Can you expand on this?

"Arguably future patients might gain from having better trained doctors, but I think this wildly overestimates the usefulness of the medical education system."

OK, so I know medical education isn't perfect, but if modafinil gives you four extra hours a day, couldn't the med schools just cram more information into those four hours? So if a med student normally works 12 hours a day, with moda they could work 16 (or 15 if they wanted an extra hour to relax), so med school could be completed in 3/4ths or 4/5ths of the time which means more doctors therefore lower prices. So you get a decent benefit in terms of quantity and I don't see why you couldn't get an increase in quality as well.

I also don't see the point of you claim:

"The same is true of executives. Now modafinil no longer means an easy promotion. Now all the executives start taking modafinil, and everyone has the same chance of getting promoted as before"

Everybody does have the same chance, but the company is more productive because everyone is working longer hours and getting more done. The company may not choose to pay their workers more for being more productive but somebody will benefit from that increased productivity.

Lastly:

"If suddenly days magically get four more hours in them, then the work week will shoot up to 60 hours and stay there."

This is quite a claim. Did coffee cause a similar extension in weekly hours worked? It might be true of a limited subset of existing businesses but I don't think that they will universally adopt it. It won't affect people who are paid by the hour and many companies today don't have time clocks or other devices to make sure you work at least 40 hours, they just want to be sure that you're getting your work done and assume it will take you around 40 hours.

Yay! More doctors and lower prices! This might work in a sane economy, but the bottleneck in training doctors has nothing to do with time length of medical school and everything to do with residency being so expensive that it has to be subsidized by Congress which Congress prefers not to do. Don't tell me that there are ten million much better systems that would allow that bottleneck to be removed; I already know that. But absent one of those ten million much better systems, merely having people complete medical school more quickly is not going to ease the doctor shortage. Having people complete residency more quickly might, but residents already stay up all night, and anyway it might not since a lot of the bottleneck there is number of patients seen which is not working-hour dependent.

I am also very skeptical that our economy would allow the shortening of medical school even if it were profitable. Has it ever seemed suspicious to you that every single college major, from Latin to Art History to Mathematics to Organic Chemistry, takes exactly four years? That there's no "cram" medical school that gets it done in three, or "relaxing" medical school that gets it done in five? I don't know whether it's about federal regulations or just a Schelling point, but I find it unlikely that it would change. (does this contradict my belief that the work week would change? Maybe, except that it's in the interests of those in power to change the work week)

"Everybody does have the same chance, but the company is more productive because everyone is working longer hours and getting more done. The company may not choose to pay their workers more for being more productive but somebody will benefit from that increased productivity."

I agree. Obviously here I was talking solely about the loss of advantage to the executives themselves. The company itself can do one of a few things. First, it can keep the executives it has and hopefully be more productive with them; that would require that the marginal benefit of executive work is greater than zero, of which I am suspicious. Second, it can fire some executives and either raise profits or cut prices or both; I think either result ends up in the "slightly more positional goods" trap I mentioned.

"This is quite a claim. Did coffee cause a similar extension in weekly hours worked? It might be true of a limited subset of existing businesses but I don't think that they will universally adopt it. It won't affect people who are paid by the hour and many companies today don't have time clocks or other devices to make sure you work at least 40 hours, they just want to be sure that you're getting your work done and assume it will take you around 40 hours."

Coffee doesn't actually work. People build tolerance to it; their non-coffee baseline decreases and their with-coffee productivity becomes no greater than non-coffee drinkers. The same thing might or might not happen with modafinil.

The companies that don't have time clocks sound like amazing places to work, although from my own anecdotal experience they are not the norm. However, if they found that everyone was completing their work really easily with time to spare, there is no conceivable economic reality in which they say "Okay, wonderful, enjoy your free afternoon". They'd either fire some of the workers and redistribute their work to the rest until working hours were the same as before with greater productivity, or if the company had room to expand they'd just assign every worker some extra workload.

Edited at 2012-10-01 03:41 am (UTC)

So wouldn't residents benefit more from Modafinil than anybody else then? Wouldn't the increase in accidents caused by new rounds of residents decrease if they weren't so sleep deprived? I don't see how you can argue that four additional hours a day won't offer some improvement in people learning/training to be doctors. You can argue that the effect is marginal, but there has to be an effect unless the medical establishment is completely incompetent.

As for every college major taking four years, that's simply not correct. Aside from the fact that most colleges are only in session for less than half the calendar year, there's double/triple majors and people taking extra courses during the semester and classes during the summer. There exist computer degree programs where you can get a Bacherlor's in 2.5 years, pharmacy degrees (which don't require a Bachelor's to get) take 5-8 years to complete. So the time to complete medical school could change, but schools are often slow to embrace change.

I doubt your claim that the marginal benefit of executive work is greater than zero (you don't give it any support). You also don't address the promotions which are not to an executive position (which I'd imagine is the majority of them). As for companies choosing to fire executives, why would they do that if their company is growing? You seem to be hijacked by the "managers are evil and incompetent and only care about the bottom line" meme.

Do you have a citation for your coffee claim? A brief google search reveals arguments both supporting and refuting it so it's not clear to me which side is true. There do exist genetic difference in caffeine metabolism so perhaps that plays a role in how coffee effects productivity.

