"“On average, female physicians complete medical training at age 31, and the age when most women doctors first give birth is 32, compared with 27 for nonphysicians, according to a 2021 study.” I've seen it argued that US medical training is longer than it really needs to be, I don't know enough about the field to have a useful opinion on that...but there are a lot of other fields in which the demand for educational credentials and hence for years of schooling is all out of proportion to the true need for and value of those credentials.
The typical medical education/career timeline in the US makes things difficult. The "typical" is something like 4 yrs college + 4 yrs med school + 3-7 yrs residency/fellowships depending on your specialty. Some places offer combined undergrad-MD programs that are six years. But I'm not sure you can chop off more than 2 years. Perhaps medical school could be shortened to 3 years but there are other difficulties with that and almost certainly unintended downstream effects. Tough problem for medicine in particular I think. But yes in general credentialism is totally out of control.
In theory we could come up with all kinds of medical training timelines that are more optimal than what we have in the US today. All with their own particular tradeoffs. The hard part is that inertia, entrenched interests, regulations of all kinds, etc etc will make that very difficult I think.
Another area where some years could be shaved off is by switching to vocational degrees.
For example, in Germany many degrees in the medical field (e.g. nursing, optometry, hearing aid technicians) used to be awarded as vocational degrees.
While there has been a trend to turn these degrees into university degrees (I think mainly for political reasons, Germany has a very low rate of people with academic degrees, as many practitioners do just fine with vocational degrees), you can still become a nurse through a 3 year program right after middle school at age of 16.
There is no tuition in vocational schools, instead students do receive salaries and get on-the-job training.
After the program, a nurse can enter the workforce at the age of 19, when a nursing student might just start to go to college. This leaves a couple of years to gain professional experience, save some money, etc. before starting a family.
As you said we need a multi-pronged approach which almost certainly includes cultural change and increased status granted to the parents of large families. But also, as you highlight we already know that there's lots of couples who want more kids and are struggling to have them due to oocyte age... so why not start by at least making it easier for those couples to have more babies. Many of the women who wait the longest to have kids are intelligent and ambitious and in good marriages (because they waited to find the right partner) and we definitely want those couples having more kids. And as you say (and as I mentioned in my post as well), convincing those women to have kids in their 20s will be very, very tough without other changes (like the decreased training time for high-status careers that you suggest). I just want to reiterate once more that supporting egg freezing does not imply a lack of support for other fertility increasing policies including those that make it more attractive for young couples to have kids - I got a lot of responses that I think mistakenly assumed these things are zero sum. But I support both things, and agree with you that the marginal babies born as a result of an egg freezing program couldn't easily be shifted to being born to a younger mom.
Consider a plan for embryos as well. There are a million frozen embryos on the shelf at any given time. Many are discarded despite other options like embryo adoption.
All kinds of reasons. People can choose embryos and also get pregnant with them via IVF. I recommend googling it to learn more. Also check out NRFA.org
This is a very interesting thought. I wonder about the genetic quality of existing embryos. On the one hand side, I would expect these to be embryos of successful career women, on the other hand, embryos are probably preserved towards the end of the fertile life of a woman.
Of course, this would only work if the reason more women aren’t pursuing this option now is cost rather than the desire to have a genetically-related child.
I tend to think cost isn’t the biggest issue. Women who delay childbearing for career reasons at least tend to be pretty well off. For partner reasons might be more mixed …
Good piece! I'm doubtful about Robin's point: “We should thus be willing to pay up to these huge amounts up front to induce the birth and raising-to-adulthood of a single child who would then pay average levels of future taxes to repay this debt.” The fact that the economy adds up huge debts per person due to profligate government spending does not justify adding to it! Am I missing something?
Yes. But not at the cost of throwing really huge amounts of money at people! It's way better than paying people to dig ditches (Keynes) but the deficit is already vast. If Robin is right, it would pay back eventually but that would take at least a quarter century.
I imagine it depends on how well you can convince the bond markets that it will pay off. If the bond markets think that the policy will improve your long run fiscal position, then they will be willing to effectively subsidise the program in the meantime and share in the future rewards when the children are grown and paying taxes. In that scenario everyone's a winner.
