research. Residents and affiliated physicians may do some TA-like precpting work.

(5) Grades in medical school are important only in not flunking out and in applying for residencies. The other important factor in residency applications is recommendations from doctors one worked with during third and fourth year. After that, the brand name of one's residency program, recommendations, and personal contacts are the most important factors in finding a job. Thus, grades (especially first- and second-year grades) matter, but in an indirect way that can be compensated for later.

(6) The principal exception to this point is that salaries diverge strikingly based on medical specialty. ROAD specialties (Radiology, Opthalmology, Anesthesiology, and Dermatology) are reported to have the highest salaries, and family practice the lowest. The AAMC reports a range from perhaps $150,000 for lower-paying specialties to $350,000 and up for the higher-paying ones. There's geographic variation, too, and seniority, and type of practice, so it gets complicated quickly. Thus, medical school grades can have a significant effect on your job and salary by affecting what specialty you get a residency in.

(7) The licensing practice is absurdly annoying, but it's less of a big deal than retaking the bar exam. Each state has its own licensing board, there are controlled-substance rules, etc. -- it adds up to a lot of paperwork and delay to be licensed in a new state. But the crucial exams and certifications are national.

(8) Because of the residency requirement, no medical school graduate can go out and just start working as a doctor. But there are well more than enough residency slots to go around (provided one is willing to compromise on geography or specialty). Leaving residency, the norm is that everyone who still wants to work as a doctor will find a job. Put another way, our regulatory system has too few residency slots given the demand for doctors, and too few medical school slots given the number of residency slots.

Also, pace Jimbino, medical schools generally require 32 course hours of STEM work in college -- 8 in biology, 8 in physics, and 16 in chemistry -- plus the MCAT, a majority of which tests science. Given the competitive nature of medical school admissions, a year of math and a year of biochemistry are strongly encouraged.

Now, it's time for the gentle scolding. All of your questions are amenable to Googling. All of them. I have enough secondhand experience with medical school that it wasn't hard for me to give (partial) answers. But really, shouldn't crowdsourcing be saved for questions to which crowds can give better answers?

Posted by: James Grimmelmann | May 27, 2012 11:18:58 PM

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