The baseball model: post-WWII surgeons as young as age 18?

And here's where I draw my long knifes (pun intended!)



This is school:



And this is life:

multiple-intelligences-theory


The person with high spatial reasoning could perhaps be a leader and innovator in surgery, but because average “school”-type intelligence in verbal and math, never gets a chance. Doesn’t even come close to medical school admission.
 
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With the era this POD is in, it’s a distinct possibility. Penicillin and Johns Hopkins turned medicine from quackery with some comfort (maybe) into actual healing arts. Surgery was always the practical, real-world that was built on a lot of practical experience and observation.

Another way it could branch is that doctors become the chief researchers and theoreticians, wirh nurse practitioners (or some more masculine name) and surgeons being your treating medical professionals.
 
Not only that, but surgery is as much art as technique. There is a lot of judgment and knowledge involved in most operations and the ever-present possibility that something goes awry or not as expected. Experience and knowledge matters here sometimes more than adept technique and good motor skills. For these reasons, I'd prefer the crusty old surgeon who knows what they are doing over the 18-year-old who cuts well but doesn't understand the whole thing.
Very insightful comment and I thank you for the criticism.

I imagine the young surgeons would train on plastic models showing a range of human variation, observe a number of this type of surgery, and second-assist and first-assist in a much more organized way than the current system.

What I’m against, or skeptical of, I suppose we could call ‘fundamentalism’ or ‘foundationalism.’ For example, the idea that studying how oxygen binds in order to fill its second shell with 8 electrons is somehow highly useful to medical practice. It’s almost like we’re elevating a form of thinking which does not come naturally to us, and discounting such things as arching across a topic and getting the big picture which do come easily to us.

In a similar vein, baseball pitchers are very attune to wind, to the size of the ballpark, and especially to the individual quirks of batters. But they are not in a hurry to get back and do physics calculations.
 
Not only that, but surgery is as much art as technique. There is a lot of judgment and knowledge involved in most operations and the ever-present possibility that something goes awry or not as expected. Experience and knowledge matters here sometimes more than adept technique and good motor skills. For these reasons, I'd prefer the crusty old surgeon who knows what they are doing over the 18-year-old who cuts well but doesn't understand the whole thing.

Agree with this. As a currently practicing surgeon, I would argue that the technique is one of relatively less important parts of what goes in to making a good surgeon. You can have an 18 year old wunderkind do a technically perfect operation but if it's the wrong operation for the wrong reason it's going to end poorly.

What you're proposing is to split the technical and the medical role of a surgeon into two distinct parts. The problem with that is that knowing what to do when frex. a brain aneurysm ruptures intraoperatively is something that absolutely requires both roles at the same time and in real-time. If you're going to have the senior guy be around the whole time to guide the young one, you might as well combine the two and save yourself a physician's salary.

I do think that a version of this will eventually be how surgery is performed, except your technician role will be performed by robots.
 
Last time I read the stats you want a professional who has enough time on the job to get some experience but not so long as to get lazy. This goes for accountants, doctors, lawyers, whatever. They are human beings and keeping up with the latest techniques and education is hard. In the case of doctors, plenty are using techniques that were state of the art when they graduated but obsolete 30 years later.

I am not in the field so I don't want to comment one way or the other. But there is an argument for youth, if only because they are closer to what is current.
 
I apologize in advance for being so blunt as to be potentially offensive, and this post is not going to be short.

Abraham Flexner's 1912 report was interesting both for its content and motivations. Hopkins by and large pushed for it (and funded it?), he gave them glowing reviews regarding their curriculum and gave scathing or at best sub-par reviews to most of the medical schools on his report. I find his work somewhat biased in its overall effects but necessary given the quality of graduate reportedly being produced by some institutions at that time. Over half of US medical schools in existence at the time were subsequently closed as a result of his report, one of the largest concerns I recall from reading it was the necessity of an undergraduate degree before going to medical school. This is somewhat ironic given the flavor of this thread, but I think the question the OP was actually trying to posit was, 'Could an accelerated track into a medical degree specifically for the practice of surgery be viable for Vietnam and World War II combat medics who may only have been 18 or 19 years old'?

