Tuesday, April 09, 2013

            Malcolm Gladwell has written four books that I have enjoyed very much.  Blink, What the Dog Saw, The Tipping Point, and Outliers.   The books are collections of interesting interviews and factoids, many of which have been published in the New Yorker Magazine.  In the book Outliers, he discussed the 10,000 hours.  Based on the research of Anders Ericsson, he demonstrates that excellence in a field of endeavor requires 10,000 hours of dedicated and directed practice.  Merely working in a field may not contribute to the requisite total because it may not be practice involving self-analysis and improvement.  While there are prodigies and recognizing that 10,000 hours is not an absolute guarantee of world class quality, it is borne out in many examples in life.   In the working world, labor unions certify their workers in the various steps of a trade working as an apprentice for 3-5 years under a master, as a journeyman for another 4 or 5 years, and finally as a master.   (This applies to electricians.  I cannot speak with absolute knowledge about other trades.)  Working 200-8 hour days in a year is 1600 hours.  If all that working were practice, it would equal 10,000 hours in 6.25 years. Given that it is not all practice, 10 years to become a master is about right.  In my own field of orthodontics, having completed 4 years of college, 4 of dental school, and 2 more of residency qualifies one to be an orthodontist, but says little of expertise.  Many years of further study and self-evaluation in every step of treatment decidedly increases the quality of the care one can deliver.  Fresh out of school with little experience, the quality of results may be good, but not great consistently. After 25 years of practice as an orthodontist, I still have challenging cases, but I can much more quickly and competently see what needs to be done at each stage, and perform the treatment.  Recognizing this as a problem, when my son joined my practice, he and I saw every patient together for the first 18 months, and still see the same patients and evaluate each other’s treatment daily.  Orthodontics does not generally carry life and death consequences, but you can see why a general surgery residency is 5 years long with specialty fellowships after that.  It takes a while to become an “expert” level provider.  That is why Consumer Reports recommends you find out about your doctor’s training and experience and track record as a provider.  Accept only the best and let the learners and those who are not motivated to self-improvement practice on someone else.