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The Dark Side of Student Loans
Issue #528, June 25, 2018

The Cost of Out-sourcing Convenience
Issue #527, June 18, 2018

Social Security: 66 or 70?
Issue #526, June 11, 2018

Student Loans: There’s (Unfortunately) a Lot More!
Issue #525, June 04, 2018

Co-signing a Note
Issue #524A, May 31, 2018

The Knight Frank Luxury Index and Collectables
Issue #524, May 28, 2018

The Importance of Diversification: The Myth of Diversification
Issue #523, May 21, 2018

How to Save Thousands on Your Food Bill
Issue #522, May 14, 2018

MoviePass and Other Things
Issue #521A, May 10, 2018

Degree Inflation, Long Training Periods, and “Certification”  Part III
Issue #521, May 07, 2018

Degree Inflation, Long Training Periods, and Certification” Part II of III
Issue #520, April 30, 2018

Follow-up on Several Things
Issue #519A, April 25, 2018

Degree Inflation, Long Training Periods, and “Certification”: Part I of II
Issue #519, April 23, 2018

The Kids Birthday Party Hustle
Issue #518A, April 18, 2018

A Pension Question: Part II of II
Issue #518, April 16, 2018

A Physician is an Executive
Issue #517A, April 11, 2018

A Pension Question: Part I of II
Issue #517, April 09, 2018

Is the Correction Over?
Issue #516A, April 05, 2018

Used Car Dealers, Student Loans, the Chinese, and Uncle George’s Rule
Issue #516, April 02, 2018

Starter Homes
Issue #515, March 26, 2018

Redecorating: Beware!
Issue #514, March 19, 2018

NASDAQ Closes at Record High
Issue #513, March 12, 2018

A 40% Chance
Issue #512, March 05, 2018

Several Things
Issue #511, February 27, 2018

Human Capital, Education and Wealth
Issue #510, February 19, 2018

Another Stock Market Update
Issue #509A, February 18, 2018

Some Thoughts on Savings
Issue #509, February 12, 2018

A Stock Market Upfate
Issue #508S, February 10, 2018

Who Can You Trust? Part II of II
Issue #508, February 05, 2018

The Christmas Decoration Pre-worn Jeans Hustle
Issue #Interim Bulletin #507A, February 03, 2018

2018 Outlook for Financial Markets
Issue #507, January 29, 2018

Who Can You Trust? Part I of II
Issue #506, January 22, 2018

Life Insurance Settlements
Issue #505, January 15, 2018

Commodities and Buying the Breakout
Issue #504, January 08, 2018

Buffett Wins His Bet
Issue #503A, January 04, 2018

Practice Real Estate and Free Agency
Issue #503, January 01, 2018

Outlook for 2018: Part III: Stocks and Bonds
Issue #502, December 25, 2017

My Outlook for 2018: Part Ii: Precious Metals
Issue #501A, December 21, 2017

Outlook for 2018: Hard Assets: Part I of III
Issue #501, December 18, 2017

More Thoughts on Bitcoin
Issue #500A, December 14, 2017

Fees and Good Relations with Bankers
Issue #500, December 11, 2017

Salvator Mundi
Issue #499A, December 07, 2017

Should You Rent or Own a Home?
Issue #499, December 04, 2017

A Gift Subscription
Issue #Interim Bulletin #498A, December 02, 2017

Stocks vs Real Estate: Asset Allocation: Part II of II
Issue #498, November 27, 2017

When Good Enough is Fine
Issue #497A, November 22, 2017

Stocks vs Real Estate: Asset Allocation. Part I of II
Issue #497, November 20, 2017

The Saudi Arrests and the Perils of Foreign Investing
Issue #496, November 13, 2017

Gambling and Las Vegas
Issue #495, November 06, 2017

Some Tips on Auto Insurance
Issue #494, October 31, 2017

Bitcoin and the Digital (Crypto) Currencies
Issue #493, October 23, 2017

The Coming Bear Market: Part II How to Prepare
Issue #492, October 16, 2017

Some Observations on Cemeteries
Issue #Interim Bulletin #491A, October 12, 2017

The Coming Bear Market: Part I: The Myth of Buy and Hold Forever
Issue #491, October 09, 2017

