[HN Gopher] The darker side of being a doctor
___________________________________________________________________
The darker side of being a doctor
Author : m-ahmed
Score : 265 points
Date : 2024-04-13 19:10 UTC (3 hours ago)
(HTM) web link (drericlevi.substack.com)
(TXT) w3m dump (drericlevi.substack.com)
| user_7832 wrote:
| Most of the issues mentioned in the article and the included
| email are concerning, however they also oddly seem to be common
| in many places across the globe. The surgeon mentioned was in
| Australia, I have seen these issues first hand in the Netherlands
| and am aware of very similar of the first 2 out of 3 issues
| (caused by overwork/understaffing/over-fatigue etc) in Belgium,
| Germany, the UK, India and god knows how many other places.
|
| However, fields like aviation have strict workload limits. You
| cannot be on call/duty for too long because fatigue kills. Issues
| like alarm fatigue are studied by agencies, and folks at
| Boeing/Airbus then implement the findings.
|
| The question is, why is it okay for medical professionals to wear
| themselves down to the bone (sometimes literally, like in this
| article), while some other professions take care to avoid it?
|
| (Edit/PS: I added a fairly detailed self-reply below on what I
| think are some of the common arguments (like on the
| number/availability of doctors) and why they don't really fly,
| pun not intended.)
| user_7832 wrote:
| (My musings/thinking-aloud): One partial hypothesis/answer is
| that there are far fewer pilots/cabin crew than there are
| doctors/medical staff, and hence it's easier to treat pilots
| properly. But fewer people makes it _harder_ to let someone off
| if they haven 't slept well so I don't really buy that.
|
| Another is that the medical profession is much more
| "flexible"/fluid in its needs, unlike flights scheduled in a
| regular manner. However, that doesn't mean it's not possible to
| give doctors an 8 hour workday, and substitute/bring more
| doctors for other shifts. In fact, this is exactly what happens
| in many 24-hour manufacturing plants/operations. Foxconn
| doesn't let a sleep deprived employee make an iPhone, but it's
| okay to let a sleep deprived doctor perform life-
| saving/potentially deadly operations?
|
| Another possibility is that "it would cost more" to have 3 docs
| instead of 1. Which might be supported by anecdotal evidence on
| how expensive things (including salaries) are in the medical
| field. However (especially if you're only familiar with the US
| healthcare system), this doesn't explain how doctors in say
| India are overworked.
|
| The "real" reason, I think behind all this? The first part is
| it's because it's "easy" to compress and push an 8 hour shift
| to a 24 hour shift, fatigue be damned. The costs are "hidden",
| it's likely even with fatigue a 99% successful operation is
| still 95 or 90% successful. Everyone can rationalize it and go
| about with their day. "Oh, unfortunately people don't always
| make it".
|
| _Not_ , "there was a 20% chance they wouldn't have made it but
| an 80% chance it was because the doctor was fatigued."
|
| When an aircraft crashes, 300 people may die instantly. This
| gets front page coverage on a newspaper. However, a few deaths
| "here" and "there" don't really show up, even if they tally up
| to thousands. This is the second factor, that "hides" and
| normalizes occasional slip-ups.
|
| </End of this wall of text> I unfortunately don't really have a
| solution. I'm sure there are brilliant UX designers here on HN
| who could help ease and streamline the admin workload.
|
| I suppose a dedicated politician/presidential candidate
| somewhere could take this upon themselves to campaign for.
| (Seriously, the NHS was part of the discussion behind Brexit.
| Supporting doctors is a brilliant political strategy, the NWA
| didn't have a song called "Fuck the paramedics".)
|
| There have been many instances of things catching on once found
| successful somewhere, be it procedures like the Heimlich or
| concepts like Lean Manufacturing. Therefore I don't doubt that
| one good Harvard Review paper showing a 20% decrease in all-
| cause patient mortality, with trials underway in a few
| hospitals, is all it will take. Question is, who will bell the
| cat!?
| uniqueuid wrote:
| Thanks for the perspective. I have doctor friends and everyone
| seems to just blindly accept that some jobs are not jobs, they
| are identities. You never pause being a doctor. But your
| comment shows that even in life-critical environments, we _do_
| have ways of organizing work so individuals can bear it. Fire
| brigades are another example.
|
| Time to push for a change. And time to call some people and ask
| whether they are truly ok right now.
| Rinzler89 wrote:
| The understaffed healthcare system works with overworked
| doctors on the basis that having a tired and overworked doctor
| is a lot of the times better than having no doctor at all,
| because (s)he most likely can end up saving more lives than
| taking with their tired brain. If your operations have a 90%
| survivability rate it could still be considered a success
| despite those 10% they end up killing, because 90% is a lot
| better than 0%.
|
| Meanwhile a tired pilot is more binary, it either can have 100%
| passenger survivability if things go well or 100% fatality if
| things go tits up, meaning the risk are too high to take
| chances.
|
| It's basic game theory.
| uniqueuid wrote:
| Good point, and you can turn it around: Doctors are never
| "finished". They could always do more to help patients. So in
| contrast to aviation, where there is a clear corridor of
| things to do, doctors have no natural upper bound on their
| work.
| eviks wrote:
| but the alternative isn't having no doctor at all, but to get
| more doctors, so the "basic game theory" is about why the
| limits on more doctors stay in place despite the higher risk
| of death etc.
| Rinzler89 wrote:
| _> but to get more doctors_
|
| Have you found that magic fountain of endless doctors?
| uniqueuid wrote:
| Sure, it's very easy! Just do things that prevent burnout
| (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/)
| and the job gets more attractive, drawing more students
| and producing less attrition:
|
| - Valuing work gives meaning (money, appreciation)
|
| - Autonomy gives feeling of control
|
| - Managing burden prevents overwork, exhaustion and
| fatigue
| dirtyhippiefree wrote:
| > Sure, it's very easy!
|
| I have issues when someone says a complicated issue can
| be solved easily...realistic expectations...
| user_7832 wrote:
| The answers to some problems may be easy to know but
| difficult to implement, due to political/financial will
| etc. For eg we know _how_ to reduce emissions, but it 's
| still a challenge. In such cases advocacy and raising
| awareness can be helpful.
| inglor_cz wrote:
| "Easy to describe" is very different from "easy to do".
|
| It reminds me of the famous "just eat less and exercise
| more", the alleged simple solution to the global obesity
| epidemic.
| nradov wrote:
| Sounds good, but healthcare already constitutes 17% of US
| GDP. And with an aging population, spending has been
| growing faster than the rate of inflation. Most of the
| funding ultimately comes from governments, self-insured
| employers, and individual patients. Those groups have no
| appetite for spending more.
|
| The bottleneck right now in producing more US physicians
| is lack of Medicare funding for residency slots (graduate
| medical education). Every year some students graduate
| from accredited medical schools with an MD but are unable
| to practice because they don't get matched to a residency
| program. Congress hasn't significantly increased funding
| in years.
|
| https://savegme.org/
| novok wrote:
| The entire medicare residency slot system seems a bit
| self inflicted, why hasn't an alternative system popped
| up?
|
| Also this is a global problem, not just the USA. You look
| at videos of student doctors in the UK for example and
| there are similar abusive schedules.
| https://www.youtube.com/watch?v=KE1XwEMGm0I
| kwhitefoot wrote:
| Read Adam Kay's "This is going to hurt" [1]. It was made
| into a miniseries. I read the book and it was so
| horrifying that I couldn't face watching the
| dramatisation.
|
| It doesn't seem to be such a big problem here in Norway
| where things like working time directives are taken much
| more seriously.
|
| [1] https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt
| malux85 wrote:
| Yeah it's called correct incentives - I look at the over
| work, and insane stress levels that doctors suffer and I
| say "NO THANKS"
|
| I am definitely not the only one
| WalterBright wrote:
| The AMA only allows a fixed number of seats in medical
| school.
|
| There also can be tiers of medical doctors. Most
| doctoring work is routine, and can be handled by a more
| of a medical tech.
| nradov wrote:
| False. The AMA has no regulatory or accreditation
| authority over medical schools. Schools can admit as many
| students as they want.
|
| The bottleneck right now in producing more US physicians
| is lack of Medicare funding for residency slots (graduate
| medical education). Every year some students graduate
| from accredited medical schools with an MD but are unable
| to practice because they don't get matched to a residency
| program. Congress hasn't significantly increased funding
| in years. At one point the AMA did lobby Congress to
| limit the number of slots but they have since reversed
| that stance and are now lobbying for higher residency
| funding.
|
| https://savegme.org/
|
| There are already tiers of clinicians. Much routine care
| can be delivered by Physician Assistants or Nurse
| Practitioners working under a Physician's supervision.
| Specific limits on their services are set at the state
| level.
| beau_g wrote:
| Why do residency programs require subsidies, are resident
| doctors each a large net financial loss to a hospital? I
| can't think of many other career paths where someone out
| of school is so underprepared for the job that the
| business could not employ them without someone else
| footing the bill, doesn't seem like a reasonable system
| that will sustain itself in the long term. I suppose
| pilots are a bit like this but they typically take the
| financial risk on themselves to some degree or get the
| taxpayer funded training via the military.
| MichaelZuo wrote:
| Do residency slots mandate public funding?
|
| Aren't they doing actual useful work same as regular
| doctors? (albiet with a higher error rate)
|
| So they could be funded through via charging for services
| rendered.
|
| Of course their effective pay may be close to zero, after
| malpractice insurance, but it will still attract some
| number of med school grads who can't get in otherwise.
