Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

The darker side of being a doctor (2017)

drericlevi.substack.com

Post reply on HN
Print view View original

221–230 of 521 posts

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

#221

Post by elijaht »

rr808 wrote: post #129
game_the0ry wrote: post #88

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?

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.

But why not 3x12hr shifts rather than (what appears to be from outside perspective), 7x12hr shifts?

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

#222

Post by lll-o-lll »

maCDzP wrote: post #56

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 no…

Yes this does seem to be the culture, at least for doctors working towards the more competitive specialties (such as surgeons). Things get much less hectic once they reach “consultant” at age 35 or so, but it’s an absolute grind until then. With no guarantee of success! If you see your GP with a bunch of extra paper on the wall, chances are they are one of the many that didn’t win the game.

What’s a good alternative though? These are high paid, high status, jobs for life. Of course it’s going to be as competitive as all heck to get them. Do we shame Olympic athletes for the dedication and sacrifice they must provide to obtain their goals? I’m not saying the current system is great, but any alternative could well be worse.

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

#223

Post by paulddraper »

ejstronge wrote: post #169
paxys wrote: post #73

Earlier quoted context omitted.

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 e…

When was the over supply.

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

#224

Post by ejstronge »

paulddraper wrote: post #223
ejstronge wrote: post #169

Earlier quoted context omitted.

> 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 e…

When was the over supply.

> When was the over supply.

A google search for '1990s physician oversupply' will give you many articles, like this one:

https://www.bmj.com/content/312/7026/269.1

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

#225

Post by nradov »

MichaelZuo wrote: post #87
nradov wrote: post #46

Earlier quoted context omitted.

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 prog…

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.

Residency slots don't mandate public funding. The majority of funding comes through the Medicare program but private foundations also contribute some. Private payers (insurance companies) also indirectly subsidize residency slots by paying teaching hospitals higher rates.

Some services performed by residents are billable, especially the more experienced ones. But the programs as a whole run at a loss after accounting for overhead so hospitals won't add more slots without a matching funding source.

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

#227

Post by mlyle »

lll-o-lll wrote: post #217
mlyle wrote: post #130

Earlier quoted context omitted.

> > 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…

This is just wrong. The supply is absolutely artificially capped, particularly for positions like surgeons. This is controlled by the Royal Australasian College of Surgeons in combination with government funding. There is no “private, full-fee universities that are not so limited” alternate path; don’t make stuff up. Source: Brother in law who is a surgeon.

> This is just wrong. The supply is absolutely artificially capped, particularly for positions like surgeons.

I feel like you don't understand the distinction about positions at universities for initial medical training vs. internship and residencies, which I believe I discussed fairly above.

see

> > Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough.

"Disparate agencies" isn't great phrasing, though, as what I really mostly meant was "each province".

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

#228

Post by refurb »

nextaccountic wrote: post #94
nradov wrote: post #67

Earlier quoted context omitted.

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

Artificially limiting the supply of doctors drives the wages up. It's a common demand of doctors worldwide

Not if you're in the universal system where the government sets the payments.

I do know that limiting the number of doctors is one of many mechanisms to limit healthcare spending. A doctor can only see so many patients in one day.

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

#229

Post by naet »

lolinder wrote: post #148
Rinzler89 wrote: post #5

Earlier quoted context omitted.

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 be…

> 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…

It's a little different because an unflown airplane doesn't kill people, but an untreated medical condition does.

Sometimes it can happen extremely quickly, but also be largely preventable with proper and timely intervention (like with a burst appendix).

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

#230

Post by WalterBright »

nradov wrote: post #46
WalterBright wrote: post #28

Earlier quoted context omitted.

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.

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 prog…

The AMA doesn't have direct control over it, I was wrong about that. But they heavily influence it:

https://blog.petrieflom.law.harvard.edu/2022/03/15/ama-scope...

Post reply on HN