[conorh]

> "These measures don't correlate well with the physician's credentials."

This. I think I've even posted about this here before. This has been my wife's experience too (surgeon). She trained with highly regarded academic surgeons that set the treatment recommendations and standards for her field. Then during her job search she went to a center with, well, surgeons not at all academic and she had a life changing moment because she realized their operations and outcomes (utilization, efficiency etc.) are far far better. At the academic centers you are recognized based on your research and publications, not on your surgical skills. These academic surgeons with relatively little experience are setting the standards for how the operation should be done and what the treatments should be. This is not at all recognized in her field unfortunately and is quite literally harming patients every day because of substandard treatment standards.

[clarkmoody]

This reminds me of Hayek's Knowledge Problem[1]: The most effective ways of solving problems are with those closest to the problems. In an economics setting, this means that central planning is inferior to distributed decision making.

Perhaps it's not a perfect analogy, since it sounds like the academic surgeons are maximizing the wrong utility function (publishing / research).

[1] https://en.wikipedia.org/wiki/Local_knowledge_problem

[epmaybe]

I think it depends on the academic center. Where I'm at some of the clinicians that don't do any research are some of the most highly regarded faculty.

I'd say a good combination of both academics and skills are needed. As another anecdote, where I am in school they have tried to teach us better clinical reasoning and procedural skills rather than solely preparing us for board exams.

The way I see it, your research and academic pursuits can wait until you have a good clinical background. You only have one chance to fully immerse yourself in the practice of medicine (residency), so why dilute that?

[rdlecler1]

I don't have the original source handy, but I recall a study showing a high correlation between hand dexterity and surgical outcomes.

[arethuza]

I was pleasantly surprised to find that applications by 17/18 year olds to medical school here in the UK require that you demonstrate manual dexterity - one person sending in a video of them plaiting their hair which apparently went down well!

[NB This is in addition to the very high academic standards that are required for places at medical school].

[Intermernet]

The problem with this is that dexterity beyond a certain level is very specific to what has been trained.

I have a friend who is an eye surgeon. I'm definitely better at playing guitar and piano than him, probably equal at things like juggling and card tricks, but absolutely inferior when it comes to cutting people's eyeballs apart.

It doesn't invalidate your point completely, but just because someone is good at plaiting hair doesn't mean they'll be good at surgery!

[hexane360]

It seems to me like there should be some middle ground. I don't think the best practicing surgeons are necessarily the best academic/theoretical surgeons (although there's definitely some overlap). That's not to say academic surgeons don't need experience, but I think there's definitely different skill sets involved.

[ThomPete]

Great insight.

Being a surgeon is more akin to performing arts. I.e you cant read your way to playing an instrument, you have to practice playing it.