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The darker side of being a doctor (2017)

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Re: The darker side of being a doctor (2017)

#161

Post by krisoft »

rr808 wrote: post #153
dimal wrote: post #143

Earlier quoted context omitted.

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.

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.

> 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".

Re: The darker side of being a doctor (2017)

#162

Post by GavinMcG »

dimal wrote: post #143
rr808 wrote: post #129

Earlier quoted context omitted.

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.

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.

Have you looked at the research regarding which of those two options leads to better patient outcomes?

Re: The darker side of being a doctor (2017)

#163

Post by archagon »

lilsoso wrote: post #146
rr808 wrote: post #125

Earlier quoted context omitted.

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.

We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.

Qualifications should come at the end of your education, not at the start.

Re: The darker side of being a doctor (2017)

#164

Post by catlikesshrimp »

rr808 wrote: post #152
jajko wrote: post #135

Earlier quoted context omitted.

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 s…

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.

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.

Re: The darker side of being a doctor (2017)

#165

Post by hagbard_c »

jajko wrote: post #135
rr808 wrote: post #125

Earlier quoted context omitted.

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.

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 s…

Same in Sweden, it is rare to meet a Swedish doctor at the 'vårdcentral' (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.

Re: The darker side of being a doctor (2017)

#166

Post by Wowfunhappy »

archagon wrote: post #163
lilsoso wrote: post #146

Earlier quoted context omitted.

We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.

Qualifications should come at the end of your education, not at the start.

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.

Re: The darker side of being a doctor (2017)

#167

Post by catlikesshrimp »

bsdz wrote: post #30

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…

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.

Re: The darker side of being a doctor (2017)

#168

Post by casenmgreen »

lilsoso wrote: post #146
rr808 wrote: post #125

Earlier quoted context omitted.

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.

We should enforce rigorous qualifications for doctors. We've relaxed the standards far too much already.

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.

Re: The darker side of being a doctor (2017)

#169

Post by ejstronge »

paxys wrote: post #73
bsdz wrote: post #30

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…

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.

> 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.

Re: The darker side of being a doctor (2017)

#170

Post by ejstronge »

tmpz22 wrote: post #59
hollerith wrote: post #47

Earlier quoted context omitted.

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 premiu…

And the schools prefer it (at least in the US) - limited highly paid doctors means they can charge exorbitant tuition.

> 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.

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