An interesting story on two cities in India, and how the unlikely city (that isn’t even a city) won.

Black and Blue Man wrote of a bizarre encounter at an assigned-seating movie theater. In one way, it makes sense that they would fear slipping someone underage into the theater. But seriously, sometimes people just want elbow room (and it’s apparently not uniformly enforced anyway). I actually know a couple who bought three seats so that he and his wife would have an empty seat between them. The airline sat someone there anyway. He quipped, “I need to gain weight so they make us buy that seat.”

Instead of just saying “It’s the AMA!!!” (it’s not), Slate actually investigates why we’re having trouble producing more doctors. The real bottleneck is residency, the slots for which are (generally) funded by the government.

The 10 best states to make a living. I’m a bit surprised to see Delaware and Massachusetts on there. Even given the salaries, I figured the astronomical costs of living would just eat that away.

From Technorati, a list of how to handle good-kid/bad-kid situations. Including, of course, not to think of them as good kids and bad kids. I would add to the list: When one kid does 90% of the misbehaving, don’t talk about how “your kids” misbehave or “your kids” can’t be trusted. If you feel comfortable talking about your kids’ ill-behavior with someone, you should be comfortable enough to say that one kid has proven tougher to handle than the other.

People tend to add IQ points where they hear someone speak with a British accent. Unless they’ve ever been to Britain (or anywhere outside the country). Apparently the British accent has actually taken a hit over the last 25 years in the overall. I blame the export of British TV programming.

Tying in a few subjects we’ve talked about around here with regard to Asian men, black women, reproduction, and China… Chinese men (of which there is, of course, a surplus) who marry African women are getting puzzled receptions back home.

I really want to write a post on this, but since I probably never will, I present The Last Psychiatrist on the Cult of Self-Esteem and whether it’s ruining our kids. This is so often discussed that it’s hard to say anything worthwhile on it, but TLP manages to.

The UAW is trying to unionize Hyundai… and failing. Hyundai employees just aren’t interested. The UAW thinks it’s due to southern attitudes. A few conservatives have suggested it’s that unions have become obsolete. There may be an element of truth to both, but another important factor is sometimes the threat of unionization forces employers to treat their employees in such a way to make unionization obsolete.

The trials of Norm “NORM!” Peterson.

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11 Responses to Linkluster XLVIII

  1. DaveinHackensack says:

    Re physicians and residencies: isn’t that another argument for dropping the requirement of qualified foreign attending physicians from having to re-do their entire residencies here? Maybe have them work under supervision for a few months instead, after passing all the necessary U.S. tests, in English. If memory serves, when this has come up at the state level, it’s been American physicians lobbying their representatives against it, for obvious reasons.

    Re TLP: his post on Michael Bay was probably his funniest yet.

    Re Hyundai: if it’s true that the threat of unionization is partly responsible for their higher wages, then that’s an argument for unionism not being obsolete. But the UAW is a special case in that it has a pretty tarnished brand after the part it played in driving 2 of the big 3 into bankruptcy. Though it has shown some flexibility of late.

  2. trumwill says:

    The case you cited a while back regarding foreign docs skipping residency was a state medical board decision, not a matter of lobbyists getting a law passed through (or preventing the same). Some of the same dynamics – doctors making decisions on doctor qualifications – but not quite the same.

    There are, of course, financial considerations. But a lot of the hostility is old fashioned elitism. There are areas that are absolutely desperate for doctors. They want MLPs, too. But you start running into resistance when you talk about doctors who didn’t go through the same training that they did. Right now the powers that be are actually amenable to filling in the gaps, but there still does remain the question of how to get there from here when there remains the desire that they go through the traditional American process.

    I don’t have an inherent problem with letting foreign docs skip residency. We might be looking at more than a few months, though. But I wouldn’t care if it were longer. My main concerns come with doctors from the third world with varying levels of training and figuring out where they are in comparison to our own doctors. I’m not so worried about western and central Europe, Japan, and so on. Heaven knows, they need the help.

    I wish I had the link, but a while back there was actually an effort to sync our training with that of other anglospheric countries. A good deal of the resistance actually came from the other side – I think for fear of losing their doctors to us. As a result, Clancy can’t go and practice in Australia.

    Regarding Hyundai, I think you’re right. There is a desire not to rock the boat with some of the best jobs in town.

  3. David Alexander says:

    I’m a bit surprised to see Delaware and Massachusetts on there. Even given the salaries, I figured the astronomical costs of living would just eat that away.

    Delaware is a weird mix of a Northeastern state that serves as the exurban area of Philadelphia and to a very limited extent Baltimore at the top end of the state, a coastal playground in the Mid-Atlantic along the shore, but a Southern state once you leave the other areas I listed. Massachusetts, isn’t the high tax haven that people make it out to be, and the housing isn’t that bad once you’re outside of Boston and some of its inner suburbs. It’s not Texas or Georgia cheap, but it’s not as extreme as New York.

  4. ? says:

    The ACGME decides on the number of residency slots available, and it’s not a simple process. The specialty boards do have input into the allotted numbers, and they don’t want to see gluts in their specialties. But it’s not so simple. Some departments that would like to establish training programs in certain specialties cannot meet accreditation requirements because of low patient volumes or procedure volumes, etc. In other cases, hospitals don’t want to support additional residents. One of the hospitals at which I trained adamantly refused to support one department’s requesting the ACGME for additional residency slots. That killed the bid. Although the hospitals get a lot more money per resident from Medicare than they ever paid any of us, they sometimes claim that the cost of additional ancillary staff to support trainees as well as the cost of the educational burden (“non-productive” lecture and conference time) and the limitations on work hours imposed by the ACGME make it unprofitable.

