The Draw of Dermatology?

This piece in the New York Times focuses on a married couple, both Harvard Medical School students, who are in their fourth year and waiting to find out about their residency placements. Like many medical students around the nation, they’re competing for competitive placements in specialty fields instead of going into less lucrative (and possibly less intellectually stimulating?) fields such as family practice and internal medicine.

And the competition is expensive:

Already saddled with about $330,000 in education loans, they borrowed $20,000 more so they could fly around the country this winter for about two dozen residency interviews each. All told, each applied to 90 such training programs.

The article makes me a little sad in general. I had a conversation at CGI U with a med school student who warned me about the “vortex” of med school. Paraphrased: “Everyone’s the same. You get to med school all idealistic, wanting to help people and stuff. Then you spend years and years studying and working, and you see the people ahead of you getting money. You see the doctors with the nice cars and comfortable lives, and you start to wonder when you’re getting yours? And you get into so much debt that you realize you have to practice, and practice well if you want to get out of that hole.”

I’m certainly idealistic about why I want to go to medical school. In fact, the struggle for me is deciding between larger scale health policy work–doing research, designing disease control programs, advocacy, etc.–and traditional clinical work, or how to balance both. I’ve never seen myself as one to get into private practice, or really even treating patients full-time as a traditional clinician. But the vortex sucks many people in.

The problem is ultimately not with the medical students who are drawn to dermatology and plastic surgery for the better pay. Medical students will inevitably be drawn toward the specialties that combine interesting work with the highest pay. From the NYTimes again:

“It is an unfortunate circumstance that you can spend an hour with a patient treating them for diabetes and hypertension and make $100, or you can do Botox and make $2,000 in the same time,” said Dr. Eric C. Parlette, 35, a dermatologist in Chestnut Hill, Mass., who chose his field because he wanted to perform procedures, like skin-cancer surgery and cosmetic treatments, while keeping regular hours and earning a rewarding salary.

The market simply isn’t working here. We need more (many more!) primary care physicians. There’s a lot more demand for services there. But people who have the money to pay more for cosmetic treatments and surgery skew the demand away from those who don’t have the money to get adequate treatment for more life-threatening conditions like diabetes and high blood pressure.

I’m not sure what the solution is either. I know it would need to be a large-scale systemic change; merely getting pre-med students to read about Paul Farmer isn’t going to change everyone. Maybe having a single-payer system where doctors are compensated as much or more for basic services as they are for cosmetic services? Or maybe a loan-repayment situation where medical school is even more expensive, but all loans are automatically repaid by the government for those not going into specialties. Who knows. Suggestions?

Clinton Global Initiative University

Last weekend I went to New Orleans to visit the Tulane School of Public Health (a prospective graduate school for a few years from now when I get tired of working again) and attend the first annual Clinton Global Initiative (CGI) University. This was also my first ever visit to New Orleans (more on that later) and a great chance to get out of small-town Arkansas for a few days.

It also meant I got the pleasure (and mild exhaustion) of making a bit of a cross-country drive. Actually, it was only eight hours or so, but some of the drive was quite beautiful, in a flat sort of way. The weather was also outstanding.

CGI University was the first annual conference for students modeled on the innovative Clinton Global Initiative meetings that have been going on for several years. At CGI, leaders in business, politics, and other fields from around the globe make commitments to action. At the next year’s CGI conference, everyone gets to hear who followed through on their commitments.

CGI University was planned similarly, with students making commitments in the areas of (1) human rights and peace, (2) global health, (3) environmental and climate change, and (4) alleviating poverty. My commitment involved connecting a group of students at my school who are interested in health policy with some local public health professors to do some research that will (hopefully) have an impact on health care in Arkansas.

CGI U featured a lot of interesting people–Bill Clinton, James Carville, Ray Nagin, General Honore, Lauren Bush, and so forth. It was also incredibly well-produced / slick (read: expensive). I hope the conference encourages students to do more good in the world than would have been done by simply giving that money directly to good work. But I imagine it did just that. I also got a chance to pass out ~100 copies of Frank, the magazine I work on at the Clinton School, to a very receptive and interested audience.

Despite the interesting speakers and such, the best part of the weekend was connecting and networking with students from around the country. It’s always reinvigorating to be around a group of talented, dedicated young people who aren’t satisfied with things as they, and who dream of things as they could be. So kudos to the Clinton Foundation for finding a way to bring all of us together.