As for companies and how they track time, I've had over twenty jobs and I've only punched a time clock at one of them. A few others have requested I submit hours but many of them haven't tracked time at all. I have been let out of work early on occasion because there was no more work to do. To say:

"there is no conceivable economic reality in which they say "Okay, wonderful, enjoy your free afternoon"."

is completely ridiculous, there exist many conceivable economic realities where this is true and some workers (generally the most skilled and intelligent) exist in those realities. If your company is doing well (which many companies, especially when not in a recession) and there isn't work to be done (this happens, not often but it does happen) then keeping employees around is bad policy because they'll just be bored, and firing them is worse policy because they've been doing a good job and firing competent workers is bad for moral, so a competent manager will let them go. Again, I think you've been hijacked by a "managers are evil and incompetent" meme.

"So wouldn't residents benefit more from Modafinil than anybody..."

Yes, residents might benefit from modafinil (many use it already). That's a bit different from the claim that it would help increase the doctor supply.

Also, careful with those clauses like "unless the medical establishment is completely incompetent" or you might get another blog post :)

"As for every college major taking four years, that's simply not correct...."

I think you're agreeing with me, not disagreeing. You agree that it's possible to double-major or triple-major in four years, meaning that in theory it should be possible to single-major it 2 or 1.33 years. But no prestigious college does this. You can get technical degrees in that amount of time, but not a degree from Harvard or the sort of places most really want to go. As you say, schools are slow to embrace change. But this makes me think the limiting factor to getting your degree quicker isn't the absence of modafinil, it's the attitude of the schools.

"I doubt your claim that the marginal benefit of executive work is greater than zero..."

That's an interesting term - the "managers are evil and incompetent and only care about the bottom line meme". I don't believe managers are evil or incompetent. I totally believe they only care about the bottom line. That's their job and I don't hold it against them. Yes, in an emerging market where the business can keep expanding indefinitely, they would keep those extra executives on. In any other situation, they are no longer useful and can be fired to cut costs

For example, suppose a company has 20 executives earning $100K/year doing 20 executives worth of work for a total budget of $2M/year. They are perfectly happy with this and have no plans to hire, say, ten extra executives because they'd have no work for them to do. Then each executive suddenly becomes 50% more productive. Now they effectively have 30 executives worth of work. But we already agreed they don't need 30 executives. So they can fire 6 executives, still get their 20 executives worth of work done, and only pay $1.4M/year, saving $600K. Your rosy-eyed hope that they could find more work for those six executives because they are expanding is contradicted by them not being in the market for 10 extra executives to begin with. Yes, a sentimental manager might choose to keep the executives on without any work for them to do even though she loses $600K by it, just because she likes them. But very few managers are that sentimental and the ones who are eventually are driven out of business by managers who earn their company $600K more.

Obviously the same applies to non-executives.

"Do you have a citation for your coffee claim..."

It sounds like you've already found citations supporting it, and want ones that conclusively counter-refute the ones against it. I don't have one of those. I was offering this as a possible explanation for why coffee doesn't increase the work week.

"As for companies and how they track time..."

If you are anything like you were when I knew you at college, I bet you end up at pretty atypical jobs :)

I agree that some managers who don't behave as proper economical agents will purely out of sentiment let employers out early. This works only in inefficient markets. In an efficient market, if one company has a sentimental manager who lets an employee out having done 10 units of work, and another company has a nonsentimental manager who realizes that in the time the employee is contracted for they can do 15 units of work for the same pay, then the nonsentimental manager will drive the sentimental manager out of business by having 150% the productivity for the same labor costs.

I deny your assertion that I have been hijacked by anti-manager memes and counter-assert that you haven't fully absorbed how markets operate (or, more charitably, you're hoping that all markets are inefficient and full of sentimental people, which holds true in some areas but not in others, and less and less so as time goes on.)

I do, however, admit that I was understating the case for the possible usefulness of modafinil.

Edited at 2012-10-01 04:58 am (UTC)

I did my undergrad work at Cal Poly, which is admittedly less prestigious than Harvard or Stanford, but is probably near the top of the second prestige tier for undergraduate engineering schools.

It took me just over three years to get my BS in Computer Science, which is near-optimal within the official standard policies. I probably could have gotten through faster had I been more diligent in seeking exceptions to the policies in the form of testing out of more classes and getting waivers for maximum course loads.

Has it ever seemed suspicious to you that every single college major, from Latin to Art History to Mathematics to Organic Chemistry, takes exactly four years? That there's no "cram" medical school that gets it done in three, or "relaxing" medical school that gets it done in five?

These schools exist. They're the same ones that normally take four years to get through; you just schedule a different number of courses than the standard curriculum calls for.

This might work in a sane economy, but the bottleneck in training doctors has nothing to do with time length of medical school and everything to do with residency being so expensive that it has to be subsidized by Congress which Congress prefers not to do.

Why is residency so expensive? If running a residency program is a net loss before public subsidies, that implies to me that residents have negative net productivity. I'd expect ubiquitous use of Modafinil by med students and residents to improve resident productivity in two ways: 1) they learn more from classroom instruction, and thus enter residency with a higher skill level, and 2) they are capable of working long and irregular shifts during residency with less productivity loss due to stress and fatigue. Improve resident productivity significantly, and for any given level of public subsidies, the market-clearing number of residency slots should increase.