1134: Equal Opportunity or Equal Outcome?

Imagine two different doctors: Dr A and Dr B, both of whom are doing their residency training in ophthalmology.

Dr A is very driven and diligent, spending many hours a week in the wet lab practicing to improve dexterity under the microscope. Dr A also prepares the night before surgery, reviewing the important points (and learning from videos) before attempting a newer procedure or dealing with a challenging case. During the surgery Dr A asks the attending for pointers to keep improving and then after the procedure, Dr A then studies the video from the case determining what could be improved. Dr A also tracks the surgical times in the operating room to see if there is needless waste and inefficiency. And every surgical day, Dr A looks to get better and better.

Dr B is certainly very smart and was also selected to be a resident in this highly competitive program. Dr B figures that the residency program will provide the necessary education and training and therefore not much extra effort is required outside of that. Dr B would rather not spend time in the wet lab and decides that the attending will teach the important techniques during the case, so minimal preparation is required ahead of time. Dr B does not keep track of surgical times and does not bother to video record the cases performed. Dr B aims to be a competent doctor and figures that with time the skillset will naturally improve.

These two doctors will have a different experience during residency and their level of skill will not likely be the same upon graduation. Given the same number of operating room days, Dr A will do more cases and more challenging cases than Dr B. Should we then penalize Dr A and give more time to Dr B so that they can both end up with the same number of cases? Should these doctors have an equal opportunity or should we force an equal outcome? Call me old fashioned, but I still believe in merit!

click to learn from my take on this topic and also to see if residents should do femto: