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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)

#431

Post by pc86 »

malfist wrote: post #379
throwaway2037 wrote: post #336

Earlier quoted context omitted.

You took the words right out of my mouth! Money is the elephant in the room here. Why doesn't the author quit surgery and start a small GP clinic? Oh, only half the pay? I see similar behaviour in law firms and investment banking.

So the answer to being overworked in a hospital is to quit, be overwhelming running your own business for half the pay? That doesn't make any sense. And not everyone has the capital or capacity to make their own business

Let's not pretend we're talking about the difference between $30k and $60k/yr here. We're talking about $400k vs. $800k. "I'll only make half a million dollars a year if I do this" does not set oneself up to be a sympathetic character.

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

#432

Post by pc86 »

throwaway2037 wrote: post #336
rqtwteye wrote: post #292

Earlier quoted context omitted.

They choose more money over avoiding burnout.

You took the words right out of my mouth! Money is the elephant in the room here. Why doesn't the author quit surgery and start a small GP clinic? Oh, only half the pay? I see similar behaviour in law firms and investment banking.

You're not wrong about the financial aspect but remember surgeons are completely incapable of being GPs. Surgery is its own residency (5 years I think?), and to be an actual GP you have to be either a family (3 years) or internal (4 years) medicine residency graduate. So in addition to the pay cut in absolute terms, you're taking 3-4 years off and making $60k/yr working 80+ hour weeks to do that other residency. So the opportunity cost alone is a few million even ignoring the pay cut.

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

#433

Post by llamaimperative »

pc86 wrote: post #424
llamaimperative wrote: post #381

Earlier quoted context omitted.

You just spend more money to scale the program. Funding for the residency program has been frozen since the late 90s, the demand for doctors has not been.

You can't "just" spend more on residency training without also "just" making med school classes bigger. You can't "just" expand med school classes without "just" increasing teaching staff, who are 9 times out of 10 physicians themselves. And very few physicians are going to willingly turn down $500k/yr clinical jobs to teach for a fraction of that.

You’re describing problems that are all solved by money.

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

#434

Post by pc86 »

llamaimperative wrote: post #433
pc86 wrote: post #424

Earlier quoted context omitted.

You can't "just" spend more on residency training without also "just" making med school classes bigger. You can't "just" expand med school classes without "just" increasing teaching staff, who are 9 times out of 10 physicians themselves. And very few physicians are going to willingly turn down $500k/yr clinical jobs to teach for a fraction of that.

You’re describing problems that are all solved by money.

And time. You double the number of residency slots but it will take years to fill them if you increase med school size at the same time, a type of coordination that is very unlikely.

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

#435

Post by dimal »

GavinMcG wrote: post #162
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.

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

Just from looking at the massive amount research on the effects of sleep deprivation and burnout on humans, and assuming that medical professionals are humans, we can infer that performance would decline. But ok, I’ll play along.

https://bmjopen.bmj.com/content/9/1/e024778

https://www.healthecareers.com/nurse-resources/nursing-patie...

https://journals.plos.org/plosone/article/comments?id=10.137...

It’s a mixed bag, but strongly leaning against longer shifts, in my opinion.

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

#436

Post by shkkmo »

pc86 wrote: post #426
shkkmo wrote: post #406

Earlier quoted context omitted.

> I think you’re giving way too much credit to medical associations to rig the game in their favor. They exert enough influence over all fifty states and the various private institutions to systemically deny training to qualified candidates? The underlying fact that the AMA is directly responsible for the doctor shortage in the USA is historically accurate. 20 years ago the AMA believes we were heading towards a doct…

I am wildly in favor of expanding the number of medical schools, expanding med school class sizes, expanding residency slots and funding per resident. None of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. If you're a doctor of one spe…

> one of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor.

That is indeed the AMA the talking point to justify their stance. However my problem with the AMA here isn't that they support some scope restrictions (clearly many decisions do require full training) but that they strongly support ALL scope restrictions without data to support such a rigid hardline stance. They do this even when the loosening scope restrictions would decrease cost and increase availability without any harm to patient outcomes. This absolutely exacerbates the physician supply problem that the AMA created. If the AMA actually care about the physician supply issues in the country, it would work with state and federal regulators to identify which scope restrictions can safely be loosened.

