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Yup. My wife is a neurosurgery resident. While she's on her research year right now, which is comparatively relaxed[1], prior to this she worked 5 years of 80+ hour weeks, including three stretches of 20+ consecutive days after another resident in her program left.

Looking back on medical school, she can't believe how ridiculously easy it was and how much free time she had.

[1] where "comparatively relaxed" still means "she works harder than anyone I know in tech".

To what end? It's well known the body has < 10 hours of high-level productivity in it per day.

Unless they get paid by the hour, I see no reason to continue to participate in such a system. Still, it should not be allowed when lives are at stake.

Well, look at it from the patients point of view... if there isn't a doctor to available, because they took some time off after a 20+ day stint...where does that leave you(the patient)? It's a tough job, but they signed up for it, and the pay is very good by comparison to other jobs that have similarly long hours.

For some contrast though, before everyone cries out "save the med students, they have it harder than any one should endure"... remember there are other jobs with far greater risks, hours, and far less pay. Ever been deployed in a military unit during wartime? I've wished there was a window to jump out of several times, or that a pager beeping was the scariest thing to fear while trying to sleep - and that was in recent engagements, it was far worse for the generation before us during wartime - doctors not so much.

> the pay is very good by comparison to other jobs that have similarly long hours.

Once you're an attending, yes. My wife, however, is still a resident. She's doing this for $50k/year.

Doctors could work shifts just like everyone else at the hospital.

Just because a worse job might exist is not a justification to continue---logic and all that.

There's no other path to becoming a doctor in the US. You can choose to go into a specialty with more relaxed hours, but you need to go through residency no matter what. If you want to be a doctor, you put up with it, like the generations before you. A sufficient number of residents organizing could do something about it, but (a) no one has time to organize when they're working 90 hour weeks and (b) there's a significant Stockholm syndrome effect in play.

It's worth noting that there have been several studies over the years investigating whether reduced hours produce better outcomes; they don't seem to. Shorter hours means more shift changes and patient handoffs, which is the source of more errors than tired residents. Also, keep in made that getting the same experience in a specialized field like neurosurgery with fewer hours per week would require extending the training program even further. It's already seven years beyond medical school, often with a one year fellowship after residency. Extending it another few years isn't really a viable option unless we significantly increase the autonomy and salary that residents receive.

You can only learn so much per day. It sounds like you are making excuses to ignore basic human rights (recognized post-industrial revolution) such as ~40 hour weeks in favor of indentured servitude. Appeals to "outcomes" do not supersede workers rights.

Sorry, I don't buy it.

Human lives supersede workers rights. If you don't like it don't go to medical school.

That's a bullshit argument. If hospitals really cared about human lives, they would keep a staff level that ensured that patients would be seen by doctors that where rested and focused. People die because doctors and nurses who've been on their feet for the past 20 hours are unfocused make stupid mistakes and hospitals simply don't care because dealing with the occasional accidental death is cheaper than hiring more doctors, and we as a society let them get away with it.

As the OP noted, people die at a higher rate when you switch to shorter shifts because information loss during shift change causes more mistakes than tired physicians.

In many hospitals doctors are paid hourly, so shorter shifts wouldn't cost the hospital money.

The patient hand-off problem is real. I just feel like there is a better solution than having these folks work 80+ hours a week.

You can hire twice as many residents and make residency twice as long so they get the same total training at 40 hours a week.

You'll have to significantly increase resident salaries, and allow residents to move between hospitals to deal with life events. This isn't impossible, but it's politically infeasable while everyone is talking about cutting medical costs (total pay to residents would need to go up ~10-fold for this to work out). It's a bad situation today, but there isn't a simple magic wand to fix it with minor changes.

They won't have to train twice as long, because a great portion of those long days are wasted due to fatigue. All these reasons are excuses for sweatshop conditions that wouldn't be tolerated elsewhere.

Have you gone through residency training? While we both consider the conditions inhumane, my wife is absolutely clear on the fact that even at the end of a shift she's still learning a ton. Surgical residents commonly stay beyond their shifts to scrub in and assist or observe especially interesting cases. Based on my conversations with my wife and other residents, you would absolutely need to extend residency to get the same training with fewer hours.

As a father whose young son had a compound fracture recently and had to wait in the ER for 3 hours to get it patched up by a grumpy, rushed, and tired ortho, this is horrifying.

Something really needs to be done about current crony capitalistic US medical industry.

I'm not sure that capitalism as such has much to do with the problem you describe, as anyone who ever went to a Soviet emergency room will be happy to tell you.