Baseball involves a *very* different skillset and while even the MLB seeks candidates with greater experience in many cases, their skillset is neither potentially lethal nor emergent as that of a surgeon. With a few exceptions, the American formula for medical education is as follows, almost always starting at age 18: 4 years of undergraduate education (age 22), 4 years of medical school education (age 26), and 3-7 years of post-graduate training (finishing at age 29-33) known as residency because the trainee physicians actually lived in the hospital. General surgery is a five year training experience, Neurosurgery is a seven year training experience, and these days both are increasingly competitive with many candidates opting for a master's degree (+2 years) or research experience (+1 - 2 years) before applying somewhere in the cycle. Fellowships add an additional 1-2 years, so the actual medical component of surgery alone from education to post-graduate training is *9 years* and can be as long as *12 years*.

Could you have someone much younger go through the system? Yes, there are programs that allow for combination BS/MD programs and graduation of medical school at age 24 and some people may start at 16 or 17, but the additional life experience of older or more diversely experienced candidates not only facilitates the establishment of rapport but also the psychological reserves of the rigors and pressures of the American medical training system. One of the reason physicians tend to congregate in their own little social groups is because this co-ed fraternity has its own language, hazing rituals, and experiences that other people often have trouble relating to. At 18 I could see a combat medic/veteran having an edge on the competition, but arguing for motor skills is only part of the question. It is learning that subtle texture, that minimal difference, that little observation on so many different illnesses that can *literally* mean a life or death difference both under the knife and not. Judgement calls and experience buffers, the opportunity to learn not only how best to perform an operation but timing and best -opportunities- to do so, these are only a sliver of the real-world education that post-graduate training provides. While an argument to shorten medical school exists, it is not popular, and the extension of residencies by a full year in the face of work-hour limitations is a hot topic. The precarious balance between seeing as much as possible while there is still oversight and getting the jobs allocated done in a timely manner is precarious, it is a pendulum not likely to stop swinging in the near-term and while an 18 year old with prior experience might have an edge on fellow students they are -not- ready for actually performing the operations needed. Time is not easily substituted or shortened in this case, and without that buffer of experience and training all the motor skills in the world will do someone no good when they are knee-deep in guts and blood only to ponder, "Now what"? without a readily available answer.

So no, I do not believe that the 'baseball model' applies nor should it be allowed to apply to surgery on the basis of dexterity or fine motor coordination.
 
Last time I read the stats you want a professional who has enough time on the job to get some experience but not so long as to get lazy. This goes for accountants, doctors, lawyers, whatever. They are human beings and keeping up with the latest techniques and education is hard. In the case of doctors, plenty are using techniques that were state of the art when they graduated but obsolete 30 years later.

I am not in the field so I don't want to comment one way or the other. But there is an argument for youth, if only because they are closer to what is current.

This is actually a very hot topic in medicine right now as the amount and cost of post-training education and re-certification testing comes under the microscope. Many physicians do work to keep current in all fields, levels of success in this regard vary though.
 
Two ways forward:

Avoid the conversion of the British "Mister" surgeon system into a full modern physician/surgeon profession. Professions require a general systems level understanding of the fullness of their field. Here we're cutting that off by retaining the early modern distinction between "mechanic" and "erudite."

Secondly, Taylorise medicine. Other professions and crafts have been destroyed by capital before. The first Taylorist assault on "the university" was Edison, and that was before the university had stabilised. Certainly prior to massification. For this one have the AMA pick a fight with the state and get deregistered like the traffic controllers.
 

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Last time I read the stats you want a professional who has enough time on the job to get some experience but not so long as to get lazy. This goes for accountants, doctors, lawyers, whatever. They are human beings and keeping up with the latest techniques and education is hard. In the case of doctors, plenty are using techniques that were state of the art when they graduated but obsolete 30 years later.

I am not in the field so I don't want to comment one way or the other. But there is an argument for youth, if only because they are closer to what is current.
There is another school of thought on this.

When you are having an angioplasty you want someone who is in at least the four figures of procedures done, ideally 5 digits (assuming you live in a major metro this isn't really difficult, some cardiologists seem to specialize in them, as I understand it it is one of those things that you get better the more you do). Dy dad's surgeon was somewhere north of 10K; when he needed a second one done it was by the REAL expert in the area who was north of 20K. All the bright young docs thought he needed open heart surgery, the Pro from Dover, who was on the teaching staff at Stanford (although he was also the Big Gun for Kaiser Northern California, God bless him and his to the 10th generation), told them to have a seat right in the corner, watch, and learn. That was 15 years ago, near as I can tell that doctor's work will outlast my Dad. Experience counts.
 
the actual medical component of surgery alone from education to post-graduate training is *9 years* and can be as long as *12 years*.

How does that compare internationally? Medical associations are known to keep a tight lid on doctor's numbers. Training is one of those ways. The US is on the lower end of doctor density for a 1st world nation.

