The other question that is rarely asked, is why isn't much more of the training and services restricted to physicians expanded to other professionals? That is, it's not just "why aren't there more physicians?" but also "why do we need a physician for X?"
There are lots of provider types who could easily expand their scope of practice with additional training, and who are currently prepared to do so. The AMA lobbies heavily against any attempts to do so all the time, every year. Pharmacists, PAs, dentists, optometrists, psychologists, nurses, ... the list goes on and on. Every year they lobby heavily to just have the opportunity to offer more services, and more services independently, the AMA fights back against it in lobbying, and politicians respond to it.
The crisis in some ways highlights how absurd this is. Right now I know of many med schools whose in-class training is about 1.5 years, and some are trying to make that 1 year. The rest is studying for licensing exams and clerkships. Now many of these schools are graduating them early to help with the pandemic.
Compare that with PAs, who often are required to have substantial medical clinical experience before starting their programs. Then they do... 1.5 years of coursework and about .5 years of clerkships before going on and then... practicing under the supervision of an MD. So, then, what's the difference between a new MD and a PA with an extra 1.5-2 years of supervised experience, especially given that extra 1.5-2 years of experience is probably more independent than what the med student gets?
The current model is absurd, and at some level I have no sympathy for complaints that hospitals are understaffed right now. This is solely the fault of the AMA and their lobbies at some level. Many services could be offloaded onto other providers, who could easily expand the scope of what they offer, especially in the middle of a public health crisis per se. There could also be a much greater diversity of training routes than undergrad -> MD -> specialty (just for example, undergrad -> specialty doctoral/professional degree -> expanded training).
Not saying that to be snarky, just saying there's a bit of survivorship bias involved in this story, as well as positive feedback loops in society in general. People with the same ability to be an ER physician who don't have RadioShack CEO on their application will not be seen the same, even if they're equally able.
The list of faulty of outright fraudulent experiments done in any number of fields, especially the biomedical sciences, also grows ever longer, but it it seems this argument is hardly ever leveled here. It's well-established now that these problems exist in other fields, such as immunology, oncology, and other fields. Even closely related fields, such as the neurosciences, have been shown to be full of improbable and unreplicable findings, and many neuroimaging results are not interpretable in the way that claims are made of them.
Theranos anyone?
Every field should be looked at with caution until the perverse incentives that currently exist in academics are addressed.
What I see instead is a bias in certain physical sciences to think that somehow experiential phenomena are less rigorous because they don't fit the mold of those sciences as much. The systems are more complex and different metaphysically, so their legitimacy is questioned. This is somehow still happening even as developments in fields like quantum physics and AI are leading many very competent scholars to question basic assumptions about the nature of experience and consciousness vis-a-vis physically observable phenomena.
The irony of the Rosenhan study is that Rosenhan was putting forth exactly the same arguments as you, that psychiatry lacks rigor because it's too subject to the whims of subjectivity. So when this paper is shown to have been a fraud (even though it was dismissed in the field for many other reasons, but overall because it was unscientific) it is evidence that psychology is unrigorous? When it is not widely known to be a fraud per se, it is cited as evidence that psychology is unrigorous as well? It seems there's no way to win: the critics of the field cite this work as evidence of lack of rigor, and then when it's shown to be fraudulent, it's also shown as lack of rigor.
The even greater irony is that many of these fraudulent studies are being identified by... you guessed it, psychologists. I would go so far as to say no field has done more for the scientific study of science than psychology. Meta-analysis has its birthplace in psychology, and all these discussions of replicability ultimately flow from psychology as a field. If anything, psychology is among the only ones to be open about these issues and to take them seriously. In many other fields, they're swept under the rug, and questioners are attacked with arrogant hostility and accusations of incompetence.
To me, though, a better analogy is assuming that because one has a detailed map of the sewer system of NYC, we now understand where we're going in Berlin, or Barcelona, or Vancouver, or that that level of detail is necessary to understand the economics of poverty or pollution. That wouldn't work for city planning and I don't know why people assumes it works for neural architecture either.
Similar tricks can be played with the human brain, things we have been able to do for decades, while people are undergoing brain surgery, and now later, with TMS. However, being able to elicit limb movements or bits of speech, or even emotional qualia is different from having a dynamic understanding of the brain in vivo in everyday life.
Certainly having an understanding of detailed circuitry is interesting and important, but to me there's a forest for the trees problem.
I had a similar reaction, working in an adjunct field but as someone who often works with neuroscientists.
My impression is that there's a lot of very oversimplified assumptions being made all the time in these fields that get glossed over in very arrogant (or naive?) ways. It's really astonishing to me, not just because of how oversimplified the assumptions are but because researchers are then surprised things don't work out.
To be fair, this is true of other fields as well. I'm more familiar with molecular genetics and genomics, and the same things happen there. There seems to be a certain hubris that goes unquestioned, and it always amazes me, the sci-fi fantasy narrative being accepted as fact.
Just to take one thing for example: there's huge anatomical differences between people's brains even at the macroscopic level, that just get glossed over in discussion. Those fMRI images you see? They're often done by aligning different images to a common map, just assuming individuals' brains are carbon copies of one another. Now you're going to try to delineate a connectome at the neural level, as if there is one connectome at that level?
When will everyone learn? Where's the public skepticism?
There are lots of provider types who could easily expand their scope of practice with additional training, and who are currently prepared to do so. The AMA lobbies heavily against any attempts to do so all the time, every year. Pharmacists, PAs, dentists, optometrists, psychologists, nurses, ... the list goes on and on. Every year they lobby heavily to just have the opportunity to offer more services, and more services independently, the AMA fights back against it in lobbying, and politicians respond to it.
The crisis in some ways highlights how absurd this is. Right now I know of many med schools whose in-class training is about 1.5 years, and some are trying to make that 1 year. The rest is studying for licensing exams and clerkships. Now many of these schools are graduating them early to help with the pandemic.
Compare that with PAs, who often are required to have substantial medical clinical experience before starting their programs. Then they do... 1.5 years of coursework and about .5 years of clerkships before going on and then... practicing under the supervision of an MD. So, then, what's the difference between a new MD and a PA with an extra 1.5-2 years of supervised experience, especially given that extra 1.5-2 years of experience is probably more independent than what the med student gets?
The current model is absurd, and at some level I have no sympathy for complaints that hospitals are understaffed right now. This is solely the fault of the AMA and their lobbies at some level. Many services could be offloaded onto other providers, who could easily expand the scope of what they offer, especially in the middle of a public health crisis per se. There could also be a much greater diversity of training routes than undergrad -> MD -> specialty (just for example, undergrad -> specialty doctoral/professional degree -> expanded training).