Top 10 Reasons I’m Not Posting Very Often

1) I’m still a full-time student. That means I have to go to classes.
2) Senior research thesis on democracy and economic/human development.
3) Awesome new job on non-class days that requires a commute but is well worth it.
4) New campus organization to work on public policy ideas.
5) All the old campus organizations to stay involved in.
6) Arranging some cool speakers to spice things up around here.
7) Girls.
8) Ridiculously intense scholarship applications with ridiculously low odds of winning.
9) Books.
10) Being burned out on blogging for a bit. I think on vacations and after graduation (in May!) I’ll have a wee bit more free time.

Just thought I’d share.

More Than Meets the Eye

Transformers. Great summer movie–amazing effects, good action sequences, and it doesn’t take itself too seriously. And, I used to be in love with the 80’s Transformers movie. So I enjoyed myself tremendously. That said,

1) Did the Air Force underwrite the entire movie or something? It was like the entire movie was product placement for USAF, and it’s probably a good plan since they’re target demographic probably likes action movies about blowing stuff up.

2) I can root for the Air Force with a much cleaner conscience when they’re indiscriminately lobbing missiles and bombs at evil robots (call me a speciesist) than when the targets are people’s houses.

3) Does the “hot girl” in the movie have to wear a gallon of makeup and fry herself in a tanning bed?

4) It’s nice that all the invading alien plots happen to focus on the U.S. Oh wait, this is Hollywood.

5) What’s with the stereotyped Mexican and South Asian characters? And why is the lead always a white male? *Steps off PC soapbox.*

Quoting King

I’m currently reading Shane Claiborne’s Irresistible Revolution. I’m sure I’ll blog on it more fully once I’ve completed my leisurely perusal, but for now I’d like to highlight some quotes Shane brought to my attention. These are from Martin Luther King, Jr.’s “A Time to Break Silence,” a speech given on the Vietnam war in 1967 at a meeting of “Clergy and Laity Concerned” at Riverside Church in New York City. MLK’s concerns went beyond his (incredible) devotion to civil rights in our country, to an even broader view of social justice. And it’s always good to reflect on values that should bring rich and poor, Christian and humanist, theist and athiest together.

[It became clear that the war in Vietnam] was sending their sons and their brothers and their husbands to fight and to die in extraordinarily high proportions relative to the rest of the population. We were taking the black young men who had been crippled by our society and sending them eight thousand miles away to guarantee liberties in Southeast Asia which they had not found in southwest Georgia and East Harlem. And so we have been repeatedly faced with the cruel irony of watching Negro and white boys on TV screens as they kill and die together for a nation that has been unable to seat them together in the same schools.

Funny how these words still ring true today:

As I have walked among the desperate, rejected, and angry young men, I have told them that Molotov cocktails and rifles would not solve their problems. I have tried to offer them my deepest compassion while maintaining my conviction that social change comes most meaningfully through nonviolent action. But they ask — and rightly so — what about Vietnam? They ask if our own nation wasn’t using massive doses of violence to solve its problems, to bring about the changes it wanted. Their questions hit home, and I knew that I could never again raise my voice against the violence of the oppressed in the ghettos without having first spoken clearly to the greatest purveyor of violence in the world today — my own government.

And here a call for a brotherhood of man, rooted in King’s own Christianity, though it could as easily be read as a call for a global humanism (in fact, King might have been closer to that than most of the Christians we know):

This I believe to be the privilege and the burden of all of us who deem ourselves bound by allegiances and loyalties which are broader and deeper than nationalism and which go beyond our nation’s self-defined goals and positions. We are called to speak for the weak, for the voiceless, for the victims of our nation and for those it calls “enemy,” for no document from human hands can make these humans any less our brothers.

King also has this quote from a Buddhist leader on the war in Vietnam:

Each day the war goes on the hatred increases in the heart of the Vietnamese and in the hearts of those of humanitarian instinct. The Americans are forcing even their friends into becoming their enemies. It is curious that the Americans, who calculate so carefully on the possibilities of military victory, do not realize that in the process they are incurring deep psychological and political defeat. The image of America will never again be the image of revolution, freedom, and democracy, but the image of violence and militarism.

