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“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,”
The ones most likely to be paid free market rates.

And in spite of the headline's emphasis on the overall shortage of PCP's in the US, most of the article focuses on the even more daunting issue of inefficient distribution of primary care resources, resulting in an even greater shortage in many areas.

About 17k new doctors per year graduate and it has been so since 1985.

You think better pay would change this?

The question here is whether they can handle 85% of duties to the same level or handle 85% of duties at 85% level. NPs and PAs by virtue of cheaper and shorter training have less clinical exposure than a full board certified physician. How willing will the public be to tolerate errors in decision making (when our health is on the line, we irrationally want the best possible, cost be damned)? And what will liability coverage be like?

If we let the market decide, we can give hospital systems the freedom to hire MDs vs NPs/PAs. The latter will be cheaper for sure, and the hospital can make the value judgement of how decreased reimbursement and potentially more errors weigh against the cost difference.

As for the overall shortage, increasing medical school spots will not help. The bottleneck is downstream. Increasing residency spots can help somewhat, assuming more recruitment from overseas. What will help the most IMHO is raising wages enough to attract talented students who would have otherwise gone into engineering or banking. Increasing medical school enrollment to take all comers runs the risk of lower quality students not being able to pass board certification or even graduate.

Make medical education cheaper. Many countries have medical school programs that start immediately after high school, without wasting time on a "pre-med" undergrad degree. Make actual pre-med courses part of a five year curriculum, taken in the first couple of years.

So, more like the UK?

I would also pay to see a Charles Dickens-Caplan exchange on poverty.

It's funny that the "doctor shortage" article quotes the AMA on the need for new doctors, but doesn't mention that the AMA was throttling the supply of doctors up until relatively recently -- like within that 10 year doctor-training timeframe.

"The United States stopped opening medical schools in the 1980s because of the predicted surplus of doctors. The Association of American Medical Colleges dropped this long-standing view in 2002 with the statement: "It now appears that those predictions may be in error." Last month [2005], it recommended increasing the number of U.S. medical students by 15%."

Yeah I know it's USA Today, sorry...

The AMA has also fought to prevent NPs and PAs from obtaining many of the same powers as doctors despite being able to handle about 85% of their duties. The ACA will create increased demand, which can be met with more NPs, PAs, and efficiency gains.

I could see a rush to expand places in medical schools, the the point where twenty years from now there is an oversupply of doctors, especially once the baby boom generation dies off. Then it will be hard to trim the number of medical schools, who are generating income from their students once they graduate. Of course, new medical students will be the last to be told about the surplus in their intended field, and will run up large debts getting an expensive education in a field where there won't be as many jobs for them.

Which is why it makes more sense to focus on NPs and PAs which can both be trained in about 2 years assuming someone already has the pre-reqs. Additionally the training is about 1/6 the cost of a doctor, at least for NPs.

I never knew that the best way to learn to practice medicine was to go to nursing school. Oh woe is me I've made the wrong choice.


That wasn't my point at all. Nice straw man though.

Yes, let's keep students dreaming of being doctors out of medical schools for their own good.

That really doesn't matter all that much though. Until rather recently, doctors who graduated elsewhere have been quite willing to immigrate to the United States (or in many cases, return--Caribbean and European medical schools do their fair share of training US citizens) and go through the 3-7 year residency required to become board-certified physicians. Increasing the number of U.S. medical students is good, yes, as I would posit that it increases the quality of the average physician. But the number of residency spots is set by Congress (funded through Medicare Part A, I believe). All these new students will be doing is displacing those who couldn't get into a school in the US and went to the Dominican Republic or Poland instead.

So, increase the residency spots?

# 3: I just remember a quote from a college professor about abstract knowledge: "You're not learning to solve today's problems. For that, we got graduates with 15 years of experience working in the real world right now. You're here (college), to be prepared to face the problems that will arise 20 years down the road".

So, why the focus on the present? Human capital formation takes time and money. Live with it or listen to the bean-counters like Andrew Hacker.