The Soviet healthcare system suffered from underinvestment due to their command economy's focus on heavy industry and military production. The problem in the United States is the exact opposite: unproductive overinvestment due to the proliferation of waste, fraud, rent-seekers, and all other types of interests that rake a profit off the top without contributing anything to patient care. It seems like a false argument to claim that because a radically socialist regime provided inferior care, our radically capitalist regime is not the cause of our inferior care.

I believe pjlegato's point was that while idealism may attract many students into medicine, it's ultimately the profit motive that keeps them working 60+ hour weeks and taking call for decades.

I have a few physicians in my extended family and this mirrors what I've seen from them; I don't know how you'd get board certified neurosurgeons to take q3 trauma call in more rural areas for years on end other than ''here's a boatload of money''. It's masochistic work.

Capitalism, especially our current flavor of it, has plenty of problems, but I think it's important to separate the core principals (mostly free markets, pursuit of self interest) from the pollutants (loopholes, cronyism and special interests).

"our radically capitalist regime"

Citation required. I'd venture the US is more accurately described as a hybrid socialist / mercantilist regime than a capitalist regime.

The US seems more of a militaristic-mercantile regime when you consider the way the budget is allocated. Sure US has progressive taxes that are pretty high, but no single payer health care, outrageously priced education system, and few social safety nets - all indicate a low level of "social ownership over means of production" which is a defining characteristic of socialism.

The US health care system has not been a free market for 50 years, likely much longer. It's got very heavy government involvement at all levels.

I said crony capitalism. I'm a free market libertarian and would totally support such a solution. Today, I had no choice in which ortho saw my son, I had no ability to discuss pricing, my insurance is limited to just the one my company provides and on and on...

The solution is automation.

... and/or deregulation (reregulation?) to open up competition. Often if not usually, the same task could be just as skillfully by done, or even more skillfully or appropriately done, by someone with a different educational route, with or without training beyond what is now typical (e.g., NPs, nurse anesthetists, PAs, optometrists, psychologists, pharmacists, RNs, you name it).

PAs provide an instructive example, but there are many others of different sorts. Often, PA schools have stricter prerequisite experience requirements, and PA students often take the bulk of their courses with the MD students, and have maybe a semester less of courses, before clinical training. So the end effect is that a PA's actual experience is often the comparable to an MD's after a couple of years of practice. Hospitals and health care systems know this, and have been gradually replacing MDs in many areas with PAs because they're cheaper but provide similar care.

We can't afford to maintain this fiction that the only way to have something skillfully done is by the MD training model.

Bar none, the happiest group of graduate students I ever worked with (at a hospital, or not) were the PAs. The education is focused, fulfilling, demanding without being exhausting. The pay is great (I know a number of guys who did a path of: high school flunkout -> GED -> nurse -> PA). Furthermore (at least 15 years ago), they don't have to deal with the vast majority of the insurance BS... they basically get to help & heal.

Yup, we just need a startup that makes Robotic Surgeons and Nurses. Easy peasy.

I'm not arguing that it's possible now, but then, we face a lot of problems without immediate solutions.

The solution might just be to expand or establish more medical schools, and graduate more doctors.

If there were twice as many doctors, the existing doctors probably wouldn't need to work 80 hours a week, and could likely cut down to 40 hours.

The other problem might be that doctors are paid extremely well in the U.S. compared to the rest of the world, and even compared to other rich first-world countries.

The problem is residency, not the medical schools. The medical schools actually turn out slightly more graduates than find places in residency programs. And without completing a residency, you aren't allowed to practice medicine.

Proposals to expand residency run into the problem that it costs the government money. Residencies are funded at the federal level; teaching hospitals get a certain amount of money per resident to compensate for the effort required to train them. And the number of residencies funded per year has (I think?) been maintained at a pretty constant level compared for a long time, with so many new doctors per year per million people.

One option, I suppose, would be to allow self-funded residencies. Why should only the government's money be good enough? But that would probably be an option only for wealthy students, or those who are willing to go even further into debt.

Another option would be to replace residencies with something more like conventional apprenticeship. Is there any reason a new doctor has to learn the practical details of her trade at a hospital, rather than working under the supervision of an experienced doctor in private practice?

Of course, nothing like this is likely to happen. The whole medical industry is extensively regulated; those regulatory barriers are wide moats that ensure fat incomes and profits, which in turn create strong interest in keeping things as they are. Barring utter crisis, nothing is going to change.