| triceratops wrote:
| > The bottleneck right now in producing more US
| physicians is lack of Medicare funding for residency
| slots... Congress hasn't significantly increased funding
| in years. Much routine care can be delivered by Physician
| Assistants or Nurse Practitioners working under a
| Physician's supervision
|
| We should all accept a lower standard of care because
| hospitals can't find more funding to train doctors? What
| are all the $20 aspirin paying for? How does every other
| profession manage to train new members without needing a
| literal act of Congress?
| yokaze wrote:
| That's a straw man. We do not need "endless doctors" just
| more (or some way to use them more efficiently).
|
| The number of doctors are limited by the pipeline to
| educate them.
|
| Most countries I know, the number of people admitted to
| study medicine exceeds the number people wanting to study
| medicine vastly exceeds the positions to do so, and
| admissions are highly competitive. To a point, I'd say,
| that it is becoming ridiculous.
|
| So, there is not a lack of people wanting to become
| doctors, but a lack of people allowed to even start to
| study to become one.
| eviks wrote:
| If you didn't cut the "limits" from the quote, you
| might've found a hint on how to answer your question
| without any magic involved. For such a small profession
| the general talent pool is endless indeed unless you...
| limit
| yokaze wrote:
| Sorry, that is bollocks. That is the story most people
| believe, and makes for a convenient story for those people
| actually to blame. Funnily, it is also the story most doctors
| themselves seem to chose to believe in.
|
| First, those are not the only choices. There is also the the
| option of training and hiring more doctors. 2
|
| Probably, there is also an option of making more efficient
| use of doctors time, but that one is more complicated.
|
| Most of the work of doctors is not life-saving.
|
| I think, you see a standard problem of pushing shit down or
| up. Government lowers budget, pushes quotas down, which gets
| pushed down further until it reaches the bottom rank and
| file, the doctors.
|
| They have to "do more with less" (Not limited to public
| sector, see Boeing), and that works for a while, until it
| doesn't.
| closewith wrote:
| > Most of the work of doctors is not life-saving.
|
| Yes, but working out which parts are and aren't critical is
| the $64,000 question.
| yokaze wrote:
| I think, that is a bit besides the point I wanted to
| make.
|
| Yes, it is very hard to know a priori, what is life-
| saving, and what not. No, I do not wanted to suggest that
| the work of doctors it is not important.
|
| The common understanding of doctors (their self-
| understanding included) is, that their work is very
| important, to the point that they exploit themselves. Or
| allow themselves to be "exploited".
|
| In this forum, more commonly you have people here working
| on productive systems, which can empathize with the
| feeling the responsibility for the operations and not
| wanting to drop the ball.
|
| People with that mindset think, they may safe a patient /
| the system, but working oneself to exhaustion won't solve
| those problems. And on the contrary, the exhaustion may
| be a contributing factor of making things worse in
| various ways. One directly by your actions, the other
| indirectly by covering up systemic problems.
| Turing_Machine wrote:
| Indeed. Is that weird mole just a weird mole, or is it
| skin cancer?
| Rinzler89 wrote:
| _> They have to "do more with less" (Not limited to public
| sector, see Boeing), and that works for a while, until it
| doesn't._
|
| Yes, which brings us back to the point I made about it
| being a numbers game. IF you start cutting back pilots
| sleep and planes' QA to boost profits, you'll reach the "it
| doesn't work" phase (planes dropping from the air killing
| everyone) much sooner and at a steeper rate than with
| overworked doctors where the decline is a lot slower and
| gradual hence why this issue gets ignored more easily by
| those in charge, because it's so slow that people keep
| getting used to this as the new normal.
|
| IF a few Boeings fall from the sky, people might stop
| flying Boeings, but people won't stop going to the doctor
| just because some people get killed from malpractice (which
| is statistically more likely than dying in a plane crash).
| sangnoir wrote:
| It's easier for the public to recognize and be outraged
| about 237 dead airline passengers compared to 237 dead
| patients even if both are caused by overtired pilots or
| "providers" (I hate that word for it's vagueness).
| impossiblefork wrote:
| I think having more physicians is the core thing.
|
| The US stands out in having so few physicians per capita
| (per 1000 it's 3.6 in the US, here in Sweden it's 7.1, in
| Germany 4.5, Spain in 4.6). This has been discussed before
| here before, and I don't think it was controversial that a
| sensible solution was to simply have more physicians.
|
| I think one major thing that the US is doing wrong with
| that which is not so well known is that the training starts
| rather late in life. Thus you get less out of the
| physicians you train. Here in Sweden a physician has a MSc
| in medicine and is ready to meet patients and be trained
| when he's 23, and I think this has the benefit that there's
| no need to overwork them.
|
| By the time they're 30 they'll have all the experience the
| need without having been overworked, and not sleeping
| enough kills intelligence, memory, drive, all mental
| qualities one may have.
|
| I think these two policies, ensuring that people graduate
| earlier-- removing the pre-med and having people start
| right away with a medicine program, and graduating in 5.5
| years, that's the right approach.
|
| Physicians would earn less, but they'd have substantially
| better lives. Being able to start younger also means
| success younger, and happier families.
| Turing_Machine wrote:
| This was in Australia (4.1).
| impossiblefork wrote:
| Ah, thank you.
| malux85 wrote:
| What about the meta-game, where doctors get burnt out or
| suicide, and that increases pressure on the remaining
| doctors, in a negative feedback loop.
|
| We should impose work limits on doctors, just like pilots.
| 317070 wrote:
| What I don't understand:
|
| Say I'm a doctor, and I declare I will only work my 40
| hours (or however much a full time is where you are). I
| will literally leave when my time is up. Oh, and I don't
| pick up phones outside of work. Or read emails.
|
| What will anyone else do about it? Fire me? Then they have
| even less doctors...
|
| It seems to me doctors do have the power to change things,
| even without collectivizing. But for some reason I don't
| understand, it doesn't seem to work out.
| kwhitefoot wrote:
| They would earn less money.
|
| > the power to change things, even without
| collectivizing.
|
| Not really it's a sort of prisoner's dilemma. The one who
| refuses to work stupid hours gets fired and someone else
| has their job. If they stood together then it might work.
| 317070 wrote:
| But there is no one waiting for their job. In most places
| there is a shortage of doctors.
| flerchin wrote:
| There's a duty of care* that doctors have. If there's no
| one else to care for your patient, you're required by law
| to care for them. (I'm not a doctor, but it's a real
| thing) It's one thing to risk being fired. It's quite
| another to lose your profession.
|
| *google "duty of care" for more info
| hinkley wrote:
| I think someone also did the math and figured out that having
| fewer handoffs side a patient led to better outcomes so now
| there's pressure to have two doctors per24 hours instead of
| three or four.
| user_7832 wrote:
| That's a very good point. I think 12 hour shifts aren't
| necessarily bad, but even EMTs/firefighters (in some
| places, afaik) have downtime after their shift. Maybe work
| one on one off, or maybe 2 on 3 off. I suspect that's still
| much better than the practice of 24 hour shifts.
| kwhitefoot wrote:
| Did they really study how doctors and other staff work in
| enough countries?
| hello_computer wrote:
| Not so sure about that. According to a few studies, medical
| error is the 3rd leading cause of death, behind heart disease
| and cancer.
|
| Many operations are elective. In such cases, having a tired
| surgeon or nurse may be worse than delaying the procedure, or
| even skipping it.
|
| https://www.bmj.com/content/353/bmj.i2139
|
| https://pubmed.ncbi.nlm.nih.gov/28186008/
|
| https://journals.lww.com/journalpatientsafety/Fulltext/2013/.
| ..
| james-redwood wrote:
| This has been extensively debunked. Read the original
| methods of the BMJ article that you linked. They took every
| single minor error, like prescribing medicine 15 minutes
| late, and if the patient died, even of an aggressive cancer
| that they had already, it would be counted in the 'medical
| error that caused the death' statistic.
|
| https://www.nytimes.com/2016/08/16/upshot/death-by-
| medical-e...
|
| https://www.medscape.com/viewarticle/863788?scode=msp&st=fp
| f...
|
| https://sciencebasedmedicine.org/medical-errors-2020/
| Mtinie wrote:
| ...but if you postpone a procedure, the medical facility
| they work at isn't able to keep up with their revenue
| targets.
|
| /s
| novok wrote:
| IMO this is doctors acting as enablers of a toxic
| administration. They need to refuse outright to not work
| crazy hours and force the system & administration to come to
| a crisis. The admins are not working those hours and thus do
| not feel the consequences of their actions and by enabling
| their bad behavior they are not getting consequences from
| their bosses, which are politicians and customers.
| ysofunny wrote:
| I think it's a matter of the 'tradinionalist' mindset in
| doctor education
|
| most doctors will think "well, I went through a hardcore
| intesnse experience in medical school, therefore that's how
| it should be"
|
| I'm saying they've normalized overwork as part of their
| specific subculture of modern medical professionals. they
| really believe they won't be as good doctors without this
| arguably abusive overwork system
|
| it's yet another group of people who all belive in some
| form of the "no pain, no gain" mindset; the issue is these
| groups don't give nobody anything unless there's some harm
| or pain involved
| lolinder wrote:
| > If your operations have a 90% survivability rate it could
| still be considered a success despite those 10% they end up
| killing, because 90% is a lot better than 0%.
|
| > Meanwhile a tired pilot is more binary, it either can have
| 100% passenger survivability if things go well or 100%
| fatality if things go tits up, meaning the risk are too high
| to take chances.
|
| This isn't how the math works. A tired pilot either kills or
| doesn't kill their passengers on a given flight the same way
| that a tired doctor either kills or doesn't kill their
| patient in a given operation. In both cases it's 100% survive
| or 0% survive.