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

#437

Post by seadan83 »

bravura wrote: post #366
alfiedotwtf wrote: post #352

Earlier quoted context omitted.

I mentioned garden gnomes as an example of how supply side economics and “scarcity drives demand” doesn’t work.

The post you replied to scoped their statement to „coveted“ applications. No one actually believes scarcity drives demand in all cases.

The grammar of the sentence, as written, would really indicate otherwise. Written in the post: "Scarcity drives demand." (exact quote)

The sub-text is that doctors are slightly corrupt and wish to be payed more, and therefore are incetivized to reduce the total number of doctors.

After reading the travails of what this doctor is going through, that seems like a very callous take, insulting even.

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

#438

Post by Anthony-G »

matheusmoreira wrote: post #403
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…

> Something I've never quite understood is why, in the UK, we cap the number of medical students per year. To keep salaries high. I'm brazilian. In recent years, brazilian medical schools have been "democratized", so to speak. The number of medical schools has exploded and acceptance of doctors from neighboring south american countries has been facilitated. About 50 thousand new doctors enter the market every year. R…

Thanks for contributing that point. It’s good to have one data point for what happens when there are no restrictions.

I’m from Ireland and have the same experience as most of the rest of the commentators on this thread, i.e., we have a chronic shortage of doctors – and nurses – in our health system. This has been the case for as long as I’ve been alive but it’s got much worse in the last decade or so.

It’s interesting to see how universal this problem is – aside from the odd country like Brazil where the pendulum seems to have swung too far in the opposite direction. It’d be nice to know if any country has found a happy medium.

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

#439

Post by pc86 »

shkkmo wrote: post #436
pc86 wrote: post #426

Earlier quoted context omitted.

I am wildly in favor of expanding the number of medical schools, expanding med school class sizes, expanding residency slots and funding per resident. None of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. If you're a doctor of one spe…

> one of this means I want decisions now made by someone who does 4 years of college, 4 years of med school, 3-7 years of residency and potentially fellowship on top of that to instead be made by a nurse "under the supervision" of a doctor. That is indeed the AMA the talking point to justify their stance. However my problem with the AMA here isn't that they support some scope restrictions (clearly many decisions do r…

That it may be an AMA talking point doesn't make it wrong, and as far as I am aware the AMA is in favor of increasing physician at supply at the supply point - increasing medical school class sizes, increasing the number of medical schools, and increasing federal funding for residency programs (which can increase the number of slots, pay existing residents more, or both).

The answer to a physician supply problem is increasing the supply of physicians, not having nurses do physicians' jobs.

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

#440

Post by seadan83 »

throwaway2037 wrote: post #336
rqtwteye wrote: post #292

Earlier quoted context omitted.

They choose more money over avoiding burnout.

You took the words right out of my mouth! Money is the elephant in the room here. Why doesn't the author quit surgery and start a small GP clinic? Oh, only half the pay? I see similar behaviour in law firms and investment banking.

Presumably, those who trained as surgeons, want to be surgeons. Sunk cost fallacy might come into play. A better analogy is someone who wants to be a software engineer, get burned out - and you say "hey, why not be a NOC technician if you can't handle it?"

Further, you assume a surgeon could just become a GP. They are different fields.

https://www.quora.com/Can-a-surgeon-also-practice-as-a-prima...

"Can a surgeon become a regular doctor?"

> They can try. But they would have no idea what they are doing. But legally, they could certainly practice as a primary care doctor. They would not be board certified, and could not sit for the ABIM exam, and would not be able to pass it if they did.

> The professions are also very different, primary care is more allied to the work of a physician, whilst a surgeon is trained to do serious surgery, not the kind a primary care doctor would do. So not sure even if you could be legally certified in both specialties you wouldn't loose your surgical skills if you spend a lot of time in primary care.

> Knowing what I know about the medical world in general I would advice against such a combination, a surgical residency is such a taxing one that you wouldn't have time to do anything else beside surgery, furthermore the required mental approach to do the work well as a surgeon or a primary care physician is also quite different.

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