I originally planned to take all of last week off, but later in the week a few topics came up that were just too good to ignore. Accordingly, we had to wait for the usual “readers’ response” section.
First, a big thank you to the readers who wrote in with thoughts about The MD/MPH Dilemma which the Boy faces. The advice was broad, but consistently thoughtful and nuanced. I forwarded every reply to TB who told me he would contact at least some.
As a long-time friend noted at the end of the conversation on a topic she was well prepared to address, “this is social capital in action.” Well, yes, in the interest of openness and to avoid accusations of hoarding, I’ll share a few key ideas.
First, each degree serves a specific purpose, so a lot depends on your purpose. If the goal is to practice medicine, go for the MD. An MPH may or may not be useful, but it’s a tall order if its sole purpose is to help apply to medical school. A student doing something medical in a gap year – say, scribing – would not be at a disadvantage to someone who did an MPH. Given that the former pays and the latter costs, getting an MPH solely as a strategic move is probably not a good idea.
Second, if the goal is to work in health policy, it’s probably best to spend some time in the policy world to see if you like it. Some people do and some people don’t. Volunteering for companies or working with a group whose goals align with yours (such as an association of community medical centers) can provide an opportunity to experience the reality of the field. I really liked this point. As I mentioned earlier, during a summer internship where I shadowed some lawyers, I realized that I didn’t want to be a lawyer. We usually get students who say they want to be teachers before they even enter elementary school. Nothing can replace real experience. TB already has experience as a therapist, so we know he doesn’t faint at the sight of blood. If he finds politics congenial, then an MPH next might make sense, and an MD would be a very expensive diversion.
Finally, some places have good “joint” MD/MPH programs, but if you’re going to do it, taking a gap year is even more important. These programs are intense, so you need to be mentally prepared. After a rigorous college program, a break is in order. Burnout doesn’t help anyone.
TB is planning to take a year off anyway, so he’ll have a chance to consider his options. In the meantime, thanks to everyone who answered the call.
In response to the article about “training track” for faculty, in which I noted that community colleges have been doing this for years, several readers asked about how to evaluate teaching for tenure purposes.
That’s a topic in itself, but my short answer is this: In my experience, most teachers are at least pretty good at teaching, and most who aren’t could use a little practice. But there’s usually the bottom five percent or so that really need to do something else. So it depends on whether you think philosophically that it’s about optimization or harm reduction. I’m on the side of harm reduction. For example, when evaluating student courses, I ignore fluctuations in the 90+ percentile scores. I look for those who score several standard deviations below the mean semester after semester. Even there, grades should be taken as signs to be considered more carefully, not as a dispositive in themselves. Likewise, in cases of consecutive courses – say Chemistry 101-102 – is there a consistent pattern of students in whom a particular professor in 101 was lower than all others in 102? If so, this is a sign to take a closer look. There may be other reasons for this – a separate cohort, a scheduling problem – but it’s worth looking at more closely.
Improvement comes from peer support and coaching. Negative decisions – which, yes, sometimes have to be made – require evidence.
If the goal is to be as exceptional with teaching as elite with research production, then the community college model likely doesn’t matter. But I respectfully suggest that we have nothing close to the certainty that we would need to do that, even if it were desirable. We have the ability to find the bombers.
Finally, in response to the post about differential learning program, several readers have pointed out well that there is already a significant racial and economic pay gap in allied health: CNAs are disproportionately women of color, and doctors are disproportionately white and Asian. Increasing the economic barrier to upward mobility would reinforce this stratification. This goes against the mission of public higher education. Yes, resources are scarce, but requiring those with the least to pay more to improve their lot is unlikely to end well.
Again, thanks to my wise and secular readers for keeping me honest, for expressing perspectives different from my own, and for affirming my faith in reasoned discourse. It can be done.
