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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#31

Post by maxerickson »

killjoywashere wrote: post #27
QML wrote: post #25

Earlier quoted context omitted.

Do you think if the United States graduated more doctors every year, it would prevent doctors as a group from being overworked and overtired? As a college student, I often wonder why pre-med is so academically competitive despite the fact that the ambition to help others is a virtue; and whether that competitiveness to get a high GPA and MCAT score is needed at all.

There has been angst about medical school admissions for decades. Med school admission really is the hurdle to get over in the US. There are more residency spots than US MD graduates to fill them. By a wide margin. There's a strong medical education research unit in the UK (Edinburgh?); I remember one of their reports on a series of med student interviews making the observation that it was unnerving how the top perfo…

In recent years residency slots have become the bottleneck.

Re: The Dark Side of Doctoring

#32

Post by hammerzeit »

pixelmonkey wrote: post #18

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…

My spouse is a doctor as well, and I've also observed the issues the author discusses. I don't think your read of the causes here is correct.

It's worth reading more about the history of medicine to truly understand what's going on here -- the culture of abusive overwork in American medicine goes at the very least back to Osler and the invention of the modern residency program, and has as much to do with cocaine than any corporate malfeasance. Certainly hospitals and the medical industry profit from this culture, but they hardly created it.

Also, on what basis do you say that longer hours with fewer tradeoffs don't improve patient outcomes? You frame it as though it's obvious but is there any evidence to back that up? My wife and most other doctors I know all claim they'd rather have longer hours with fewer handoffs.

Re: The Dark Side of Doctoring

#33

Post by [deleted] »

QML wrote: post #25
pixelmonkey wrote: post #18

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... a doctor is just one of the many commoditi…

Do you think if the United States graduated more doctors every year, it would prevent doctors as a group from being overworked and overtired? As a college student, I often wonder why pre-med is so academically competitive despite the fact that the ambition to help others is a virtue; and whether that competitiveness to get a high GPA and MCAT score is needed at all.

[deleted]

Re: The Dark Side of Doctoring

#34

Post by Kenji »

johan_larson wrote: post #8

Why continue in a job that sucks that hard? Is it the money? The prestige? Family expectations? It seems like a terrible way to live.

Why continue going to bed too late every night? Why continue to eat unhealthy food? Why continue to work out too little? Why continue taking drugs? Why doesn't everyone just live a perfect life? It's not easy to give up things and change, even if it's ultimately for the better. Let's face it: Workaholism and burnout are addiction problems.

Re: The Dark Side of Doctoring

#35

Post by killjoywashere »

maxerickson wrote: post #31
killjoywashere wrote: post #27

Earlier quoted context omitted.

There has been angst about medical school admissions for decades. Med school admission really is the hurdle to get over in the US. There are more residency spots than US MD graduates to fill them. By a wide margin. There's a strong medical education research unit in the UK (Edinburgh?); I remember one of their reports on a series of med student interviews making the observation that it was unnerving how the top perfo…

In recent years residency slots have become the bottleneck.

There are ~30,000 PGY-1 spots and only about 18,000 allopathic medical school graduates. (1) All the native allopaths and all the osteopaths together can't fill all the residency spots. We inhale foreign medical graduates.

(1) Pages v and 14: http://www.nrmp.org/wp-content/uploads/2017/04/Main-Match-Re...

Re: The Dark Side of Doctoring

#36

Post by pdelbarba »

maxerickson wrote: post #26
protonfish wrote: post #3

The FAA enforces work limitations on pilots, but we schedule our health care workers like this? How are there not even civil cases against errors caused by this kind of administrative foolishness? Overworking doctors like this is insane.

The training for airline pilots is a lot less than for doctors. A couple thousand hours of flying, many of which can be paid work (like flying an add banner).

Depends on what you call training. 250 hours under a private (no payment allowed) licence, then you get your CPL. All of this is on your dime (average about $200/hr with instructor and such). The CPL phase work afterward (banner flying, flight instruction, etc) pays like garbage since the GA community is struggling significantly. To do airline work, you need minimum 1500 hours (ATP), then pilots have a sort of residency beyond that where they need to spend a month in airline training, then years as a first officer before becoming a captain (PIC). On top of this, you have the regionals where you get payed like crap before you can typically get a seat at a major airline.

Re: The Dark Side of Doctoring

#37

Post by red_hairing »

drewg123 wrote: post #21

It seems like we have an undersupply of physicians. My understanding is that the AMA limits medical school admissions[1] in order to keep salaries artificially high. This naturally leads to overwork in addition to high salaries. [1] http://www.usatoday.com/news/health/2005-03-02-doctor-shorta...

the medical cartel is very powerful...it is really a sort of extortion racket the doctor cartel has going on here in america...they suppress supply and thus increase their wealth....I say we use the fed govt to fund medical school construction in every third world nation and then import half the grads...supply and demand...demand and supply...that law never dies..

Re: The Dark Side of Doctoring

#38

Post by qudat »

EvanAnderson wrote: post #23
drewg123 wrote: post #21

It seems like we have an undersupply of physicians. My understanding is that the AMA limits medical school admissions[1] in order to keep salaries artificially high. This naturally leads to overwork in addition to high salaries. [1] http://www.usatoday.com/news/health/2005-03-02-doctor-shorta...

Here's the go-to that I send people to when this comes up: https://skeptics.stackexchange.com/questions/4561/does-the-a...

tl;dr Federal health spending is the limiting factor.

Question: Why do we need the government to fund residents? The fact that every single going-to-be physician must do so through government funding boggles my mind.

On top of that, depending on the number of hours worked, many residents barely make minimum wage.

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