[cookiecaper]

The things you mention -- gatekeepers with teeth -- are a nightmare. They have eviscerated the medical and legal professions to the point of self-parody. They exist to keep otherwise qualified people out explicitly because they want to keep their wages high.

[JoeAltmaier]

That's uncharitable. They exist to keep quacks away - both professions are extremely sensitive and prone to fakery.

[cookiecaper]

There is no need for onerous restrictions they place on admittance. It used to be that you became a lawyer by apprenticing in a lawyer's office and reading the text of the law. That's how lawyers came up for generations until the post-secondary boom in the 1950s. Now, that time-tested method is illegal in all but a small handful of states due to ABA guidelines.

Of course, the superficial justification is that if you don't go to school for 8 years and pay $150k+ into the education industry before you can get a crack at real work, then it's because you're a fraud who wants to fleece the general populous. There is obviously going to be a surface justification. However, many lawyers are still primarily interested in fleecing people, and the artifical barriers to entrance probably only serve to further incentivize it; that's a big chunk of debt hanging over one guy's head.

Suppose he wanted to undercut his competition and offer meaningful legal services that a normal person could actually afford; oops, he needs to bill $200/hr because after overhead, 65% of that goes to his student loan payments. :|

However, I'm sure that the ABA and AMA do not function at all like unions and are run by truly beautiful people with stunningly pure hearts who would never put their own self-interest above the general welfare. I am sure the strength of their character fully precludes any attempt to keep competition low and/or to make the minimum viable price point of the profession artificially high. Such a thing would serve only to enrich them and their compatriots while blanket disqualifying large chunks of people that would otherwise make great lawyers and/or doctors, and of course, the people in charge would never even fathom something like that.

[GFK_of_xmaspast]

In the modern day the gatekeeping is starting to fail and there's "a metric shitload" of underworked lawyers out there due to the law school glut and wages are collapsing: http://www.lawyersgunsmoneyblog.com/2015/05/the-collapsing-e...

[cookiecaper]

Discussion of the counterpoint (click through to original article): https://news.ycombinator.com/item?id=3672815 (I acknowledge this is a couple years older; it's from 2012).

[hiram112]

They exist to keep their own wages artificially high. Honestly, I think half my freshman Chem. I lecture of 500 students was pre-med. Only about 1/20 of them ended up in medical school, due to the artificial limits imposed by the AMA. We have a huge lack of doctors in the US due to the boomer generation getting older, but the medical school enrollment has not increased.

In fact, the AMA was originally founded to keep mid-wives from taking a cut of their most lucrative child-birthing business. They are one of the biggest lobbying organizations in the country after the military industrial complex. Along with the Bar Association, Teachers and Police Unions, and financial organizations, the AMA proudly proclaims that their goal is to enforce 'quality' standards for the good of the public. Don't fall for the spin.

We software engineers currently lack the social intelligence to realize how bad we're getting screwed, which is ironic considering the technical prowess we've collectively got.

[Grishnakh]

>They exist to keep quacks away

No, actually they don't. Chiropractors are still practicing, and in huge numbers, and probably gaining in popularity, and they don't just do chiropractic these days, they also do homeopathy, "supplements", and various other bogus remedies. "Naturopathic" doctors are also a big thing. There's no shortage of quackery in the medical field.

[JoeAltmaier]

They were forced by govt to do that, after a century of resisting.

[GFK_of_xmaspast]

Chiropractors still need to be licensed.

[Grishnakh]

How does that help things? I can easily find you a licensed chiropractor who will "diagnose" your ailments by just pushing down on your outstretched arm while holding a supplement or homeopathic remedy in front of you to determine if that supplement will fix the problem or not. I won't even get into "subluxations".

And because that chiropractor is licensed by the State, the State government is explicitly endorsing this doctor's medicine and all the "theory" that backs it.

[cookiecaper]

There is an argument that this is an in-demand service that will be practiced legitimately or illegitimately. Thus, instead of providing the atmosphere for a black market, the state licenses practitioners so that some standards can be enforced and so that it has a way to prevent known-harmful quacks from practicing.

[Grishnakh]

You could make that argument about a bunch of things: prostitution, drugs, auto mechanics, etc. But I don't see much push to license these things rather than criminalize them or ignore them. Drugs cost society a huge amount in many ways, but there's been no push to license that until just recently with marijuana. Mechanics aren't licensed, though they do have a totally private certification system. How many people have died from bad chiropractors, compared to cars breaking down (not so much now, but in the old days this was probably a problem) or using tainted illegal drugs? And how many people have died by going to chiropractors or other such quacks instead of real doctors? Steve Jobs is a good example of the latter.

[JoeAltmaier]

Hm. Just because I have a drivers' license doesn't mean the State endorses me. Just gives me permission to operate in public.

[Grishnakh]

Wow, that's incredibly wrong and ignorant. What do you think the driving test is for? Yeah, the testing regime is a bit of a joke in many places in the US, but the intention is to make sure a driver is competent to operate the vehicle in traffic and read road signs, so YES, it IS an endorsement. If you're completely clueless and unable to operate a car and pass a written test, you can't get a license. The whole purpose of drivers' licenses is to ensure competency and improve safety.

[maxerickson]

In Michigan, the permission to ride a motorcycle is called an endorsement.

[tamana]

None of those people are MDs!

[Grishnakh]

They're part of the same medical establishment, as far as laypeople are concerned, and they're licensed by the State exactly the same way MDs and DOs are, so they must be equivalent.

[GFK_of_xmaspast]

I don't want some yutz who came out of a ten week medical bootcamp doing rude things to my corpus.

[SilasX]

What about someone who had informally studied physiology and medicine consistently since he was 5, followed the literature religiously, and had always advised people on ailments (in ways that consistently matched or even corrected what doctors did), and was able to give lengthy extemporaneous talks about medical problems and the pros and cons of treating them different ways? And the bootcamp was just plugging him into understanding of professional clinical practices and connecting him to clinics with credibility?

(That's roughly where I was before going to a programming bootcamp, mapped over to the medical world.)

[cookiecaper]

There is a middle ground between 10 weeks of training and 10 years of training plus hundreds of thousands in debt. The AMA and ABA are out of control.

[tamana]

Law is only 7 years training and the first 4 are in any field you choose. And there are opportunities for paid semipro internships every summer.

[cookiecaper]

Medicine is 4 years undergrad (in which an aggressive pre-med curriculum must be completed in order to be considered for admission to med school) + 4 years med school + 1 year residency (9 years), and if you're becoming a specialist, throw 3-5 more years in there for extra classroom time and an extended residency. Also bear in mind that this is just formal schooling; these totals don't include the time needed to prepare for specialized entrance exams like the MCAT. It's excessive.

As for law, most non-US jurisdictions allow attorneys to practice after 5 years of training and the receipt of a LLB degree, whereas the US typically requires the full 7 years and a JD. Just another way the ABA is protecting the American public.

[aianus]

Are you aware that medical schools are largely pass/fail with a 95%+ graduation rate? Makes it hard for me to have any confidence in the credential whatsoever.

In comparison, over 20% of my freshman CS class flunked out before 3rd year and there were still plenty of subpar students that made it to the finish line.

[naveen99]

Organic chemistry weeds out a lot of premeds before they even get to medical school. Also medical school is not the end of it. Lot of people fail out of residency. And residency is a lot more brutal. You don't get to keep making mistakes. And then the medical boards do take away lot of medical licenses for all kinds of stuff based on complaints by patients, pharmacists, others.