Just the usual risk with any deficit expansion that it spooks markets. I don't think that's too much of a concern in the US though, but definitely very applicable for a.lot of other developed countries.
It's a lot cheaper for a government to increase population by bringing in adult immigrants than it is to for that same government to try to increase the birth rate and then pay for 18+ years of public education. 😈
I wouldn't have recommended we get so far in debt, but once we have then that makes an opportunity for kids to be a direct profitable strategy for a state in such debt. The state could borrow the money to pay for this strategy, and investors would be willing to fund that, as they'd see the money would in fact get paid back via the kids taxes.
The more debt matters, but is acceptable if it pays for enough to pay it back. Just as it is more acceptable to borrow on a house to pay for a room addition.
Rather than using government, which always has bad side effects, why not enable a mechanism by which individuals can voluntarily invest in other people's children? That should be workable if such an investment would truly pay off.
The simple private solution is to let parents endow their kids with debt or equity obligations, and then sell those to pay for parenting costs. It is the fact that few are willing to allow this that forces us to consider a second best option of having the state do a similar thing.
Wondering: are there any validated algorithms that would give a woman a personalized estimate of her current and projected fertility, considering factors such as age, various health conditions, health history, etc? Seems like it might be useful
I don't think anyone would want to hear their number.
It is much more convenient to read about some random actress becoming a happy mom at 50, while people understandably keep quiet about the sorrow and humiliation of their failed IVF treatments.
The numbers would be pretty bad for many. If we look at the cumulative graphs on this page https://en.wikipedia.org/wiki/Age_and_female_fertility , surprisingly many women will already have problems conceiving in their late 20s.
I don't have the reference on hand, but I remember reading that individual eggs already have a chromosomal defect rate of around 90% at a woman's age of 30.
Normally this doesn't go too well to bring up these points in a discussion, people are really in denial about their biology, and it goes against anything else that we recommend the younger generation. See also Sheryl Sandberg's quote in my other comment.
I fully agree with you, we need a massive culture shift about the topic, and we should be much more open about the biological realities of life.
Most women (and men, too!) love babies. Just look at how the maternal instincts are switched on when a woman looks at a child. It's totally natural, and nothing to be ashamed of.
And yet, public discourse is dominated not by how we can achieve what we secretly desire, but by mentally deranged activists projecting their personal problems onto others.
Hardly a week goes by without yet another "regretting motherhood" article in the newspaper, or yet another article praising yet another strong independent women, who postponed having children, all to work at some soulless corporation that would get rid of her without blinking an eye.
In the meantime, my friends secretly confess how they regret not having had children, or how their last IVF failed again.
I cannot imagine the pain these poor women are going through, insurance only pays for a certain number of tries, and the treatment is tremendously expensive and humiliating.
I once overheard an older woman gloating over how today's women could easily have children way into their 40s. She was shocked when I told her how small the chances are in reality.
On the other hand, the moment I talk about these numbers, I immediately get accused of wanting to subjugate women into the role of societies breeding stock, like one of Elfriede Jelinek's male villains.
This vocal minority is derailing any conversation about the realities of life, and is deliberately setting up people to stay childless. We seriously need some better biology education.
There are companies that offer egg freezing for their employees and few take it up.
Going through IVF is unpleasant. Even if free, most people will only do it if there is some concrete reason to (they are planning to have kids in the near future with their husband). It’s a hard sell to say “go through this unpleasant medical procedure in case you’re still alone until your late 30s.”
I don’t disagree with the proposal, but the biggest issue is that women don’t want to do it even when it’s free.
So the doctor devotes her 20s and 30s to her career and then begins a family at age 40.
Her daughter, whose life is a testimony to the wisdom of her mother, does the same thing, and thus the grandmother meets her first grandchild at age 80.
In the next generation, grandparents are holograms only.
--------
I just happened upon your site and have spent the morning reading it (and following many of the links). You are more entertaining than many of your fellow technopoptimists.