Ps. What would you prefer for your kids? Dumbed-down math?

A few thoughts re algebra:

1) Why is algebra a singular indicator of students dropping out? Is it because algebra is a uniquely difficult topic, or because the type of content makes it less likely that teachers will fudge grading to allow most students to pass? In algebra, if you don't get the concepts you will answer every question wrong. Things like history and English are an ever-flowing stream of essays and partial credit.

2) With algebra, at least something high-quality is being taught. If it is replaced with something else, what is our confidence that the "something else" will be equally good, rather than just fluff. For all the author's worry about "precious resources" in my experience lots of time and resources are spent on suboptimal activities. Why not start with eliminating the real time-wasters?

3) The earlier specialization in education starts, the earlier various career paths are being closed, to children who are not yet ready to decide what career they want.

4) In my opinion, this is mainly driven by a misguided goal of getting every student to graduate, whether they want to or not. I sympathize with those who are trying hard but don't get it. However, the vast majority of dropouts don't fall into this category. Tailoring education so that those who don't put forth effort can succeed anyway does a great deal of harm to everyone. Making education more rigorous rather than less would be a far better approach. Let people who don't care drop out. We already have ample programs to help them if they later decide this was a mistake. Anyone who works hard at a GED and community college can get into a good university. Nobody is going to look back and say "having to take algebra was the reason I am a failure." But many people are failures who were led to believe that not doing anything was good enough to get by.

Children were doing algebra in kindergarten when they solved 2 + box = 3.

The problem I see in math education is that our kids have lost the ability to think in the abstract. They look at an algebra problem and see x and y as letters, not numbers. In multivariable calculus, they can't consider y a constant when they differentiate with respect to x. In statistics, they can't fathom Greek letters.

Algebra isn't the problem. The problem is that our elementary school math teachers SUCK.

If the goal is to drive up graduation rates, then let's just pass a law granting every 22-year-old or older American a college degree, with the specifics chosen randomly according to the numerology encoding of the person's name. Then, since we will no longer be able to use college degrees as economic signaling devices, either the proletariat will triumph or there will be extensive testing for every job; either outcome will result in enlargement of government bureaucracy.

5. "the great stagnation" strikes again !

Regarding the Political Science professors article on eliminating Algebra from college prerequisites. I agree with his implicit point that eliminating Algebra from college would undoubtedly raise graduation rates. However, I suspect the value of the degree thus granted would drop substantially.

There is already a sharp difference in the value of a economically useful degree with heavy math requirements vs one light in math requirements. I suspect that passing Algebra (an other maths) is a proxy for logical decision making in general. A liberal arts degree that was even lighter on math than the current standard wouldn't be worth as much, since a lot of the current signaling value would be destroyed.

#3 has the right idea at first, but definitely goes off the rails.

"(That said, I do not advocate vocational tracks for students considered, almost always unfairly, as less studious.)"

Anyone who has ever tutored kids who failed algebra and were in remedial courses would know that are almost always very limited when it comes to mental horsepower. I don't share the author's fear that we are denying opportunities to people who (without the unnecessary burden of learning algebra) would have become great philosophers or poets. These kids are more suited to manual labor or occupations with limited cognitive complexity. Why not design their instruction around this fact?

You needs 32 pounds of dirt in your garden. You have 2 pounds right now from an old project. How many 3-pound bags do you need to buy?

3x + 2 = 32.

Any adult should be able to do that. I won't try to defend the average person learning, say, calculus.

Obviously they should be able to. The question more concerns whether they have the mental resources necessary. There are a surprising number of people whose brains are seemingly incapable of the level of mental abstraction needed to solve the simple algebraic problems one encounters in every day life. You can teach them routine mathematical calculations, but good luck with anything more complex. I am not trying to disparage them, but oftentimes people talk about educational policy as if it's simply a matter of finding the right curriculum or teacher. It's pretty widely accepted that you can't teach mentally retarded children many parts of standard school curriculum. Why is it so hard to believe that people on the low end of the normal range of intelligence have similar, less acute limitations?