The Market makes New Highs
Issue #490, October 02, 2017

The Importance of a New High
Issue #489, September 25, 2017

A Little Insurance: Wealth, War and Wisdom
Issue #488, September 18, 2017

Some Observations
Issue #487, September 11, 2017

How to be Successful in Your Career
Issue #486A, September 07, 2017

How NOT to Buy a Home
Issue #486, September 04, 2017

This Week in the Market
Issue #485, August 28, 2017

Is the “Trump Bump” Running Out of Gas?
Issue #484, August 21, 2017

Gold is on the Move
Issue #483, August 14, 2017

The Importance of Estimation
Issue #482, August 07, 2017

Buying Art and Collecting: Part II of II
Issue #481, July 31, 2017

Buying Art and Collecting in General, Part I of II
Issue #480, July 24, 2017

Physicians need to be More Forceful: Follow-up
Issue #479, July 17, 2017

Physicians need to be More Forceful
Issue #478, July 10, 2017

Your First “Real” Investment
Issue #477, July 03, 2017

Leasing a Watch: Don’t
Issue #476, June 26, 2017

The Importance of Your Children having a Job
Issue #475, June 16, 2017

The Problem with Medical Student Debt is—the Med Schools
Issue #474, June 12, 2017

Critters and Varmints in your Home and Yard
Issue #473A, June 07, 2017

Leveraged ETFs
Issue #472, May 29, 2017

Leasing a Vehicle: Don’t!
Issue #471, May 22, 2017

Issue #470, May 15, 2017

More on Buying Jewelry
Issue #469, May 08, 2017

Buying Jewelry: Gold, Diamonds and Pearls
Issue #468, April 30, 2017

Thomas Sowell: Part III of III
Issue #467, April 24, 2017

Thomas Sowell: Pat II of III
Issue #466, April 17, 2017

Live Close to Where You Work
Issue #465, April 10, 2017

Medtronic in Hospital Management
Issue #Interim Bulletin #464A, April 07, 2017

Thomas Sowell: Part I of II
Issue #464, April 03, 2017

A Political Contribution a an Investment: Part II of II
Issue #463, March 27, 2017

A Political Contribution as an Investment: Part I of II
Issue #462, March 20, 2017

Buffett Selling Vacation Home
Issue #461, March 13, 2017

Advanced Placement (AP) ourses
Issue #460, March 06, 2017

The Importance of a Credit History
Issue #459A, March 02, 2017

A Credit Card Scam
Issue #459, February 27, 2017

The Electronic Health Reord
Issue #458, February 20, 2017

Issue #457, February 13, 2017

Platinum and Palladium
Issue #456, February 06, 2017

Economic Outlook for 2017: Part II of II
Issue #455A, February 02, 2017

Economic Outlook for 2017: Part I of II
Issue #455, January 30, 2017

A Story From Vegas
Issue #454A, January 25, 2017

Land Donation Deals and the IRS
Issue #454, January 23, 2017

The Theory of Gambler’s Ruin
Issue #453, January 16, 2017

Student Loans: But Wait, There’s More!
Issue #452, January 13, 2017

A Second Home
Issue #Interim Bulletin #451A, January 04, 2017

The Consumer Confidence Index
Issue #451, January 02, 2017


By Robert M. Doroghazi, M.D., F.A.C.C.

