Archive for November, 2011

Back to school: How parent involvement affects student achievement (At a glance)

Posted by jcmaziquemd on November 26, 2011



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Teenie Harris | Life on the Hill | By William Meyers – WSJ.com

Posted by jcmaziquemd on November 23, 2011


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Should ladies’ nights really be illegal? An excerpt from Richard Thompson’s Ford’s new book, Rights Gone W rong.

Posted by jcmaziquemd on November 22, 2011

Should ladies’ nights really be illegal? An excerpt from Richard Thompson’s Ford’s new book, Rights Gone Wrong.
By Richard Thompson Ford | Posted Tuesday, Nov. 1, 2011, at 4:26 PM ET
| Posted Tuesday, Nov. 1, 2011, at 4:26 PM ET

How the civil rights movement led to a ban on ladies’ nights.
This is the first of three articles excerpted from Richard Ford’s new book, Rights Gone Wrong: How Law Corrupts the Struggle for Equality.Isbpw1hyo2NzDMr4oTJZmfiWh2PI88o5ZfY9fpBNdubNxnTAWHNM2904FCun_9K6ydmsOwOi72tZPIRqmUylD_Ie76GDk0LlK3RON15xst54wEyML24
On May 4, 2006, a man named Michael Cohn filed suit to stop Mother’s Day. The previous year, the California Angels had held a Mother’s Day celebration, which included a “#1 Angels Baseball Mom” contest and a Mother’s Day tote bag giveaway. According to the court that heard Cohn’s lawsuit, “due to the difficult logistics of discerning which women were mothers in the heavy traffic of entry to the game, the team decided to generalize ‘mothers’ as females 18 years and over” and give them—and only them—the Mother’s Day gifts. Cohn didn’t fit that description, and so he didn’t get a fetching Mother’s Day goodie bag. Enraged that he was denied a gift because of his sex, he sued.
Rest easy: The courts dismissed the lawsuit, and the Golden State remains safe for maternal celebrations. The California Court of Appeals pointed out that the Angels did not in fact intend to denigrate or disadvantage men; instead the team wanted, as Scripture admonishes and as loving children have done for millennia, to honor their mothers: “The intended discrimination,” the court insisted, “is not female versus male, but rather mothers versus the rest of the population.” The court further noted: “It is a biological fact that only women can be mothers. … [T]he Angels did not arbitrarily create this difference.”
In other words, it was not the Angels’ Mother’s Day celebration that discriminated against Michael Cohn. It was Mother Nature, and her policies are not subject to the court’s jurisdiction.
So far, Mother’s Day has survived legal challenge. But the zealous guardians of sexual equality have had success in other struggles against the menace of matriarchy, in particular the social and cultural scourge that is “Ladies’ Night.” In 1979, a student named Dennis Koire saw the ugly face of discrimination when he was excluded from a bar that admitted his female companion. Koire soon began to notice female chauvinism everywhere: Car washes offered women discounts on discriminatory “Ladies’ Days” and nightclubs waived cover charges for women. When Koire sought to assert his equal rights, not only was he rebuffed—he was ridiculed. “Come back when you’re wearing a skirt,” quipped one car wash manger. “So sue me,” dared a nightclub proprietor.
Koire did just that: With the help of the ACLU he took his complaint all the way to the California Supreme Court, which in 1985 held that “Ladies’ Nights” violated the state’s Unruh Civil Rights Act, which in dramatic and unequivocal language entitles anyone in the state to “full and equal accommodations, advantages, facilities, privileges, or services in all business establishments of every kind whatsoever.”
Koire’s lawsuit was the beginning of the end for ladies’ nights in America. In 1998 David Gillespie filed a complaint with the New Jersey Division of Civil Rights against the Coastline Restaurant, which waived a $5 admission charge and offered drink discounts exclusively to women on ladies’ night. The state sided with Gillespie in 2004 and dropped the gavel on ladies’ nights. In 2006 Stephen Horner sued a Denver nightclub over its ladies’ night policy. Horner explained his opposition to the unfair advantages women enjoy in American society: “Women are growing up these days feeling they’re entitled to favors. I believe this entitlement mentality is counterproductive to the social goals of a[n] egalitarian society.” He then added, apparently without irony: “I’m going to ask for every dollar I’m owed to the letter of the law, which is $500.”
