Major Surgery - limits to abolishing specialization

[MarxSchmarx]

I have been reading up a bit on the practice of surgery methodology of late, and have been thinking how all this falls under the question of specialization.

This is a classic problem that I feel the left has never compellingly addressed. A lot of orthopedic and brain surgery is in fact incredibly rote, but also it is one of those fields where there is a strong case for intensive study and years of specialization and division of labor. I mean, on some level, if someone were sawing through my skull, I'd kinda want somebody who really knows what they're doing - and my threshold for expertise would be much higher than somebody who, say, programs my video games.

Should there be exemptions for some fields, like surgery, from something like a "four months in the office, four months in the field, four months in the factory" routine?

I grant that 99.9% of jobs out there do not require specialized knowledge. And that roughly holds for a lot of medical fields currently practiced by MDs. But with most major surgery, the evidence appears overwhelming that the more you do it, the better you get at it.

So is it really practical, or even optimal, from a patient care perspective, to let surgeons be as casual about their practice as, say, bicycle assemblers or computer programmers will be in a post-capitalist world? How do we justify taking years out of a person's life (and that, I've concluded, is realistically what it takes) to make somebody a decent surgeon? How do you think a post-capitalist economy appropriately renumerate and ensure such people are available?

[MrCool]

So is it really practical, or even optimal, from a patient care perspective, to let surgeons be as casual about their practice as, say, bicycle assemblers or computer programmers will be in a post-capitalist world?

I'd say it depends on the specializisation of the surgeon. If all one does is stitch up wounds in the emergency room, they can be more casual than someone who would be performing brain surgery.


How do we justify taking years out of a person's life (and that, I've concluded, is realistically what it takes) to make somebody a decent surgeon?

We're not taking away many years from a person's life, they themself deside to do so. (If they want to be good at it.)

[Jimmie Higgins]

Especially in the near-term after a revolution there are going to be many positions that can't easily or instantly be brought into a more socialized method of labor distribution. This is why I think a period of worker's rule will be necessary. This is also why I think that before and during a revolutionary period, once the working class has been able to develop its own organizations and movement with a high degree of general working class support, it needs to work on drawing non-workers towards working class hegemony: convincing sections of the petty-bourgeois to side with the worker's movement over the status-quo. Allies who run family businesses or farms will be helpful (and these small businesses that operate in working class communities have been won over to our side even during strike waves and other periods of heightened class struggle) and professionals can be convinced that they will be more able to be a good doctor or craftsman under worker's power. Some professionals like corrections officers or many lawyers or advertising designer will just not be able to be appealed to except on a sort of individual basis because a revolution would probably cause them to loose their position, but I think many doctors and even surgeons and engineers and so on will side with us just on the basis that a worker's rule will be more rational and healthy than the chaos and uncertainty and violence of capitalist rule.

But with general worker's hegemony in society, and with most relations brought under democratic and socialist methods, the necessity of a few specialized positions such as skilled engineers and surgeons will not be enough to undo the vast majority of collective and worker-run positions. A surgeon who is highly skilled might even get more compensation or benefits depending on the need and the availability of people with these skills, but they would still have to report to some kind of democratic "board" of the hospital workers and possibly some community input, just as today surgeons have to answer to an undemocratic bureaucratic hospital board with some lawyer input.

Eventually the availability of education or improvements in technology may reduce the need for some specialists, but until then I don't think it would be a problem as long as the vast majority of society is firmly in the hands of the working class.

[ckaihatsu]

Specialization goes well beyond the readily apparent 'special skill' definition -- it's really a whole *paradigm* unto itself, and hooks into the broadest questions of society and civilization.

Taking surgery as an example -- who's to say that that's the *only*, best intervention for treating a particular ailment for a particular person? I don't mean to get into a technical *medical* discussion here, but rather to say that, as a treatment, it's what's socially called-for according to current medical norms, for certain conditions.

Taking it "up a level", would a revolutionary society view *medicine* and ailments and disease in exactly the same ways as we do today? Perhaps *that* paradigm would change as well as the material-manufacturing one, which is much easier to see as being prone to a paradigm shift.

Our *political* concern with specialization should always be the power it implicitly corrals as a part of its claim to exclusivity. "You got a sharp pain in your head that won't go away after you've taken all kinds of drugs? Here, I'm the one you need to listen to about this, and I'll tell you exactly what you need to do."

I'm obviously dramatizing this, and I don't mean to be dismissive of actual medical science -- but at the same time *any* claim to specialization, no matter the field, is a kind of 'instant monopolization' that will *automatically* attract power-obsessed egocentrics like flies.

The more that general and best-practice knowledge can be disseminated out to everyone, the better off society will be since more people will be capable and ready to present well-informed challenges and objections to spurious claims made on the basis of 'specialization'.

As things are now we're suffering under a claim to specialization over the comprehensive administration of the world's society -- that claim is that the only way it can be done is through the institution of private property and market relations. The more we can challenge this claim and present an alternative, feasible method for the same, but better, the more we are able to cut away at any "objective" basis to that claim, no matter how "natural" and "timeless" it may feel because of being the prevailing status quo.

