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The Dark Side of Doctoring

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Re: The Dark Side of Doctoring

#51

Post by markroseman »

One theme coming up here is the idea of just graduating more doctors, but even ignoring artificial pressures to keep supply low, it's not that simple. Many disciplines, particularly things like surgery, have a lot of requirements beyond just doctors, i.e. nurses, anaesthesia, OR's, hospitals, etc.

In Canada, we have a fair number of people in certain specialties that cannot find work - think a radiation oncologist who needs some pretty specialized and expensive equipment that only exists in a few places to be useful. But also even more basic... gastroenterologists who can't get enough OR time to do scopes on their patients.

Re: The Dark Side of Doctoring

#52

Post by robbiep »

Here is some context for this article: Dr Levi is n Australian surgeon. He is responding to a letter from the wife of a gastroenterologist who committed suicide recently.

Last week was the Royal Australasian College of Surgeons Annual scientific Congress in adelaide so physician wellbeing is well and truly on the radar, in particular following 3 suicides in the last 6-9 months of junior trainees, one of whom was a friend of mine from medical school.

There is now an enquiry into Doctor suicides and wellbeing being performed at the state level in NSW and we (doctors) expect this scope to be broadened to nationwide

Re: The Dark Side of Doctoring

#53

Post by abandonliberty »

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…

How much selective pressure do doctors experience on their performance?

Healthcare is one of those fields where there's no guarantee on the quality of the service. There's no pay for performance. Actually, doctors who perform too well would reduce healthcare spending.

There are plenty of reasons to keep developers happy because it directly affects the end product and profit.

Re: The Dark Side of Doctoring

#54

Post by pc2g4d »

djsumdog wrote: post #47
pc2g4d wrote: post #45

So... because the supply of doctors is restricted but demand for doctors grows proportionally to the population, the amount of work per doctor gradually increases and doctors, persuaded by their ethical obligation of care, put up with it as long as possible until they snap. Yeah? I just recently had a friend completely burn out of medicine, sell his house, and start traveling the world. He was brilliant, a good docto…

This is what I felt when I read the article. It was surprised even the Australian system is just as overloaded as our American system. I feel like a lot of these problems could be deal with if there were simply more doctors. That being said, it's a difficult profession. Not a lot of people want to do it. Even fewer in such specialised positions as surgery, where mistakes literally cost people lives. There's no rollin…

The high cost of medical school seems directly related to the restriction on the number of physicians. Because only N seats are available whereas maybe 10*N seats would be desired in a free labor market, each school can charge immensely for each seat. The most idealistic will still be willing to apply and take on the debt.

Of course, I'm no expert in this stuff, this is just my hot take. I'm sure it's hugely more complicated.

I don't think a sabbatical is a bad thing at all. But this is more than that, and it's driven by burnout rather than a simple desire for refresh and reflection. That's what I think is negative here.

Re: The Dark Side of Doctoring

#56

Post by maxander »

qudat wrote: post #38
EvanAnderson wrote: post #23

Earlier quoted context omitted.

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.

I suspect that this is the "companies don't want to train workers" problem, the same one that makes employers demand 10 years of Java experience for crap jobs, writ large.

Re: The Dark Side of Doctoring

#57

Post by ploxiln »

hammerzeit wrote: post #32
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…

Maybe patient handoffs are so dangerous because of the dysfunction everywhere else in the system. Maybe patient current-state summary and recent-changes log could be much better maintained, if doctors had a bit more time and the forms/systems for it were refactored a bit.

Doesn't it sound like medicine is like a web service infrastructure where everything is on fire, and there's just no time to really fix the root causes?

FWIW, my mother is an MD, a Family Practitioner. She eventually became head of FP for a small commercial hospital chain in the US. Two years ago, after perhaps 18 years of professional practice, she moved to New Zealand and is a FP in a small town. She takes 3 days off a week, has reasonable hours, does less paperwork, does more with her own hands which she would refer to specialists in the US. She absolutely loves it.

Re: The Dark Side of Doctoring

#58

Post by Gatsky »

robbiep wrote: post #52

Here is some context for this article: Dr Levi is n Australian surgeon. He is responding to a letter from the wife of a gastroenterologist who committed suicide recently. Last week was the Royal Australasian College of Surgeons Annual scientific Congress in adelaide so physician wellbeing is well and truly on the radar, in particular following 3 suicides in the last 6-9 months of junior trainees, one of whom was a fr…

I wish I could applaud this. But what sort of professional organisation waits until its members are actually dying before putting well-being in the radar?

The RACS, RACP etc are sclerotic organisations run by old white men in bow ties (I've met several of them) with no real incentive to improve conditions for trainees. The only way I have seen actual change happen is when junior staff band together and effectively go on strike.

Re: The Dark Side of Doctoring

#59

Post by javiramos »

killjoywashere wrote: post #35
maxerickson wrote: post #31

Earlier quoted context omitted.

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...

Wow surprised to see that almost half of all PGY-1 residents are foreign-trained.

Re: The Dark Side of Doctoring

#60

Post by maxerickson »

pdelbarba wrote: post #36
maxerickson wrote: post #26

Earlier quoted context omitted.

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 reside…

Doctors begin their professional training after 7 or 8 years of post secondary education.

Much of the time, on their own dime.

They also generally work hard enough in high school to get excellent grades (do flight instructors check transcripts or just if the check clears?).

It's easy to imagine doing 250 hours over 3 or 4 years while doing something else most of the time.

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