In 2007 Todd Phillips, a lawyer specializing in gender bias, sued a Las Vegas gym that offered women a discount on initiation fees and a separate workout area. Courts in Iowa, Pennsylvania, Connecticut, and Hawaii have found that ladies’ nights and similar promotions or discounts are unlawful sex discrimination. And in 2007, the California Supreme Court reaffirmed its opposition to ladies’ nights, finding for lawyer Marc Angelucci of the National Coalition of Free Men—not a gang of Chicago-school libertarians but a “men’s rights” organization—in his lawsuit against a Southern California club that occasionally waived its $20 entrance fee to women. Angelucci was awarded $4,000 in damages for each violation. jJBn5U70girB9DNbBj_ZHMeh-L8vkn2Ym05tS054kN_MZsEpexR-vT2Xx25h1Kr2fvU199yq1C4kR2rWrPwKoEGizuu54ueQZ2B0z_oJNEqyL9Y7FVs
Although the law in several states apparently prohibits ladies’ nights, popular opinion echoes the approval of Kool and the Gang: It’s ladies’ night, and the feeling’s right.After New Jersey banned ladies’ nights in 2004, then-Gov. James McGreevey condemned the decision as ”bureaucratic nonsense” that “reflects a complete lack of common sense and good judgment.” (Attempts to amend New Jersey’s civil rights laws to allow ladies’ nights failed.*) A columnist in the National Review called the ruling “emblematic of the growing arrogance of a government caste that seeks to micromanage every aspect of American’s lives.” Liberals, meanwhile, complained that the decision distorted the true purpose of civil rights laws and diverted resources from real injustices. The less politically minded lamented the death of chivalry and a misguided step toward an androgynous culture.
In the Koire case in California in 1985, California Supreme Court Chief Justice Rose Bird insisted that “the legality of sex-based price discounts cannot depend on subjective value judgments about which types of sex-based distinctions are important or harmful.” On the legal Web site Findlaw, a lawyer compared ladies’ night to the racist contempt of apartheid and the Jim Crow era, insisting that “one act of discrimination does not cancel out another. … If a bar had a ‘Whites’ Night’ followed by a ‘Blacks’ Night’ no one would blink an eye before denouncing … each night.” George Washington University law professor John Banzhaf, who has encouraged his students to sue to stop ladies’ nights, argues that ladies’ night is in principle indistinguishable from discriminatory customs that denigrate women—that discrimination is discrimination. Using this kind of logic, offering your seat on the bus to a woman because of her sex is just as bad as making black people sit in the back of the bus because of their race.
Today most people agree that sexist rules and customs that keep women down and perpetuate stereotypes of female frailty, passivity, and incompetence should be prohibited in the workplace and expunged from the public sphere. But only a handful of extremists would extend laws against sex discrimination to forbid chivalry or ban a time-honored tradition like Mother’s Day or an innocent custom like ladies’ night.
Of course, read literally, without the mediating influence of good judgment or common sense, the laws that prohibit truly demeaning and invidious sex discrimination apply to ladies’ night promotions and the use of female sex as an expedient proxy for mothers in a Mother’s Day giveaway. Rights go wrong when propelled beyond the boundaries of good sense by abstract thinking. Justice Bird’s admonishment notwithstanding, legal prohibition must depend on judgments about which practices are important or harmful. Not every distinction—even if based on race or sex—is invidious.
Correction, Nov. 2, 2011: This article originally stated that New Jersey had amended its civil rights laws to allow Ladies’ Nights. It has not. (Return to the corrected sentence.)

