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No Doctor Should Work 30 Hours Straight with No Sleep

theatlantic.com

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Re: No Doctor Should Work 30 Hours Straight with No Sleep

#131

Post by themantalope »

tjic wrote: post #114
diimdeep wrote: post #107

In the US alone, the Association of American Medical Colleges (AAMC) estimates a shortage of 91,500 physicians by 2020 and up to 130,600 by the year 2025. https://en.wikipedia.org/wiki/Physician_supply#Global_View

Note that the AMA, run by doctors, is required by US law to give their approval before a new medical school may open, or an existing medical school can expand its program. The doctors who would see their salaries fall if supply increased have complete control over supply. This is complete regulatory capture, and it's terrible.

While this is true, the real bottleneck is the availability of training positions. Other commenters have pointed out that these positions are generally increasing in number, but not nearly at a rate large enough to make up for the shortfall.

One positive argument to having a body like the AMA leverage some control over medical schools is that it helps to ensure that schools only open/expand if the AMA thinks that their students will have reasonably good chances of getting residency positions. It helps to avoid the sort of situation that is currently going on in law school and PhD programs where there are no where near enough positions available for all the students who are graduating from those programs.

And I do generally agree with you that there are some significant regulatory problems regarding training and residency positions, especially since residents have basically zero leverage at all.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#133

Post by trowawee »

maxerickson wrote: post #127
dougmccune wrote: post #113

Earlier quoted context omitted.

Even if there are people like yourself who actually want to work 17 hour days for 7 days in a row (!), shouldn't we as patients be able to have doctors who are not allowed to do that insanity? Medical error is the #3 cause of death in the US. It seems entirely irresponsible to take someone's life into your hands without proper rest.

work 17 hour days for 7 days in a row (!) They explicitly said 17 hours was rare.

I don't really care how rare it is; I never want to be treated by someone who's been going for more than 8 hours, much less someone who's been going for 17.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#134

Post by Symbiote »

dv_dt wrote: post #130
hahajk wrote: post #106

Earlier quoted context omitted.

I always wondered why the public puts up with it. Aviation is always provided as a contrast to the medical community: pilots have legally-mandated sleep requirements. My hunch is that when a plane crashes, everyone freaks because planes aren't supposed to crash. When someone dies at a hospital nobody notices because people die at hospitals all the time.

If the plane crashes, the pilot has a good chance of dying too, if the doctor makes a mistake, not so much.

Air traffic controller then. I hope they have regulated hours in the USA...

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#135

Post by trowawee »

minimuffins wrote: post #51

Learning about new ways that our medical industry is totally dysfunctional is baffling and infuriating. It seems to be an inexhaustible well of misery for workers and patients alike. These conditions are like something out of a 19th century factory town. One more way the US healthcare system is a ridiculous anachronism. My first questions are 1) Is sleep deprivation and the generally toxic work culture for doctors an…

The problem is that doctors are never going to organize against this, because A) most have been thoroughly inculcated in a culture that worships that kind of work ethic and B) the limited number of physicians is the reason they make absurd amounts of money. The median ER doc in SF makes $328,047[1], and ER's a relatively low-paying specialty. The solution is regulation with teeth, similar to the rules governing pilots.

[1]: http://www1.salary.com/CA/San-Francisco/ER-Doctor-Salary.htm...

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#136

Post by themantalope »

djsumdog wrote: post #2

I remember hearing about sleep deprivation in the medical field before; especially for people who work in the ER or as surgeons. The demand in the US for nurses and doctors is very high, and so are the education costs which can be prohibitive to people getting into medicine. There's a whole system of failures, from the cost of education to the student loan systems to medical insurance and billing, that has led direct…

>Many med students today feel that they can't become GPs because they simply won't make enough to pay back their student loans.

I'm at a private (but good) medical school and this is definitely a problem. My tuition (not including living expenses) is about $50,000 per year. And to be honest, there isn't a huge difference in tuition between most private and public medical schools. I'm from NYS, which does a pretty good job subsidizing its state schools. When I was applying to medical school, the in-state price was around $35,000 per year. However, just over the border in Pennsylvania the price at Pitt (which is public) was around $48,000 per year, for out of state students, and maybe 40 or 42k for in state students.

