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Comment by ZeroGravitas | Hacker News Reader

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.

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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.

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.

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