When education isn’t a civil right: An excerpt from Richard Thompson’s Ford’s new book, Rights Gone Wrong
By Richard Thompson Ford | Posted Wednesday, Nov. 2, 2011, at 11:50 AM ET
| Posted Wednesday, Nov. 2, 2011, at 11:50 AM ET

Why it’s not always best to treat education as a civil right.eP2sjXWt0um3UJKt_d3Piy7oat4N0Z6uApPOaH_cv8dKgC7IKgXhnvW8Thp84HBzhkSzVDEqmibkrFNKQoCW7arUXLQTSV5DB9tQqC74JXaIxExyyAc
This is the second of three articles excerpted from Richard Ford’s new book, Rights Gone Wrong: How Law Corrupts the Struggle for Equality.
Tom Freston, who helped start MTV and was present at the creation of such timeless classics as Beavis and Butthead, earned a nice living as an entertainment executive. When he retired as head of Viacom in 2006, he received a $60 million severance package. So why, in the late 1990s, did he sue the city of New York to reimburse him for his son’s private-school tuition?
In 1995, after his son was diagnosed with ADHD, Freston enrolled him in the prestigious Stephen Gaynor School, which specializes in students with learning disabilities. Under the Individuals With Disabilities Education Act, if a school district receives federal funding, it must develop “specially designed instruction, at no cost to parents, to meet the unique needs of a child with a disability.” If the school district fails to provide a child with an “appropriate” education, the parents are legally entitled to tuition reimbursement for private schools.
New York agreed to compensate Freston in 1997 and 1998. In 1999 (annual tuition: $21,819), it offered Freston’s son a slot at a prestigious public school for students with disabilities. Freston declined. The district then declined to reimburse him. Freston then sued. For him, the case wasn’t about money—he donated his reimbursements to a tutoring program for public school children—but about the principle: He was fighting for the rights of all students with disabilities. From the district’s perspective, the case was about an abuse of the law by wealthy parents “who never intended to use the public schools.”
They both have a point. What the case shows most starkly, however, is the inadequacy of using civil rights law to improve the education of all students—both with and without disabilities.
One of the briefs filed on behalf of the city of New York complained that “[I]n one recent year, public schools spent over 20% of their general operating budgets on special education students. But, as a brief filed on behalf of Freston pointed out, most of that amount was spent on special education in publicschools—not on tuition reimbursement. Tuition reimbursement wasn’t a unique problem—it was just a dramatic example of the cost of special education generally.
Mark Kelman, my colleague at Stanford Law School, and Gillian Lester, now a professor at U.C.–Berkeley Law School, conducted an extensive study of learning disability claims in public schools and wrote a book about it. They visited a number of local school districts and talked to local school administrators, teachers, and parents to see how the disability rights laws worked in practice. Their conclusion: Treating the education of learning disabled children as a civil rights issue benefits rich families at the expense of the poor, and actually makes it harder to educate most students—disabled and nondisabled alike.
For nondisabled children, the problem is obvious: The law requires school districts to spend more—often a lot more—on costly special services reserved exclusively for children diagnosed with learning disabilities. This might make sense if the districts were awash in money, or if the special services were uniquely helpful to the children with learning disabilities, the way, say, Braille texts are uniquely helpful to the blind. But in fact, many of the special services the schools are required to provide for children with learning disabilities would benefit any child: smaller classes with better student- teacher ratios, one-on-one tutoring, immunity from discipline for disruptive behavior, extra time on exams.
Under IDEA, schools that fail to effectively educate disabled children can be made to pay for private school tuition. But the public schools—especially those in large cities like New York—are failing to educate many of their students who aren’t disabled, too. In 2004, more than 3 percent of all students served by the District of Columbia schools were in private placements, at a cost of 15 percent of the district’s entire budget. Yet D.C. schools “struggle to provide an adequate education to any of their students,” write two researchers at the Manhattan Institute. “Disabled students are entitled … to demand an adequate education,” they note, while nondisabled students “lack the same mechanism for exiting failing schools.”
It’s easy for parents to argue that public school classes don’t offer an adequate education to their learning disabled children when they don’t offer an adequate education to anyone. Contrary to the civil rights theory underlying the IDEA, disabled students who don’t receive an appropriate education aren’t necessarily being discriminated against—tragically, they’re often receiving the same (poor) quality education as everyone else.
The civil rights approach to special education also disserves many disabled children—especially those from poor and minority families. Special education under the IDEA can range from a reimbursement of expensive private school tuition to isolation in a dead-end class with “slow” children. Kelman and Lester worry that poor children typically receive very different treatment under IDEA mandates than do the children of wealthy parents, who have the wherewithal to pressure school districts for better and more costly options: “The IDEA system,” they write, “permit[s] relatively privileged white pupils to capture high-cost … in-class resources that others with similar educational deficits cannot obtain, while, at the same time, allowing disproportionate numbers of African-American and poor pupils to be shunted into [special ed] classes.”
There was even more reason to worry that the IDEA system benefited the rich at the expense of the poor in the case of demands for tuition reimbursement like Tom Freston’s, because only wealthy parents could afford to send their child to an expensive private school and sue for reimbursement later.
In 2009 students with learning disabilities accounted for almost half the entire population of disabled students receiving special services under the IDEA.
It’s no accident that the explosion of learning disability diagnoses comes at the same time the public schools are increasingly troubled by overcrowding, spotty teaching quality and violence. Given the state of many American public schools, who can blame parents for seeking private alternatives or trying to finagle extra resources for their children? While all students suffer from overcrowding and indifferent teaching, poor performers—whether diagnosed with disabilities or not—suffer most.
The parents of such students are right to insist that the schools are failing to help their children realize their potential, and failing them more dramatically than they are failing students who learn easily and without much help. In that sense poor schools are inherently discriminatory: They make any student who has difficultly learning—for whatever reason—worse off than students who learn easily.
The solution is obvious: better services for everyone. But IDEA doesn’t make the public schools better. Instead it shifts resources to a small fraction of the larger group of people who need them most. This might make some sense if that small fraction were especially injured by inadequate education, or if these students would uniquely profit from the extra resources. But if, as many educators believe, these children need the same things that any other student needs—good teaching in small classes—then it’s wrong to treat their needs as inalienable civil rights when we treat the needs of other students as luxuries that nearly bankrupt districts can’t afford.
At any rate, the IDEA doesn’t even try to find out whether children with learning disabilities get more out of extra resources than other children would. The law is premised on the unexamined conviction that some children should have more than others—regardless of whether they need it more, or will benefit more from it. All in the name of equality.

