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Learning the Trade

The Invisible Adjunct has a really "nice entry":http://www.invisibleadjunct.com/archives/000238.html about a "lawsuit":http://www.nytimes.com/2003/08/18/politics/18RESI.html filed by medical residents who claim the system of matching new MDs with residency programs is anti-competetive. IA points out quite aptly that Match representatives' use of the "it's an apprenticeship" argument is rather bogus, just as it's bogus in graduate education.

Residents, like graduate RAs and TAs, do significant work for their institutions. I cannot speak specifically for hospitals, but I know for a fact that my own institution, in its current state, would crumble without the apprenticed labor of its TAs. I imagine that most hospitals are in a similar situation.

A slight aside, that gets me to the point: An editorial in the student paper yesterday rightly "bemoaned faculty flight":http://wildcat.arizona.edu/papers/97/3/03_2.html, but ignorantly condemned graduate teaching. I won't argue that grad instructors are necessarily more _proficient_ than their faculty (though they may be _fresher_, certainly, having just recently done such things as write dissertation proposals and take preliminary exams), nor do I begrudge the author the desire to have interactions with professors. But I do take issue with the assumption that being taught by a graduate student is an inferior experience. Faculty who are leaving aren't going other places in search of better teaching jobs; they're going places with better facilities and resources for research. Graduate students on the other hand, take teaching as a serious component of their training and work conscientiously to be good at it.

We work hard at our teaching and research, just as medical residents work hard at honing their own skills. If such work truly constitutes an apprenticeship, then our institutions fail to provide us with even meager trappings: Adequate stipends for housing, careful attention to our professional progress, training in exchange for our labor. But if we are employees, as my signed Loyalty Oath to the State of Arizona* suggests, then the institution has still failed: Salaries are uncompetetive; for purposes of benefits we are treated as students rather than employees, making us subject to a dismal health plan.

A half-formed (and therefore probably only marginally coherent) thought regarding residents. Survey research of pre- and post-graduation medical students shows that the experience of medical education tends to moderate financial aspiration. Students lured by high salaries and those motivated by a service-healing orientation are both pushed down and up, respectively, on the scale of monetary goals. In other words, medical education tends to produce mainly upper-middle class aspirants. Not being as current on markets as perhaps I should be, I imagine that this homogenization facilitates what residents claim is anti-competetiveness on the part of the Match program, but that subspecialization may act as a counter, as practitioners from highly specialized fields demand better deals in their Match. On the other hand, current re-emphasis on primary care may push institutions (or allow them the rhetorical legitimacy to do so) farther toward flatter salaries.

*Required of all state employees: "I will defend Arizona against all enemies foreign and domestic." Really.