>There is a contradiction that might operate [pun] under socialism
(or any regime) as well as under current capitalism. The survival
rate of surgical patients in a hospital is in more or less direct
proportion to the number of that type of surgery performed in
a given hospital. The reasons for this bear out Gar's argument
that "there are quite a few other types work which save
lives within the medical profession," but in an uncomfortable
way. The more times a surgical team performs an operation,
the higher its success ratio. This means that one has to choose
between (a) overworked medical teams or (b) lower rate
of survival of patients.
The evidence for this is less than overwhelming. I've seen the studies you are talking about -- and they are not between teams which do a particular operation 4 hours a day 4 days a week and teams which do a particular operation 12 hours a day, 6 days a week. The studies compare teams which do particular operations regularly with those who do them once in a blue moon. In short we are not talking bell curves here, but simply comparing experienced labor to inexperienced labor.
This leads us to Yoshies question -- of how labor would be divided in socialist society. We have no ultimate answer -- but the question here is specific enough that we can come up with an answer that MAY be useful.
To start with specialization would not be eliminated. Nor would be specialization within the profession be eliminated. So you would still have people trained as heart specialists, nephroologists etc -- and also those trained in the more generalized medical skills (internists,endrocrinologists, family practicioners -- all of which are every bit as vital as the super-specialists.)
But anyone training in one of these "elite" sets of skills would also be trained in one of the "lower" skills -- practical nursing, technician etc....
Of course this means that some of the people our society trains to do nothing change bed pans would have to be given a full medical education -- but this is a bad thing only if we assume that this was the only potential they had, or the one they most wanted to use. If Medical training was left unchanged this would also extend the time required to train greatly -- but at least one year of current medical training for a doctor is essentially an exercise in sleep deprivation, rather than true education. Its primary purpose is to build loyalty to the medical profession -- one of the purposes boot camp servers in the military. By eliminating the "boot camp" aspect of residency, medical training, even with an additional skill, would take no longer than now.
Once the doctor was full trained and had completed residency and internship, then work would split betweeen thet two specialities , giving plenty of practice in both.
Incidentally, surgery is not the biggest life saver in medicine. In spite of it's abuse, antibotics, and simple treatments by Family practicioners, and doctors of Internal medicine, plus the simpler surgeries -- just as treatment of broken bones probably save more lives than all the heart specialists etc. put together.
And as someone who took care of a critically ill family member who was under a specialists care for six months -- I can tell you that Nursing is as vital as specialists care. A specialist may spend a half an hour once every couple of weeks with a desperartely ill patient. It is the nurse who changes the blankets, feeds the patient who sees changes in symptom. A nurse diagnosed my late fathers cancer weeks before any doctor could confirm it. (This incidentally is something we are about to lose. In the name of efficiency, feeding, changing of bed clothes etc. is being delegated to people without nursing training -- leaving nurses to do strictly 'medical' tasks which will greatly reduce the quality of patient care.) I have talked to several talkers, including some specialists who argree that if doctors spent half their time as nurses, nurses half their time as doctors -- both skills would improve. The nurse whose practical knowledge enabled her to diagnose a cancer before a doctor could lacked the formal training that would have allowed her to confirm the diagnoses. The doctor, who was trained only as a nephrologist, and who had practiced as such for 12 years lacked the ability the nurse had to recognize cancer from the "cancer pallor" of my fathers skin, and from other subtler symptoms she could not describe to me.
I'm going to away from email for two weeks -- and won't have time to read the lbo-backlog once I return. So please copy me in personally on any replies you make, and want a response to. (lipowg at sprintmail.com) . The response will obviously be in a couple of weeks, not immediate.
Thanks
Gar W. Lipow