Are civil rights lawsuits still relevant? An excerpt from Richard Thompson Ford’s new book, Rights Gone Wrong
By Richard Thompson Ford | Posted Thursday, Nov. 3, 2011, at 10:18 AM ET
| Posted Thursday, Nov. 3, 2011, at 10:18 AM ET

Why civil rights lawsuits are becoming irrelevant in the fight for social justice.
This is the last of three articles adapted from Richard Ford’s new book, Rights Gone Wrong: How Law Corrupts the Struggle for Equality.
Since the 1960s, the ideas developed during the civil rights movement have dominated American race relations. Courts and governmental agencies enforce legal prohibitions against discrimination, and private businesses and universities follow suit, fashioning their own diversity policies. Even private individuals think about race relations in civil-rights terms: We aspire to the ideal of “colorblindness” and condemn the evils “discrimination” and “bias.” American civil rights legislation has been a model for other nations, and the American civil rights movement has inspired important struggles against injustice, such as the South African anti-apartheid movement and the international movement for gay rights.
For a long time this way of thinking made perfect sense. When it comes to outright discrimination and overt prejudice, civil rights have been an astonishing success. But today’s most serious social injustices aren’t caused by bias and bigotry. In the context of race, they stem from segregation—a legacy of past racism but not by and large the result of ongoing discrimination—and the many disadvantages that follow from living in isolated, economically depressed and crime-ridden neighborhoods. Civil rights litigation and activism have hardly made a dent in these formidable obstacles. In fact, civil rights thinking can distract attention from the real problems, emphasizing dramatic incidents that aren’t good examples of the larger injustices.
Civil rights haven’t been a panacea for the illness of social prejudice, but like a patient who keeps popping pills because the prescription isn’t working, we’re now at risk of an overdose. Civil rights litigation has exploded since the 1970s, far outpacing the growth in civil litigation generally. In 1991 the federal courts heard about 8,300 employment discrimination cases; in 2000 they heard more than 22,000. Civil rights laws, properly framed and limited, serve a vital social purpose, but too many civil rights can be as bad as too few, and an overly aggressive civil rights regime can be as destructive as an ineffectual one.REZahZ75bP9WzEssxIerwecG7jXDXPuWwmfDhLqyv1h2yCQUljrx7uJMUxh-34c9Tm8hLehvCmVhqOewDGt-i6ylliHEIs8u7Rou1AeVzYDNIqqIx6M
Civil rights litigation and activism don’t do enough to redress today’s most serious social injustices, many of which aren’t caused by overt prejudice or simple discrimination. Inner city blacks are more isolated from, and less likely to succeed in, the prosperous American mainstream than they were in the 1970s. Joblessness among blacks without a high school education is higher than at any time in American history: In 2004, 72 percent of black men who didn’t finish high school are unemployed, and more than half of inner city black men don’t finish high school. By the time they reach their mid-30s, roughly 60 percent of these young men will have been incarcerated. Women still earn about 75 cents for every dollar men earn for comparable work. The unemployed elderly are more likely to stay that way than younger job seekers, because of a complex set of economic and institutional factors. The disabled still lack the access to jobs, education, and public buildings—things that most of us take for granted. Gay men and lesbians face widespread hostility and contempt. These problems remain entrenched despite more than 40 years of comprehensive civil rights enforcement; numerous new civil rights laws at the federal, state, and local level extending entitlements to an increasing number of new groups; countless costly and acrimonious lawsuits; and the constant drumbeat of civil rights activism.
At the same time, opportunists and special interest lobbying groups have used civil rights laws to get an edge in competitive schools and job markets, demanding special privileges and even cold hard cash as a matter of civil rights. Civil rights laws prohibiting discrimination have been pressed to perverse and illogical extremes: Laws against sex discrimination are used to require coed public restrooms and outlaw “Ladies’ Nights” at singles bars; one litigant even sued to stop Mother’s Day. Cynical opportunists and reckless extremists on both the left and the right have hijacked civil rights, using them to gain personal advantage at public expense, to push radical schemes despite democratic opposition and in some cases, even to reverse and undermine the social justice goals civil rights were supposed to achieve.
