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Do weed-out courses for pre-meds produce too many false negatives?

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I don’t have a lot to add to what many have already said about the latest kids-on-campus-these days story to get attention. There are definitely problems with the student-as-consumer model of education and the temptation to lessen academic standards, although these problems will be more acute at lower-demand schools engaging in a brutal competition to maintain enrollment as demographics and bad immigration policy reduce the number of applicants. In this specific case, however, it’s not exactly implausible that an 84-year-old star researcher was not teaching the material effectively, and it’s frankly bizarre that NYU had contingent faculty teaching such a critical course in the first place.

Eric Levitz asks a larger question related to this story: does requiring students who aspire to be doctors to pass a punishingly difficult organic chemistry class actually make any sense?

But there is another, less appreciated dimension to the NYU affair: the genuinely excessive difficulty of becoming a doctor in the United States.

The primary reason why students found their failure to pass Jones’s class so devastating was that organic chemistry is a “weed out” class for would-be doctors. Every year, “orgo” thins the ranks of the nation’s premeds, with those unable to master the famously difficult course forfeiting their dreams of practicing medicine. But it is not clear that this filtering process is actually in the public interest.

The substance of the organic-chemistry curriculum does not come up all that much in medical training or practice. There are myriad fields of medicine where an inability to command the finer points of the subject would have no negative impact on the quality of care. As the former dean of Harvard Medical School Jeffrey Flier argued Monday, an undergraduate can do poorly in orgo and nevertheless make a “great doc.”

If a mastery of organic chemistry’s subject matter is not absolutely necessary to practice medicine, why have we made that a precondition for medical training in the United States? One answer is that we need some arbitrary mechanism for filtering aspiring doctors into other professions because we manufactured a scarcity of medical school and residency slots.

As Robert Orr of the Niskanen Center explains, the U.S. government issued a report in 1981 warning of an imminent “physician surplus” and recommending “immediate action to curtail both the domestic training of physicians as well as the admittance of those trained outside of the country.” The report’s argument was ill conceived. Its authors did not recognize that demand for health care is not static, but rather invariably rises as nations get wealthier. There is no hard limit on the human desire for health and longevity. If we can afford to pay for more services that ostensibly improve our physical well-being or reduce our risk of near-term mortality, we’re going to do so. Thus, rather than encouraging Americans to spend less on health care, restricting the supply of doctors was only ever going to change what we spent out health-care dollars on. Instead of giving the American public easy access to abundant providers, the U.S. health-care system directed us towards high-intensity medical interventions. This system delivered some beneficent innovations but also a strong tendency toward financially motivated overtreatment that poorly served patients and wasted resources.

Needless to say, I am not qualified to determine what courses students need to take and show mastery of to be adequately prepared for med school. But it does seem clear that assumptions based on the idea that we need to create an unnecessary scarcity of doctors should be abandoned. We need more people to become doctors and we don’t need arbitrary standards that weed out a lot of undergrads who could become perfectly competent medical professionals.

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