Friday, October 21, 2011

Personal Accountability and Opportunity in the U.S.

The death of Steve Jobs has been discussed for several days. He apparently regretted his decision to postpone surgery for his surgically curable uncommon type of pancreatic cancer choosing “alternative medicine” instead. But another aspect of his life also caught my attention.

Steve Jobs was, to use a quaint term no longer in vogue, an “illegitimate” child. He was given up for adoption. He was raised in a middle class home in California and dropped out of college after one semester. He was poor for a while but worked hard and became a very successful man.

This got me thinking about other people who made the most of their lot in life.

When I was running a surgical residency, every year it seems I interviewed at least one applicant to my program who had this sort of story.

My parents fled Viet Nam in 1974. I arrived in the US at the age of 15 and spoke no English. My parents worked several jobs and I went to high school. At age 21, I graduated from college with honors and a degree in physics. I scored a 31 [good score] on my MCAT and was accepted at six medical schools. I scored in the 230s [good score] on my USMLE exams, Parts I and II.

These applicants got good grades in medical school and had excellent letters of recommendation. They often did extracurricular projects resulting in published research.

Why am I telling you this?

I get tired of hearing people whining about the lack of opportunity in this country. How is it that a kid from Southeast Asia who couldn’t even speak English when he got here can be so successful? Yet people who are born and raised here can’t see any possible avenue to success. It must be the government’s fault, Wall Street’s fault or someone else’s fault.

I don't get it. Can you explain?


Anonymous said...

That argument is of the form "the world is fair because people who clearly deserve Nobel Prizes get Nobel Prizes." While we consider that a meritocracy is a fair society we forget that the outcome is that people who are deemed nonmeritorious sink to the bottom.

So, is it correct to say the world is fair because students who obviously outperform are chosen by those in power? Or, is it laziness to say "Hey, you got good scores and brown-nosed effectively. How's about kissing up to me for a while?" Which sounds more like "Der, I chuse gude 'cuz USMLE smarter den me 'n make my job eazee".

Skeptical Scalpel said...


I do not understand your comment. Should I choose under-performing applicants to be surgeons?

Anonymous said...

While I tend to agree with you, a lot of the OWSers will reply to this argument that not everyone is born with the same set of talents to be able to make it from nothing. Additionally there are a lot of people who work just as hard and never have the same opportunity.

Thousands of examples where people worked for decades for a company extremely hard and got laid off, people who have done everything they were 'supposed' to do in life by getting undergraduate or graduate or law degrees whose paths have dead ended.

Skeptical Scalpel said...

@a different Anonymous (obviously)

Thanks for the comments. You can't tell me that someone who is born and raised in the US doesn't have the same opportunity as a kid from Vietnam. I understand that some may not possess the same degree of intelligence as others, but hard work usually pays off. I'm afraid you will not get any sympathy from me regarding lawyers. There are way too many. It's been in all the media that there are no lawyer jobs. Then don't go to law school. It reminds me of the women's studies majors who are shocked, shocked to find that they have no marketable skills.

//.amanda.eleven. said...

When you are born here in the U.S. and have never had to truly work or see someone dear to your heart work non-stop just to make barely enough to sustain a family, then it's hard to find the drive to succeed. At least, that's what I think. Not to say that everyone falls into the "I-won't-work-hard" category, but a number of people do.

Pam said...

It is pretty obvious to me why children of immigrants (especially refugees) are more likely to succeed in this country than children born in slums where gangs and drug use are prevalent.

But what does Steve Jobs have in common with a Vietnamese immigrant? Let's say he hadn't been put up for adoption and was raised in poverty. Do you think he still would have started Apple? Not likely.

Additionally, lawyers aside, there are millions of people who have worked hard their whole lives and gotten laid off or lost their retirement money in the last five years. They're not whining about a lack of opportunity, they're justifiably angry about the way the financial system works in this country. So am I! You saw Inside Job!

I am very far away and haven't been able to closely follow OWS, but I find it hard to believe that you don't think they have a point. They may not have a strategy or a clear goal, but they do have a point. Things are bad and they have to change.

Anonymous said...

