[alistairSH]

Except in the United States it is true. Something like 80% of new military recruits come from military families (parent, sibling, uncle/aunt, or grandparent).

Similarly over the last few decades the number of medical doctors who have immediate family who are also doctors has grown.

Social and economic class in the US is increasingly set in stone and hereditary.

[mothballed]

Medical schools require a lot of volunteering and things like 'slinging hot dogs to pay tuition' don't count unless you grew up without clothes surviving on rabid dogs in the holler of W Virginia working the coal mines from age 8. We all know who has time to volunteer or do minimum wage healthcare instead of work the best paying shitty side job they can get: the rich.

It's set up heavily tilted so you have to be rich, or dirt poor enough for a sob story, or a desired minority. Even if you do volunteer a lot and are middle class, you probably didnt know anyone that could help you into the most prestigious positions. A middle class person of equal aptitude would likely go into something like engineering or law which have fewer class-signalling non-academic purity tests.

[alistairSH]

That gating on medical training has always been there (at least for 40 years, if not more). But the number of doctors from doctor families has increased.

And just generally, socioeconomic mobility has decreased in the US across the population.

[mothballed]

Always been gated. But the slider has been dragged even further in the purity test direction. The intelligent un-pure now tend to become NP or PA, those programs still let you practice independently and slide more towards academics and less at whether a rich person set you up to be taken care of while you play mother Teresa until the switch flips the day you are accepted.

[triceratops]

> Medical schools require a lot of volunteering

But...why? Why not just let in the applicants that have the best grades?

[Plasmoid]

Because there are so many applicants that have good grades.

A more cynical view is that the governing boards want a way to pick and choose who they let in. So they create "holistic" application systems to get "360 degree view of the candidate".

[waterhouse]

No matter how many have good grades, you can always pick the top n by grades—unless there's a ceiling that the top m > n have all hit. Which, if you're talking about "grades" as in GPA, is plausible.

MCAT seems more relevant, though. According to Claude: "Roughly 0.1% or fewer of test-takers score a perfect 528 in any given year — typically only a few dozen individuals out of the ~120,000 or so who sit for the exam annually." So it should work fairly well for them to sort by MCAT and take however many they have (or expect to have) room for.

[ryandrake]

I think OP's point was that the governing boards don't want the people with the top n grades. They want certain people, and by making the admissions criteria fuzzy, they can pick and choose those certain people and then say "well, our admission criteria is subjective," and "we are looking for 'well rounded people," and all kinds of other vague weasely ways to let them legitimately shape the student body in the way they want.

See also: "Cultural fit" when hiring.

[BobBagwill]

One of my roommates who was premed had a "hot car" poster as a motivational study aid. After a short term as a candy striper at a local hospital, he changed majors. The system works! ;-)

[oivey]

At a certain point, grades become arbitrary and won’t necessarily select for the best candidates. Obviously the current system doesn’t, either.

The actual solution is to increase the number of slots for training doctors to match the huge number of qualified applicants. It makes even more sense given that there is a shortage of doctors and health care costs are astronomical.

[andrew_lettuce]

I want a doctor who was a strong student with diverse experiences, lots of soft skills and can handle the entire psychological spectrum of being a doctor, not the doctor who was solely the best at exams.

[triceratops]

There are all kinds of doctors though? The ones who don't have soft skills or diverse experiences can go into pathology or other fields that don't involve as much patient interaction. Why lose out on their gifts altogether if they're genuinely interested in medicine.

[jjmarr]

> No matter how many have good grades, you can always pick the top n by grades. Which, if you're talking about "grades" as in GPA, is plausible.

I live in Ontario and we're there. 40% of Waterloo students had above a 95% average in high school. The average GPA to get into UofT med school is 3.94/4.00 GPA.

What has happened as a result is students killing themselves and each other. If you fail one test in any course, you cannot move to the next level.

So, if you go on the UofT subreddit there's endless stories of pre-med students sabotaging each other. Faking friendliness, destroying notes, etc etc. This is arguably rational because the pool is small and there's little to gain by studying harder if you already have a perfect GPA.

https://www.reddit.com/r/UofT/comments/1sbu811/had_no_idea_t...

You don't want this type of person as a doctor. They will sabotage others because that is how they got ahead in the past. In a medical environment that kills people.

[triceratops]

Too many kids want to be doctors and have the grades for it? That's an opportunity, not a problem.

Training more doctors is just never an option for some reason.

Don't build systems that reward amoral psychopaths.

[waterhouse]

> This is arguably rational because the pool is small and there's little to gain by studying harder if you already have a perfect GPA.