As to organ markets, it's so easy to imagine a pitiless world where part of financial planning is deciding when to sell off a kidney (as a normal obligation for down-payment on a first home?) with the sale of a lung scheduled for the beginning of retirement.
Maybe use that techno-optimism toward growing replacement organs in the lab? (as a placeholder until you guys figure out immortality)
------
But yeah, thanks for writing. I'll keep reading.
P.S. I'm not sure why everyone is worried about population decline. Seems like human population is still on a upswing.
I am very much in favor of being able to sell kidneys. The marginal benefit of the first functioning kidney is a lot higher than the second. I also believe that Iran has a functioning market in donated kidneys and the sky hasn't fallen there.
Very interesting post! My first concern with this suggestion is if it could end up having an adverse effect on fertility by encouraging people to take risks with their fertility. You largely answer that by showing that young eggs are the solution! But I wonder if it's Still missing that, in terms of ameliorating population ageing, the number that ultimately matters is the reproductive rate per unit time - encouraging people to have kids into their 40s may still be an issue in terms of creating younger generations in time to support ageing ones.
I've long believed that making egg-freezing affordable, safe, and effective would improve gender relations by a huge margin because it would effectively sync up men and women's timetable on not only family and career, but even casual dating. With so much of the gender wars predicated on dating grievances, a world where one gender isn't trying to hurry or slow down the other in matters of love and sex would be a less embittered one. Women won't feel like men are wasting their most fertile years, and men won't feel that women are trying to lock them down too soon.
Women have the power in their 20s and don't want to settle for boring men when they can casually date fun guys instead, to quote Sheryl Sandberg:
"When looking for a life partner, my advice to women is date all of them: the bad boys, the cool boys, the commitment-phobic boys, the crazy boys. But do not marry them. The things that make the bad boys sexy do not make them good husbands. When it comes time to settle down, find someone who wants an equal partner. Someone who thinks women should be smart, opinionated and ambitious. Someone who values fairness and expects or, even better, wants to do his share in the home. These men exist and, trust me, over time, nothing is sexier.” ― Sheryl Sandberg, Lean In: Women, Work, and the Will to Lead
On the other hand, in their 30s, men have the upper hand, and they have no interest in settling down with older women on a schedule, when they can instead have fun. There is an interesting discussion on men's view here, the tenor of which is "I'm not a dating retirement home. I won't be the guy she falls back on.": https://old.reddit.com/r/AskMen/comments/27szuq/what_do_you_think_of_ceo_sheryl_sandbergs_advice/
Social freezing would instead make the situation worse: it would further encourage casual dating for women and attractive men (i.e. above average men in their 20s and most men in their 30s). Both would have even less reasons to settle down.
Sandberg's comments are definitely narcissistic in that she doesn't seem to quite grasp why that would not be appealing for most men, to be the "dating retirement home." Of course she has the right to selfishly pursue her own interests, but to openly say that and have this attitude of "Why can't you (men) just be happy for us?" shows the deep rot of that kind of girlboss feminism.
Anyway, my hope with the egg-freezing is that if women have to get their fun of their system in their 20s, then men will have their chance in their 30s. Meanwhile, 30-something women won't feel the pressure of the biological clock anymore, thanks to egg-freezing. And by the time both men and women are in their late 30s or even 40s, both will have gotten bored of the "fun" phase and are ready to settle down, now with their timelines synced.
"“On average, female physicians complete medical training at age 31, and the age when most women doctors first give birth is 32, compared with 27 for nonphysicians, according to a 2021 study.” I've seen it argued that US medical training is longer than it really needs to be, I don't know enough about the field to have a useful opinion on that...but there are a lot of other fields in which the demand for educational credentials and hence for years of schooling is all out of proportion to the true need for and value of those credentials.
The typical medical education/career timeline in the US makes things difficult. The "typical" is something like 4 yrs college + 4 yrs med school + 3-7 yrs residency/fellowships depending on your specialty. Some places offer combined undergrad-MD programs that are six years. But I'm not sure you can chop off more than 2 years. Perhaps medical school could be shortened to 3 years but there are other difficulties with that and almost certainly unintended downstream effects. Tough problem for medicine in particular I think. But yes in general credentialism is totally out of control.
