The darker side of being a doctor (2017)

I think it has to do with the cost structure of the good. Healthcare is dominated by labour costs, which means in industrializing economies it lags behind in productivity and labour starts getting squeezed to try and keep prices at a reasonable level. A pilot, despiute being in a highly skilled profession, is only a small part of the puzzle when it comes to the cost of flights.

I think having more physicians is the core thing.

The US stands out in having so few physicians per capita (per 1000 it's 3.6 in the US, here in Sweden it's 7.1, in Germany 4.5, Spain in 4.6). This has been discussed before here before, and I don't think it was controversial that a sensible solution was to simply have more physicians.

I think one major thing that the US is doing wrong with that which is not so well known is that the training starts rather late in life. Thus you get less out of the physicians you train. Here in Sweden a physician has a MSc in medicine and is ready to meet patients and be trained when he's 23, and I think this has the benefit that there's no need to overwork them.

By the time they're 30 they'll have all the experience the need without having been overworked, and not sleeping enough kills intelligence, memory, drive, all mental qualities one may have.

I think these two policies, ensuring that people graduate earlier-- removing the pre-med and having people start right away with a medicine program, and graduating in 5.5 years, that's the right approach.

Physicians would earn less, but they'd have substantially better lives. Being able to start younger also means success younger, and happier families.

> Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better

c.f.

"...everything is rushed, and mistakes are bound to occur."

"I am realising more and more that what brings me greatest distress is the relentless administrative pressure which take away the meaningful clinical engagement I have with my patients."

"I was burned out and I couldn’t control my emotions at work and at home. I’m not inherently an offensive or rude person, I’m just a person pushed to the limits and set to fail because of the circumstances around my work."

> In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those service

This is Australia, which does not have artificial restrictions on the supply of doctors to the same extent. On the other hand, they don't have a surplus of surgeons nor can nurse practitioners do the work

> (note the comment about denying other physicians income).

Yah, he's saying that if he doesn't come in, the backlog gets worse, and other people don't get paid.

> He's proud he's never sought help or tried to change anything.

He says he would like to seek support, but highlights the structural problems that prevent it:

"I know where I can get support, but practically, when and how am I going to get that support?"

"In addition, doctors who scream for help may be formally reported, therefore having restrictions placed on their practice and then incurring higher medical indemnity fees in some situations. Trainees who ask for help may be labelled as underperforming and have to be commenced on probation or remediation. We may not have practical access to the support that are often advertised."

I absolutely am in agreement with you that the things done to artificially lower the supply of residency training in the US are terrible. But those criticisms don't seem to apply to this essay.

Thanks for sharing. This is so disheartening. The other day I was debating with my friends how a doctors life is so cool that they don’t have to go though grueling coding interviews every single time they want to change jobs, don’t have to prove themselves every single quarter, don’t have to be answerable to anyone or write performance reviews or be subjected to arbitrary rubrics. Boy, I was so wrong. Every procession has its hazards. This has been a learning for me. Although I do feel that the PCP doctors in US seem to have a simpler life. They leave office at 5 and don’t take calls in the night. Happy to be corrected though.