I feel like the patient desires should matter here. Personally, as someone with complex medical needs that entails spending a lot of time with doctors and healthcare professionals, I want the best care possible. The best care possible does not come from people who are sleep deprived and chronically stressed. (I do see the argument that doctors should be trained to handle stress spikes, but that's different than running on empty for months/years). I wouldn't want a lawyer handling my case that has only slept 4-5 hours a night at best for months or whose body is constantly full of adrenaline and cortisol: That lawyer is going to do a shitty job.
It shouldn't be on us as patients to memorize the change over times between shifts to choose when to go in based on getting a rested doctor (actual advice that's traded around). The medical hazing culture is directly harmful to patients and is, in my opinion, a violation of the Hippocratic Oath.
If you want to work yourself to death in order to make a ton of money, go into fintech or join a hedge fund instead of playing with peoples' lives. If you can get into and through med school, odds are you could pick up another just as high paying profession.
It's really amazing how it's illegal to drive a truck without mandatory rest periods but it's not just allowed but expected that doctors will administer medical care under shiftwork conditions guaranteed to create extreme fatigue.
It's a trade-off. I won't defend abusive working conditions or forced sleep deprivation. But research has shown that the risk of serious medical errors greatly increases when a hospitalized patient is handed off from one doctor to another. This is a real phenomenon which has been extensively studied. So, when doctors work long hours it does improve patient outcomes, up to a point.
how is this relevant though? One could conceive of a schedule where doctors and nurses work 12 hours shifts 3 days a week, and give them every other day off. Then nobody is sleep deprived and handoffs are reduced. Just hire double the doctors and nurses, this way there are no gaps in the work week!
Logically this is a very obvious and simple solution. But there are a few problems.
1. doctors and nurses expect to be paid a lot of money. Especially doctors, because they go into a lot of debt to get their education.
2. there IS money in the system to hire double the amount of doctors and nurses, but there’s an artificial shortage of doctors
3. there are many administrators with their hand in the cookie jar. More money should go to the people working directly with patients.
The status quo isn’t a good trade off. It’s probably the best outcome in our currently broken system though.
most serious errors crop up during shift changes. nurses forget to check a box, or get distracted and leave something out, doctors don't do a follow up, etc.
over millions of hospital hours across the US -- the 3rd most populous country in the world -- each shift change causes dozens of errors, and people sometimes die from that.
increasing them to 12 or 24 hour shifts does increase the likelihood of fatigue-based poor decisions and errors, but at a lesser amount than shift change-related errors.
As far as I understand, the most common achievable choice is between staffing a hospital with 3 8 hour shifts per day or 2 1w hour shifts per day. Studies have shown the 12 hour shift system has better outcomes.
Rules apply to all transportation jobs: truck drivers, airplane pilots, railroad engineers, etc. The affect of fatigue on attention and decision making is very well studied.
Regardless of how you feel, patients aren't the ones paying most of the bills so their desires are way down on the list of priorities for the healthcare system. If you want your desires to matter, and you have the money, then you can pay extra for a concierge medicine service. Otherwise since we have increasing demand for healthcare with flat supply you can expect longer waits and less personalized attention from increasingly stressed out doctors.
I'm not trying to be mean to you, just explaining the reality of the situation.
The reality is created by policy. The AMA zealously protects MDs and (Medicare-funded) fellowships as a cartel exempt from antitrust laws. Any they fight PAs and NPs tooth and nail.
I understand that. I think it's morally repugnant and a sign of an ethically bankrupt society. I also have very strong feelings about the amount of debt we place doctors into as well as the fact that we place all the burden for malpractice on them vs. putting some of that burden on the insurance companies and administrative overhead that create the policies that make malpractice more likely. Doctors wouldn't have to be artificially scarce in order to make giant salaries if they weren't almost all in exorbitant amounts of educational debt. The lack of political will the US has to take care of sick people is a disgusting symptom of our infrastructural and institutional collapse.
Is a healthcare system where nobody cares about the desires and will of the patients a healthcare system or a sinecure producing machine for people who know anatomy and physiology?
I personally will likely be fine. I did a stint in a medical library and am literate in medical research (and can therefore take on a lot of the work that doctors previously did when they had more time with patients - I can show up to appointments/procedures with very clear recommendations and advocate for them in a way that is respected as I have the credentials to be taken seriously by medical professionals). I also have a medical doctor + several NPs in my family and can be tended to outside the system if it does collapse. I'm worried about everyone else and the society in which we're raising our children and grandchildren.
We run the software industry on the expectation devs should constantly be crunching and we’re surprised when software is broken and people leave after 6 months so nobody has any legacy knowledge
Although I think this has been getting better as big companies “grew up” and mostly stopped now
> It shouldn't be on us as patients to memorize the change over times between shifts to choose when to go in based on getting a rested doctor (actual advice that's traded around). The medical hazing culture is directly harmful to patients and is, in my opinion, a violation of the Hippocratic Oath.
I mean that's really easy, don't be sick after 7pm, the night shift people are always worse!
To first order, if doctors work fewer hours, more doctors will be required to serve the aggregate medical demand.
More doctors working on the same amount of medical demand will be an increased supply of doctors, and so will reduce doctors salaries.
This seems like an ideal outcome for consumers, and I suspect the AMA would lobby against this. But American doctors should also be aware that their famously world class compensation might be reduced with this tradeoff.
I'm not sure there would be such a shortage. Here in North Carolina we have a "shortage" of teachers. But there's tons of folks that are qualified, they just can't afford to live on a teacher's salary and don't want to put up with the politics and bad policies. If the state made teaching a valued profession and paid people what they're worth, they'd instantly fill those vacancies.