Experience counts.

I wish I could quote some stats. Not my area so I don't keep track of it. My understanding is that statistically there is a limit to the benefit gained by experience which tapers off over time. (eg a new doctor with 5 years experience is more effective than a old doctor with 20 years experience.) That is why there is an argument over it.
 
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There is another school of thought on this.

When you are having an angioplasty you want someone who is in at least the four figures of procedures done, ideally 5 digits (assuming you live in a major metro this isn't really difficult, some cardiologists seem to specialize in them, as I understand it it is one of those things that you get better the more you do). Dy dad's surgeon was somewhere north of 10K; when he needed a second one done it was by the REAL expert in the area who was north of 20K. All the bright young docs thought he needed open heart surgery, the Pro from Dover, who was on the teaching staff at Stanford (although he was also the Big Gun for Kaiser Northern California, God bless him and his to the 10th generation), told them to have a seat right in the corner, watch, and learn. That was 15 years ago, near as I can tell that doctor's work will outlast my Dad. Experience counts.

Irony. Heart catheterization was developed by a medical student who was later expelled (either for being so impudent or not letting his chair be lead on the paper) and the physician who brought it to the US died in a plane crash trying to save an hour by flying instead of driving over one of the more boring routes available in the Eastern US. Had he lived...
 
How does that compare internationally? Medical associations are known to keep a tight lid on doctor's numbers. Training is one of those ways. The US is on the lower end of doctor density for a 1st world nation.

I'm not entirely certain. Given the house worth of debt many medical students graduate with now, maybe two depending on undergrad debt, the incentives for going into several areas of medicine are not what they once were. And the limitations of public funding for residency training mean that without some assistance we may lose more to the private sector and potentially Switzerland or Japan depending on their other skill sets.

I wish I could quote some stats. Not my area so I don't keep track of it. My understanding is that statistically there is a limit to the benefit gained by experience which tapers off over time. (eg a new doctor with 5 years experience is more effective than a old doctor with 20 years experience.) That is why there is an argument over it.

Again, this is a hot topic area, and given that many physicians are working into their late 60s/70s I would say there are still benefits for someone who keeps current in their field with a lot of experience. For stats maybe check pubmed.gov or the WHO?
 
Agree with this. Maturity and life experience is quite important. You don't want the average 18 year old kid telling parents their child has an inoperable brain tumor. They don't have the emotional bandwidth or experience to parse out those kind of life and death decisions. It's a disservice to the patients and to the provider - it's a recipe for massive physician burnout, which god knows is already enough of a problem.

I do think there is some room for shortening the timeframe of college/med school. I certainly could've done 6 years instead of 8 and probably not lost much with regard to preparation for residency. That being said an 18-20 year old me wouldn't be able to handle the emotional stress of the job.

Most other health systems limit the number of attending physicians. Frex, in the NHS there are only a certain number of attending slots per hospital (consultants). The residents are stuck as residents (registrars) until a spot opens up and they get picked up. In the US I expect the physician shortage will mostly be sorted with the increasing reliance on physician extenders (ARNP, PA) - so in some way that fits with an aspect of what the OP is suggesting.

Re: the experience debate I believe there is a balance between experience and age. For neurosurgery, in general I would recommend someone who is 5-15 years out of their training. Five years is when most practitioners will be board-certified and getting comfortable being an independent surgeon. Much past 15 years the odds of sclerosis/boredom/loss of dexterity starts to become an issue. While numbers of procedure performed is an OK metric, for most surgical subspecialty procedures getting into the four digit realm is impossible or will take decades
 
In the legal world you have this where some incredible lawyers (especially in litigation) cut their teeth as legal assistants and paralegals, go to law school in the late 30s or early 40s and rocket up.
This is better than when a young lawyer joins the DA’s office at age 25 and are so used to winning and seeing a one-to-one correspondence between effort and grades,

and this is the person we expect to make important ethical system respecting the victim and victim’s family and also expecting the accused person’s right to a fair trial ? ? ?

No wonder we get such things as the prosecutor hugely overcharging so that it’s a rational decision to plea bargain, even if you’re innocent.
 
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I guess I’m against the idea of a priesthood where in their 20s a young man or woman gets full rights to the profession. This is the case in both medicine and law.

And religion itself of course. Like several days after my grandfather’s funeral, the young Catholic priest who visited my grandmother at her home and during their conversation asked her, Have you cried yet. He asked both matter-of-factly and with heart. He did at least an okay job. I had recently graduated from high school, and so was young myself and don’t feel I can really judge beyond that.