Why do you need algabra when math will suffice?

32 - 2 = 30

30 divided by 3 = 10

90% of people have no need for algabra whatsoever.

But you did algebra there, in fact most people do algebra every day. The problem is that it is taught really basly. There is no reason that 80% of the population can't be introduced to algebraic thinking at that level, and I have a very hard time beliving that 50% of the popularion can't be taught basic algebra. Algebra is among the most useful of subjects, if you are going to start restricting it, might I suggest that no one should be allowed to take out any loan that has interest on it or allowed to have a credit card until they have taken an exam in simple algebra.

You literally just solved dan's equation step by step. The skill you consider obvious is algebra, and kids learn that skill in algebra class whether it's obvious to them or not.

And I assume you mean "arithmetic" where you say "math", because otherwise the statement is silly.

Well done, you have just demonstrated that you understand the concept of algebra. You just dropped the literal "x".

Yep, except without the formal algebra (or more curiosity, etc), he lacked the ability to generalize the problem.

A second grader could figure out the problem my way. Do you think a second grader could solve:

Simplify: -2[-3(x − 2y) + 4y].
Expand (2x + 3)(x2 − x − 5).

Better yet, tell me how such formulas are used everyday?

Don't you think someone has a serious, serious problem if they can't follow a very simple formula?I mean they don't have to understand it, they just have to be able to follow a list of two or three simple steps and do arithmetic.

+1 @Dan1111
especially (3): Say Billy has a hard time with grade 8 algebra; in one universe algebra is not required, he drops it and never learns math. In an alternate universe, Billy must deal with it, figures it out, and becomes a successful engineer, doctor, or math teacher. It is not enough to think about the kids who cannot seem to do it and thus are helped by the policy, we must also think about the kids who struggle but would eventually succeed.

There is also the question of tracking and creating stigma. Having ''regular'' and ''advanced'' tracks isn't so bad, but now having a ''watered-down'' track too?

What Prof. Hacker suggests is replacing math with statistics. Different thing. Math is neither better nor worse than statistics, as economics is neither better nor worse than history. They are different fields. Do kids need stats? Sure! They could also use more home finance and tool shop, etc. But giving up basic high school math without exploring the reasons why kids struggle is a bad idea.

And how about logic? People use logical constructs (syllogism, implication, induction, etc.) in everyday speech, but as far as I know it is not studied outside of college level math & philosophy.

The algebra article is ridiculous, and it follows the normal invidious logic of most affirmative action programs. Minorities are unlikely to finish high school because of algebra, so instead of improving the schools, let's dumb down the curriculum so that these underpriveliged kids have absolutely no chance of succeeding in the real world. But we can all look at the high graduation rates and feel good about ourselves. Graduation rates are already higher than they should be, and it hasn't benefited anyone, except maybe college professors who teach remedial math and English and majors of dubious value for kids with no practical academic skills (like the author of this article). Furthermore, it removes any benefit at all that remains from obtaining a high school diploma for everyone else.

The much more obvious and correct strategy would be to look for ways to improve instruction, but this flies in the face of the left wing union dogma at whose altar Northeastern liberal arts professors are willing to sacrifice every black and brown kid in the country. (and then call conservatives racist for opposing them)

On the other hand, shouldn't we teach useful things in high school? And if something is both not useful and results in failure to gain accreditation, well that thing should be at the top of the list for elimination, right?

I would start with basic finance, basic law, some kind of reading/writing classes, maybe (very) basic economics, (very) basic physics. Those are all essential. Then you can start thinking about other useful things like foreign languages, basic stats. The main thing I would cut is history/social studies, which anyone can easily learn by reading a book and is useful only in understanding cultural references, PE, fine arts, all useless. Really geometry and algebra are probably not very useful either. I think there is no excuse for teaching them without teaching basic finance which is about 1000x more important to the average person.