|
| Pilots aside, we _also_ have laws about keeping truck drivers
| from driving too many hours, and accidents involving drowsy
| truck drivers are unlikely to have fatality counts measured
| in the hundreds.
|
| The difference between doctors and pilots/truckers isn't in
| the amount of risk involved, it's that surgeries are
| _expected_ to have a non-zero fatality rate. A doctor can do
| their job perfectly and still lose a patient, so it 's harder
| to prove that the fatality rate would be lower if we gave
| surgeons more rest. When a truck driver falls asleep at the
| wheel and kills someone it's obvious because they did
| something provably illegal or unsafe right before the crash.
| When a surgeon fails it's a lot harder to prove it was
| preventable.
| eviks wrote:
| Complicated question, on potential factor: maybe because the
| doctors kill one by one instead of in batches, so the
| ridiculous artificial entry limits that result in very high
| workload, but results in artificially high pay, doesn't meet a
| strong enough force to be adjusted?
| closewith wrote:
| > The question is, why is it okay for medical professionals to
| wear themselves down to the bone (sometimes literally, like in
| this article), while some other professions take care to avoid
| it?
|
| I think the answer here is that if you there aren't enough
| pilots, schedules can be reduced. You can't scale back (in any
| ethical way, anyway) the demand for healthcare. People will
| just die at a higher rate and outcomes will worsen.
| user_7832 wrote:
| Thank you for your comment, that's a very good point. I self-
| replied a bit lower with more discussion on this, primarily
| to the effect that the "solution" in that case would be to
| hire more doctors. The concept of a "standby" doctor (like a
| volunteer firefighter) could be used (more), for eg retired
| former doctors/nurses.
| novok wrote:
| There is a lot of protectionism & abuse in the doctor
| system, to the point where I think common tropes are put as
| fronts to keep up a status quo to hide the reality. You
| have to look at actions vs. the statements at this point.
| "The purpose of a system is what it does"
|
| Statement: We need more doctors in Canada.
|
| Actions: It's much harder than 20 years ago to get into med
| school or a residency (USA medicare). It's even harder to
| go to med school in Canada than the USA! Doctors from other
| countries have much higher testing standards than local med
| school graduates in Canada to get licensed. To the point
| where they move to the USA because it's easier to start
| working than it is in Canada itself. Foreign Doctor moves
| to canada and becomes a taxi driver is a trope in Canada
| because of the excessively high barriers.
| protastus wrote:
| I share the same objection about the lack of regulation in the
| medical profession worldwide.
|
| My best friend from high school became an MD and I witnessed
| doctors in training being proud of powering through extremely
| long, back to back shifts with little rest.
|
| Meanwhile, as an engineer I've seen short and strict shift
| limits on employees operating machinery like trucks and
| forklifts. Under the obvious principle that insufficient sleep
| impairs judgement, put lives at risk and creates massive
| liability.
| nradov wrote:
| For inpatient hospital care, research has shown that
| transitions in care are particularly risky for patients. When
| one doctor goes off shift and hands off a patient to another
| doctor, sometimes things fall through the cracks. In theory all
| of the data needed for a smooth transition should be documented
| in the patient chart, but in practice this doesn't always get
| done plus there is some tacit knowledge which clinicians build
| up by observing a particular patient which can't be put into
| words.
|
| This risk of iatrogenic harm has been used to justify long
| hours, particularly for residents in teaching hospitals. I'm
| not saying that it's necessarily a good idea or that there are
| no better alternatives, just explaining some of the rationale.
| user_7832 wrote:
| Thanks, I commented a bit above already to a similar
| response. I would say that there's a balance between very
| short shifts and 24(or more) hour shifts. 12 hours for
| example is doable occasionally/with breaks in between shifts.
| Right now the pendulum is at one extreme.
|
| [0] - https://news.ycombinator.com/item?id=40025540
| tum92 wrote:
| I haven't read that literature very closely, but will say
| that I have seen lots of handoffs, and they generally involve
| someone who has been working 12+ hours, very often 24+ hours,
| who needs to hand off 10s of patients to 3+ people, all of
| whom have things to do and can be hard to schedule around,
| before they can go home.
|
| It is not at all surprising to me that these kind of hand
| offs result in things being missed, and equally obvious that
| decreasing the patients per provider and increasing hand off
| window hours would at least reduce some of those errors, if
| not outright improve them. Bonus points for putting the peak
| of handoffs into late morning hours, where much more of the
| decision making is completed.
|
| Of course, the only way to do that is to either:
|
| 1) drag hours out longer, which I think lots of MDs would be
| fine with if they weren't expected to turn around and do it
| again in 18-36 hours, requiring increased staffing
|
| Or 2) increase staffing all around and just maintain more
| reasonable ratios
| postepowanieadm wrote:
| It's even worse. In the EU the working week is to be an average
| of about 48h. ...unless you are an medical professional, then
| you "may" opt-out and work up to 78h. It's completely legal,
| and regulated by the law of the EU:)
|
| https://www.europarl.europa.eu/meetdocs/2014_2019/documents/...
| tarkin2 wrote:
| The cynic in me says they have bad working conditions since
| they're public funded: governments, to a large extent, don't
| want to increase or divert taxes to provide better working
| conditions since they'd rather give their friends in the
| private sector a slice of the immovable and highly lucrative
| pie.
|
| A partly-privatised healthcare system only works when all agree
| to balance the intangible long-term benefits of universal
| healthcare with tangible private-sector financial-gain. I don't
| see this happening when the private sector is seen as the
| panacea of all social-ills and when universal healthcare isn't
| seen a means to increase productivity.
| derbOac wrote:
| The answer is implied, right there in the first paragraph: "...
| I've never been diagnosed with a mental illness."
|
| At least in the US, there's a kind of masochistic pride in the
| physician community, that everything he described in his essay
| is laudable, noble, to be emulated. Nowhere does he acknowledge
| the risks to his patients or whether the costs are worth it in
| the end, or if a different system might be better. And he's
| holding up the lack of mental illness diagnosis as if it's
| something to be proud of, as opposed to never being diagnosed
| with say, cardiovascular disease or cancer. He's proud he's
| never sought help or tried to change anything. Sure he mentions
| problems with patient care in passing, but what he's really
| upset about is "just being another employee".
|
| In the end in his mindset whatever he's complaining about is
| better than the alternatives, which is ceding over some of the
| care responsibilities to others or opening up healthcare to a
| more competitive market so he's not the only provider who could
| provide those services (note the comment about denying other
| physicians income). The AMA and physicians union (yes it's a
| union) basically guarantees this in lieu of having real
| competition, decreased income, and so forth.
|
| Why is it different in something like aviation? My guess is
| because the failures are more visible, they're on the nightly
| news, people are there posting pictures on social media? For
| whatever reason, I don't think pilot organizations ever managed
| to remove themselves from scrutiny in the same way as
| physicians did. We see pilots as highly skilled professionals,
| but part of a system, with alternatives, and the subject of
| fair scrutiny from outsiders who are not pilots: engineers,
| safety experts, investigators and so forth. In my experience
| when these kinds of issues come up in healthcare though,
| everyone defers to physician groups themselves, as if no one
| else has expertise enough to scrutinize them.
|
| I imagine too at some level, part of the issue is that the
| pilots themselves are subject to their own mistakes: if a pilot
| crashes a plane, they take themselves out at the same time. If
| a surgeon makes a mistake and kills a patient, they still walk
| home and can rationalize whatever they want, all they want.
|
| I'm growing unsympathetic to these types of essays (the one
| linked). If physicians want me to empathize with them more,
| maybe they should stop stigmatizing mental unwellness and
| recognize it in themselves. Maybe they as a professional group
| should admit that others could take on some of the load, maybe
| even better in some situations. It feels a bit like they create
| a mess out of selfish greed or ego and then expect me to feel
| bad for them.
| mlyle wrote:
| > Nowhere does he acknowledge the risks to his patients or
| whether the costs are worth it in the end, or if a different
| system might be better
|
| c.f.
|
| "...everything is rushed, and mistakes are bound to occur."
|
| "I am realising more and more that what brings me greatest
| distress is the relentless administrative pressure which take
| away the meaningful clinical engagement I have with my
| patients."
|
| "I was burned out and I couldn't control my emotions at work
| and at home. I'm not inherently an offensive or rude person,
| I'm just a person pushed to the limits and set to fail
| because of the circumstances around my work."
|
| > In the end in his mindset whatever he's complaining about
| is better than the alternatives, which is ceding over some of
| the care responsibilities to others or opening up healthcare
| to a more competitive market so he's not the only provider
| who could provide those service
|
| This is Australia, which does not have artificial
| restrictions on the supply of doctors to the same extent. On
| the other hand, they don't have a surplus of surgeons nor can
| nurse practitioners do the work
|
| > (note the comment about denying other physicians income).
|
| Yah, he's saying that if he doesn't come in, the backlog gets
| worse, and other people don't get paid.
|
| > He's proud he's never sought help or tried to change
| anything.
|
| He says he would like to seek support, but highlights the
| structural problems that prevent it:
|
| "I know where I can get support, but practically, when and
| how am I going to get that support?"
|
| "In addition, doctors who scream for help may be formally
| reported, therefore having restrictions placed on their
| practice and then incurring higher medical indemnity fees in
| some situations. Trainees who ask for help may be labelled as
| underperforming and have to be commenced on probation or
| remediation. We may not have practical access to the support
| that are often advertised."
|
| I absolutely am in agreement with you that the things done to
| artificially lower the supply of residency training in the US
| are terrible. But those criticisms don't seem to apply to
| this essay.