If you will, rephrase that quote for me with Iraq in mind instead of Vietnam (not the analogy is a perfect one, but analogies never are… this particular quote however makes a useful point):

Each day the war goes on the hatred increases in the heart of the Iraqis and in the hearts of those of humanitarian instinct. The Americans are forcing even their friends into becoming their enemies. It is curious that the Americans, who calculate so carefully on the possibilities of military victory, do not realize that in the process they are incurring deep psychological and political defeat. The image of America will never again be the image of revolution, freedom, and democracy, but the image of violence and militarism.

And here he waxes prophetic. One could make the same claim today about US militarism:

The war in Vietnam is but a symptom of a far deeper malady within the American spirit, and if we ignore this sobering reality…and if we ignore this sobering reality, we will find ourselves organizing “clergy and laymen concerned” committees for the next generation.

And another gem:

On the one hand, we are called to play the Good Samaritan on life’s roadside, but that will be only an initial act. One day we must come to see that the whole Jericho Road must be transformed so that men and women will not be constantly beaten and robbed as they make their journey on life’s highway. True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.

And here’s another quote, though this time I’ve replaced “Communism” with “terrorism”:

This kind of positive revolution of values is our best defense against terrorism. War is not the answer. Terrorism will never be defeated by the use of atomic bombs or nuclear weapons. Let us not join those who shout war and, through their misguided passions, urge the United States to relinquish its participation in the United Nations. These are days which demand wise restraint and calm reasonableness. We must not engage in a negative antiterrorism, but rather in a positive thrust for democracy, realizing that our greatest defense against terrorism is to take offensive action in behalf of justice. We must with positive action seek to remove those conditions of poverty, insecurity, and injustice, which are the fertile soil in which the seed of terrorism grows and develops.

Hello from Kazakhstan

Have you ever wondered what country the state you live in has an equivalent GDP to? OK, probably not, but now you can know!

(Via Elrod)

Freeganism

The NYT has an article on Freegans–people who reject consumerism and try to live off other’s trash.

Anthropologically speaking, it’s fascinating. Freeganism is certainly unsustainable (ironically) without the rampant consumerism of American society. The best metaphor is that of “scavengers of the developed world,” found on the front page of the NYT article.

While I may be too much of a cynic to find the lifestyle that appealing, all of it comes from a realization I can certainly sympathize with:

“Most people work 40-plus hours a week at jobs they don’t like to buy things they don’t need.”

May I always do work I love, and may I not buy crap I don’t need. Amen.

Obama’s Father’s Day

Eugene Robinson has a brief but excellent piece on TruthDig about Obama’s speech for Father’s Day. Fatherhood is, of course, a major theme for Obama, who’s own black father was absent. If you haven’t already read Dreams from My Father, I highly recommend it.

When anyone runs for office, the question of motivation immediately and inevitably (as it should) rises to the surface. Is Obama talking about black men and responsibility because he cares, or to appeal to the white voter base that’s wondering just how black he is? Robinson wonders too:

Is Obama speaking to African-Americans, or is he really trying to reach those whites who believe that most of black America’s problems are self-inflicted? I’m paid to be skeptical, but I think something much deeper than political calculation is involved here. One revelation that comes with spending time with politicians is that they actually have core beliefs. To cite one example, John Edwards may be a multimillionaire but I can’t doubt his sincerity when he talks about poverty. I’ve seen him volunteer in a soup kitchen without first summoning the television cameras. He grew up poor, and the experience has never left him.

One can care about an issue and also use it for political advantage. This is what we as voters actually want–for candidates to spend time talking about issues that happen to be both important to us and meaningful to them. I like this man more and more.

Obama grew up without his black father. It doesn’t take a psychologist to discern the impact this absence had. He has explained it himself in his books, at considerable length. He talked about it Friday in the fatherhood speech, saying that his mother—struggling to raise two children as a single parent—at times needed to rely on food stamps to make it through the month. He also spoke with admiration of his wife Michelle’s father, who was diagnosed with multiple sclerosis yet supported his family by going to work every day at a water filtration plant, “even when he had to rely on a walker to get him there.”

And Obama also pointed out some economic undercurrents I hadn’t really though about:

There’s nothing startling about Obama’s analysis of the macroeconomic forces that contribute to the problem of absent black fathers. Blue-collar jobs that once paid well and offered security, such as his father-in-law’s job at the plant, have largely disappeared. “In the last six years, over 300,000 black males have lost jobs in the manufacturing sector,” Obama said. The forces of globalization are inexorable. Inner-city schools don’t prepare students to compete in today’s economy.