I agree that stats, finance, economics and computer science (but not necessarily physics) should be part of the required curriculum. But how can anyone understand any of that without knowing algebra?

I am a firm believer in understanding basic math. But like many, by the time I was finally able to go back and do something about it my mind was no longer capable of putting the most important concepts into long term memory. The years our minds are actually best for that tend to be the years we are already into the thick of our work lives. Chances are the crucial high school classes happen when there are too many distractions. However, for those who aren't good with math, they really should at the very least be offered a path that includes logic and critical thinking for whatever work they pursue. From what I understand, logic and critical thinking are presently being discouraged at the high school level, which really worries me.

#1: If only there were some system for equilibriating the supply of doctors with demand thereof… some way of systematically thinking about and solving this type of problem…

Algebra as taught in our schools is 95% intelligence/diligence test and 5% education. Algebra could be taught in a way that what is learned is very useful but is mostly not, rather it is mostly an academic exercise/intelligence test. Who uses factoring of quadratic equations once out of school?

Argh, article like #3 make me want to pull my hair out. Dumb-sh*t poly-sci major making generalizations about something he obviously doesn't understand. Mathematics is a language that describes the size of things. To say we shouldn't teach it because it's hard is like saying Chinese culture isn't worth understanding because Mandarin is difficult.

There are two reasons a child doesn't do well in algebra: 1) they're not that smart or 2) they have a bad teacher. I'm going to lean heavily towards the second. Or there's an expansion of 2: they've had nothing but bad math teachers their whole education. Elementary school teachers who subconsciously communicate that math is difficult and not worth knowing. Poor math understanding begets poor math understanding in the next generation.

Math is hard, let's go shopping (and learn about CPI!). <- Actually, writing that out makes me really think the whole article is satire.

We allow people to teach our kids who had the second lowest average SAT scores, just behind Home Economics. Their grades in college are grossly inflated, and they are taught by "professors" who have among the lowest average GRE scores and who have the easiest PHDs to obtain.

We should eliminate the Education major and start hiring Math, English, and History majors to teach. At the very least, we should have alternative teacher credentialing across the country.

The vast majority of "teachers" in colleges and universities never had a single course on how to teach, yet they manage to do so. Some are poor at it, but that has more to do with the emphasis on research and lack of quality control than an absence of credentialism. Tenure also needs to be eliminated and discipline restored in public schools. I would say that discipline explains the private/public gap in achievement far more than parental income or teacher quality.

We expect too little from our children, and we get less than we expect. When my elder daughter was in a public school, I discovered she didn't know her multiplication tables or parts of speech by fifth grade. We spent weeks of summer vacation working on both Math and English and she did very well thereafter. We sent our younger daughter to private school, and we didn't have this problem.

When we wanted to move the elder daughter from one seventh grade class to another, the school refused because that would violate union rules. The Catholic school we were paying for never gave us any excuses and complied with every wish that we requested in good faith.

And we live in a relatively wealthy suburb of Chicago, so there is no excuse for the public school to be underfunded or otherwise disadvantaged.

Bottom line is that you get what you pay for.

I would add a third reason. From the article:
"It’s true that students in Finland, South Korea and Canada score better on mathematics tests. But it’s their perseverance, not their classroom algebra, that fits them for demanding jobs."

Looks to me like Hacker misses the obvious connection that it is perseverance that makes them excel at both algebra and demanding jobs. Algebra, and math in general, is not magic. It can be learned and grasped if one studies the right stuff hard and long enough.


The reason is that Dream of the Red Chamber is really really wrong. That it is a bout a relatively alien culture and there are some serious textual issues only adds to the lack of popularity.

But I would certainly reccomend reading it, it is one of the finest novels I have ever read. Clearly in my top 5.

I worked with a freshman highschool class for kids who have trouble with algebra. From my experience with that class the problem wasn't algebra but basic math skills. These kids had a horrible time with negative numbers(both addition/subtraction and multiplication/division). Multiplication tables for numbers 1-10 weren't mastered either. Many of the kids had trouble adding fractions with different denominators. One kid even restored to counting with his fingers because he hadn't memorized simple addition/subtraction tables!