| lazyasciiart wrote:
| > which does not have artificial restrictions on the supply
| of doctors to the same extent
|
| Yes it does. One of the really interesting questions is
| actually why the same problems have been created in so many
| otherwise-different systems.
|
| Edit: a post giving details on the Australian medical
| training constraints https://www.aph.gov.au/About_Parliamen
| t/Parliamentary_depart...
| mlyle wrote:
| > > to the same extent
|
| Your source says that the government sets (indirectly) a
| limit on the number of places at most public
| universities, but there are private, full-fee
| universities that are not so limited.
|
| Internship slots, in turn, are set by disparate
| government agencies. They've climbed, but probably not
| climbed enough.
|
| Compare to the US, where congress basically directly
| controls the number of residency slots and has failed to
| increase them really at all to keep up with increasing
| population and increasing need for medical services.
| kwhitefoot wrote:
| > At least in the US, there's a kind of masochistic pride in
| the physician community,
|
| But the question is why does the rest of society insist that
| pilots be properly rested but not doctors? I'm sure a lot of
| pilots would also work crazy amounts of overtime if allowed.
| ta_1138 wrote:
| Pilot failures are really visible, and kill hundreds atll
| at once. Bad medical decisions lead to more deaths overall,
| but it's far less likely the public will hear it, and even
| if they do, it's one person at a time.
|
| Far more people die from car crashes than airplane crashes
| too: It's not even close. And yet, people who have no
| business behind a wheel drive, and the penalties for being
| a poor driver are typically minimal. Same difference.
| al_borland wrote:
| When a pilot or a truck driver fall asleep, it's easy to
| see the cause and effect. When sleeping, they can't control
| the vehicle.
|
| With other professions, the people are awake, their brain
| just isn't functioning properly, so it's easier for people
| to ignore the true cause, since well rested people can make
| mistakes too.
| ptsneves wrote:
| Not only pilots. Truck driver resting time is heavily
| regulated to the point the need to record start and end or
| they will be fined at best. Their employers will also be on
| the hook if drivers are non compliant.
|
| A truck driver! But doctors? No... they are Uberhuman and
| can make life or death decisions after 24 hours on call and
| awake. Ridiculous. It is a topic that angers me a lot.
|
| This happens in Portugal as well as Poland, it indeed feel
| universal. I think the reason is that doctors are kind of
| like gods: in the hour of your biggest need it is them that
| can help, therefore they are highly respected and have huge
| influence over a wide cross section of society. Everybody
| will eventually need a doctor in their life.
|
| Another pet outrage topic related to doctors is the amount
| of time they need for training. They train almost 12 years
| after high school before they are qualified. What a
| wasteful training. They learn lots of generalities to the
| specialize in the end. With a 10 or 12 year higher
| education you are speaking about phd or post docs for a
| profession that requires 1 for every 1000 citizens. Imagine
| that ratio of phds and post docs. Is being a GP really
| requiring such training? I don't think so and agree with
| above posts that their duties should be broken down, opened
| and delegated.
| patall wrote:
| Because when there is no pilot, the airplane simply does
| not fly. Nobody dies, there is just an economic damage. But
| if there is no doctor, people still get ill, and then
| people die. Which makes it ethically easy to impose the one
| but not the other. And which is also the reason why pilots
| can go on strike, while the same is much more limited for
| any kind of (medical) care job.
| The_Blade wrote:
| I would also add the famous Bert Cooper line, "I never heard
| the word client in there." He mentions patients, but they are
| all wrapped up in a woe-is-me section I work so hard and yet
| I haven't been diagnosed with a mental illness.
|
| He sounds like the kind of person that brags about being
| mentally sound but is secretly addicted to benzos. Always
| advocate for yourself!
| Tarq0n wrote:
| I think it has to do with the cost structure of the good.
| Healthcare is dominated by labour costs, which means in
| industrializing economies it lags behind in productivity and
| labour starts getting squeezed to try and keep prices at a
| reasonable level. A pilot, despiute being in a highly skilled
| profession, is only a small part of the puzzle when it comes to
| the cost of flights.
| simonbarker87 wrote:
| My assumption is that is a doctor does nothing the situation
| will get worse. So therefore them doing anything is seen as a
| step in the right direction, they will improve things over the
| base line?
|
| A pilot isn't in charge of a deteriorating situation, then
| doing something could make things worse below the base line (a
| tiredness induced mistake) so therefore make sure the only do
| stuff when fit to do so?
|
| Note I've used questions on both of these examples as it's more
| of a half thought and a feeling that a statement or fully
| fleshed out thought.
|
| I guess the summary is, I'd rather have a tired doctor work on
| me in an emergency than no doctor work on me. I'd rather not
| fly on the plane than have a dangerously tired pilot fly the
| plane.
|
| That's being said the system clearly needs improving and we
| need more medical professionals to balance the work load.
| jstummbillig wrote:
| Compared to aviation, bad outcomes in medicine are a) not news
| material and also b) taken into account beforehand.
|
| Phobias apart, we simply do not expect to die, when we fly. In
| contrast, we openly consider % survival rates of medical
| procedures. These rates have human error already baked in, and
| would be lower if humans made less errors. And then there is
| the primal fear of not getting help, if needed, because no help
| was available, which certainly works on our collective will to
| action here.
|
| A 50% survival procedure for medicine might work, because it's
| either that or death. Aviation is always a few plane
| malfunctions (not even outright crashes) in quick succession
| away from the entire industry crashing.
| rors wrote:
| My partner is a surgeon in the UK. She's planning on leaving
| the profession at the end of the year. We talk a lot about what
| is wrong with the medical profession.
|
| One issue is the type of person attracted to the profession.
| They're incredibly academically talented, not driven by money,
| and desire status and recognition. Surgeons are the most
| extreme cases of this personality type, as they're harder jobs
| to get and have a lot of pressure. These people are the types
| who get their head done, roll up their sleeves, and get on with
| things. They're not used to asking for help or additional
| resources. They're the sort of people who care for others!
| Medicine self-selects for martyrs.
|
| In addition, you have so many hoops to jump through (training,
| specialisations, etc) with significant time investment that can
| be lost in moments by pissing off training directors or other
| senior doctors. My partner ends up working more than her
| contracted hours because her bosses expect her to, although
| they would never explicitly enforce stricter rules. If she
| works her contracted hours she can kiss a consultant job (UK
| equivalent of attending) goodbye as her bosses won't provide a
| reference for the role.
|
| Because the stakes in medicine are literally life and death,
| meaning that it is heavily regulated. There are horror stories
| around the GMC, the UK regulator, and doctors are terrified of
| being investigated. They adopt a legalistic mentality where
| they only treat if they're sure that they won't get prosecuted.
| It's very different from aviation with its no blame culture.
|
| Finally, another factor that is making medicine so tough is
| that it is a success story! People live longer, and pathologies
| that were once fatal can be managed with ever more complex
| treatments. As demographics lean to older populations, then the
| demand keeps increasing.
| orangesite wrote:
| aka The darker side of having people who wouldn't make it through
| the first four weeks of med school managing health services.
| yazzku wrote:
| And they got MBAs instead.
| IncreasePosts wrote:
| I know America strictly limits the number of people who can
| become doctors every year. Does Australia have a similar system?
|
| It seems insane to me to first limit how many there can be, and
| then overwork the ones you do allow to become doctors.
| yazzku wrote:
| >I had worked in a hospital where I didn't get home for days at
| a time, sleeping overnight in hospital quarters, outpatient
| clinic benches and in my car. I used to have my sleeping bag,
| toiletries and change in the boot of my car because I didn't
| know if I was going to make it home some nights. Plans change
| every single day at work because of emergencies. I can't even
| be sure what the next hour will bring when I am on call.
|
| This is absolutely insane. Are we reading a town doctor's tale
| or a war tale?
| thundergolfer wrote:
| Though significant restrictions on supply do exist, the problem
| does not seem to be nearly as bad in Australia as in the USA
| [1]. In Australia there's ~15 medical graduates per 100k vs ~8
| in USA.
|
| The doctors in Australia are still definitely overworked
| though. A decent number of the people I went to school with
| became doctors in Australia, and though we work roughly the
| same number of hours (~60-70hrs/week), my work in the software
| industry is like a stroll in the park.
|
| It was remarkable to hear my male friends who became doctors
| admitting that they had broken down crying in meetings with
| their boss because of workplace stress and exhaustion.
|
| 1. https://www.ama.com.au/ama-
| rounds/13-may-2022/articles/more-...
| genewitch wrote:
| there's more than 12 times the number of people in the US.
| Yes i understand this is "per 100k", but this still kind of
| reads like "adding lanes to highways does not reduce
| traffic," and that means that there is some other issue. If
| you have more doctors, more people will go to the doctor.
| This is good, more people should go to the doctor, because
| early and preventative care reduces the overall cost burden
| on the system.
|
| And i don't want to put this in its own comment or even
| continue reading the defense of doctors (as they stand now):
| Women get shafted so hard by the medical community. People
| with mental health issues get screwed by the medical system.
| Both get their problems written off for non-medical reasons.
| There are bad practitioners just like there are bad
| developers and bad general contractors and bad bridge
| builders and bad pilots. The whole system is not very good
| and i don't see, necessarily, how merely adding more medical
| degree holding people to the mix will improve things. There
| isn't enough patient advocacy, there's too much friction with
| medical insurance (in the US).
|
| But at least the shareholders are making money.
| candiddevmike wrote:
| Why do you work that many hours?
| Gunax wrote:
| While it's true that there is a limit (really there is a limit
| to every university study), there is also a limit to the number
| of people who are qualified and interested.