I don’t know if it would be that hard. Med school is only 6 years in Europe and I’m not sure doctors here are worse
In theory we could come up with all kinds of medical training timelines that are more optimal than what we have in the US today. All with their own particular tradeoffs. The hard part is that inertia, entrenched interests, regulations of all kinds, etc etc will make that very difficult I think.
yes see here https://www.richardhanania.com/p/critical-age-theory?utm_source=profile&utm_medium=reader2
Another area where some years could be shaved off is by switching to vocational degrees.
For example, in Germany many degrees in the medical field (e.g. nursing, optometry, hearing aid technicians) used to be awarded as vocational degrees.
While there has been a trend to turn these degrees into university degrees (I think mainly for political reasons, Germany has a very low rate of people with academic degrees, as many practitioners do just fine with vocational degrees), you can still become a nurse through a 3 year program right after middle school at age of 16.
There is no tuition in vocational schools, instead students do receive salaries and get on-the-job training.
After the program, a nurse can enter the workforce at the age of 19, when a nursing student might just start to go to college. This leaves a couple of years to gain professional experience, save some money, etc. before starting a family.
Great post and thank you for the plug!
As you said we need a multi-pronged approach which almost certainly includes cultural change and increased status granted to the parents of large families. But also, as you highlight we already know that there's lots of couples who want more kids and are struggling to have them due to oocyte age... so why not start by at least making it easier for those couples to have more babies. Many of the women who wait the longest to have kids are intelligent and ambitious and in good marriages (because they waited to find the right partner) and we definitely want those couples having more kids. And as you say (and as I mentioned in my post as well), convincing those women to have kids in their 20s will be very, very tough without other changes (like the decreased training time for high-status careers that you suggest). I just want to reiterate once more that supporting egg freezing does not imply a lack of support for other fertility increasing policies including those that make it more attractive for young couples to have kids - I got a lot of responses that I think mistakenly assumed these things are zero sum. But I support both things, and agree with you that the marginal babies born as a result of an egg freezing program couldn't easily be shifted to being born to a younger mom.
Yeah ofc, that’s how I see it as well
Consider a plan for embryos as well. There are a million frozen embryos on the shelf at any given time. Many are discarded despite other options like embryo adoption.
by "embryo adoption" do you mean people using embryos that are not biologically related to them?
Yes. People can adopt embryos. It’s already a thing.
Interesting. Why would one do that vs kid adoption? Can you choose bio parents in this situation? Like traits and so on?
All kinds of reasons. People can choose embryos and also get pregnant with them via IVF. I recommend googling it to learn more. Also check out NRFA.org
Thank you
This is a very interesting thought. I wonder about the genetic quality of existing embryos. On the one hand side, I would expect these to be embryos of successful career women, on the other hand, embryos are probably preserved towards the end of the fertile life of a woman.
It might be more cost-effective to just cover egg donation/IVF for women with age-related infertility?
Of course, this would only work if the reason more women aren’t pursuing this option now is cost rather than the desire to have a genetically-related child.
Yeah agreed.
I tend to think cost isn’t the biggest issue. Women who delay childbearing for career reasons at least tend to be pretty well off. For partner reasons might be more mixed …
btw wanted to ask- what do you think about this?
https://www.allcatsarefemale.com/p/egg-freezing-utilization-rates?utm_source=profile&utm_medium=reader2
Good piece! I'm doubtful about Robin's point: “We should thus be willing to pay up to these huge amounts up front to induce the birth and raising-to-adulthood of a single child who would then pay average levels of future taxes to repay this debt.” The fact that the economy adds up huge debts per person due to profligate government spending does not justify adding to it! Am I missing something?
Wdym? Isn’t it good for the economy to have more people?
Yes. But not at the cost of throwing really huge amounts of money at people! It's way better than paying people to dig ditches (Keynes) but the deficit is already vast. If Robin is right, it would pay back eventually but that would take at least a quarter century.
yeah I am not an expert in the economics of this ...