And that... is why I politely, yet firmly instruct anyone rendering medical care to not let a resident within 10 feet of me. "This is a teaching hospital!" doesn't cut it when the means of teaching are so irresponsible.

What if someone asks for directions to the nearest hospital? "We ask them politely, yet firmly to (ask someone else)."

Yep. Unfortunately, medical school is only the beginning.

Depending on your residency or fellowship program, it is not unusuall to sustain 80+ hours per week. And unlike nurses, you don't get to disconnect from work when you aren't in the hospital. There are pages to answer, notes to write, labs to review, and on and on...

The mental and emotional load is tremendous and there is no room for error. it's truly a miracle more people don't end up the subject of Morbidity and Mortality presentations from botched lines and pneumos.

The real problem is many residents make real decisions, and their judgement is often impaired by fatigue.

The majority of today's US med school students admitted in 2016 were born in 1992. They grew up watching the silly kids and stupid parents sit-com world of Disney Channel and Nickelodeon while getting soccer trophies for showing up. They wasted a lot of time playing non-educational games rather than reading or working hard to accomplish real things.

While they had to work incredibly hard to get into medical school, and it's harder than it's ever been, I feel like anyone born in the 90s or later is going to be at a disadvantage, because the level of stress is not only much higher than before but many just aren't prepared for the stress.

<sarcasm>However, I think that because of this, medical schools will have to change. It's just too darn hard!</sarcasm>

Getting real though: med school is f'ing hard. Reading this did not surprise me, and if anything, I was surprised that the writer did not know what he was getting into when he got in. The things he is complaining about are the same things I've heard for decades.

Also- the Helen Keller comment, while disrespectful to those that are hearing and/or sight challenged, made me laugh.

I can't tell if this sarcastic, but I think its important to point out that much of the challenge and stress of US medical school is self inflicted by the current culture - and leads to bad health outcomes for patients.

My point was that medical school culture hasn't changed. It's been brutal for years.

The main difference between those going to med school and the 90s and now in my opinion is a mix of the expectations by students that the increase in level of difficulty should be comparable to the transition between high school and college, or college and graduate school. It's not, and it never was. High expectations have always been the rule.

However, for the past 25 years, there have been many more immigrants or children of immigrants that work their asses off competing harder and raising the bar.

The medical schools should not lower the bar to make it less stressful. Instead, we need more medical students to matriculate to P.A. programs and nursing programs, where they can do just as much good helping many of the same patients, sometimes making similar salaries. Eventually there will be more medical schools, which will help some. Or, maybe some of these doctors that feel that they had to go through too much can work their way up and teach so that they can give their students an easier individualized and sensitive education and see where that leads.

However, imo it should always be extremely difficult to get in and to succeed. That's the point. I don't think people should commit suicide. They should just quit.

There is little evidence that hazing leads to better outcomes. Nor, does making medical school technically difficult leads to better outcomes. The US takes longer to train its medical professionals then most other places leading to more expensive care, and a overall deficit of doctors.

As somebody who works with pathologists, I don't find the academic part of medicine more difficult then say physics - but the pay is substantially different. This artificial labor shortage is protected by the systematic failures discussed in many of the HN comments.

None of these things are defensible.

I only have a very shallow understanding. I think the term 'resident' comes from actually living at the hospital. A resident was expected to care for a single patient from beginning to end. They needed to be available at all times to handle that specific patient's needs.

There are deep challenges with continuity of care. How does one person hand of treatment to another person?

Imagine you and I are both working on a project. There's only one computer, you use it from 6AM to 6PM, I use it from 6PM to 6AM. We can only work on one feature at a time. How do we coordinate that handoff every day? That alone sounds like a huge pain. With a doctor, everything can super time critical, and requires just as much depth of understanding. You may have a an understanding of something that i didn't understand in the handoff. building a project, we roll back my code talk some more and do better the next day. With doctors, maybe somebody dies.

I know it's a convoluted example. I imagine most stuff is routine and can be passed around safely. But it's only routine until it isn't, and there's no way to know up front. As much as developers hate being treated like cogs, it seems like it would make doctors lives quite a bit easier. Just seems like a super hard problem. And if you don't get it right people could die. So, like, that sucks.

You meant to reply to a different comment?

Vague, long winded, round about way of saying, maybe it's not self inflicted. Continuity of care is hard. Maybe fewer patients or other responsibilities would help. Ultimately, in my shallow understanding, residents just sort of have to be there to take care of their patients, because passing patients around is dangerous.