It’s not just that civil rights laws are abused or taken too far: Some may be doing more harm than good. For instance, the 14 Amendment to the Constitution was enacted after emancipation, to ensure that newly freed slaves would have a chance at a decent and dignified life, and it has been one of the most important constitutional guarantees of equality for most of the 20 century, serving as the legal foundation of desegregation in 1954’s Brown v. Board of Education. But more recently the 14 Amendment guarantee of equal protection has stymied sensible, if controversial, efforts to correct racial inequality, in direct contravention of its historical purpose. Most dramatically, in 2007 the 14 Amendment was used to prevent racial integration in the public schools.
Civil rights have “occupied the field” of social justice, crowding out alternative ways of thinking and new solutions. It’s hard to think of a social cause that isn’t framed in terms of rights, and a growing number of social groups seek to define themselves as embattled or despised minorities in order to qualify for civil rights–style public sympathy, if not formal legal entitlements. Rights against discrimination on the basis of age, disability, sexual orientation, height, weight, and physical appearance followed hard on the heels of the right against race, sex, and religious discrimination created by the omnibus civil rights legislation of the 1960s. Civil rights are an important part of many social justice struggles, but they are subject to the law of diminishing returns. Rights can offer limited improvements in a narrow set of circumstances. But the effectiveness of the civil rights approach diminishes, and its costs increase, as it is applied to more novel, complex, and elusive social problems.
Those working for social justice all too often eschew the difficult and unpleasant task of popular persuasion, lured by the false hope of a short cut by way of judicially mandated civil rights. Even policy reform pursued through the democratic process often takes the form of new individual entitlements, following the lead of the Civil Rights Act of 1964. It’s now common to think of individual rights as the most effective way to attack injustice. Few remember that when the law was passed, enforcement by private individuals was a second-best compromise that the act’s strongest supporters thought risked making the new law ineffectual. In many ways, they were right: The most disadvantaged victims of America’s long-lived racial hierarchy, trapped in poverty-stricken ghettos and quarantined in prisons, have enjoyed few of the benefits of the civil rights legislation.
Meanwhile, what we could call “rights consciousness” occupies a larger part of our culture than ever before. Today the rights to life, liberty, and the pursuit of happiness seem almost quaint in a field crowded with novel and ambitious new rights. International human rights were developed as a response to torture and genocide, but they quickly expanded to guarantee a variety of substantive goods and social services, including housing, medical care, dignified employment, and cultural integrity. The Bill of Rights of the Constitution has inspired the Taxpayers’ Bill of Rights, the Airline Passenger’s Bill of Rights, the Consumer’s Bill of Rights (a telling reflection of our national priorities), and the Pizza Lover’s Bill of Rights (ditto). Each of these new rights is inspired by a laudable and important aspiration (with the exception of pizza). But is the language and logic of rights the best way to think through or address all these concerns? And what does it say about public confidence in political and economic institutions and our relationships with our fellow citizens that we pursue so many of our goals and imagine so much of our life in terms of formal entitlements?
Civil rights are remarkably effective against overt prejudice perpetrated by identifiable bigots. But they have proven impotent against today’s most severe social injustices, which involve covert and repressed prejudice or the innocent perpetuation of past prejudice. Like an overprescribed antibiotic that kills beneficial micro-organisms and eventually encourages resistant strains of bacteria, the civil rights approach to social justice, once a miracle cure, now threatens to do more harm than good.

