I was arguing with a classmate today, and the issue is still sort of on my mind. The university is instituting a system whereby pre-med (or mostly pre-med) students take a "watered down" version of a basic science course. The problem is that now a bunch of them fail these basic science courses. From what I could understand, she has several issues that came up as a result of this new policy. However, she was going back and forth on these issues a lot, so my understanding might not be correct. Also, I got the feeling that point one was the most important and she was just bringing up the second two points to justify point one. So, without further ado, allow me to unload my mind:

1. She doesn't want the university to take sub-par students and graduate sub-par students.
2. She doesn't think that people who can't pass a basic science course at the university should be doctors.
3. She thinks that there should be an equitable distribution of talented doctors geographically such that people who live in rural Alaska will have access to the same standard of care available in a major city.

For her first point, fair enough; I don't really care.

For the second point, I think that it lends itself to a great amount of pickiness. If she's not willing to be treated by a doctor who can't pass a basic science course at this particular university, then she's ruling out a lot of talented doctors. At Berkeley, there are different basic science courses for different types of people. For example, there's a physics course for physics majors, a physics course for non-physics science majors, and a physics course for "presidents," the rationale being that if you don't want to be a physicists, then there are things it's not worth your time to learn. The pre-meds take the one for non-physics science majors. By her standard, she would be unwilling to be treated by a doctor coming out of Berkeley, but Berkeley is a world class institution that I'm sure has produced a number of extremely competent doctors.

There might also be a sub-point here in which she thinks that if you don't pass physics for physics majors, you just won't be a competent doctor. If this is the case, then there are a lot of incompetent doctors out there, probably working in rural middle-of-nowhere areas, which is an injustice.

And now we come to the third point. My thought is that in order to be a doctor at all, you have to do decently on the MCAT and pass three board exams. At this point, I assume that you are competent. However, there is always going to be a spectrum of ability, and so the best will have more choice in where they will go. It is more likely that they will choose to work in a big city with a good hospital. In fact, working in this kind of environment will help them be good doctors, since there are so many other specialists around to consult with. Being in a city is also pretty much necessary for research. So if the best and the brightest tend to go to big cities, and being in a big city helps them be excellent doctors and scientists, then of course there will be an inequitable distribution of talent geographically. It might be unfair, but since I assume that after passing three boards, all doctors are competent, I think that it's acceptable. Putting the best doctors in rural areas might actually be considered an injustice as well, as fewer people will have access to their care. In a city, they'll be able to specialize and have a bigger patient population which is a better use of talent for society as a whole.