|
| For instance, there are only about 20k people who score > 510
| on the MCAT per year (the average matriculant has about a 512).
| And remember that includes US & Canada.
|
| While I know there are a lot of people rejected from medical
| school each year, some probably should not be accepted to
| medical school. I think we could probably increase the number
| of seats by about 20%.
|
| The American and Canadian medical schools place a high bar on
| accepting students, so nearly everyone who is accepted
| graduates. It's uncommon for medical students to perform
| poorly.
|
| But this isn't true everywhere. Some places prefer to admit
| many students and let them sink-or-swim.
| robocat wrote:
| > there are only about 20k people who score > 510 on the MCAT
| per year
|
| The article clearly shows the skills necessary to work as a
| doctor are a lot wider than academic ability.
|
| One pleasure/pain of being a software developer is that there
| is less gatekeeping.
| ejstronge wrote:
| > The article clearly shows the skills necessary to work as
| a doctor are a lot wider than academic ability.
|
| Where does the article show this?
| gosub100 wrote:
| Its not just limiting the numbers, but also the way matching is
| done. The current way is that upon admission to med school, you
| must be willing to accept just about any practice specialty.
| This is another thing that could be flipped on its head by
| allowing you to be any kind of doctor, provided that you attain
| the required MD and complete training.
|
| Yes, I know, certain medical specialties are very competitive,
| but (IMO) they should be forced to admit you if you pay for the
| training. For instance, if I could be a radiologist, I would.
| But I dont want to be any other kind of doctor. They could say
| "ok, you will be eligible for radiology residency upon earning
| an MD and completing some standardized program proving you
| learned the book-side of radiology. Upon completion of that,
| (and , say 1 year of generalist MD work), then some radiology
| residency essentially has to admit you. Not interview for it,
| and jump up and down like a puppy, and based on how likeable
| you are, maybe, they let you in.
|
| This could open the door for non-traditional doctors in
| general: Word could get around, "hey, this podiatry program is
| cool, 2 years training, 1 year public service, and you could
| earn $200k", knowing what kind of dr you will be might have an
| interesting effect in attracting people who otherwise would
| have never considered it (to fill the unpopular specialist
| roles like podiatry or psychiatry).
| bryanlarsen wrote:
| (At least some) of the new generation of doctors appears to be
| better about refusing overwork. AFAICT that's a large component
| of the doctor shortage here in Canada -- the ratio of doctors to
| patients is better than ever but if a doctor "only" does 40 hours
| a week you need more of them.
| keybored wrote:
| > I am realising more and more that what brings me greatest
| distress is the relentless administrative pressure which take
| away the meaningful clinical engagement I have with my patients.
| And I wonder if this is what many young doctors are experiencing
| as well. Medicine used to be a meaningful pursuit. Now it has
| become a tiresome industry. The joy, purpose and meaning of
| medicine has been codified, sterilised, protocolised,
| industrialised and regimented. Doctors are caught in a web of
| business, no longer a noble vocation. The altruism of young
| doctors have been replaced by the shackles of efficiency,
| productivity and key performance indicators.
|
| tl;dr: professional feels like a proletarian.
| grepLeigh wrote:
| The three factors mentioned (loss of control, loss of support,
| loss of meaning) are the pillars of occupational burnout,
| according to researchers like Christina Maslach.
|
| In many cases, someone experiencing occupational burnout NEEDS
| extended time away from their work environment to heal. In severe
| cases, they might not be able to return to work at full capacity
| for years (or ever). This creates a negative feedback loop for
| understaffed doctors, nurses, and other healthcare workers.
| npretorius wrote:
| Have doctor's unions helped before?
| kwhitefoot wrote:
| Why would they? Did pilot's unions campaign for strict rules
| regarding pilot's working hours? Or was it the FAA/CAA/etc.
| that did it?
| hello_computer wrote:
| There was a philosopher who once wrote " _all regimes exist under
| the consent of the governed_. " This should go double for the
| medical profession. They have the brains, the education--and in
| most cases, the money--to object, weather a fight if need be, and
| comfortably pivot if they lose. If the situation is intolerable,
| the person to blame is in the mirror. They are competitive
| people. The bureaucrats and administrators understand this, and
| use it to pull their strings--make them dance. _Click. Click.
| Click._
| bsdz wrote:
| Something I've never quite understood is why, in the UK, we cap
| the number of medical students per year. I've known very bright
| people who aspired to be doctors but had their applications
| turned down only to go on to do phds and become scientists
| instead. I'd rather have twice as many doctors who work sensible
| hours rather than the status quo burn out. Looks like there are
| calls to change this.
| https://commonslibrary.parliament.uk/research-briefings/cbp-...
| kvonhorn wrote:
| Supply and demand. If you artificially cap the supply of
| doctors, then the doctors can ramp up their prices.
| KittenInABox wrote:
| I don't even think doctors want the cap, tbh. Your average
| emergency physician would take all the qualified help they
| can get.
| lazyasciiart wrote:
| Yes, but how many residents can each emergency physician
| train at once? Doctors are similar to apprentices for the
| last part of their training.
| hollerith wrote:
| That explains why doctors like the status quo. Insurers like
| it, too, because expensive tests and expensive procedures
| must be ordered by a doctor (at least if insurance is going
| to pay for it) and if the patient gives up on getting in to
| see a doctor, then the insurer does not need to pay for the
| expensive test or expensive procedure. In the US, employers
| like it, too, because they end up paying the insurance
| premiums for their employees.
| tmpz22 wrote:
| And the schools prefer it (at least in the US) - limited
| highly paid doctors means they can charge exorbitant
| tuition.
| ejstronge wrote:
| > And the schools prefer it (at least in the US) -
| limited highly paid doctors means they can charge
| exorbitant tuition.
|
| What's the evidence for your position? Researchers who
| study this question have shown that the cost of medical
| education is significantly higher than the price assessed
| to students.
|
| In other words, having more medical students would cost
| schools money.
| abyssin wrote:
| There is an article in Le Monde diplomatique of February 2024
| that briefly tells the story of the first numerus closus in
| France in the sixties.
| bsdz wrote:
| Perhaps there's a little of that going on here in the UK.
| Doctors can certainly command a decent salary especially if
| they specialise, run private clinics etc. That said, I feel
| it's probably more complicated than that. Each place costs
| approx PS230k (only PS65k paid by student by way of loans).
| This means increasing supply is a costly endeavour. The
| government also says that they wish to maintain teaching and
| learning standards; although, I don't really buy that part.
| tim333 wrote:
| Of course the UK government can avoid the training cost by
| hiring foreigners. From my personal experience maybe half
| the NHS doctors are from overseas.
| truculent wrote:
| I'm not sure this really stands up in a UK context: https://w
| ww.nuffieldtrust.org.uk/sites/default/files/styles/...
| nradov wrote:
| Artificially limiting the supply of doctors is one way of
| rationing healthcare and holding down costs. Healthcare in the
| UK is largely funded through the NHS. Voters are already
| financially struggling and don't want to pay higher taxes. In
| some cases, even emergency patients are waiting hours in
| ambulances because hospitals are so overloaded.
|
| https://www.bbc.com/news/uk-england-cornwall-68171254
| nextaccountic wrote:
| Artificially limiting the supply of doctors drives the wages
| up. It's a common demand of doctors worldwide
| lolinder wrote:
| This doesn't make a lot of sense as an explanation for the
| policy--if there were more doctors trained that doesn't
| _require_ that they find jobs, but it does make it easier for
| hospitals to replace their doctors if and when they need to,
| and likely at a lower price. If healthcare costs were the
| reason I 'd expect the government to cap the number of
| doctors they employ now, not try to guess how many doctors
| they'll wish they could employ in six years.
| robocat wrote:
| > hospitals are so overloaded
|
| How do you suggest we limit the demand for healthcare?
| phren0logy wrote:
| In the US, anyone can walk into the emergency room for
| treatment, but people who don't have insurance are very
| unlikely to participate in preventative care.
|
| The way to decrease demand For complicated and expensive
| interventions to preventable problems is to increase access
| to preventative care.
| robocat wrote:
| I'm not sure what you mean by preventative care.
|
| In New Zealand "poor" might be a synonym for uninsured?
| However my peer group is middle aged professionals (not
| poor) with as variety of healthcare issues. Only a very
| few would preventative care help. _Prevention_ would help
| many of my friends. A friend with a cancer scare that
| keeps smoking. A friend with gout that doesn 't change
| habits. Multiple friends with issues from drugs that
| continue to take drugs. All my friends and me that are
| unfit and eat poor diets. I've given up drinking recently
| but I'm most definitely an outlier.
|
| Prevention is often the cure.
|
| Assuming you mean prevention when you say preventative
| care?
| switch007 wrote:
| In the UK they severely limit access to any diagnostics,
| and your GP just gives you antibiotics and/or anti
| depressants.
|
| At the hospital, they just classify your symptoms as "not
| critical", refuse to admit you and kick you back to your
| GP, who then refuses to refer you for any investigations, I
| imagine because there is a gun to their head over targets
| etc
|
| If your levels are high, you're told oh it's not severe. If
| it's severe, you're told oh it's not critical etc
|
| We have a system where everyone just gaslights you that
| you're in fact not sick because you aren't 3 seconds from
| death
| robocat wrote:
| That reduces access but it doesn't affect the _demand_
| for healthcare.
|
| I'm in New Zealand: not a heap better than you describe.
| Here GPs are overworked and getting an appointment is
| difficult. The health system has waitlists to control
| access to a limited number of procedures performed in
| each specialty. You need to be healthy enough to pass the
| access requirements and for acute surgery you need to
| live long enough to get to the front of the queue.