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Must See: ‘Negro: A Docu-Series about Latino Identity’ | Clutch Magazine: The Digital Magazine for the Young , Contemporary Woman of Color

Posted by jcmaziquemd on November 21, 2011


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Posted by jcmaziquemd on November 17, 2011

Biomedical Science Careers Student Conference DescriptionThis conference is designed for postdoctoral fellows; medical, dental and graduate students; college and community college students; post-baccalaureates; and high school seniors and juniors
There are two objectives of the Biomedical Science Careers Student Conference. The primary objective is to provide over 800 African-American, Hispanic/Latino and American

Indian/Alaska Native students with an opportunity to network with advisors/role models from the basic and clinical sciences, medicine, public health, academic administration and the

private sector. These advisors/role models will encourage students to complete advanced studies, and provide concrete advice and information on available resources, professional

opportunities and career paths in biomedical science fields. The second objective is to enable student participants to meet, inspire and network with one another.

Student participants

should be seriously interested in or currently studying in biomedical, biotechnology and science-related fields, such as medicine, chemistry, physics, biology, nursing, dentistry,

pharmacy, biomedical engineering, biotechnology, physical therapy, public health, allied health or environmental science.

CAN BE REQUESTED AT LISE_KAYE AudienceHigh School, Community College, College, Medical School, Dental School, Graduate School, Post-Doc DateMar 31, 2012 Time7:30AM LocationThe Westin Hotel Copley Place Cost0 SponsorThe Biomedical Science Careers Program (BSCP) ContactAddressc/o Harvard Medical School – 164 Longwood Avenue Phone617.432.0552 Emaillise_kaye Fax617.432.3834 CityBoston StateMassachusetts ContactZip02115 RSVP Addressc/o Harvard Medical School – 164 Longwood Avenue RSVP Phone 617.432.0552 RSVP CityBoston RSVP StateMassachusetts RSVPZip02115 RSVPURLhttp://www.bscp.org RSVPDeadLineFeb 1, 2012

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Charles P. Pierce on the brutal truth about the crimes at Penn State – Grantland