In general I like globalization because I see it bringing jobs to the poor in the developing world. I understand that there’s an effect on blue-collar workers in the United States, but I tend to see protectionism as a short-sighted and inefficient solution. We have to get those workers better jobs, not set up artificial barriers to their jobs going to more cost-effective, equally-needy overseas workers. But I’m certainly torn by the affect the current situation has. Notably, Obama recently had a minor political gaff that served to bring the outsourcing issue back onto the table for the Democratic candidates. And what does Obama–former overseas resident (Indonesia) that he is–say?

“While it’s not possible to stop globalization in its tracks, what we can do is make sure we have a government that’s looking out for our workers,” Obama said. “We can do more to create a government that’s creating quality jobs here in America, and we can do more to create a government that’s helping workers who lose their jobs.” In Newton, Obama spoke before about 300 people and promised to increase federal grants and job training programs to communities dealing with job losses.

I’m down with that.

Let Freedom Ring?

I am not a patriot. I dislike nationalism in all its forms, and I hold no extraordinary allegiance to my country of birth. I see no more reason to fight for the economic gain of those who share my nationality at the expense of others as I do to fight for my Caucasian ethnicity.

I do however hold allegiance to certain principles–freedom and justice being primary among them–that I believe are worthwhile. To the extent that America is in line with those principles, or at least better than some other countries, I love America. To the extent that America falls short, I am an irrepressible critic. Principle stands higher than country, and it seems that most of the wars in the world have followed when country stands higher than principle.

Truthdig has a piece on Bush’s (positive) reception in Albania, at the same time as a report was released by the Council of Europe on America’s secret prisons. From the report:

What was previously just a set of allegations is now proven: large numbers of people have been abducted from various locations across the world and transferred to countries where they have been persecuted and where it is known that torture is common practice. Others have been held in arbitrary detention, without any precise charges leveled against them and without any judicial oversight. … Still others have simply disappeared for indefinite periods and have been held in secret prisons, including in member states of the Council of Europe.

So, how should we judge President Bush? They say history will judge him… Who knows, maybe later Americans will retain their penchant for preemptive war and laud Bush as a hero for setting a precedent. That’s not an America that I look forward to. One thing I can certainly say now is that the abuses of freedom and human rights that were often justified in our foreign policy by utilitarian calculations (civil war in Guatemala or elsewhere is better than a Communist takeover) have been thrown front and center by George Bush. From TruthDig:

We will remember that long after it was clear that Guantanamo was doing serious harm to our nation’s reputation in the world—on Sunday, Bush’s former secretary of state, Colin Powell, called for the place to be shut down “this afternoon”—Bush stubbornly kept it open.

Let the scandals of today pass. Certain things will stick in our minds much longer:

We will remember Alberto Gonzales not for his hapless stewardship of the Justice Department or the firings of those U.S. attorneys—well, actually, we will remember him for those things—but we’ll also remember that when he was White House counsel he dutifully provided legalistic justification for subjecting prisoners to treatment that international agreements clearly define as torture.

And, one last note on the Council of Europe report:

Marty [the author of the report] makes this point in his report. “We are fully aware of the seriousness of the terrorist threat and the danger it poses to our societies,” he writes. “However, we believe that the end does not justify the means in this area.” Resorting to “abuse and illegal acts,” he says, “actually amounts to a resounding failure of our system and plays right into the hands of the criminals who seek to destroy our societies through terror.”

If America is a beacon for freedom, justice, and human rights, then she is worthy of praise. If she is a den of selfish, aggressive foreign policy and a hunger for economic gain with no question of its consequences, then she is not. Most Americans don’t really care about numbers killed that much. In truth, American forces have killed (whether purposefully or accidentally) many more civilians in Afghanistan, Iraq, and elsewhere then died on 9/11 in New York. The conflagration begun by our military belligerency has arguably resulted in the deaths of more civilians than the continuation of Saddam’s murderous regime would have.

We, as Americans, normally accept these numbers not because we like death, but because we believe the American government is fighting for something that is true, noble, and just: American forces are fighting to preserve the American way of life. If America is not just in its treatment of enemies, are we fighting for justice, or for blind self-preservation?

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