You are a body to the healthcare system. My wife is a hospice nurse and they're happy to grind you into the ground as long as it suits them.
The darker side of being a doctor (2017)
41–50 of 521 posts
Re: The darker side of being a doctor (2017)
#42Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…
> The question is, why is it okay for medical professionals to wear themselves down to the bone (sometimes literally, like in this article), while some other professions take care to avoid it? I think the answer here is that if you there aren't enough pilots, schedules can be reduced. You can't scale back (in any ethical way, anyway) the demand for healthcare. People will just die at a higher rate and outcomes will w…
Thank you for your comment, that's a very good point. I self-replied a bit lower with more discussion on this, primarily to the effect that the "solution" in that case would be to hire more doctors. The concept of a "standby" doctor (like a volunteer firefighter) could be used (more), for eg retired former doctors/nurses.
Re: The darker side of being a doctor (2017)
#43Something 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…
Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.
I don't even think doctors want the cap, tbh. Your average emergency physician would take all the qualified help they can get.
Re: The darker side of being a doctor (2017)
#44Earlier quoted context omitted.
but the alternative isn't having no doctor at all, but to get more doctors, so the "basic game theory" is about why the limits on more doctors stay in place despite the higher risk of death etc.
> but to get more doctors Have you found that magic fountain of endless doctors?
That's a straw man. We do not need "endless doctors" just more (or some way to use them more efficiently).
The number of doctors are limited by the pipeline to educate them.
Most countries I know, the number of people admitted to study medicine exceeds the number people wanting to study medicine vastly exceeds the positions to do so, and admissions are highly competitive. To a point, I'd say, that it is becoming ridiculous.
So, there is not a lack of people wanting to become doctors, but a lack of people allowed to even start to study to become one.
Re: The darker side of being a doctor (2017)
#45Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…
The cynic in me says they have bad working conditions since they're public funded: governments, to a large extent, don't want to increase or divert taxes to provide better working conditions since they'd rather give their friends in the private sector a slice of the immovable and highly lucrative pie.
A partly-privatised healthcare system only works when all agree to balance the intangible long-term benefits of universal healthcare with tangible private-sector financial-gain. I don't see this happening when the private sector is seen as the panacea of all social-ills and when universal healthcare isn't seen a means to increase productivity.
Re: The darker side of being a doctor (2017)
#46Earlier quoted context omitted.
> but to get more doctors Have you found that magic fountain of endless doctors?
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 program. Congress hasn't significantly increased funding in years. At one point the AMA did lobby Congress to limit the number of slots but they have since reversed that stance and are now lobbying for higher residency funding.
There are already tiers of clinicians. Much routine care can be delivered by Physician Assistants or Nurse Practitioners working under a Physician's supervision. Specific limits on their services are set at the state level.
Re: The darker side of being a doctor (2017)
#47Something 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…
Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.
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 premiums for their employees.
Re: The darker side of being a doctor (2017)
#48The answer is simple, mandatory limits on hours and days worked. Also fix healthcare regulation and the process of becoming a doctor so there isn't a supply shortage of doctors and surgeons.
Re: The darker side of being a doctor (2017)
#49Something 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…
Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.
There is an article in Le Monde diplomatique of February 2024 that briefly tells the story of the first numerus closus in France in the sixties.
Re: The darker side of being a doctor (2017)
#50Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how ma…
For inpatient hospital care, research has shown that transitions in care are particularly risky for patients. When one doctor goes off shift and hands off a patient to another doctor, sometimes things fall through the cracks. In theory all of the data needed for a smooth transition should be documented in the patient chart, but in practice this doesn't always get done plus there is some tacit knowledge which clinicia…
Thanks, I commented a bit above already to a similar response. I would say that there's a balance between very short shifts and 24(or more) hour shifts. 12 hours for example is doable occasionally/with breaks in between shifts. Right now the pendulum is at one extreme.