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Comment by neuroma | Hacker News Reader

Can confirm many doctors work insane hours, which are hard to even imagine for people who do office jobs.

The notion that you can only do 4 hours of productive work a day is frankly a luxury. If you have 10 hours of work to do, all of which is essential for people's immediate wellbeing, you find ways of being productive.

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I've never seen a convincing explanation for why doctors work these long hours that didn't boil down to 'the doctors union restricts the supply of new doctors and limits the tasks that can be delegated to non-doctors'.

As a result, the regular mention of their long hours generally just makes me angry at them rather than grateful to them, but I guess I'm in the minority.

Some of it is capitalism. Here’s a nice introduction to private equity in radiology.

https://www.benwhite.com/medicine/the-private-equity-model-i...

Now with surgery? Again there’s some capitalism but also surgery is hard. Extremely hard. Here’s a link to a common surgery for orthopedics for example. They have to memorize these procedure steps and be very quick. Time on the table for the patient matters for money and for anesthesia (more dangerous for longer GA cases).

https://www.orthobullets.com/knee-and-sports/12234/acl-recon...

Anyways you can be mad about moats and artificial supply constraints for things like dermatology but for surgery and family practice? Not really.

Another factor is geography. Can you imagine doing 12-14 years of school and low paid training, have 250-500k in debt and then move out to a rural area to practice? Many doctors don’t want to do that, so the ones that do are paid well but are usually extremely busy.

Anyways, there’s just a lot of factors that limit supply, it’s not the nefarious doctors union trying to squeeze every last drop.

I don't think there is any country in the world where doctors work for 40 hours, regardless of the economic model.

The world of human disease places some limitations on what can be done. Many people either do not have the grit or the stomach to become doctors (I could easily learn the theory, but I couldn't cope with all the blood, pus, vomit and frequent feeling of helplessness). People develop critical problems at 2 am. A doctor should know their patients and vice versa; they aren't fungible and ping-ponging a sick person between shifts tends to worsen the outcomes.

That plus just having to deal with all of those different personalities. Sick people can be incredibly difficult to deal with. I was in the hospital for an extended period a few years ago. The nurse said she and her colleagues liked treating me. I asked why. She said “because you’re normal.”

Medical school application rates beg to differ.

There's at least 10x more people that want to be doctors than get to be doctors.

They apply, but that does not necessarily mean that they would be able to finish the training. Being a doctor is prestigious and unsuitable candidates might be drawn to the golden haze.

Those application rates are 10:1 in india, but only 2:1 in the usa.

You really have to memorize when you have a checklist the nurse could read off so you don't miss a step? I wouldn't trust my memory to hold a single step of that checklist, I'd refer to it every time.

In "the checklist manifesto" the author suggests one of the main benefits of checklists for medical procedures is that nurses or other lower ranked people in the room who know the doctor is about to kill someone or cut off the wrong leg by mistake can communicate this information without the Doctor ruining their career for making them look stupid.

This isn't my domain by any means, but one common argument for long hours that is that patient handoffs during shift changes can cause information loss, and thus cause medical errors which lead to worse patient outcomes. The shifts are intentionally kept long to reduce the number of times that this handoff has to occur.

Again, this isn't my wheelhouse at all. I'm just repeating something I hear often when this topic comes up.

At the plastic factory, I preferred 12-hour shifts to 8-hour for this reason. I just got more efficient as my shift went longer. I also felt the loss of efficiency whenever I took a vacation. The thing I disapprove of is the sleep deprivation.

I don't think it's as simple as you imagine. Any time you're delegating a task from someone who has double digit years of training to someone who (perhaps) has only a couple, you are likely (but not always) increasing the probability of error, and errors in this domain have real consequences. This includes potential for malpractice lawsuits because "the lazy doctor had their nurse doing all the work".

Whilst I agree that there must be better ways for healthcare staff to work than at max capacity until they burn out... it seems odd to be angry at them for this. Most would prefer a healthy work life balance, and patients would surely prefer a well rested clinician.

Doctors are highly specialized mechanics for the human body. The reason they can work the hours they do is because most of what they do is not creative and can be done on basically autopilot.

MDs also work in a profession with a fairly unique quality: you always get paid more for doing more work, and the work is more or less completely prepackaged into self-contained units for you - i.e. a GP seeing patients more or less breaks their day into a pattern of independently compensated, 15-30 minute slots.

Not exactly. Only some are paid per session, as this is typically private medicine, which is not the normal in most of the world. Publicly funded medicine accounts for the great majority of work done, and these doctors around the World are paid the same regardless of their workload. USA has a very unusual system, internationally.

Also, only part of the job is autopilot, much of it is difficult and taxing. Experts will manage their attention and energy throughout busy days.

The point is that humans can and do work hard and at difficult tasks for long periods day after day. The cost is eventual burnout though, hence why so many doctors quit or go part time.

This is almost certainly taking a toll on the doctors health. They’re stuck in that situation because of unions, but that isn’t the case for an SWE. We shouldn’t be expected to work at our healths expense.

How are unions responsible for doctors’ long work hours? According to a quick google there are very low rates of unionization and it seems to be a recent phenomenon (I didn’t know there were any.)

Downvotes for asking a Q?

>For the past quarter-century, the American Medical Association and other industry groups have predicted a glut of doctors and worked to limit the number of new physicians. In 1994, the Journal of the American Medical Association predicted a surplus of 165,000 doctors by 2000.

Most residencies are paid for my Medicare funds. The 1997 Balanced Budget Act capped the number of residencies that Medicare funds, which led to fewer physicians. Who pushed for the cap?

>Lawmakers received cover from the American Medical Association (AMA), the Association of American Medical Colleges, and other major stakeholders in American medicine who endorsed caps on funding for residents and other graduate medical education programs. In March 1997, months before the Balanced Budget Act was enacted, the AMA even suggested reducing the number of US residency positions by approximately 25% from 25,000 to fewer than 19,000. “The United States is on the verge of a serious oversupply of physicians,” said the AMA and other physicians’ groups in a joint statement

https://qz.com/1676207/the-us-is-on-the-verge-of-a-devastati...

And also in the past they have lobbied to shut down medical schools which led to shortages in the 60s. https://www.nejm.org/doi/full/10.1056/NEJMhpr033066

They have recently pushed for more physicians but those changes will take time.

The AMA is not a union, nor is the American Bar Association, nor is the Society of Actuaries. These are professional organizations. They aren't involved in collective bargaining and they don't call strikes (putting aside for argument's sake the ethical issues with doctors going on strike).

Here's a document from the AMA itself stating their stance on unions (implying they don't consider themselves a union): https://www.ama-assn.org/system/files/advocacy-issue-brief-p...

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