My housemate is a nurse specializing in ECMO. In the time I've known him, his salary and benefits have been reduced twice. He'd note at his last job how many people were leaving because the scheduling makes it impossible to take time off and the benefits were paltry and getting worse. Three separate people needed to approve his time off requests for PTO he'd earned.
I would bet good money the same thing would happen in medicine. Pay people what they're worth and give them workable hours and lots of folks who are qualified (or easily recertified) for the positions will come out of the woodwork.
Since demand for healthcare is growing rapidly I expect that doctors will still be well paid even if the AMA succeeds in getting Congress to add more residency program funding, and thereby increase the supply.
I have two nieces who are Canadian but have completed medical school in Australia. They are currently in the equivalent of internship, heading for residency.
They work 40-hour weeks (compared to 60-90 in Canada), and are paid overtime when they go over. Their salaries are $100,000/year+ (equivalent to USD $66,000) which seems to be fine for them and more than they would receive in Canada.
The post-medical-school phase seems to go on longer (minimum 5 years) than in Canada, which may account for some of the difference.
Not accurate, at all, on several levels. In Australia you'll be making a six digit income as a doctor (and medicine is a five year undergrad degree), you won't have six digit student loans, and the AMA's lobbying makes it quite difficult to transition your medical degree to the US, even from another "so-called first world country".
As I mentioned, this is more than they would receive in Canada (and, because they are paid for overtime, weekends, etc., their actual salary would be significantly higher).
Their father is a GP and worked in the U.S. for about a decade. He was happy to return to Canada and not have to deal with HMOs and all the other crap. His clinic here has a single office worker handling billing for 5 or 6 doctors; in Indiana, they had at least one per doctor.
He actually said that his salary in Canada ended up being higher because of the lower administration costs, lower malpractice insurance, insurance companies refusing to pay the full invoices, etc.
As a doctor in Australia you have absolutely no idea what you’re talking about. This is a first year salary. The equivalent in the US is around 45-55,000 USD annually FOR THE ENTIRE RESIDENCY, no overtime pay.
But if doctors work fewer hours that means the supply of doctor hours will be vastly outstripped by the demand causing the price of a doctor hour to increase. So wouldn't it be a self-balancing mechanism?
How do you propose to make more doctors? Right now the primary bottleneck is limited residency program funding from Medicare. There hasn't been much political appetite for major increases.
Given our aging demographic profile with increasing chronic disease burden the problem is likely to get worse. Expect higher prices and longer waits to see a doctor. A more realistic solution will probably be to shift more primary care to lower credentialed practitioners such as Physician Assistants and Nurse Practitioners.
I mean, it _could_ be the job. But a lot of older doctors feel like the younger generation needs to go through the same struggles and hardships they did. This reminds me of something I occasionally see in my parenting of my kids - the desire I have for my kids to do things that validate _my own_ childhood experience.
This line of reasoning is very common. "If young people don't have to endure the same suffering I did then my suffering doesn't mean anything." It comes up in student loan forgiveness, predatory work environments, and many more. Arresting intergenerational harm would admit that ones own suffering was pointless and that isn't something people can deal with accepting. It's a group coping mechanism, which serves a purpose, but also comes with downsides.
I agree with the general principle, but student loan forgiveness is in a completely different category. When a loan is forgiven that's not just free money from the government, it increases the national debt which impacts all citizens. I sympathize with those who made unwise choices as youths to take on excessive student debt. But I sympathize more with working-class people who never took out student loans and instead got a job or enlisted in the military. Why should they now pay for the mistakes of college students who partied for 4+ years in college majors with no earning potential?
Student loan forgiveness also creates a moral hazard. Every future generation of students will then expect that they can take out unlimited loans and if things don't work out then no worries, the debt will just magically vanish.
How do you feel about loan forgiveness for those of us who made good decisions at the time and the conditions changed?
On a personal level, I got MS my very last semester in graduate school. This prevents me from doing the career I trained to do and I instead am working in a lower paying position. Because I can work at all, I'm still on the hook for all my loans even though I can't actually make use of the education I acquired. (Disability discharge is only if you can't work at all, so if you go through all of med school and get a TBI in a car accident the week after you graduate and can't practice but can still work retail, you still have to pay all that money back).
On a societal level, what about the people who were in college during the GFC? I graduated in 2010 and plenty of people graduated in '08/'09/10 who made very reasonable decisions about what to study and how much to take out in loans that got upended because our government and Wall Street can't manage their liabilities. For example, I counted on my father's help to reduce the loans I took out for undergrad, but I ended up with a ton of loans my senior year because everything crashed. Is that my fault or bad decision making? That as a 17 year old I couldn't better predict where the economy would be in 4-5 years than the adults and politicians in charge? Or the kids who've recently gone into CS after it was promised to them as a golden ticket only for the COVID years to fuck them over?
I agree that we shouldn't expect society to be on the hook for bad decisions, but painting student loans as only the result of bad decisions basically looks at the people falling through the cracks and shrugs, declaring them acceptable losses. That doesn't make people want to participate in society or engage in good faith. Which is also a problem.
Yes, I agree. And we shouldn't have paid for the mistakes of GM managers and debtors by bailing them out either. People who make bad decisions should take the consequences.
One use of an AI tool potentially would be to try to correlate the angle that a publication would benefit from by pushing a particular viewpoint. In other words, I want to read not the article, but what WSJ gets from it. That’ll tell me if the article is worth reading at all more than a summary of it.
It shouldn't be on us as patients to memorize the change over times between shifts to choose when to go in based on getting a rested doctor (actual advice that's traded around). The medical hazing culture is directly harmful to patients and is, in my opinion, a violation of the Hippocratic Oath.
If you want to work yourself to death in order to make a ton of money, go into fintech or join a hedge fund instead of playing with peoples' lives. If you can get into and through med school, odds are you could pick up another just as high paying profession.