    Some specialties have gotten away with increasing their numbers in the past, but the results haven’t been pretty long-term. Programs in these specialties regularly graduate people who cannot find jobs anywhere for months or years. Some specialties aren’t amenable to hanging out a shingle. If a graduate in one of those specialties can’t find a job after residency, they’re screwed. Seriously, they face 8-12 years of life drown the drain with nothing to show for it.

    Having foreign physicians re-do their residencies also improves their English. I’ve met a few Asian residents who went from barely being able to hold a conversation to being fluent in patient situations. However, that took a few years rather than a few months. Native Spanish speakers from Latin America also expressed significant communication difficulties at first that took a lot of practice to resolve. It’s a relevant concern because Asia and the third world are much more likely to be the sources of our foreign physicians going forward (just look at any VA hospital staff to see it already). European physicians don’t have much incentive to move here anymore, and that incentive will only decline further with the implementation of health care reform.

  5. Kevin says:

    Re: Self Esteem is Ruining our Kids

    One of the most insightful ideas that I have ever come across came in an article about job satisfaction. Basically, the idea in that column was that people tend to think of job satisfaction as being a like-dislike continuum, with “I love my job” on one side and “I hate my job” on another. The better way of thinking about job satisfaction is to have two continuums, like and dislike. Things that you hate about your job, e.g., long hours and low pay, don’t make you like if that they get resolved. If you are an extrovert working in a lab all day, you’re not going to like your job very much, even if you work 30 hours and week and make a lot of money. Conversely, if you are an extrovert and you work in sales, you may hate the long hours and low pay, but you may love the interactions you have with your clients.

    I think the one continuum versus two idea applies to a lot of situations, including interpersonal relationships. You may have had caring, supportive parents but if you’ve never accomplished anything, you’re going to feel aimless and depressed. Conversely, you may have serious psychiatric issues caused by dysfunctional parents, but if you work hard and accomplish something, you can still take pride in yourself.

    The problem is that people don’t differentiate between self-esteem in terms of I-am-loved and self-esteem in terms of I-have-accomplished. They are two different continuums. No matter how loved you are, you won’t have accomplishment esteem if you don’t accomplish anything. And no matter how accomplished you are, if you’re not loved, you’re going to be lonely.

    Which is why it’s so important to let kids fail. Failure in one pursut does not mean failure as a person, and the only way to succeed is to know that you can fail and try again. A corollary to this is that you have to give kids the freedom to fail, which means the freedom to try, which means the freedom to try by themselves. Putting helmets on kids is not the problem. A kid who’s not wearing a helmet but can only ride his bike in the driveway is going to have a harder time in life than a kid wearing a helmet riding freely through the neighborhood.

  6. Peter says:

    Being (somewhat) introverted may make it easier to cope with the special pressures of sales. If you’re an extrovert you probably have a genuine liking for people, and that’s going to cause a bit of a moral crisis, or at least confusion, after you spend even just a few days in the business and realize that most people are schmucks. Think about it: you enjoy meeting new people, you believe most people are fundamentally good, you spend an hour analyzing a customer’s needs and presenting the best solutions for those needs … only for the customer to reply “Let me think about it.”

    You’re better off being an introvert with a more jaundiced view of humanity. Fewer illusions to be shattered.

  7. trumwill says:


    The ACGME determines residency slot allocation, but the government generally pays for them, which was my point. And in addition to the factors you mention, there’s also the fact that residency programs are expensive. As are medical schools. People wonder why medical schools and residencies are so few while law schools are so many, it’s because the former is expensive, while the latter are profit centers.

    You have me curious about what specialties you’re referring to. The wife is in primary care (more specifically for places that lack specialists), so obviously it’s outside my observation. You’re right about a lot of specialists not being able to hang up a shingle. Callie’s hospital doesn’t have the team required for epidurals. Not necessarily because they wouldn’t find them, but because there aren’t enough babies delivered here for such a team support itself.

    While the actual practice of medicine may be similar in the US and India (for instance), the overall culture is different. And medicine is an area where communication matters. Particularly in primary care, which is where the greatest need exists. I do think that we might be able to find another way, but I really do think it will be more than spending six months or so under someone else’s tutelage.

    You also touch on another point. I think we need more docs because we have a shortage. Others think we need more docs because it will bring prices down (a point on which I am skeptical, under the current payment regime). But if we bring doctorly wages down, we’re not going to attract first world doctors, but rather third world. A lot of people wouldn’t mind, but a lot of people really, really do.

  8. trumwill says:

    Kevin, nothing to add to your comment. Very good points.

  9. Kirk says:

    I like the STS pics at the top. Makes me wish I had seen more launches, especially back in the day when interest was so minimal traffic wasn’t a problem.

    That said, I’ll always remember the ones I did see, both live and on tv.

  10. Mike Hunt says:

    Too bad nobody cares about NASA anymore. It is a relic from another time. It lost a lot of luster with that crazy girl astronaut.


    The trials of Norm “NORM!” Peterson.

    This article is literally about the character of Norm Peterson. I thought it was going to be about George Wendt and the decline of his career.

  11. trumwill says:

    I guess he did kind of drop off the map. But if you’re going to be typecast, you can really do a lot worse than being remembered for being Norm Peterson.

    It’s interesting that Ted Danson is going to be a cop on a cop show now. That’s not a direction I would have guessed.

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