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How Being a Doctor Became the Most Miserable Profession

thedailybeast.com

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Re: How Being a Doctor Became the Most Miserable Profession

#51

Post by araftery »

tdees40 wrote: post #7

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…

I disagree. The problem is frankly that we've come to expect too much from modern medicine. Doing a triple bypass surgery on a 90-year-old is expensive, plain and simple. Yes, we can save his life, but we have to be willing to pay the cost—and we aren't.

Medicare is a monopsony. They represent such a large share of patients for many practices that they set their own prices. And when people expect medicare both to pay for their triple bypass and not to go broke at the same time, what we get bankrupt hospitals and over-worked doctors.

Being more responsible about the way we apportion healthcare is the only reasonable option.

Re: How Being a Doctor Became the Most Miserable Profession

#52

Post by PeterisP »

adventured wrote: post #30
rdmcfee wrote: post #14

In Canada our GPs are paid approximately $31 for a regular visit. They pay their overhead out of this $31 and still typically keep 65-70% of their billings. It's amazing that the billing costs in the US are a factor of magnitude higher.

I wonder how salaries for nurses and doctors compare in the US vs Canada. Do you happen to have any data on that (or know of a good government source for it in Canada)? I know that compared to much of first world Europe, our nurses and doctors often make two to four times as much as their counter parts there. Wonder if that's true compared to Canada as well.

If you take away the need to pay back six-figure student loans and tens of thousands each year for malpractice insurance - then much more of that money stays in the doctors pocket.

Doctors in Europe live quite well, and don't have as ridiculous workhours as the numerous USA examples listed, or the suicide problem.

Re: How Being a Doctor Became the Most Miserable Profession

#53

Post by SapphireSun »

hga wrote: post #42
SapphireSun wrote: post #37

Earlier quoted context omitted.

I get that deprivation training can be helpful, but to be deprived nearly 100% of the time in a safety critical, fast paced environment? That's crazy. These guys aren't special forces (who I assume have in-field careers similar to pro-sports players), they're normal people trying to work at this for many decades. If your goal is to reduce medical errors, create systems that don't depend on a single person's fluctuati…

A nit, in the military this is not limited to "special forces", and I'm just talking about the stresses of peacetime. Look at e.g. https://en.wikipedia.org/wiki/Watch_system which doesn't list the 4 hours on, 4 hours off system the US Navy used, at least in the '50s when my father was First Lieutenant on a North Atlantic radar picket ship. He still remembers it being very hard.

This is interesting. Thanks for the link!

Nonetheless, I don't think these guys are getting 4 on 4 off... I think they just work basically straight through for 12-16 (or more) hours and get maybe a day a week off.

I can completely sympathize though that 4 on 4 off would be incredibly hard in and of itself. I'm not sure I could do it for weeks let alone months on end.

Re: How Being a Doctor Became the Most Miserable Profession

#54

Post by cassowary37 »

A consideration of the economics would suggest that any doc who trained in the last two decades isn't in it for the money - the ROI on an MD is far less than most other advanced degrees. If we wanted to be wealthy, with the grades and letters required to get into med school in the US, most of us could readily have chosen other professions. (Heck, some even walk away from startups, believe it or not). My impression as someone in practice for more than a decade, who cares for a large number of docs, and has run a large clinic: It's really not the reimbursement. It's the combination of dealing with payers determined to deny treatment, massive requirements in terms of documentation and ongoing accreditation, and - in particular - constant pressure to spend less time with more patients. Then, we read posts like these which buy into conspiracy theories about how we're out to poison patients with expensive medications to line our pockets. The time problem in particular afflicts primary care docs the most, but even the surgeons complain about it. As far as ACA and its impact, there's no question it's a hack (and not a good one) - most economists not on the far right agree single payer would be optimal - but under the political circumstances, it was probably the best we could get. Regardless, we'll move to a system where the majority of care isn't delivered by docs. Then we'll complain about it. But, it will be more cost-effective.

