The darker side of being a doctor (2017) • Hacker News Board

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

#271

Post by smallmancontrov » Sun, Apr 14, 2024, 3:55 AM UTC

fasa99 wrote: post #267

smallmancontrov wrote: post #266

Earlier quoted context omitted.

Facilities can be built. Training programs can be expanded. Those are reasons why programs can't be doubled this year, but inside of a few years it's all possible. This problem has been cooking for decades. What actually happened was cartel shit. https://www.washingtonpost.com/archive/politics/1997/03/09/r...

I agree with this - in the US we have nurses picking up doctor roles (e.g. anesthesia), hours-worked caps, PAs (physician assistants) also picking up doctor roles, tons of international physicians coming for underserved specialities (family medicine, pediatrics, psych, etc). And of course, residents super overworked. I think it speaks for itself that making medicine 2x - 3x more people per year would help the problem…

Yep, and it'll get worse before it gets better. The boomer wave will (continue to) hit faster than we can grow the system. The best time to fix it was a decade ago when everyone saw it coming, but the second best time is now.

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

#272

Post by Gunax » Sun, Apr 14, 2024, 3:58 AM UTC

robocat wrote: post #111

Gunax wrote: post #81

Earlier quoted context omitted.

While it's true that there is a limit (really there is a limit to every university study), there is also a limit to the number of people who are qualified and interested. For instance, there are only about 20k people who score > 510 on the MCAT per year (the average matriculant has about a 512). And remember that includes US & Canada. While I know there are a lot of people rejected from medical school each year, some…

> there are only about 20k people who score > 510 on the MCAT per year The article clearly shows the skills necessary to work as a doctor are a lot wider than academic ability. One pleasure/pain of being a software developer is that there is less gatekeeping.

Certainly. My point is that there isn't an unlimited pool of qualified candidates.

There are things other than academics, but that makes the pool even smaller.

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

#273

Post by emodendroket » Sun, Apr 14, 2024, 4:03 AM UTC

Solvency wrote: post #264

toldyouso2022 wrote: post #251

Earlier quoted context omitted.

It's the same in the US, Italy, etc Doctors are a cartel receiving a monopoly from the State. That's all there is to it, really

but.. why?

Well, compare the trajectory of doctors to factory workers as career paths.

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

#274

Post by sslayer » Sun, Apr 14, 2024, 4:05 AM UTC

ketzo wrote: post #268

Solvency wrote: post #264

Earlier quoted context omitted.

but.. why?

It’s extremely beneficial to the people who are already doctors (dramatically increases salary, prestige, power), and that is a powerful group in most societies.

Also, being a coveted occupation ensures that there will always be a pool of people fighting for it. Scarcity drives demand.

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

#275

Post by amarshall » Sun, Apr 14, 2024, 4:08 AM UTC

beryilma wrote: post #263

I have no sympathy for doctors. They are a part of an exploitative system, and they know and accept it. Most of them are in it for money, in the first place. The experience that the author describes is not much different than a fancy lawyer's or that of a Wall Street finance person. They all knew about the long hours, but money is more attractive...

Many only accept it because there is little choice but do so if they wish to pursue the profession. Despite what you may think, many are not in it for the money, but genuinely enjoy their work (but wish it was fewer hours) and helping patients.

In the U.S., some hospitals are seeing residents and fellows truly refusing to accept the status quo—they are voting to unionize in hopes they will be able to finally upend the exploitative system (at least for trainees).

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

#276

Post by novok » Sun, Apr 14, 2024, 4:34 AM UTC

catlikesshrimp wrote: post #167

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…

The standards have gone up considerably compared to 20 years ago. I'd say return to the standards of 20-40 years ago at similar admission rates , remove leetcoding equivalents such as volunteering in Africa and A++ on organic chemistry (which you never use at an A++ level as a doctor) and everything will be just fine.

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

#277

Post by burnished » Sun, Apr 14, 2024, 4:35 AM UTC

georgeburdell wrote: post #209

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…

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.

Are you suggesting that the solution is that immigrants just make better decisions?

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

#278

Post by nradov » Sun, Apr 14, 2024, 4:45 AM UTC

robocat wrote: post #137

phren0logy wrote: post #107

Earlier quoted context omitted.

In the US, anyone can walk into the emergency room for treatment, but people who don’t have insurance are very unlikely to participate in preventative care. The way to decrease demand For complicated and expensive interventions to preventable problems is to increase access to preventative care.

I'm not sure what you mean by preventative care. In New Zealand "poor" might be a synonym for uninsured? However my peer group is middle aged professionals (not poor) with as variety of healthcare issues. Only a very few would preventative care help. Prevention would help many of my friends. A friend with a cancer scare that keeps smoking. A friend with gout that doesn't change habits. Multiple friends with issues fr…

Prevention and preventive care are typically classified separately, although it's a bit of a gray area. US residents on health plans receive free access to preventive services including immunizations, screening tests, etc.

https://www.healthcare.gov/coverage/preventive-care-benefits...

But prevention is largely outside the scope of medical care. For issues like diet, exercise, and avoidance of substance abuse patients may be able to get help from a variety of other sources including public health agencies, therapists, social workers, dieticians, personal trainers, etc.

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

#279

Post by jimmar » Sun, Apr 14, 2024, 4:54 AM UTC

A brain surgeon saved my sister's life. In the days after her recovery, my dad ran into her surgeon eating in the hospital cafeteria at 11pm. My dad asked him when his shift ended and the surgeon just looked at him and said, "I live at the hospital." There was just so much work he had to do. Rewarding work, but grueling.

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

#280

Post by novok » Sun, Apr 14, 2024, 5:00 AM UTC

skybrian wrote: post #269

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…

Health care professionals do form unions and go on strike sometimes, which can be seen as a way of looking out for each other.

Having friends on the other side of those medical union strikes, I think the hospital systems play hard ball and the unions don't get good outcomes often. My friend quit the hospital because how they were wringing her dry and pushing economical things that she found unethical. She quit and started her own private practice, makes more money, works less hours and is much happier now.