The strategies needed to solve algebra problems like isolating variables was difficult for them too. But it was the combination of learning new material on top of a worthless foundation of math skills that caused the most trouble. These kids should not have been in Algebra class they should be in basic arithmetic! Doing any sort of complex algebra will take you forever and cause frustration if you can't do the basics.

Secretariat's three records in the Triple Crown remain unbroken since 1973, and this is a sport where athletes are selectively bred and the competitive conditions have barely changed.

The article's headline and TC's paraphrase are misleading. "Shortage" would suggest a supply side problem, that ACA was somehow reducing the supply of physicians. Instead, the article discovers that demand will -- wait for this one – increase! I don’t remember everything that was said during the health insurance finance reform debate, but I do not recall anyone suggesting that ACA was going to decrease the demand for health services. Thanks to great reporting we can be assured that at least in California, it did not.

No you did miss it. ACA is supposed to increase demand for every single preventative testing and care option then have decreased ER care and !Voila! you've magically decreased health spending. Just ask MA

What kind of moron thinks algebra isn't-

"Andrew Hacker is an emeritus professor of political science"

Yeah, ok. Forget I asked.

His books seem to deal with a lot of descriptive statistics.

#3: Read the NYT piece and substitute "algebra" with "Shakespeare". It's an equally valid opinion.
Peter D

Good point. Leo Tolstoy, possibly the greatest writer of all time in any language, forcefully argued that Shakespeare was overrated garbage.

God knows why, but English classes have devolved over the years from teaching useful grammar and communication skills to four years of literature appreciation. And even that isn't taught very well. If students today want to learn actual language skills their only hope is to take Latin, if it's offered.

I learned far more about writing in my high school history classes than I did in the English ones. My history teacher taught us how to construct, defend, and clearly express a thesis. My English teachers were either largely incompetant or heavily into litcrit intellectual masturbation.

I don't see the comparison at all. Algebra is a broadly useful skill, and the foundation for many more specifically useful skills. Even for the non-specialist, the broad utility of algebra is such that it is hard to imagine a course of study worthy of a traditional college that does not include at least a semester of such.

The same would be true, obviously, for an English writing class. English literature, is a very different matter. There, the goal is a common experience. One can argue whether Shakespeare is superlative, great, good, or garbage, but a group of people who have all read Shakespeare can communicate in ways that a group of people who have each read a different set of great-but-obscure authors cannot. That's genuinely useful.

It's also pretty much the end of the story, at least for anyone who isn't planning to become an English-literature professor. If, for whatever reason, we need to excise lumps of mandatory college curriculum, Shakespeare would be far more dispensible than algebra.

But I'd just as soon not see either removed just for the sake of increasing graduation rates. A person who cannot both perform algebra and understand Shakespeare, probably ought to be somewhere other than a college or university in the first place. Maybe there are better things for college students to do, better authors for them to read, but they will be approximately as difficult as algebra and Shakespeare, and so as destructive to the fantasy that everyone ought to graduate from college.

The problem is that at the high school level, the same class is presumed to be doing both, and to the extent that it does teach writing, tends to do so in a format and style that is largely irrelevant to anyone who isn't planning to become an English/literature major in college.

If you can't hack high school algebra, then you probably aren't destined for a future involving much intellectual work anyway. I think there's a much better case to be made for replacing calculus with statistics as the capstone of a non-STEM major's mathematical education at the college level, however.

As someone with a B.S. in Mathematics who currently works in data analysis, I could not think of a better policy then cutting Algebra from the curriculum. I only wish they had done it 20 years ago, so my current pay would be much higher, but I am young enough to wait for the benefits if they cut it now. Where can I send political donations?

I suppose I could console myself with a side job of tutoring those on the college track in the algebra they aren't learning in public school. Love how that works, I could earn my tax money back by teaching students what my tax money was suppose to be spent doing.

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