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The darker side of being a doctor (2017)

drericlevi.substack.com

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

#231
post #155
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…

The picture you are painting is way too dark. And does not give a realistic picture. A lot of what you say is true for doctors in their first 5-10 years into their career, when employed in a hospital. This not true for doctors which reached a certain level like „oberarzt“ and above. This is especially not true for doctors with their own „office“ (business). Yeah people may cry, but normally it is very hard to bring a…

Surgeon here, in private practice. Agree with the article - all the stressors he mentions are typical of both residents and staff physicians. The hour crunch for me is better post residency but overall the stress is unchanged. Probably higher after training with the added responsibilities & risks.

My sense is that the field developed in the era of independent/private practice, where the grueling hours worked was justified by high pay and minimal bureaucratic/administrative burden. Add decades of stagnant/falling pay plus death by a thousand administrative cuts and the profession no longer justifies the difficult working conditions as convincingly. Some practices are still good, others terrible. Look at the rate of physician turnover to see which is which.

Oh and the “provider” discussion is worth paying attention to. Your doctor has this calculus worked out - years & energy invested, work environment & income expected, then the only viable option in your city is to be employed by a large hospital system (because hospitals get paid at least double for the same work, outcome is as expected.) But wait there’s more: you are now called “provider” by your large hospital employer who hires 2x NP employees to do the “same” work as you and pay half. Guess what direction the pricing pressure is going. In the future expect few MDs to stay in primary care because the system does not support that path. Specialty training is the future for MDs who invest time, energy, & money to excel in their field.

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

#232
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.

this is completely wrong. there are not enough doctors at all levels. not everyone is going to be a brain surgeon.

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

#234

Earlier quoted context omitted.

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…

I think you're possibly describing nurse practitioners?

Yes they are describing NPs and PAs. MDs are the PhDs of the medical world. Don’t get me started on “DNPs”

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

#235

Earlier quoted context omitted.

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

Must've been nice

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

#236

Earlier quoted context omitted.

Potentially controversial opinion, but perhaps it is exactly the immigrants who are enabling the dysfunction to continue? I imagine tougher decisions would have been made to balance doctor quality of life with patient outcomes without immigrants taking whatever abuse the current system throws at them.

Ah, yes. Literal victim blaming.

They voluntarily immigrated to the country to take highly skilled jobs and are free to leave at any time. They are not victims; they are willing participants in an exploitative system.

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

#237
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.

What sort of qualifications? 99th percentile talent in subjects like organic chemistry, which are actually not used by 99% of doctors in the real world? Willingness to work themselves so long and hard that their judgement is usually substantially impaired?

And does the (my impression) widespread support for oh-so-rigorous qualifications for doctors reflect any real-world data about actual resulting quality of patient care? Or is it a way for prospective patients to vocalize a bunch of anxieties and emotions about medical care, plus a way for the doctors who've had to endure such treatment to say "all the noobs should have to suffer as much as I did"?

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

#238

Earlier quoted context omitted.

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…

But Costa Rica has one of the longest wait times for non emergency surgeries. https://www.oecd-ilibrary.org/sites/f8ac5867-en/index.html?i... So high wait times there doesn't sound entirely perfect either.

Wouldn't this partly be a sign of markets deciding what wait time is worth it? For non-emergency surgery, like cataracts or knee replaces cited in the data, people can live with the conditions. It looks like wait times are consistent, meaning the backup isn't growing steadily over time. I'm pretty sure that would mean different populations just have a different threshold for how long they're willing to wait. If it was a consistent imbalance between the number of surgeries needed and the medical capacity I would expect to see wait times grow over time.

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

#239
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…

Potentially controversial opinion, but perhaps it is exactly the immigrants who are enabling the dysfunction to continue? I imagine tougher decisions would have been made to balance doctor quality of life with patient outcomes without immigrants taking whatever abuse the current system throws at them.

This is getting downvoted like it is some horrible bigoted remark, and I don’t think it is. It seems reasonable to me to say that immigration can paper over problems.

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

#240

Earlier quoted context omitted.

Potentially controversial opinion, but perhaps it is exactly the immigrants who are enabling the dysfunction to continue? I imagine tougher decisions would have been made to balance doctor quality of life with patient outcomes without immigrants taking whatever abuse the current system throws at them.

Ah, yes. Literal victim blaming.

The governments set the immigration policies. They probably think it’s easier to import doctors than fix the problems with medical schools, hospitals, doctors guilds, payment systems, ect… It is very uncharitable to view this as an attack on immigrants.
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