| paxys wrote:
| Because doctors' associations and regulatory bodies (like AAMC
| in the US) lobby to keep it that way to keep the value of their
| profession up.
| dmead wrote:
| And then make young residents work themselves to death.
| ejstronge wrote:
| > Because doctors' associations and regulatory bodies (like
| AAMC in the US) lobby to keep it that way to keep the value
| of their profession up.
|
| This isn't true of the AAMC position in the US today, and
| when it was true in the 90s, there were many articles about
| an upcoming oversupply of physicians.
|
| First, US medical school graduating classes are smaller in
| number than the number of available residency positions. So
| every year, the US is importing physicians trained in other
| countries.
|
| Next, residency positions (required to practice in the US)
| are funded by the US government. You could readily contact
| your US representatives about the problem you perceive - if
| this a legitimate concern for you.
|
| Additionally, US residency positions _don 't need to be
| funded by any government body, at all!_ Hospitals need
| 'simply' show that there is enough patient volume to support
| educating additional residents. This is another avenue where
| you can intervene, if this is indeed something you care
| about.
|
| Lastly, 'advanced practice providers' are filling in large
| amounts of the deficits in physicians in primary care
| providers. So focusing on the number of physicians is to
| ignore the huge growth of NPs and PAs - some of whom can
| function without a physician in some parts of their practice.
|
| I see many people blame 'the AAMC' for healthcare problems,
| but worry that not many appreciate the lack of a role the
| AAMC plays in the number of providers in America.
| dzink wrote:
| The training of each doctor takes a lot of resources,
| especially specific numbers of cases necessary for each of the
| specialists who do surgery of any kind. If a surgeon does not
| do a procedure on a regular basis they lose skill in it and the
| less practice a doctor has had in a field, the worse their
| outcomes. So if you get 10 whipples in a year in an area and
| you have too many surgeons or hospitals taking less than 1 per
| year, without one getting more than a number of cases a year,
| all of them will be bad and your mortality will be high.
| dogmatism wrote:
| NHS is in a process of replacing doctors with physician
| assistants
| arp242 wrote:
| Your own link contains your answer:
|
| > Expanding the cap on medical and dental school places is
| complicated by the cost of training, current university and
| clinical placement capacity, and the current number of
| clinically qualified academic staff who design and deliver
| courses.
|
| Furthermore, the NHS actually needs the funds to hire staff.
|
| The core problem is that people are getting older with more
| complex health care requirements, that more and more conditions
| become treatable, that healthcare is often expensive, and that
| no one wants to pay for it.
| bsdz wrote:
| I don't really feel it does. Sure I can see the costs
| involved complicate things. However, doubling the cap will
| likely introduce some economies of scale, surely that would
| reduce training costs. Also capacity would grow to meet
| training demand; Universities are always keen for more
| students. Also increasing the working pool will ultimately
| lead to more "clinically qualified academic staff". All this
| might become irrelevant with technology replacing
| GPs/Physicians. Perhaps in 10 years time we'll be examined by
| robots at our local pharmacy.
| arp242 wrote:
| > All this might become irrelevant with technology
| replacing GPs/Physicians. Perhaps in 10 years time we'll be
| examined by robots at our local pharmacy.
|
| lolno. Aside from the fact that AI is nowhere near good
| enough, we can't really build robots anywhere close to the
| dexterity required to do many of the physical actions. Also
| people like having human contact.
|
| "Economies of scale" only works well for things like
| manufacture, and is much more limited for many other
| things. It certainly doesn't reduce the cost of actually
| paying a yearly salary to these people, or ensuring you
| have enough places (hospitals) for the to work at, which
| isn't cheap either. There are some small advantages one can
| take here on there, but in general, it scales fairly
| linearly. This is not just me saying that, your own link,
| again, says that.
|
| Training 10 junior devs really is about 10 times as much
| work as training 1. Maybe slightly less because you can
| group _some_ things, but not too much. And training 20
| junior devs is about twice as much work as training 10.
|
| It really is just a funding issue - which is what everyone
| has been saying for years. Labour wants to increase spots
| by abolishing non-doms - we'll see if that works when they
| win the election.
|
| Otherwise feel free to stand for election and propose the
| _n_ % tax hike required for all of this and see how well
| that goes.
| rr808 wrote:
| An associated problem is that bright people from rural or poor
| areas who are really passionate about being a doctor dont get
| the right grades to get in. Middle class kids in cities get in
| because its a good career but dont really like it that much and
| definitely dont want to work outside their city. My brother
| worked as a doctor until his thirties then quit, such a waste
| of training.
| jajko wrote:
| In Switzerland, at least for the french part, most of the
| doctors are not Swiss anymore. It literally became white
| collar immigrant job. Wife is one of those and sees the
| problem very clearly due to speaking about this with both
| (those few) swiss colleagues and the rest - its simply not
| attractive career path for locals, too much suffering and
| risk for relatively little reward.
|
| Those bright enough go to law, IT and similar.
|
| Speaking for my wife, she had to wade through absolutely
| brutal first 10 years for absolutely no good reason (she
| ain't no neurosurgeon, just internal medicine GP with FMH),
| no personal life at all at the prime of her life. 50 work
| week in contract (when average here is 42), reality with all
| required bureaucracy goes to 60-70, for everybody,
| consistently, unpaid (illegal here but who cares, state owns
| the hospital), often much more and catching up with tons of
| bureaucracy/billing at home.
|
| Add night shifts, which most of us elsewhere have no
| experience with, that mess you up for many further days. You
| are a fraction of yourself, mentally and physically, for
| easily a week, more if you had to go through say 4-5 in a
| row.
|
| These are the conditions that we put repeatedly people who
| have full control over life and death and health of their
| patients, often without further supervision, hoping they
| somehow magically never ever make a mistake, and when they
| do, folks immediately cry a murder and families sue to hell
| with massive dollar signs in their eyes.
|
| You complain about that, or that you spend whole weekend
| being on call 48h unable to do anything really for literally
| 20 USD altogether (price of a canteen lunch here), including
| when you have to come and work 10-hour shift? You are put
| under pressure, shushed for being a pussy if you complain,
| told to toughen up since previous generations had it even
| tougher, and they somehow got through. Nobody mentions how
| horrible parents those absent folks were, how burned out they
| often were, quietly weeping or drinking themselves into
| oblivion. Well yes, those that didn't just quit, didn't go
| insane, didn't commit suicide, sure they got through. And now
| enjoy seeing young going through a bit milder version of the
| same. Of course there are insane amounts of money involved,
| but its always between insurance and hospital, doctors get
| less than capable IT folks for much less work. I am IT guy
| and consider this utterly fucked up wrong.
|
| A good friend of ours sued the hospital (biggest public in
| Switzerland) for breaking basic Swiss law consistently like
| that, he was first but quickly gathered tons of other
| doctors. IIRC hospital finally caved in, a bit, but he is
| gone from it for good to private sector. Twice the pay, half
| the crap.
|
| I could go on and on like this, a lot of doctor friends in
| our circles. It ain't some dream job, (at least a bit well-
| placed) IT job is a blessing in comparison.
|
| /rant
| rr808 wrote:
| I think its similar worldwide. Like I said my brother quit.
| Its also true that IT people are ridiculously overpaid.
| Both problems will inevitably revert to the mean.
| catlikesshrimp wrote:
| Not everywhere though. The life of a doctor is much
| better in Costa Rica, even in public institutions. The
| extra time is paid. And the syndicates are strong (which
| has worked well)
|
| The doctors in Nicaragua, the neighboring country, is as
| described in your comment, except the economy of the
| whole country is in shambles, and they also have to
| "voluntarily" participate in "government" political
| activities. Oh, and since the country is poor there are
| no immigrants waiting in line to fulfill those positions.
| peschu wrote:
| The picture you are painting is way too dark. And does not
| give a realistic picture.
|
| A lot of what you say is true for doctors in their first
| 5-10 years into their career, when employed in a hospital.
|
| This not true for doctors which reached a certain level
| like ,,oberarzt" and above.
|
| This is especially not true for doctors with their own
| ,,office" (business).
|
| Yeah people may cry, but normally it is very hard to bring
| a doctor to justice even when there are quite obvious
| mistakes or misconduct. They are very well protected, suing
| a doctor not seldom takes 10 years from start to verdict,
| with a lot of legal costs involved.
|
| And last but not least, it is a very secure profession. You
| must be really really stupid to end up jobless. So you have
| 5-10 years with a ,,ok" salary compared to the power you
| invest. And 20-30 Years with a very good to exceptional
| salary, especially when compared to the broader population.
| hagbard_c wrote:
| Same in Sweden, it is rare to meet a Swedish doctor at the
| 'vardcentral' (group practice). In my infrequent visits
| with one of my children I've met doctors from Iran, from
| Iraq, from Germany and from the Netherlands but not from
| Sweden. Nurses tend to come from Sweden. What seems to
| happen is that Swedish doctors find work in e.g. Norway
| where the pay is a lot higher while the working environment
| is less stressful. That in itself is also a bit of an
| oddity since Swedish doctors don't see as many patients per
| day as those in e.g. the Netherlands do.
| lilsoso wrote:
| We should enforce rigorous qualifications for doctors. We've
| relaxed the standards far too much already.
| archagon wrote:
| Qualifications should come at the end of your education,
| not at the start.
| Wowfunhappy wrote:
| Educating doctors is really expensive. It would really
| suck to invest all that money in someone (or in yourself)
| just for them to fail a final test or whatever.