It's very easy to try and simplify something as complex as the human experience in a culture as complex and diverse as America. Isn't that what we are talking about after all? The human experience; the American experience. It is human nature to feel strong positive emotions about a story where someone (your med student, for example) overcomes adversity and becomes successful. However, for every one of these stories, there are thousands where the outcome is different; that's why we call it beating the odds; that's why it feels so good. Which makes me want to ask: how are we defining success in America? American culture is obsessed with fortune and fame, just look at the slew of reality TV shows (American Idol; The Amazing Race; Extremen Makeover (home or body); Who Wants to be a Millionaire? etc.) where the goal is to become rich. Another example are the lotteries. I believe the reason we are obsessed with fortune and fame (and keep in mind fame is merely a path to fortune) is because of the growing income disparity between the wealthiest Americans (1%) and the rest of us (99%). The OWS movement is not about, my neighbor is a millionaire so I deserve to be one too. No, it is about the growing income disparity in this country. It is about the shrinking middle class. It is about the game being rigged by the 1% who every continue to consolidate more and more of the economic power. There is a word for this - oligarchy. We are in very dangerous territory, and we better change things if we don't want a full blown revolution in this country.

Skeptical Scalpel said...

I didn't say OWS didn't have a point. I agree that Wall Street has screwed up our economy. And I can't believe that Obama appointed the same people to run the economy. Yes, I did see "Inside Job."

I don't hear any constructive solutions. Things like asking for a minimum wage of $20/hour are ridiculous and undermine the credibility of the movement. (It's on their website even though they say they don't necessarily endorse it.) Same with people holding signs that say things like "I spent 7 years in college and can't find a job."

Vickie said...

"Admin note: This is not an official list of demands. This is a forum post submitted by a single user and hyped by irresponsible news/commentary agencies like Fox News and This content was not published by the collective, nor was it ever proposed or agreed to on a consensus basis with the NYC General Assembly. There is NO official list of demands."

That seems pretty clear that it is one guy's idea. He started some conversations, but it is far from a movement consensus. It's not fair to focus on that one list.

This sounds pretty good to me: "While we encourage the participation of autonomous working groups, no single person or group has the authority to make demands on behalf of general assemblies around the world.

We are our demands. This #ows movement is about empowering communities to form their own general assemblies, to fight back against the tyranny of the 1%. Our collective struggles cannot be co-opted." -Posted on their website yesterday

Skeptical Scalpel said...

If they don't endorse the post about the minimum wage, why is it displayed as if it was official?

maureen helbig said...

I love your story about the surgical resident application, but I think the point of the OWS is more about frustration.
I don't think that anyone can say that you can't succeed in this country of ours, you can, we did. My mother was an immigrant and loved this country and succeeded in the best way possible, she had a loving family.
She was not greedy... The motive for most of the people in charge is ...more.... more money, more power, more people seeing things only their way , and a very narrow way that is.
And It is not about hating rich people, it is about fairness, mutual respect, and integrity... I remarked a week or so ago about the inequity of my primary care doc getting $37 dollars in reimbursement (plus my $20 co pay) for a yearly physical, when a trip to the nail salon is easily $50.
As you can see it is still bugging me... These are the reimbursements dictated by private insurers who I can tell you are making a heck of a lot more than $37 for their input into our society. So it comes back to why are their protests ... it comes back to the reason for all other protests , something is wrong (in the past, woman's rights, civil rights, taxes too high, wars that are killing out soldiers, etc...) It is the beauty of our democracy... we have the right to protest and so glad we do.
Now onto Steve Jobs... He eventually had the whipple... I have never known anyone to survive more than 5 years after a whipple, and I mean known, I have 3 friends ranging in age from 38-77 who died within 3 years post whipple.
Steve Jobs made the mistake of not taking the establishment seriously, used some alternative stuff, but I don't believe any of that shortened his life. He had a huge ego, was gifted with his ability to make technology accessible to us, for that I am grateful. I don't think his death should be used as a statement on alternative therapies. It is a narrow scope to only see things one way....

Skeptical Scalpel said...

Jobs did not have the usual and more lethal type of pancreatic cancer. He had a neuroendocrine tumor that would have probably been curable with surgery.

Regarding your OWS comments, I don't disagree that Wall Street people are greedy. What I don't like is the assertion that there is no opportunity in the US.

maureen helbig said...