[campesino]

Should there be exemptions for some fields, like surgery, from something like a "four months in the office, four months in the field, four months in the factory" routine?


I don't think that is how it will be, farmers will farm when they can farm. so will factory workers. If there is no work they might produce something else. brain surgeon will perform brain surgery when need, but when there is no need for brain surgery, they will probably be going around giving preventive care and doing research on new medical technology/techniques/medicine aiming to create a healthier world.

How will we ensure there will be brain surgeons? well we recognize and develop the talents of people who would make excellent brain surgeon/carpenters/teachers etc. and tell them they can put their talent to great use and help fellow human beings. Hopefully they choose the vocation that best suits their desires and talents.

[ckaihatsu]

I don't think that is how it will be, farmers will farm when they can farm. so will factory workers. If there is no work they might produce something else. brain surgeon will perform brain surgery when need, but when there is no need for brain surgery, they will probably be going around giving preventive care and doing research on new medical technology/techniques/medicine aiming to create a healthier world.

How will we ensure there will be brain surgeons? well we recognize and develop the talents of people who would make excellent brain surgeon/carpenters/teachers etc. and tell them they can put their talent to great use and help fellow human beings. Hopefully they choose the vocation that best suits their desires and talents.


Doesn't this just encourage specialization -- ?








[...]

Hayes pins the blame on an unlikely suspect: meritocracy. We thought we would just simply pick out the best and raise them to the top, but once they got there they inevitably used their privilege to entrench themselves and their kids. Opening up the elite to more efficient competition didn’t make things more fair, it just legitimated a more intense scramble. The result was an arms race among the elite, pushing all of them to embrace the most unscrupulous forms of cheating and fraud to secure their coveted positions.

elite power accumulated in one sector can be traded for elite power in another: a regulator can become a bank VP, a modern TV host can use their stardom to become a bestselling author. This creates a unitary elite, detached from the bulk of society, yet at the same time even more insecure.

[...]




The Following 3 Users Say Thank You to cyu For This Useful Post:

campesino, ckaihatsu, Lynx

[campesino]

@ckaihatsu
what is wrong with specialization, if there is no private property?

[Teacher]

I don't think specialization and division of labor is as awful a thing as some of these economic models like parecon suggest. Specialization is efficient, we want it. I think there are ways to have the benefits of efficiency without creating a privileged strata of workers.

I think socially people are probably more concerned with everyone having access to quality medical care than whether or not doctors are being forced to clean toilets or work on a farm. Besides, it isn't as if doing surgery all day is exactly easy work.

However, I think that a socialist society would have a lot of doctors per capita, which would probably mean that doctors could be made to help clean toilets and whatnot without sacrificing anyone's medical care.

[ckaihatsu]

@ckaihatsu
what is wrong with specialization, if there is no private property?


The smallest act of displacing a needed task onto another is an action of validated specialization. This isn't to say that it's right or wrong, but rather that, whether the other knows it or not, they have just been granted a particular political dispensation as a result of the labor not being done "in-house". This is irrespective of any given societal mode of production in operation.








[I]t may happen to be the case that what they're producing is also needed or wanted by much *greater* numbers of people, and that it would be good if those liberated laborers could work for a *week* or longer to satisfy the requirements of that larger pool of people. Upon hearing of it those liberated laborers might very well *hesitate* and be *reluctant* to give up so much of their time and effort just so others could get some new items. They could very well call for some kind of an *arrangement* to be made so that they are materially *compensated* for the specialized role that they are committing to.

According to this proposed model the liberated-labor *service* performed to produce freely available -- pre-planned -- assets, resources, or goods, could be compensated with a certain rate of labor credits per hour, from those who have an interest in a certain kind of production taking place:

http://www.revleft.com/vb/blog.php?b=11269

[ckaihatsu]

@ckaihatsu
what is wrong with specialization, if there is no private property?


I addressed this at another thread fairly recently:








[I want] to make plain the objective dynamic of a societal 'blind spot' -- if mass public opinion is negligent on a particular social matter that is *materially* important then whoever *does* tend to it will automatically be 'specialized', or 'a specialist', by default, and will gain disproportionately as a result of it not being readily addressed at a broader scale.

If a certain segment of *labor* takes up the slack then it leads either to a kind of labor black-market, where the surrounding sector of that economics becomes overvalued and artificially dangerous as a result of being illicit, or to a *glorified* sector of labor, as with many specialized professions.

If a certain segment of *administration* takes up the slack then it leads to a kind of bureaucratic elitism, or Stalinism, as a result of the power vacuum not being addressed on a *mass* basis.

[NewLeft]

I don't think specialization and division of labor is as awful a thing as some of these economic models like parecon suggest. Specialization is efficient, we want it. I think there are ways to have the benefits of efficiency without creating a privileged strata of workers.

I think socially people are probably more concerned with everyone having access to quality medical care than whether or not doctors are being forced to clean toilets or work on a farm. Besides, it isn't as if doing surgery all day is exactly easy work.
Parecon is obsessed with creating balanced jobs to the degree that it's undesirable. The task of a surgeon could be split and even the amount of schooling could be reduced to only what is necessary. It's really the training part that is important.