Posted by jcmaziquemd on November 16, 2011


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10 Black Women Taking the Tech World by Storm | Clutch Magazine: The Digital Magazine for the Young, Contemporary Woman of Color

Posted by jcmaziquemd on November 16, 2011


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Are You Being Pimped By Your Pastor? | Clutch Magazine: The Digital Magazine for the Young, Contemporary Woman of Color

Posted by jcmaziquemd on November 16, 2011


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My Son Quoted In Time Magazine

Posted by jcmaziquemd on November 16, 2011

Can Doctors Have Work-Life Balance? Medical Students Discuss

By DR. ZACHARY F. MEISEL AND GINA SIDDIQUI Tuesday, November 15, 2011


If having work-life balance is important to you, then don’t become a doctor. That was Dr. Karen Sibert’s advice to students considering careers in medicine, in a controversial New York Times op-ed last summer. "You can’t have it all," Sibert wrote, exhorting students — women mostly — to remember that "medical education is a privilege, not an entitlement, and it confers a real moral obligation to serve."

If you want to work and be a mother, then you can find a job in journalism or professional cooking or law. But "if you want to be a doctor, be a doctor," wrote Sibert, an anesthesiologist, concluding: "Patients need doctors to take care of them. Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work."

Sibert’s piece likely sparked countless conversations — and moments of doubt — at medical schools around the country. Ours was no exception. In the wake of Sibert’s column, Gina Siddiqui, a medical student at University of Pennsylvania, where I teach, and I launched our own conversation about being a doctor-in-training and how doctors ultimately fit into the future of health care in the U.S. We recruited other students to participate, including second-years Alexandra Charrow, Derek Mazique and Ofole Mgbako.

What follows are excerpts of that roundtable conversation. Driving the debate was the question of whether being a doctor is in some way exceptional, more important to society than any other profession. I started the ball rolling thusly: "What do you guys think is your duty to society, and how do you feel it is different from that of your peers going into other fields? Should all doctors have to work full-time?"

The students’ responses:

Alexandra Charrow: Implicit in what you’re asking is the question of whether doctors are "special," so special that we should be required to work additional hours and so integral to society that we have additional duties. For the 60 or so years that physicians have been able to actually cure people there has been an increasing fetishization of the field. Numerous TV shows and movies romanticize the occupation, feeding into a belief that medicine is the grandest and noblest of professions. Medicine is not the only profession with the power and duty to save lives — air traffic controllers save lives every day. Yet how many shows are there about air traffic controllers? We are not alone in our unwavering responsibility, our duties, and our power.

Derek Mazique: The complexity of medicine, the physician shortage, and the rise of managed care almost guarantee that physicians are no longer the only decision-makers in the room. So now, I think physicians are decidedly "less special." Are they skilled and necessary for the average consumer? Yes, but so is their accountant.

Ofole Mgbako: Through my experiences with people living with HIV, I realized that the way people readily share the most intimate details of their lives and entrust their bodies with physicians is unlike any other profession. Each interaction with a patient is based on an unspoken covenant, a belief that the doctor not only will do no harm, but also will try to relieve suffering. I believe this basic, universal interaction between patient and physician engenders a greater responsibility on the part of physicians. It is difficult to speak to how much this dynamic sets us apart from the teachers, the lawyers, the scientists, the politicians. However, this dynamic does set us apart to some degree.

Regardless of how much more "exceptional" doctors may be — indeed, Sibert’s original argument was that doctors not only play a special role in society, but also that there are necessarily too few of them to justify any of us choosing to be a part-time doctor — our student moderator, Gina Siddiqui, concluded that forcing physicians to work longer isn’t necessarily the right answer. "I don’t know if it’s feeling special or a strong sense of duty or what, but on balance, I think most doctors will choose to work more, and coercing more hours out of those that don’t is unlikely to do much good for patients," Siddiqui says. "For the record, I think everyone should think his or her job is special, just like every mom should think her kid is special."

