> There's no survivorship bias in going to med school, becoming a specialist and then earning 400k/yr.
There is, just not as pronounced as in the lottery example. You ignore all the students who failed or dropped out of med school, didn't make the cut to become a specialist, or had to take a job that didn't make 400k/yr.
But if some make it to med school but then don't succeed, how many of those failure cases ended up not working hard enough?
Once you have a class of medical students, it's not a lottery system on who succeeds. Short of those who, through no fault of their own, run out of money or have some unfortunate circumstance that takes them out of the program - the ones who succeed seem very likely to have made it on merit of some combination of hard work and intelligence.
You'd be surprised. There are several pressures that keep doctor supply low in the US, not least the medical boards staffed by doctors who ahem have obvious moral hazard to constrain supply and maintain their 400k/year income.
A close friend of mine is now a cardiologist. As far as I can tell his residency was a three-year hazing ritual / sleep-dep experiment. To top it off, when he was finally done and out in San Francisco visiting us, he got the call to take some final test. The test had to be done the next day and had to be done in person at one of six cities in the country, the closest one being in LA. We scrambled to get him a plane ticket and some sleep.
He passed, but excuse me what the actual fuck? That's not character-building. That's straight up institutionalized caprice.
I don't disagree that the AMA's stranglehold on MD distribution is a problem.
But I have several members of my family who are/were doctors. Residency is hard, pure and simple. It's hard for everyone and takes tremendous perseverance. But perseverance is the opposite of luck.
I don't know what the perfect method is or if there is even a perfect method performable by all instructors and applicable to all medical students.
I do know in my personal life that the "trial by fire" method of education makes a huge impression and can be very successful. The military uses this method as well to great historical success.
And there it is: They failed because they "didn't work hard enough." It's really easy to classify failures as not working hard enough, and successful people as having worked hard enough.
But what's hard enough? Can we quantify by any means other than the outcome?
We can point to people who have never worked on their business for more than 40 hours a week and their business has succeeded. We can point to people who have put more than 120 hours a week into their business who have failed. Who really worked harder?
You misunderstand the "No True Scotsman" fallacy to apply it to this situation. There's a metric for success (graduating), and no one claimed that the only possible way that someone didn't make it is "work harder". I said that perhaps that's the reason since by the time people make it to medical school, they're on a fairly even playing field.
NTS is typically applicable when someone expresses a goal like "being a good Christian" and then continues to redefine what that means, never admitting that some are good Christians because of endless redefinitions of the metrics.
The 40 hour business success is the rarity and often it's predicated upon other previous sacrifices made so that 40 hours is later sufficient.
As with the xkcd comic, it seems silly to base your success model on the lottery type system that is the rarity rather than on what works most generally.
Besides, it's not always about the amount of time being worked.
Merit is a combination of hours put in, intelligence, the value of decisions made, etc.
I'm not arguing for strictly the number of hours worked. I'm arguing for merit based upon a number of factors vs the idea that all success is determined by luck.
There are also ways out of med school that are less than critical failures. Did someone who failed to become a doctor but became a Nurse fail? Pick a path with many options allows one to be flexible in the future.
There is, just not as pronounced as in the lottery example. You ignore all the students who failed or dropped out of med school, didn't make the cut to become a specialist, or had to take a job that didn't make 400k/yr.