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Comment by Tycho | Hacker News Reader

Can someone explain to me why we have very highly paid medical staff working crazy hours, as opposed to simply having more medical staff working normal hours and getting paid proportionally less? Is it because we can’t train enough of these people so we must overwork the existing ones to meet the demand for healthcare?

(Obviously from the patients’ point of view they’d rather not have any important medical decisions made by sleep deprived doctors.)

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Because it's operated like a cartel:

https://fee.org/articles/the-medical-cartel-is-keeping-healt...

I'm surprised this hasn't been solved by lawsuits yet. I have to assume that a surgery going wrong when the surgeon hasn't slept in 24h is pretty much an automatic guilty verdict.

Because the actual surgeon is not a resident at the end of a 24 hour shift, it's a staff doctor on call or a local doctor with privileges at that hospital or surgery center.

It takes like a decade to train a doctor, and a bit over a decade ago was when the American Medical Association stopped trying so hard to limit the number of new doctors, we got the first new school of medicine since the 80s. The biggest barrier to entry right now is probably the residency requirements that make up a few of those training years, there are only so many hospitals and only so many slots in each hospital. The funding for residency is gated by federal funds.

Hand-offs are also dangerous in many parts of medicine. So, often times, hospitals want the decisions being made by a single shift to mitigate the risk of transcription errors between shifts.

I was in a hospital for a few days thanks to a relative being in critical care. I can tell you that no two practitioners are ever in the same room at the same time, so the standard of care is already one of continuous hand-offs and transcriptions.

It's complex, but basically we can't train doctors fast enough.

Residency in particular is the biggest bottleneck. It takes a lot of effort to have a residency program and there simply aren't enough of them.

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