Responding to your comments about my comments. The greed is not just about Wall Street.
Steve Jobs did have the surgery and died.

Skeptical Scalpel said...

Yes, he died but he didn't have the surgery in a timely way. He waited 9 months after the diagnosis was made while he underwent "alternative" therapies. If he had had the surgery sooner, he might have survived.

Anonymous said...

You give two pieces of anecdotal evidence and then generalise this to all of society - that's where you're wrong. Your straw man picture does not reflect reality and so is not suitable for obtaining insights.

I agree with previous commenters that there must be plenty of opportunities in the US, but by far not enough for everyone. Few can make it and succeed, but most can't. If every medical student performed like the one you mention - would there be excellent jobs for all of them?

Skeptical Scalpel said...

As a matter of fact, there would be jobs for every medical student, even ones who aren't high-performing. We currently have to allow thousands of foreign MDs to fill training positions ever year.

There is a major shortage of physicians projected for the next 20-30 years. There will not be enough general surgeons, among many other types of specialists. See

Anonymous said...

Scalpel, I have doubts about the projections of "shortages". There are other corporate motivations for the marketing of "shortages". MDs are just a little late into those realizations.

About your immigrant student. Remember too that for many years there were corporate write-off incentives as well as government "good-will" incentives to promote talented immigrants in the edu system. I do now know of several I've met over the years not just in medicine. Many were just the kids of immigrants who were very american actually and just did a little research on how to get a free ride. This was true of people I've met in both careers. They are very honest and open about how easy it was. Some said once they did the paperwork and the interviewing, all they needed to do was show up at those little dinners once a year and put on a bit of accent...

This is not true in every case of course, but opportunity is just that. Immigrants are not ignorant to an opportunity to "play the game" whether already stateside or planning on coming over ASAP. The failure to understand that they are just as high functioning as anybody in that way is ridiculous.


maureen helbig said...

"And I can't believe that Obama appointed the same people to run the economy." I missed this... I agree!!!!! Yeah....

Anonymous said...

Skeptical Scalpel, you've made the error of relying on too small a sample size. When you consider statistics on a national scale (i.e. it seems utterly incomprehensible to me that any intelligent and intellectually honest person could come to the conclusions you apparently have.

The world you grew up in doesn't exist any more as the previous link and this article (,_graphic_data_that_shows_exactly_what_motivates_the_occupy_movement_/?page=entire) point out.
"In 1970 the top 100 CEOs earned $45 for every $1 earned by the average worker. By 2006, the ratio climbed to an obscene 1,723 to one." You have worked in a high-paying profession during this entire time period if I'm not mistaken.

Would you honestly have us believe that wouldn't feel nervous about the current economic situation if you suddenly lost your job, your savings, and your medical insurance?

Obviously there are opportunities for a few exceptional people. I suspect that this will always be the case, no matter how bad conditions are. The real question is whether there are enough opportunities for the average person.

Skeptical Scalpel said...

Good comments. Thanks. I'm nervous about the economy and I still have a job. I am as appalled about CEO salaries as anyone. I'm unhappy about the bank bailouts. I don't see how they helped me or any other non-banker.

I'm not an economist. I looked at your links but I'm not sure how accurate they are. Regrettably, no leader has emerged to challenge the status quo. So what's the next step?

Kellie (General Surgeon) said...

I was one of the people who grew up poor. One of the things that appalls me is the fact that one of the things that some of the folks running for public office or who are in public office want to decrease/get rid of is guaranteed loans and grants for college. Not sure if I would have or could have been able to go to college without the grants. I am still paying back student loans for med school. I had to get loans for living on as well as for tuition. Grand total was "only" about 75K, but cannot imagine how I would pay back the loans that kids going to med school have to pay now. I didn't have a car or live anywhere fancy and I had a roommate.

I was lucky. I had three things that many people who grew up where I did didn't. I had supportive (emotionally as they couldn't financially support me) parents, drive and luckily intelligence enough to get into med school.

SO many people don't have that. These are the people who used to work in manufacturing and made a decent living.

One of the things that does anger me is the people who think they have to have the new car and big house even before they've figured out how to pay a bill.

Skeptical Scalpel said...


Thanks for the comment. Well said.

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