I went to an in state school for undergrad, and I'm very fortunate to have no debt from that. However, many of my classmates who went to good private undergrad schools (Ivy league etc) will have (a lot) of debt from both undergrad and med school. They literally have no choice - they need to go into a high paying specialty if they ever want to pay their loans off.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#137

Post by kelnos »

mcv wrote: post #92
pdxandi wrote: post #34

Earlier quoted context omitted.

My wife's a second-year resident and it's pretty unbelievable how hard and how much they work. She's on her 18th straight day of working long days during the week and long nights during the weekend. Legally there's an 80-hour per week cap, but no resident would ever complain. They do 24 hour shifts, but never 30 hour ones, though other programs at her hospital do. I felt upset about her hours all through medical scho…

So what happened? Was there a massive disaster that created an overwhelming flood of patients, that everybody needs to work overtime? Because under normal circumstances, a competently run hospital should be able to function with normal 8-hour shifts. If that's not possible, then management fucked up. Accepting these kind of hours as standard is completely unreasonable and dangerous, especially in hospital, where live…

A doctor friend of mine claims that the benefits of doctor-patient continuity outweigh any downsides of sleep deprivation. That sounded like a rationalization or cop-out to me, though. I can't imagine how that could be true, or that they're aren't other ways to solve the continuity problem that don't involve zombie doctors.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#138

Post by kelnos »

koolba wrote: post #97
pdxandi wrote: post #34

Earlier quoted context omitted.

My wife's a second-year resident and it's pretty unbelievable how hard and how much they work. She's on her 18th straight day of working long days during the week and long nights during the weekend. Legally there's an 80-hour per week cap, but no resident would ever complain. They do 24 hour shifts, but never 30 hour ones, though other programs at her hospital do. I felt upset about her hours all through medical scho…

Why can't you have children? Would it completely throw her off her eventual completion of her residency or just delay it? All women deal with it differently, but most are able to function within their normal bounds until at least the six or seventh month. > Writing this comment makes me realize how painful it feels at times that her medical training runs our lives. s/runs/ruins/?

Post-birth is a consideration as well. Assuming the parents intend to breast-feed, the child will need the mother every hour or two for several months after birth. After a few month the interval widens, but not by much -- at least, not by enough to allow the mother to take on anywhere near a regular doctor's workload. So it's not just the last few months of pregnancy that are a concern.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#139

Post by mcv »

kelnos wrote: post #137
mcv wrote: post #92

Earlier quoted context omitted.

So what happened? Was there a massive disaster that created an overwhelming flood of patients, that everybody needs to work overtime? Because under normal circumstances, a competently run hospital should be able to function with normal 8-hour shifts. If that's not possible, then management fucked up. Accepting these kind of hours as standard is completely unreasonable and dangerous, especially in hospital, where live…

A doctor friend of mine claims that the benefits of doctor-patient continuity outweigh any downsides of sleep deprivation. That sounded like a rationalization or cop-out to me, though. I can't imagine how that could be true, or that they're aren't other ways to solve the continuity problem that don't involve zombie doctors.

Even then, finishing with your current patient and then going home should still not lead to regular 12 hour shifts.

Re: No Doctor Should Work 30 Hours Straight with No Sleep

#140

Post by dougmccune »

maxerickson wrote: post #127
dougmccune wrote: post #113

Earlier quoted context omitted.

Even if there are people like yourself who actually want to work 17 hour days for 7 days in a row (!), shouldn't we as patients be able to have doctors who are not allowed to do that insanity? Medical error is the #3 cause of death in the US. It seems entirely irresponsible to take someone's life into your hands without proper rest.

work 17 hour days for 7 days in a row (!) They explicitly said 17 hours was rare.

Ah, I probably misread the comment a bit. I read it as working 7am to past midnight is rare, making 7am to midnight (or just before) normal. But you're probably right in that what was meant was that there are other, more sane working hours (not defined in the comment) that are the normal conditions.

But yes, to agree with the sibling comment, I'd prefer to never have any doctor in any hospital seeing a patient after they have been working for 17 or more straight hours.

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