I imagine it depends on how well you can convince the bond markets that it will pay off. If the bond markets think that the policy will improve your long run fiscal position, then they will be willing to effectively subsidise the program in the meantime and share in the future rewards when the children are grown and paying taxes. In that scenario everyone's a winner.
Just the usual risk with any deficit expansion that it spooks markets. I don't think that's too much of a concern in the US though, but definitely very applicable for a.lot of other developed countries.
It's a lot cheaper for a government to increase population by bringing in adult immigrants than it is to for that same government to try to increase the birth rate and then pay for 18+ years of public education. 😈
I wouldn't have recommended we get so far in debt, but once we have then that makes an opportunity for kids to be a direct profitable strategy for a state in such debt. The state could borrow the money to pay for this strategy, and investors would be willing to fund that, as they'd see the money would in fact get paid back via the kids taxes.
If you already have debt does that mean that more debt doesn’t matter?
The more debt matters, but is acceptable if it pays for enough to pay it back. Just as it is more acceptable to borrow on a house to pay for a room addition.
Rather than using government, which always has bad side effects, why not enable a mechanism by which individuals can voluntarily invest in other people's children? That should be workable if such an investment would truly pay off.
The simple private solution is to let parents endow their kids with debt or equity obligations, and then sell those to pay for parenting costs. It is the fact that few are willing to allow this that forces us to consider a second best option of having the state do a similar thing.
If having kids is good for the economy, then immigration is even better...
Wondering: are there any validated algorithms that would give a woman a personalized estimate of her current and projected fertility, considering factors such as age, various health conditions, health history, etc? Seems like it might be useful
unfortunately no, fertility and women's health are super underresearched
Which bothers me!!!!
I don't think anyone would want to hear their number.
It is much more convenient to read about some random actress becoming a happy mom at 50, while people understandably keep quiet about the sorrow and humiliation of their failed IVF treatments.
The numbers would be pretty bad for many. If we look at the cumulative graphs on this page https://en.wikipedia.org/wiki/Age_and_female_fertility , surprisingly many women will already have problems conceiving in their late 20s.
I don't have the reference on hand, but I remember reading that individual eggs already have a chromosomal defect rate of around 90% at a woman's age of 30.
Normally this doesn't go too well to bring up these points in a discussion, people are really in denial about their biology, and it goes against anything else that we recommend the younger generation. See also Sheryl Sandberg's quote in my other comment.
There are certainly reasons why one might not want to see one's future in advance...as explained in this song:
https://www.youtube.com/watch?v=ORqD4q2B97U
But in this case, isn't it better to know while you can still do something about it?
I fully agree with you, we need a massive culture shift about the topic, and we should be much more open about the biological realities of life.
Most women (and men, too!) love babies. Just look at how the maternal instincts are switched on when a woman looks at a child. It's totally natural, and nothing to be ashamed of.
And yet, public discourse is dominated not by how we can achieve what we secretly desire, but by mentally deranged activists projecting their personal problems onto others.
Hardly a week goes by without yet another "regretting motherhood" article in the newspaper, or yet another article praising yet another strong independent women, who postponed having children, all to work at some soulless corporation that would get rid of her without blinking an eye.
In the meantime, my friends secretly confess how they regret not having had children, or how their last IVF failed again.
I cannot imagine the pain these poor women are going through, insurance only pays for a certain number of tries, and the treatment is tremendously expensive and humiliating.
I once overheard an older woman gloating over how today's women could easily have children way into their 40s. She was shocked when I told her how small the chances are in reality.
On the other hand, the moment I talk about these numbers, I immediately get accused of wanting to subjugate women into the role of societies breeding stock, like one of Elfriede Jelinek's male villains.
This vocal minority is derailing any conversation about the realities of life, and is deliberately setting up people to stay childless. We seriously need some better biology education.
p.s. thanks for the song!
No. What we need is younger marriages, and much more celebration of fertility.
There are companies that offer egg freezing for their employees and few take it up.
