I say socialism. What I mean is any kind of redistributive income policy which goes after ‘the rich’ in favor of ‘the working class’ (expect me to excoriate that latter term in the near future). Anything with any degree of a ‘from each according to his ability, to each according to his need’ flavor. People are self-interested. This is a given. They will not work if they feel the payoff isn’t good enough for the effort/time/investment they put in. Socialism presupposes effort and ability will correlate if there’s no difference in payoff for achievement. Economics, behavioral ecology, game theoretics, in short any behavioral science that’s shown predictive ability refute this. Payoff and achievement correlate. Payoff and effort correlate. Payoff and ability correlate. Payoff correlates even better with a combination of ability and effort (which predictably leads to achievement).

Anyway, back to my story. So I went to the Dermatology Interest Group meeting for lunch today. I have about as much interest in dermatology as my dog does in vector calculus, but the speaker today was on the general topic of how to be competitive for residency placement in any specialty, so I went. Plus there was free pizza (remember what I said about people being self-interested). Dermatology, along with opthalmology, anesthesiology, and ENT (ear, nose, throat) are pretty much the most competitive residencies, period. OU had over 270 applicants for 2 spots last year, for instance.

The reason they’re so competitive is because they’re what we call the ‘lifestyle’ specialties. A lot of money, easy work hours (many doctors in these specialties don’t even work full days), and well, that’s about it. Effort, compensation, correlation. See?

This in one of those professions where you’d think there’d be a lot more idealists than others. The questing after lifestyle specialties has gotten so bad that directors of those programs are starting to look down on kids who ’show an interest’ in the specialty just a bit too early:

“So son, I see you’ve been shadowing a dermatologist since you were in undergrad.”
“Yes sir.”
“Why’d you become interested in this particular specialty.”
“The umm. You know. Thing. Acne. Pimples. I have a passion for pimples.”
“Reaaaaaally. Are you sure it wasn’t for Mercedes and a cushy lifestyle?”

Our speaker’s thing is clinical research. He’s interested in the processes by which auto-immune disease can attack the collagen and scaffolding that support our skin. Pretty cool stuff. The kind of thing that’s driven by passion, not money. But of course, in that specialty, he knows that most people don’t join for that. In fact, there’s a dearth of researchers in derm because the money’s just too good in private practice.

Moving beyond derm to the whole of the medical profession. The most well-compensated specialties attract our most diligent and arguably our brightest. The ‘gunners’ who obssess over straight A’s. They choose dermatology, ENT, ophtalmology. They don’t choose family practice, internal medicine, or any of those things that most think of as more vital (literally) than lasik and pimple cream. These young residents, once board certified, then proceed to shun research, payoff not being good enough.

Get the point? Even within a highly-compensated profession (Adolescent Psychiatry at 120,000 is one of the lowest median income specialties…it’s also what I want to do), we see those who put in the most effort, and those who arguably have the most ability going into the specialties that pay the most. Even when no matter what they do they’d be in the top tax bracket, they still choose money.

This saddens the idealist in me. Medicine for me is more calling than profession. I’d rather be researching monkeys if my ethos would allow it. But the behavioral ecologist that I nearly was merely shrugs. To be self-interested is to be human. Even more importantly, self-interest is one of the most basic underlying rules of behavior of all animals; it’s the guiding light of evolution. Natural selection only occurrs because animals quest after selfish ends.

And this is where the socialist and I part ways. I understand that self-interest is a part of us. That we will always make our decisions based on how much wealth, power, comfort we’ll accrue. The socialist doesn’t. In fact he denies it. He believes that being able to be a doctor, an engineer, an artist is enough to motivate one to do so. It isn’t.