|
| For what it's worth, I do agree we should train more
| doctors, but I think it's a complicated problem.
| casenmgreen wrote:
| We do not need all doctors to be uber doctors.
|
| We need a range of doctors, _who range in price according
| to quality_.
|
| That way for simple stuff, which anyone can get right, we
| go to a cheap, reasonable doctor.
|
| A similar example would be if we only had _uber_ software
| engineers. Each one had to have a PhD. There were _no_
| cheap and okay developers who could do say web-sites but
| not write a programming language from scratch.
| disambiguation wrote:
| idk why doesn't my startup hire twice as many people? wouldn't
| we get the work done twice as fast and make twice as much
| money?
| hazbot wrote:
| With doctors you can parallelize treating different patients
| pretty easily.
| gravescale wrote:
| Training places are already rammed to the gills, there aren't
| enough places to put substantially more students. Junior
| doctors already have to compete to get training slots even
| vaguely where they live and if they miss that they simply have
| to physically move to a different city. Medical training isn't
| as simple as just adding a lecture theatre and a few
| classrooms, or even a whole university building faculty of
| lecturers and admin. You also need a hospital (and GP surgeries
| etc) to be attached as well as enough senior staff to train
| them when they are there. That training is very intensive on
| trainer:trainee ratios and the senior staff are also in
| critically short supply as the ones who were trained up when
| there was training capacity (which, to be fair, was a time when
| it was far cheaper to train a medical student), are retiring by
| the thousands and many newer junior doctors quit or emigrate as
| a result of their experiences up to that point.
|
| Hospitals cost absurdly large amounts of money, especially in
| the UK where there are consultancies and layers of
| subcontracting for everything. So the infrastructure costs of
| adding even a few hundred student places is astronomical.
|
| Due to strategic underinvestment (or ideological sabotage, or
| governance incompetence, depending on outlook) there is now a
| self-reinforcing problem: not enough hospitals and staff to
| train doctors to beef up existing hospital staffing or work in
| hypothetical new hospitals even if a money firehose was turned
| on.
|
| Rather than having a tall glass of concrete and doing the hard
| thing, which will still take decades to manifest, what the
| government is currently doing is a rerun of Healthcare
| Assistants where more care is delegated to much cheaper-to-
| train staff. Plus quite a bit of noise about "AI" bring used to
| allow them to sweat the asset of the staff they do have by, for
| example having one radiologist verifying AI findings rather
| than a pair-based system.
|
| Which will all work "kinda ok" and let them punt the problems
| at least into the next government's domain when they lose the
| next election and can spend 5 years screaming from the
| Opposition benches about the mess. But you cannot do it forever
| (or the hail-Mary works, there's an AI revolution and you can
| actually run a hospital with an app, 2 agency nurses, a few
| smart plugs and an AWS instance).
|
| Of course "doing the hard thing" would be easy to say if it was
| just the NHS, but there's the same structural degradation in
| everything. So you also need to spend billions on education.
| That's the same general problem - shortage of facilities and
| not enough existing staff to train new staff and the ones you
| do train quit. Schools are currently one something like a
| 300-year replacement rate and that's without considering
| population growth or even the hundreds of schools that need
| rebuilding because they're made of RAAC. Then roads need
| billions to repair the accumulating damage. The railways need
| huge investment and staffing. Energy is the same - virtually no
| supply of domestic nuclear design engineers mean they get
| absolutely rinsed on even squinting in the direction of a
| drawing of reactor (though Hinkley Point C cost spiral is
| currently EDF's problem, not the taxpayer and green energy is
| actually a rare success story). Defence is similar (e.g. ships
| being retired because they need the staff elsewhere). At least
| some water networks are collapsing into a multi-billion hole
| after private dividend extraction. So that money firehose has a
| lot of work to do, even if they would turn it on. Which is
| ideological poison apparently.
| catlikesshrimp wrote:
| My life experience showed me that allowing more people in lead
| to less capable people in. Less capable students graduate as
| worse doctors. And doctors who came from more wealthy families
| usually do much better, regardless of their prowess. I won't go
| into details, it is unnecessary.
|
| The end result is that the health practice degrades overall,
| and social inequality strenghtens. I think nobody is happy with
| the former reason.
| DonnyV wrote:
| This is what happens when everything is financialized. There is
| no reason that we should be running doctors into the ground.
| Health professionals are a necessity in a functioning society. I
| know in the US Government seems to have no problem throwing money
| at corporations and providing endless tax breaks. But god forbid
| we proved a functioning health system.
|
| For the US this needs to happen.
|
| 1) Medicare For All - a universal, no pay at service, insurance
| system, everyone taxed at 4% for it.
|
| 2) People that have the grades to make it to medical school
| should get a free ride.
|
| 3) Small Private practices should come back with free digital
| billing with the new health insurance system.
|
| 4) Price regulation on all basic medical supplies and medicines.
| No more $20 tongue depressors
|
| 5) All medicines researched at public Universities will not be
| sold or given to private industry. They will be licensed. That
| money goes back into supporting this system.
| jokethrowaway wrote:
| Public healthcare doesn't work.
|
| They just get progressively worse and start adding expenses for
| the patients. The quality is terrible, despite the propaganda.
| The best companies were offering private healthcare with their
| offer.
|
| I've seen it happen in two countries, now I live in one which
| just made most of private healthcare (which is excellent
| quality) available as public. It's working well for now but
| they're spending a ridiculous amount of money and it's not
| sustainable. Doctors are happy, I'm not because my taxes
| increased from 12.5% to 15%.
|
| Public mismanagement is huge, they'll screw it up.
|
| The USA government needs to stop being in bed with insurance
| companies to make everything expensive, then your private
| system will be fine.
| DonnyV wrote:
| I didn't say Public healthcare. Only the insurance is public.
| The healthcare system still stays private.
| kwhitefoot wrote:
| > Public healthcare doesn't work.
|
| It works here.
| IvyMike wrote:
| It appears that Dr. Eric Levi works in England.
| GiorgioG wrote:
| You are a body to the healthcare system. My wife is a hospice
| nurse and they're happy to grind you into the ground as long as
| it suits them.
| genewitch wrote:
| as long as the client has money in their savings account*
| willmadden wrote:
| The answer is simple, mandatory limits on hours and days worked.
| Also fix healthcare regulation and the process of becoming a
| doctor so there isn't a supply shortage of doctors and surgeons.
| kingkawn wrote:
| The profession as a whole is profoundly hostile to any serious
| considerations of mental health, and it's going to take many more
| suicides before even the smallest steps are taken toward obvious
| quality of life improvements.
| genewitch wrote:
| humanity as a whole is profoundly hostile to any serious
| considerations of mental health. Dr. Drew once agreed with a
| rant by cohost adam carolla along the lines of (this is a
| whisper transcription. blame me for mistranscriptions, idc)
|
| "It just doesn't make any sense to me. What's so bizarre in our
| culture, if you'd broken your leg when you were a kid and you
| needed a few years of physical therapy, you'd get it. You'd be
| running on it, and by the way, people would be applauding your
| great commitment that you go out and work out every day on your
| leg, and you make sure that you're going to overcome that
| problem, and you're going to get back up on skis again and
| whatever. The same thing is true with our brain, and somehow
| because it's our brain, no, no, no. Sorry. We'll have none of
| that. What would [...] tell you to do? Oh, he'd say just decide
| to change. You just gotta decide to change. You gotta get up,
| you gotta dust yourself off, you gotta take a long look in the
| mirror, and you gotta decide to change. I can't change for you,
| and all the people wishing you'd change around you aren't gonna
| make you change. There's only one person that can change your
| life, and that person's name is [...]. You want to lose weight,
| you're gonna have to burn more calories, and you're gonna... "
| kingkawn wrote:
| All true. I think doctors as possessors of the monopoly on
| health spending are uniquely positioned to fuck the whole
| society up with their own blindness to monumental aspects of
| health
| andoando wrote:
| The shit we make doctors go through is unnecessarily insane. It
| takes 300-400k of debt and grueling 7-8 years on top of a
| bachelors degree, with bunch of uncertainty on where you'll be or
| whether you ever make it, just to start working. If you ever quit
| before then, any progress made counts for zero and you have to
| start all over again in a new field with a ton of debt.
|
| Why doesnt an MD or even credits at a medical school count toward
| nursing, physician assistsnt, etc?
|
| Lastly, med school is unnecessarily long. You don't need most of
| the material to do family medicine for example.
|
| I really don't understand how such inefficiencies could be
| tolerated.
| nradov wrote:
| I agree but the education system is starting to improve. Some
| schools now offer combined Baccalaureate-MD programs which can
| reduce the education time by up to 2 years.
|
| https://students-residents.aamc.org/medical-school-admission...
|
| Tennessee now allows some physicians to practice without
| completing a residency program, largely as a way to attract
| immigrants to work in underserved communities.
|
| https://www.medscape.com/viewarticle/993693
| praptak wrote:
| _" Medicine used to be a meaningful pursuit. Now it has become a
| tiresome industry. The joy, purpose and meaning of medicine has
| been codified, sterilised, protocolised, industrialised and
| regimented. Doctors are caught in a web of business, no longer a
| noble vocation. The altruism of young doctors have been replaced
| by the shackles of efficiency, productivity and key performance
| indicators."_
|
| That's textbook Marxist alienation of work. It was not supposed
| to happen to middle class workers though.
| lurking15 wrote:
| Oddly enough medicine has never been more regulated and
| financed by government so hard to say this is some sort of
| marxist dynamic, more like the consequences of centralization
| that happened after (because of) WWII. You see this in the
| US/UK/Canada regardless of whether they're "socialized" it's a
| mess everywhere.