Going through IVF is unpleasant. Even if free, most people will only do it if there is some concrete reason to (they are planning to have kids in the near future with their husband). It’s a hard sell to say “go through this unpleasant medical procedure in case you’re still alone until your late 30s.”
I don’t disagree with the proposal, but the biggest issue is that women don’t want to do it even when it’s free.
So the doctor devotes her 20s and 30s to her career and then begins a family at age 40.
Her daughter, whose life is a testimony to the wisdom of her mother, does the same thing, and thus the grandmother meets her first grandchild at age 80.
In the next generation, grandparents are holograms only.
--------
I just happened upon your site and have spent the morning reading it (and following many of the links). You are more entertaining than many of your fellow technopoptimists.
As to organ markets, it's so easy to imagine a pitiless world where part of financial planning is deciding when to sell off a kidney (as a normal obligation for down-payment on a first home?) with the sale of a lung scheduled for the beginning of retirement.
Maybe use that techno-optimism toward growing replacement organs in the lab? (as a placeholder until you guys figure out immortality)
------
But yeah, thanks for writing. I'll keep reading.
P.S. I'm not sure why everyone is worried about population decline. Seems like human population is still on a upswing.
I am very much in favor of being able to sell kidneys. The marginal benefit of the first functioning kidney is a lot higher than the second. I also believe that Iran has a functioning market in donated kidneys and the sky hasn't fallen there.
Very interesting post! My first concern with this suggestion is if it could end up having an adverse effect on fertility by encouraging people to take risks with their fertility. You largely answer that by showing that young eggs are the solution! But I wonder if it's Still missing that, in terms of ameliorating population ageing, the number that ultimately matters is the reproductive rate per unit time - encouraging people to have kids into their 40s may still be an issue in terms of creating younger generations in time to support ageing ones.
I've long believed that making egg-freezing affordable, safe, and effective would improve gender relations by a huge margin because it would effectively sync up men and women's timetable on not only family and career, but even casual dating. With so much of the gender wars predicated on dating grievances, a world where one gender isn't trying to hurry or slow down the other in matters of love and sex would be a less embittered one. Women won't feel like men are wasting their most fertile years, and men won't feel that women are trying to lock them down too soon.
I don't think it would work.
Women have the power in their 20s and don't want to settle for boring men when they can casually date fun guys instead, to quote Sheryl Sandberg:
"When looking for a life partner, my advice to women is date all of them: the bad boys, the cool boys, the commitment-phobic boys, the crazy boys. But do not marry them. The things that make the bad boys sexy do not make them good husbands. When it comes time to settle down, find someone who wants an equal partner. Someone who thinks women should be smart, opinionated and ambitious. Someone who values fairness and expects or, even better, wants to do his share in the home. These men exist and, trust me, over time, nothing is sexier.” ― Sheryl Sandberg, Lean In: Women, Work, and the Will to Lead
On the other hand, in their 30s, men have the upper hand, and they have no interest in settling down with older women on a schedule, when they can instead have fun. There is an interesting discussion on men's view here, the tenor of which is "I'm not a dating retirement home. I won't be the guy she falls back on.": https://old.reddit.com/r/AskMen/comments/27szuq/what_do_you_think_of_ceo_sheryl_sandbergs_advice/
Social freezing would instead make the situation worse: it would further encourage casual dating for women and attractive men (i.e. above average men in their 20s and most men in their 30s). Both would have even less reasons to settle down.
Sandberg's comments are definitely narcissistic in that she doesn't seem to quite grasp why that would not be appealing for most men, to be the "dating retirement home." Of course she has the right to selfishly pursue her own interests, but to openly say that and have this attitude of "Why can't you (men) just be happy for us?" shows the deep rot of that kind of girlboss feminism.
Anyway, my hope with the egg-freezing is that if women have to get their fun of their system in their 20s, then men will have their chance in their 30s. Meanwhile, 30-something women won't feel the pressure of the biological clock anymore, thanks to egg-freezing. And by the time both men and women are in their late 30s or even 40s, both will have gotten bored of the "fun" phase and are ready to settle down, now with their timelines synced.
Interesting thought, thanks for the explanation!