有照行醫和波蘭醫師落日條款
One of the arguments given for licensure and stringent admission requirements to medical school is that this would keep up the quality of physicians in the nation.
Friedman argues that it is illogical to reason that we must restrict the number of people allowed to be doctors to keep up the quality of physicians, when there is the fact that some people get no medical service.1
On this count, I keep hearing that Taiwan’s market for physicians is saturated. However, certain things make me wonder whether we couldn’t benefit from more doctors. First, whether having more doctors working in smaller shifts might allow doctors to have better life quality? And second, since there is obviously a great lack of doctors in some other countries, whether we couldn’t provide the training for such a need?
A few months back Taiwan was embroiled in the issue of accepting doctors trained in Poland. Apparently, they have a much lower admission standard (Basic English speaking abilities and a biology test a junior high student could pass with flying colors), and require no hands-on internship, even in Taiwan. Many Taiwanese medical students have argued passionately against allowing them to sit through the same licensing exam in Taiwan. They say that they would lower the quality of medical care in Taiwan.2
While I would find it better if these students were required internship in Taiwan as the mode of communication and pathological demographic here is different from Poland, what I realized as I listened to the arguments the medical students put forth is that what they care about most is protecting themselves. Such a conversation took place during a Toastmaster’s outing where there were two biology students, one psychology student and five medical students. The students spoke candidly about their fear and angst that, after spending seven years of their life learning a trade, they might have to face a market where they would be paid even less than they believed they would get when they tested for admission, and possibly wouldn’t even be able to find a job. They are afraid that the influx of doctors trained in Poland would cost them their jobs and lower the average wages for physicians in Taiwan.
Their position is easy to understand if you consider the background of most medical students in Taiwan – youngsters straight out of high school who make the best grades during college entrance exams in Taiwan, most of whom go into medicine for the financial security and prestige (hearing that you are a medical student automatically gets an oooh effect from neighbors and make even the least personable boys hot commodity). These students make this choice when at least 54% of college students in Taiwan feel that they’ve chosen the wrong major.3 The education systelm in Taiwan has not made allowing students time outside of school to develop their own interests a part of the educational goal. The goal is, in fact, to cram as much information into the curriculum as possible, leaving students and teachers little time to pursue critical thinking and related scholastic projects that do not involve pure lecturing. Most Taiwanese high school students thus pick their majors with little notion of actual preference, sometimes at the behest of parents and teachers who are frequently more interested in conventional notions of prestige and financial security. In this respect, I greatly doubt that medical students are the exception.
There are certainly a number of medical students who are very dedicated towards healthcare. Among my friends is Eddy, who came to Taiwan from Malaysia to study medicine. He grew up dreaming of being a doctor and working very hard towards that goal. He turned down opportunities to go into research because he thought that he needed to focus on his medical studies so that his patients can benefit. He’d like to do pro-bono work sometime in the future. There’s also Jessica, who has traveled to many countries, does a great deal of volunteer work, is into medical research, and believes that we can make the world a better place.
But from what I’ve observed in my school they are not the majority. My roommate said her dream was not to be a doctor, but a nursery school teacher, but she made the grade and just filled in the most wanted list. Another friend of mine in medical school is very fond of physics and wants to transfer. His parents do not seem to be aware of this. Some of them change direction after realizing that this is not their dream. Most stay on due to family pressure, how coveted their positions are, and just a general resignation to fate. I believe these would feel very lost if their prospective futures suddenly entailed less pay and less guaranteed employment.
The incongruity in the argument against the Sunset Clause struck me when I heard one of our Toastmaster medical students actually admit “Actually, we all know that you don’t have to be the smartest person in your class to be an adequate doctor.”
It is also an odd argument to say that if wages were lowered doctors may have to resort to trickery, which may lower the quality of medical service – as if we must pay doctors to remain honest.1 I wonder if lowered wages may in fact repel those more interested in financial security and allow individuals who are truly attracted to the profession to come into play.
If wages were lowered and more doctors existed in a society (that is, for societies that are already paying a large salary to physicians), hospitals may be able and willing to hire more doctors and induce shorter shifts, which would do away with the complaint that doctors work so much they don’t have time for themselves or their families. This way, more people could have a job they actually like, and more people could actually have a life.
Reference:
1. “Occupational Licensure” by Milton Friedman (1982) in Capitalism and Freedom, The University of Chicago Press.
2. 波蘭醫生事件－要求學歷認證，拒絕落日條款！
http://blog.roodo.com/pida/archives/8893543.html
3. 54% 大專畢業生 自任選錯
http://www.libertytimes.com.tw/2009/new/jul/28/today-life12.htm
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