Re: How Being a Doctor Became the Most Miserable Profession

#55

Post by nine_k »

mentalhealth wrote: post #27
SapphireSun wrote: post #15

I don't get why overworked personnel aren't regarded as a dire safety issue. There's a reason the FAA restricted the number of hours commercial pilots are allowed to fly per week without rest. http://www.usatoday.com/story/todayinthesky/2014/01/03/pilot... I met a resident the other day, and they routinely get four hours of sleep or less and worked for shifts that are insanely long that are basically dictated by pati…

It's extremely difficult to study the effects of sleep deprivation on the rate of medical error, but several studies have shown that the highest numbers of medical errors occur during handoffs between shifts. Reducing the frequency of those handoffs by increasing shift length reduces the total number of detectable medical errors. Additionally, the work hour restrictions placed on residents over the last few years app…

Longer shifts does not mean that doctors can't have longer sleep that 4 hours. Let doctors have 16 or even 18-hour long shifts interleaved with days without shifts at all, for sleeping and some [light] paperwork.

Re: How Being a Doctor Became the Most Miserable Profession

#56

Post by rdmcfee »

PeterisP wrote: post #52
adventured wrote: post #30

Earlier quoted context omitted.

I wonder how salaries for nurses and doctors compare in the US vs Canada. Do you happen to have any data on that (or know of a good government source for it in Canada)? I know that compared to much of first world Europe, our nurses and doctors often make two to four times as much as their counter parts there. Wonder if that's true compared to Canada as well.

If you take away the need to pay back six-figure student loans and tens of thousands each year for malpractice insurance - then much more of that money stays in the doctors pocket. Doctors in Europe live quite well, and don't have as ridiculous workhours as the numerous USA examples listed, or the suicide problem.

Tuition at UBC med is $16,000 per year and many students qualify for up to $100,000 in bursaries. After 4 years of academics there is a paid residency. It's not a huge salary (~$50k) but enough to avoid going into debt.

Re: How Being a Doctor Became the Most Miserable Profession

#57

Post by hga »

adharmad wrote: post #45
hga wrote: post #24

Earlier quoted context omitted.

One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won…

Not sure why you were downvoted, but this is the exact reason that a couple of my relatives in medical profession gave when asked why their training involved 24-36 hour shifts routinely with very few sleep breaks.

Well, the downvoting didn't stick.

I learned this primarily from my mother, who was a RN nurse anesthetist, and a doctor who became my father's primary hunting partner about the time I was old enough to start actively hunting.

Re: How Being a Doctor Became the Most Miserable Profession

#58

Post by rdmcfee »

tdees40 wrote: post #7

The biggest problem is just the AMA. They limit the number of doctors in America, so there are just too few. This drives up the salaries for the few doctors who live the tell the tale (but certainly don't want to go into primary care, when other more lucrative jobs are on offer), and drives up the hours for everyone. Making it easier to become a doctor would improve things immediately (especially given the recent res…

Coming from the healthcare marketing field, I can tell you there are many doctors who are looking for more patients. Especially specialists.

Re: How Being a Doctor Became the Most Miserable Profession

#59

Post by DatBear »

Funny that the article links to http://www.dailymail.co.uk/news/article-2600319/Medicare-dat... which references the top paid doctors by medicare... I read an article last week saying that this data would be misinterpreted, as a lot of the "top paid" doctors actually are just like whole departments using the lead physician's billing code, and they don't actually get any of that money - and here we are.

Re: How Being a Doctor Became the Most Miserable Profession

#60

Post by alayne »

joshlegs wrote: post #43

> In fact, physicians are so bummed out that 9 out of 10 doctors would discourage anyone from entering the profession. OP missed a perfect headline opportunity: "9 out of 10 doctors recommend not becoming a doctor." But seriously, we wonder what's wrong with healthcare. I seriously believe it's because of the lawsuit-happy nature of patients nowadays. Yeah, something could go wrong during your surgery, or your diagno…

I've read that malpractice insurance is a few thousand dollars a year and the premiums have been going down.
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