21 August 2026

Your Doctor Spent Four Years Learning Things Google Knows

Here's the case against today's argument, upfront: medical training is not just a knowledge download. Doctors learn to talk to frightened people. They learn what it feels like to be wrong when the stakes are high. They learn to notice the thing the patient didn't mention. A lot of that only comes from doing it, badly, under supervision, many times. If your complaint is just "they memorised a lot of stuff," you're not describing medical school fully.

Okay. Now here's the thing I can't stop thinking about.

In the UK, becoming a doctor costs around £70,000–£90,000 in tuition and living costs over five years, if you're paying full fees around £100,000 in tuition and living costs over five years for a home student on capped fees. An international student paying genuine full fees pays ~~£51,961 a year at Edinburgh1, which is £250,000 or more in tuition alone across the degree.~~ around £36,300 a year at Edinburgh for the clinical years, which is roughly £190,000–£220,000 in tuition alone across the six-year degree. The struck sentence described neither, and home students are precisely the ones not paying full fees. In the US, it's worse — medical school alone averages over $200,000. Then you do years of residency, paid barely above minimum wage on about $68,000 in the first year2, which is four and a half times annualised federal minimum wage3. Set against the eighty-hour week the rules permit4 it comes to roughly $16 an hour, which is the honest version of the point and a weaker one.

Who can absorb that? People whose families can loan them money, or who are comfortable taking on debts that would make most people's hands shake. The knowledge barrier and the money barrier have been tied together so long we've stopped seeing them as separate things.

Here's the question: when you make someone prove they can survive a decade of financial punishment before they're allowed to treat patients, are you filtering for good doctors? Or are you filtering for people with a particular relationship to money and risk?

Medicine loves to say its barriers exist for patient safety. Some of them do. The licensing requirements that ensure someone has actually practised on real patients before operating alone — that's about safety. The requirement to memorise the entire British National Formulary before you're allowed to prescribe — in a world where every phone has the BNF on it — is that still about safety? No such requirement exists, and this post invented it. The Prescribing Safety Assessment, the national UK prescribing exam, is deliberately open book: candidates have the BNF in front of them while they sit it. The GMC's Outcomes for Graduates requires the opposite of memorising, asking that a doctor can access reliable information about medicines and use the tools that support prescribing. The example was doing all the work in this paragraph and it was made up. Or is that a scarcity artefact: a test born when you couldn't look it up, that outlived the looking-up problem?

A 2018 study in JAMA found that doctors from lower-income backgrounds were more likely to practise in underserved areas. No such study was found. Searches of the journal and of Europe PMC turned up nothing matching it. Related work exists on rural origin and on race, and a 2023 JAMA paper looks at what medical students say they intend to do, but none of it is the citation given here. A journal and a year attached to a claim that cannot be traced is worse than no citation at all, because it borrows the authority without earning it. The places that most need doctors are least likely to get them partly because the route to becoming a doctor was designed, over decades, in ways that quietly selected against people who grew up in those places.

This is the pattern I keep finding. The test is defended as a principle — patient safety, professional standards — but it was born as a price. The price made sense when information was scarce and errors were uncatchable. Now information isn't scarce and many errors are catchable in real time. The test stayed.

I'm not saying anyone should operate on you after a weekend course. I'm saying: there are probably twenty things inside medical training that are genuinely about safety, and another forty that are about something else — tradition, status, keeping the numbers manageable — and we've never been asked to sort them out loud.

The people best placed to do the sorting are the ones already inside. They have the most to lose from an honest answer.

That's not a conspiracy. It's just how incentives work.