But to the extent he’s good at talking with senior citizens shortly after the death of a spouse, it’s not because of skills he’s learned in seminary school.
 
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Americans have their choice of priesthoods. Why not of surgical or legal self-certifying professions? Why can an arsehole determine their own confession, but has an intermediary when it comes to selecting which incompetent conveyancer will defend their drink driving charge?
 
With the era this POD is in, it’s a distinct possibility. Penicillin and Johns Hopkins turned medicine from quackery with some comfort (maybe) into actual healing arts. Surgery was always the practical, real-world that was built on a lot of practical experience and observation.

Another way it could branch is that doctors become the chief researchers and theoreticians, wirh nurse practitioners (or some more masculine name) and surgeons being your treating medical professionals.
I understand that during World War most of the newly discovered and manufactured antibiotics were sent to soldiers and sailors, with some civilians getting them in exceptional circumstances.

And absolutely a game changer! This part of medicine moved into the modern age.

I remember during the 2009 H1N1 swine flu epidemic, the UK set up phone lines in which citizens could call and get prescriptions. Yes, this new variant of flu turned out more minor than at first feared. And I understand that there were some problems with the phone lines.

It seems like it would be pretty simple to put the symptoms on flu on one side of one piece of paper. Plus, whether flu is spreading in your geographic area.

And you need to tell people to please complete the Tamiflu medicine, because if you don’t, you’re increasing the chance of the virus developing resistance, which can hurt either you in a relapse or other people. And tell them in a way in which they’re just as smart as you. They may just not happen to know this particular bit of information.

And everyone, please understand that I’m advocating quite a bit more training than this and much more of a middle-of-the-road way of doing it.
 
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Francisco Lindor of the Cleveland Indians. He is 24, and this is his fourth year in the majors.

He did get a hit against my Astros yesterday, although we won handily. The two teams play again Saturday afternoon.
 
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Speaking as a currently retired specialty surgeon, this idea is completely nonsense. Depending on your educational model, the post secondary education for a medical degree is 6-8 years (European and North American models). Following getting your medical degree, the post degree training is 5-8 YEARS before you are considered competent to be on your own. The decision as to whether or not to perform surgery is done by the surgeon NOT by a non-surgeon - a non surgeon MD may refer a patient who may (or may not) be a candidate for surgery but the decision to operate or not and which surgery to perform is done by the surgeon. During my career I had a good number of patients referred for potential surgery where that was NOT the appropriate treatment as well as a fair number of patients who should have been referred and gotten their surgery much sooner than they did for the best outcomes. Diagnostic skills related to your surgical specialty are as important as surgical skills, and take place before you pick up the scalpel.

Experience counts. At the end of my postgraduate training (6 years) I was much better with diagnosis and technique than at the beginning. It is not uncommon that one can encounter an unexpected anatomic variation (there are lots of them) or something else unsuspected once you are in an operation and you then need to shift gears, often urgently. If you have a complex problem, if things go poorly, etc there is no time to go to the library and check things out - you need to act right away and if you don't bad, very bad, things happen.

The "teenage doctors" on a few TV shows are interesting fantasy but just that. Even if someone could cram their education through medical school in by the age of 18 (basically ASB - just too much stuff), and they had natural physical skills like some ballplayers, they now have to embark on the actually training to become a surgeon. You start small, assisting (often second assisting) at operations, caring for pre and postop patients, and in the clinic and gradually assume more and more responsibility for operations with a senior surgeon there with you. Ask yourself if you want an 18 year old who has just completed his private pilot training to take the controls, without a co-pilot, of a large passenger jet on which you and your family are passengers. Sure he has great reflexes and eagle eye vision but...

When everything is going well, its nice but in the middle of the night when everything with the patient is turning to crap, that is when you need all your skill, experience, and maturity - been there, done that more often than you can realize.
 
I see where this is going...but how the shit would this actually work? Do we send high school kids to “surgery school” in the afternoons if they qualify? Do we have 14-year-olds doing practice surgery on pig carcasses or whatever the hell they do in med school these days? Do we have a mandatory retirement age for surgeons of, like, 42 or something? (I pick 42 because it’s when the Navy won’t recruit people anymore and the pro athlete older than 42 is a mighty rare sight, Tom Brady notwithstanding.) And what of retired surgeons? Or surgeons who don’t work out? Do we train them to be doctors? Do we fix the outrageous cost of medical school? Because that would be fucking Super.

Great idea but no idea how it would come together.
 
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