Given the students’ debate, I wondered further whether their views on the exceptionalism of doctors — and on the importance of work-life balance — were affecting their choice of specialty, particularly in light of the deepening primary care physician shortage. I asked them: "Do salary and lifestyle play a role?"

Their responses:

D.M.: Both my parents are in primary care, and seeing them practice has been a powerful example of how the field has changed. Perhaps most telling for me is how the current primary care situation is a perfect storm of low reimbursement and doctor burnout. Both of my parents have had to increase the number of patients they see — for my mother who is in private practice, that’s the only way she can keep the lights on. I didn’t go into medicine in order to emerge as a strictly lifestyle physician … but I did go into medicine expecting to forge meaningful relationships with my patients and to perform my intellectual craft to the utmost. Primary care in its current iteration makes these goals seem even more difficult. Of course, money is a factor, but these expectations of a personally fulfilling medical career also steer my decision-making process.

A.C.: Personally, I recognize the pressure and fear … that either my family values or career choices will have to change. I often meet physicians who tell me it’s possible to have both a family and a career, but for the most part, they are men with wives who have made the tough decision to work part-time for them. The women I have met have painted a more pragmatic picture — you can have what you want, just not all of it.

D.M.: All of us have been fixated on the profession, the role of lifestyle when picking a specialty, and our own particular experiences as medical students. But at the end of the day, our concern for the patient should be paramount, and it’s also worth exploring the effects that these choices will have on them. If a surgeon spends less time in the operating room, will he or she show a greater error rate and will more patients be harmed? If doctors work shorter shifts and hand off patients more, will discontinuity of care lead to a spike in adverse drug events and complications?

A.C.: This reminds me of the arguments hashed out concerning reduced residency work hours. Certainly there are many who still claim an 80-hour max workweek has reduced quality of care. However, others would argue that extra sleep, spending time with family, and eating regularly make up for reduced hours. I imagine that at some number of hours of experience, the quality of care reaches a plateau. With people working well into their 60s, 70s, and 80s, perhaps it is better to allow physicians to slow the rate at which they accumulate expertise in order to make their lifelong commitments to their specialty more sustainable. If doctors are able to fulfill other life obligations early in their career, they might be willing to stay in the profession longer, allowing society many years to benefit from a skilled physician’s services.

O.M.: What’s interesting to me is the tension between being a balanced, content physician who explores his or her interests outside of medicine and being an extremely driven workaholic who gives up family time and other hobbies in order to be engrossed by work. Thus, in addition to the monetary concerns Derek brought up, I think more medical students will be drawn to specialties that allow them the flexibility to explore other aspects of themselves in addition to medicine: in addition to [being] future doctors, my peers are journalists, writers, musicians, entrepreneurs and engineers.

As a teacher of medicine, I was inspired and not a little bit relieved that the students in our program had given so much thought to their training and the way their own values were shaping their decisions as up-and-coming physicians. But the question remained, How does the role of the individual doctor fit into the greater context of American health?

Our student moderator concluded with another shrewd observation about the state of our country’s health: that our well-being is bound largely to our environment, and not only to the quality or quantity of the health care we receive. "Looking back on our discussion, I am struck by how the increasing sophistication of medicine hasn’t made a single one of us feel a greater sense of control over health outcomes," Siddiqui says. "The more we learn about the causes of disease, the more interrelated we realize our work is with farmers, urban planners and school counselors. In this environment, our aspirations to heal are bound less to our office hours and more to the communities we cannot afford to be strangers to."

I am not surprised that the students pushed back against Sibert’s essay. This discussion could have easily become about self-determination and the right to determine the shape of one’s own career. But, instead, these students challenged Sibert by using humility and introspection — which bodes well for their future patients.

Dr. Meisel is a practicing emergency physician and assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania. He is medical editor of the LDI Health Economist from the Leonard Davis Institute of Health Economics. Follow him on Twitter at @zacharymeisel.

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Read more: http://healthland.time.com/2011/11/15/can-doctors-have-work-life-balance-medical-students-discuss/print/#ixzz1dqptQv9s

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