I’ve been reading a fascinating book, The Case Against Education: Why the Education System Is a Waste of Time and Money, by Bryan Caplan. It starts off with a bang, stating that we spend far too much money on education, not too little. He makes the case that education brings about higher compensation only because educational achievements provide signals of desirable characteristics, not because the education has any intrinsic value. The case the book makes, supported by extensive data, is entirely compelling.
The book resonates with me, because I can see the same phenomena at work in dermatology. For example, Caplan makes the case as the percentage of people who get college degrees increases, the value of that college degree becomes less significant. Oh, how this describes what we see with dermatology residency applicants and their lists of accomplishments! It used to be that having done dermatology research meant something; now, every applicant has experience in dermatology research, making it less impressive to come across. Moreover, the book describes how the signals escalate over time. The need for a high school diploma morphing into a need for a bachelor’s degree, and then into a master’s degree, mirrors how we see the number of publications by dermatology residency applicants climbing dramatically over time. In addition, the book makes the very strong case that what is learned in school, if anything is learned, is irrelevant to the job market—just as having done all this dermatology research is essentially irrelevant to being a good dermatology resident.
It is easy to think Caplan’s idea of spending less on education would increase inequity, but he makes a convincing argument that the costly expenditures needed to get higher and higher degrees to compete for jobs contributes to an unlevel playing field. Again, we see the same thing among dermatology residency applicants who now feel the need to do research on a volunteer basis for an entire year in order to compete for a residency spot, something that students of lower income backgrounds would be less able to afford. Does that year of research experience make better dermatologists or lead to more researchers, or is it simply, as Caplan would have us believe, primarily a very costly signal of a student’s drive and commitment?
That is not to say we should throw education out the window, because we do need expert training to provide sound care for our patients. This issue, we feature coverage of a number of conferences from April (page 12) and the push to get full-size sunscreens classified as medical items for carry-on luggage (page 44).
Regardless of educational background and accolades, putting patients first is what makes a good dermatologist.