| maCDzP wrote:
| My not so generous and extreme take is that the medical
| profession has a "hero culture".
|
| There is prestige in working your ass of and living for work.
| Work life balance is for the weak people who can't take it, they
| are not real health professionals. They don't have what it takes.
|
| I have seen the same culture in aid work.
|
| I find it ironic that both health professionals and aid workers
| are there to help people, but not for each other. Then it's cut
| throat.
| jokethrowaway wrote:
| This can happen in any work.
|
| But I concede, medicine is grueling - not worth the money if you
| ask me.
| eclectic29 wrote:
| Thanks for sharing. This is so disheartening. The other day I was
| debating with my friends how a doctors life is so cool that they
| don't have to go though grueling coding interviews every single
| time they want to change jobs, don't have to prove themselves
| every single quarter, don't have to be answerable to anyone or
| write performance reviews or be subjected to arbitrary rubrics.
| Boy, I was so wrong. Every procession has its hazards. This has
| been a learning for me. Although I do feel that the PCP doctors
| in US seem to have a simpler life. They leave office at 5 and
| don't take calls in the night. Happy to be corrected though.
| Turing_Machine wrote:
| Even PCPs sometimes have to go home with the knowledge that
| someone died, and (being human) wondering if there was
| something else they could have done.
|
| Now imagine that happening dozens or hundreds of times over the
| course of a career.
|
| Unless coders are working on air traffic control or something
| similarly critical, it's pretty rare for a bug to kill someone.
| dogmatism wrote:
| US PCP doctors do take calls. It's less common for them to go
| to the hospital to admit their own patients anymore since the
| rise of "hospitalists" but they still take outpatient calls and
| calls from the ER.
|
| Also, PCPs are subject to the most metrics/rubrics of any, and
| all the crap paperwork that any specialist can foist off onto
| them, they do. Shit rolls downhill, and PCP's are at the bottom
|
| They may stop seeing patients at 5, but they sure as shit
| aren't done at 5. Most are logging back in even later doing all
| the "paperwork" they didn't have time to do during the day.
| Even has a nickname: "pajama time"
| game_the0ry wrote:
| I don't understand why doctors that are entering the field need
| to be over-staffed and over-worked. I have a cousin who is an Er
| surgeon and she needs works 3 days a week, but that certainly was
| not the case when she was starting out.
|
| The work culture of the medical profession looks horribly
| inefficient. What benefit do you get from buying out young
| doctors?
| jstummbillig wrote:
| Discipline. (I am not saying it's worth it. I don't know.)
| opinion-is-bad wrote:
| Poor incentives for the existing members of the system that
| hold power to implement change. They already cap the number of
| med students to control salaries, perhaps burning out young
| doctors fulfills the same purpose, while also (temporarily)
| covering for the lack of doctors available because of the
| artificial limit?
| rr808 wrote:
| Some wards with really sick people benefit from having longer
| shifts as you see the person progress and have fewer shift
| changes. Ie with 2 people doing 12 hr shifts is better than 3
| people doing 8 hours shifts as the doctors and nurses see how a
| patient is doing and dont have to communicate to next shift.
| Something like ER where people come and go all day wouldn't
| benefit from this however.
| jajko wrote:
| Yes but you _really_ don 't want to be treated at the end of
| that 12-hour shift, quality of service drops down
| significantly, they are significantly more tired at that
| point. Doctors are just humans like rest of us, and those
| shifts are often brutal.
| game_the0ry wrote:
| That's what I am trying to say, sleep deprivation causes
| people to make mistakes.
| dimal wrote:
| I'd rather have three well-rested people and an additional
| shift change than two burned out, exhausted people. People
| who are exhausted make mistakes. Maybe it would be better to
| focus on improving internal communication.
| rr808 wrote:
| Maybe, I think we have to trust the medical people that
| they know what they're doing. My baby daughter was in
| incubated in ICU twice with severe Bronchiolitis. It was
| nice to see the same people look after her for a week
| rather than a continual stream of people clocking on and
| off.
| krisoft wrote:
| > It was nice to see the same people look after her for a
| week rather than a continual stream of people clocking on
| and off.
|
| Surely those people were sleeping from time to time
| during the week, weren't they? That is the "people
| clocking on and off".
| GavinMcG wrote:
| Have you looked at the research regarding which of those
| two options leads to better patient outcomes?
| game_the0ry wrote:
| Have you? I'd love to hear that answer.
| game_the0ry wrote:
| So would I.
| spxneo wrote:
| People think doctors are some super human that they can heal
| themselves but they are people just like you and me. It's
| despicable that they along with veterans are being treated with
| ambivalence.
|
| The most recent example of contempt towards doctors described in
| the article I've seen comes from South Koreans who enjoy a
| generous, affordable, high quality healthcare that exceeds those
| in North America complaining doctors make "too much" and that
| there isn't enough doctors.
| neilv wrote:
| Especially since the Covid vaccine return to some normalcy for
| many of us, always in the back of my mind whenever dealing with
| healthcare providers, is that they're probably the ones that both
| survived and stuck through that catastrophe.
|
| And, some places, I get the impression they have fewer staff now,
| and greater financial challenges.
|
| > _If I decide to work less, who is going to cover the hospital?
| If the hospital aren't employing other doctors, we can't allow
| patients to go uncovered. I accept the fact that I have a duty of
| care to be on call._
|
| The hospital also has a duty of care.
| treprinum wrote:
| Enforcing duration of medical actions must be some of the most
| idiotic things a healthcare MBA/MPH could come up with. Forcing a
| surgeon to finish surgery exactly within allocated time is
| putting lives at risk. The factory model should never be applied
| to fields like these.
| wuj wrote:
| One point I resonated with is the high administrative overhead of
| being a doctor. I can imagine the stress of using an outdated EMR
| system when the time you have for each patient is so limited. I
| see lots of AI companies are trying to transform the MedTech
| industry, but I'm unsure how much of their products useful / are
| actually adopted by the hospitals. Maybe some experts in that
| space can enlighten me on that?
|
| I also agree that running hospitals like a private business is at
| odds with the essence of healthcare. However, this trend might be
| more indicative of a broader societal shift rather than a
| phenomenon unique to this sector.
| lukko wrote:
| One of my old registrars co-founded this company:
| https://tortus.ai. They are doing a trial at Great Ormond
| Street at the moment - I haven't tried what they're building
| but it's an AI assistant that reduces some of the admin burden.
|
| I am really hopeful that systems like this will take off - the
| reality of being a junior doctor in the UK is that most of your
| time will be used on quite tedious admin tasks (documenting
| every patient interaction, filling forms, booking clinics etc.)
| using very & slow outdated computer systems. I don't think
| anyone expects this when they apply to medical school, and it
| can be quite demoralising when you start your first job.
| quasse wrote:
| > I see lots of AI companies are trying to transform the
| MedTech industry, but I'm unsure how much of their products
| useful / are actually adopted by the hospitals. Maybe some
| experts in that space can enlighten me on that?
|
| My impression (as an outsider with a partner in the medical
| field) is that the prime function of the "medical industry" is
| to generate reams and reams of documentation about "care
| provided" to an insanely granular level. Functionally, this
| information is mostly bullshit that is irrelevant to providing
| medical care, but it serves a very important purpose for the
| medical administrative class so that they can bill the patient
| for each bandage applied or Ibuprofen administered.
|
| AI MedTech companies mostly seem primed to increase this
| firehose of bullshit. Whether or not that will take the
| pressure off front-line medical personnel who are currently
| tasked with generating it remains to be seen, but you'd be hard
| pressed to convince me.
| lukko wrote:
| There are a few other reasons - doctors document every
| interaction partly for medico-legal reasons - just in case
| something happens. The notes become especially long and
| defensive in any situations that have a possibility of being
| misinterpreted. If it's not written down, it didn't happen.
| It's obviously also a record for other clinicians /
| healthcare professionals to read through and see what
| happened during the admission.
|
| But yep I do worry about any kind of generative AI in this
| context.
| vehementi wrote:
| I wonder why this guy has a plug for that home doctor book which
| looks reeeeally sketchy. I went looking for reviews of it and
| reddit is filled by spam from just one reddit user
| Havoc wrote:
| I didn't even consider surgeon as an option. The idea of a life
| being dependent on my steady hand, skill and knowledge is
| terrifying. Literally I'm having a bad day, mess up, someone
| dies?
|
| ...having people brave enough to take that on drown in red tape
| is a shameful black mark on society.
| worik wrote:
| Doctors meet better unions in that country
|
| Senior doctors in New Zealan have one of the most powerful unions
| in the country
|
| Junior doctors are catching up
|
| It is still a punishing career, but not like that.
| H8crilA wrote:
| In many countries doctors' unions actually encourage this sort
| of stuff, by restricting the number of spots in medical
| degrees. Making sure there are as few juniors as possible,
| making their life more miserable than it needs to be - this
| sort of stuff.
| skybrian wrote:
| It's side point, but I'm wondering, why does the blog post start
| with a link to a book? It looks like an interesting book, but I
| don't see the relationship. Has Substack started running
| advertising?
| csbbbb wrote:
| I empathize in general.
|
| Still, I wonder how much each one of those overbooked surgeries
| cost the patient. Months' worth of savings? Year's worth of debt?
| Their life?
|
| At the same time, most established doctors seem to make enough
| money to easily manage their school debt and afford a privileged
| lifestyle amongst privileged lifestyles, without worrying about
| job security.
|
| Considering all this, it's tempting for me to approach doctors
| with the same implicit deal I get from healthcare system: if you
| want me to care, it'll cost you.
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