Regarding the bottom of the med school class still being doctors…there is the issue of non-random sorting into specialities. And that’s not based on the need to be “good” at med school for being a particular kind of doctor, but the desirability of the specialty itself (salary, lifestyle, perceived prestige, interest level, etc)…so incentives are not aligned for the best health of the nation. That’s one reason for a civilized nation to “manage” medicine instead of letting all aspects be free market. At some point America will have spectacular skin care…but at what cost?
So here’s my new analogy to college admissions: there are misaligned incentives that, if unchecked, will lead to unintended outcomes in the next generation. On CC we have kids asking whether it’s strategic to change their intended major in order to have a better chance at a certain school…this is prestige skewing the future workforce. We have talk of top finance firms preferring a Brown Classics major to a URI Econ major…so is the latter expected to go to grad school for Ancient Greek now? I’m being a little facetious but I think there are market forces that come into play that are less of an issue in countries where undergrad institution choice causes less angst. Incentive alignment happens at a system level, not by individual participants.