So there is a low ceiling, and if they instead used MCAT or something with a higher ceiling (where, apparently, the number of perfect scores is about 50 per year—in America, presumably lower in Canada due to population size), then studying harder would benefit them. That seems like a much better outlet for competitive urges.

But also, how small is the pool of qualified applicants? If there were something like "they're going to take n people from your school, at which there are 30 plausible candidates", then sabotaging one might conceivably be worthwhile. But if the pool is—well, Google says 3,000 medical students get accepted each year in Canada (and the qualified applicant pool is presumably at least somewhat larger), and sabotaging one person is extremely unlikely to help you personally. (This is one case where it's good that the expected-value "benefits", of sabotaging person X, are widely distributed among thousands of medical candidates, and thus it's a "free-rider problem" where no individual candidate has a strong motivation to do the work.)

Is there some multi-stage thing where they pick 10 people from each high school, or 30 from a town, or something? Or is there major grading on a curve, or a big benefit for being the top person in your classroom of 15? That seems like how you would get real incentives for this backstabbing behavior. Otherwise, I can't see how it's rational (even to a complete sociopath), and would have to chalk it up to individual miscreants and possibly some kind of culture that encourages it in other ways.

[triceratops]

> Because there are so many applicants that have good grades.

So train more doctors.

[waterhouse]

That would increase competition and thus depress wages for existing doctors, who are the ones who make the decisions here. I heard, from a medical school attendee, that she overheard some doctors discussing whether it would be a good idea to require a fifth year of medical school to become a general practitioner (luckily, they were like, "Eh... nah"). It did not seem like it bothered them that this would make it even harder for civilians to get medical care.

[triceratops]

I thought lawmakers made the decisions. Silly me! :-D

[vel0city]

> Because there are so many applicants that have good grades.

Sounds like we need more spots for these people to go

[andrew_lettuce]

Because everybody has the same gamified, inflated high grades

[Sir_Twist]

I wonder how much of this has to do with seeing someone you are close to work as a doctor makes being a doctor (or military recruit, SWE, etc.) seem real and achievable to you. When I was little I wanted to be a firefighter purely because my father was a firefighter; it wouldn’t surprise me if the same goes for a lot of other people.

[mothballed]

I can't prove it, but I've heard more than one story of those with relatives in the military managing to get someone to pull rank and put them on better and upwards promoting assignments.

[gedy]

Joining Military isn't really a "class" thing - unless you mean lower income people join the military more often to get started in life.

Military academies are more of a upper class thing though.

[ok_dad]

Military academies are not upper class at all, mostly middle class folks. Officers are generally of the same stock as any other white collar job in engineering, law, business, etc.

[majormajor]

>(parent, sibling, uncle/aunt, or grandparent)

That's a pretty wide net. What percentage of the total population has a military connection in that many degrees?

[alistairSH]

Obv not a great sample, but within my peer group, none have parents or siblings. I have an uncle. Grandparent is a weird one - for anybody born in the 70s as I was, it’s almost a given to have a grandparent or four who served. Being European, all of mine served at the tail end of WWII or immediate aftermath.

[pmc123]

I've noticed the same trend with SWEs tbh. Many new grads from the top schools have parents who were SWEs or SWE adjaent

[red-iron-pine]

not necessarily SWE but definitely engineering / STEM pedigrees.

e.g. my buddy whose grandad was a lineman and later a telephone company manager, and dad was a mechanical engineer, and he ended up SRE / devops

[wholinator2]

In the United States i suspect some portion of this is due to "legacy" admissions whereby some child is admitted to a competitive program or given very advantageous scholarships not because of their hard work and displayed competence, but because of their parents. I know that it will be very possible for my children to end up at ivy league if they take the legacy advantage I've given them, even though ivy league has been completely off the table for me my entire life. They'll start _much, much_ higher on the ladder than I could.

[Larrikin]

Legacy admission was removed in response to affirmative action being destroyed by the Trump administration.

[gtowey]

I'm not sure what you're trying to say here. They were not "removed", they were made to be disallowed if and only if the school wanted to receive a certain kind of government funding. Some schools have enough money that they can ignore this. Notably, Stanford said they would give up the funding to keep their policy of legacy admissions.

So the richest, most prestigious schools where legacy admissions are a gateway to the upper classes, will keep the policy.

[RestlessMind]

> affirmative action being destroyed by the Trump administration.

Affirmative action was gutted by SCOTUS when Biden was president. Not that it was popular before. California of all places rejected it by 56-44 margin in 2020.