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Comment by mixmastamyk | Hacker News Reader

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.

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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.

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.

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