Brain Drain: Doctors

In my era, it was considered the pinnacle of academic success to go to med school.  Law school was slightly behind, but essentially equivalent.  People who went to graduate school in hard sciences, as many of my friends did, went because they loved their field, were intrigued by it. They hoped - especially the engineering and computer types - that they might become prosperous thereby, but it was the fascination, or perhaps the joy of being good at something, that drove them. It was similar among my friends who went for advanced degrees in humanities or social sciences. The MBA was an exception.  That was for people who had loved history or economics or German as undergrads, but were now buckling down to make serious career money.

That was true of the generation before mine as well.  There is an interesting event in Asimov's autobiography In Memory Yet Green of him addressing a group of medical students. He had a PhD in chemistry, but one of the questions was clearly meant to sort out whether he was a "real doctor" (snigger). That's the way people viewed it then. I don't think that would be true now.  I don't know, and I don't know when the change occurred. Yet the testimony of literature and everyday conversation supports the idea that the best and brightest became medical doctors throughout the 20th C. If you hated blood you could excuse your way out, and women were at first pressured away from med school, then pressured into it, inflection point somewhere in the 60's.

Yet - consider that doctors killed more than they saved until about 1940, penicillin being the big boost. The germ theory became established, gradually but long before that, so basic sanitation and quarantine were understood. Anesthesia and aspirin had come along, X-rays could tell you whether and how a bone needed to be set, yet by 1935 the smartest people - or at any rate those who had the reputation in every town of being the smartest - were still killing more people than they saved. Babe Ruth made more than the president in 1930 and joked "I had a better year." He had a better year, in the sense of providing useful service, than most doctors that year, too.  As did most of the rest of the major leagues.

Part of this may have come from the medical profession's insistence on making its smart practitioners stupid by training them during sleeplessness (while working in hospitals, where the sickest patients are, and killing them), then insisting that they have at least some hours of stupidity by being on call throughout their careers. Yet all of our parents and grandparents conspired in this, to grant the highest status and often wealth to those who didn't actually do much good.

We should be grateful that as many people as did decided that they really loved computer programming or geology, deciding that med school could go hang. Yet I wonder if we didn't waste a good deal of American brainpower by culturally rewarding medicine over other fields. (I believe many others have already made the same observation about law school.  I don't feel qualified to answer that.)

I have always thought Allen Ginsberg's most famous quote to be incomprehensible and foolish.  But if you slip in the word "medicine" for "madness," with an eye to the many night shifts that residents do, it begins to approach sense.

“I saw the best minds of my generation destroyed by medicine, starving hysterical naked, dragging themselves through the negro streets at dawn looking for an angry fix angelheaded hipsters burning for the ancient heavenly connection to the starry dynamo in the machinery of the night.”