Degree Inflation, Long Training Periods, and “Certification”  Part III

Issue #521, May 07, 2018

        What ties this all together: the continued push for more training and more degrees? Why require an RN to have a Degree when those with a Diploma did just fine, require more years of training for physicians with no evidence to back it up, require Board Certification when none was required before, or require a college degree to perform a job currently performed quite well by one without a college degree?
RMD comment: it’s what drives everything: money and power.
    1) When I was preparing the series of Commentaries for The American Journal of Medicine, I asked someone in the medical establishment why the governing Boards required all the extra years of training, or Board certification (ex: for Congestive Heart Failure) where none was require before? He said it was sometimes the Board, but often the people in the specific area. They wanted to create an aura, a sense of distinction and legitimacy for their specialty.
    I would call this elitism. They wanted to create a pond where none existed before, so they can be the big fish. To make an analogy: What’s the “best” country club? The most exclusive, the most expensive, the most uppity, with the fewest members, with no hoi polloi (a 1930s term for the masses, the common people).
    2) The University-Industrial Complex obviously wants more people to attend college, although they are quite aware that at least one-third of college grads hold jobs not requiring a college education. The only way to reign in the University-Industrial Complex is to cut off funding. The government needs to exit the student loan business.
    3) The more Boards and Societies, the more requirements, the more exams, the more fees for exams and certification and continuing education. Some feel this was the primary driver for the American Board of Internal Medicine to require the new onerous Maintenance of Certification (MOC) requirements imposed several years ago. 
    4) Bureaucrats love this trend. As people comply with the rules previously set, the only way the bureaucrats can remain in power is to set more rules: the more expensive, the better. Bureaucrats can also hide behind “certification”. If an employee without a degree makes an error, the boss might be subject to criticism. But if someone with a Bachelor’s Degree or a Master’s commits the same error, even if they are not as talented, the boss is OK because the employee is “certified”. Employers can also charge more for someone with a higher level degree, even if they are doing the same job.
    5) Those who demand more training and more degrees are routinely buried in Academia or the back office. The people with the least practical experience and little appreciation for the real world are telling those on the front lines that they need more training to do a job they are already doing quite well. 
    6) Although not a primary driver, the powers-that-be are certainly opportunistic, taking advantage of the cheap labor of those required to spend extra years in training. I have spoken with multiple physicians who hold this opinion.   
    There is no doubt this trend is an important driver of the exploding student debt. I’ll bet the requirement of more certification is the direct cause of—at least—10-20% of the increase in student debt. We are turning people into professional students. They are forced to stay in school longer, or go back to school, to earn a degree so they can apply for a job for which they are otherwise already qualified.
    Moreover, by prolonging schooling and training and denying people the chance to make decisions and accept responsibility, we are making them perpetual kids. If someone in their 20s with a nurse or physician or Bachelor’s Degree-quality intellect is expected to be mature, they will be mature.
    My recommendations:
    1) an education must be looked at as an investment. What is the value added? Compare Engineering or Business to History or Philosophy. An unfortunate trend is going to out-of-state (more expensive) schools rather than staying in-state.
    2) For today’s students, the smartest kids in the class, who could do whatever they want: I would get an MBA. By the time their physician contemporaries finishes training, an MBA could have earned $1M and hold a responsible, or even prominent, position.
    3) If you wish to pursue a career in health care, consider
    A) dentist. i) The training period is significantly shorter. ii) The income is similar to a physician, and if you are willing to work hard, can be very lucrative. iii) Basically no government/insurance company hassles. People pay cash. iv) Rare calls (I retired because of call).
    B) A very successful MD in the medical instrument-maker industry told me that if he had to do it all over again, he would go straight from med school to get an MBA.
    4) Health care is becoming more “corporatized”. Administration is a growth area. The training period is significantly shorter, and the CEOs at “not-for-profit” hospitals make about 2.5X more than the average physician. If you are willing to go to the dark side, be a “suit”. Many high-level health care administrators make 7-figure salaries while they are telling the MDs what to do. See my Commentary “Negative Secular Trends in Medicine: High CEO Salaries” in the February, 2016 issue of The American Journal of Medicine.
    5) Start your own business, or, work in an unregulated industry, with tech at the top of the top of the list. If you can write the best computer code, or hack into the Kremlin’s computers, you don’t need any letters behind your name. 
    Lowry’s continues to feel the current weakness in the market is a correction, not the start of a bear market, and probabilities favor a breakout to new highs.
    During the Civil War, David “Damn the torpedoes, full speed ahead” Farragut was the first man to receive the rank of Admiral in the US Navy. Farragut entered the Navy in 1810 at age 9 as a midshipman. During the War of 1812, the USS Essex captured a prize. At age 12, Farragut commanded the crew that sailed the captured prize to port.
    RMD comment: It’s hard—impossible—to imagine a 12 year old being given such a responsibility today.
    Why it’s important to read.  Collateral knowledge is when you learn something in one area that applies elsewhere. Newton’s laws describing gravity and motion explained the Universe well for more than 200 years, but broke down when approaching the speed of light. That was an insight that has served me well for 50 years. To see if a something works, carry it to the extreme.
    As the discussion in these last 3 Newsletters illustrates, people without a degree who have performed their job quite well for years might no longer qualify for the same position. Ex: say that for the 2018-2019 season, a college degree is required to play in the NBA. “I’m sorry Mr. James, but we can’t renew your contract. You never attended college, there are no letters behind your name”. LeBron: “You talkin’ to me, man?”
    RMD comment: Humor and satire are often the most effective way to make a point.
    I’ll put out an Interim Bulletin in midweek about MoviePass. In the meantime, if you have MoviePass, use it while you can.
    Next weekend I’ll discuss how you can save thousands every year on your food bill, and be healthier, and look better. 

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