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I don't see how your wife's unreasonable work schedule is supposed to make me feel better about the poor quality of health care I receive. If anything, it makes me question her judgement more, that's just not healthy. How are unhealthy people supposed to educate people on health?

It's likely not her choice.

In the UK medical professionals are doing the sensible thing, and leaving the profession. I'm sure most of them would much rather stay, but they're making the rational choice as individuals.

That's not the best choice for patients as a group though.

There's a serious under-staffing, under-pay and conditions crisis.

It's always her choice. And I'm not being flip. Only individuals making good decisions will change this situation. My wife is also a physician and she has thoughtfully opted out of the "rat race." It's good for her, good for her institution, and good for the populations she serves.

So if doctors are intelligent, why do they put up with such a horrible system? Surely they have some sort of power in these scenarios?

They have very little power in most primary care specialties. The expectation from hospitals is you will work this hard or they won’t hire you. Hospitals are more than happy to just dump more hours onto their over-exhausted doctors rather than hire new ones who ask for fewer hours. The expectation from other doctors is you will work this hard because if you don’t, someone else will have to pick up the slack. Also, most of them sign as part of their contract basically “I’ll show up outside of contracted time if it is necessary for patient safety”, turns out this is like 50% of the time because they’re so understaffed

Have they not realized that they can unionize?

Doctors have invested huge sums of time, money, and effort into getting the qualifications needed to perform their jobs, and there are few alternative jobs they can transition into if they are given a bad deal.

I don't mean to be unfair, but this isn't that far from

>If you're so smart why are you poor?

Intelligence has nothing to do with power or leverage in a situation

But it has everything to do with understanding that you can form a union, no?

If you don't even know about these organisations then you're not really qualified to talk about what doctors should or shouldn't be doing or what power they do or don't have.

https://www.bma.org.uk/

https://www.hcsa.com/

https://doctorsinunite.com/

So why haven't those orgs accomplished anything to get better working conditions for doctors?

How do you know they haven't? Just because things aren't perfect doesn't mean things can't be better than they were previously, the NHS has been around for 70 years after all.

Yes, they are striking in the UK.

My point was not at all to make you feel better. It was to explain a systematic reason why doctors underperform and empathize with their position instead of blaming them personally.

To be clear, I was not meaning to blame and sincerely apologize that my comment may have come across that way. Your comment was very helpful in conveying why, ceteris peribus, the perception of doctors may be diminishing. They are too overworked to excel beyond the standard of care, and even consistently meeting the standard of care is a tall order.

But that’s what I was trying to suggest by saying that it seems the medical field, as a whole, seems to be optimizing for the wrong thing, viz. quantity over quality. As others note, there are clearly economic forces at play, and maybe too much constraint on the supply side. And it’s not clear to me that any reasonable discussion is occurring with respect to that. And so I reiterate my pessimism that we’ll somehow get from where we at currently, to a brighter future brought about by a kuhnian revolution as hinted at in the original article. We need to fix what’s broken before adding new features, to put it in software terms.

> Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day)

Honestly, that makes me agree with the parent comment that the medical profession must be getting stupider to not let a doctor take a break or eat a meal on a 15 hour day.

The parent comment didn't say the medical profession, it said;

>Are doctors, as a group, becoming stupider?

do you see "getting stupider" as synonymous with "less profitable in a capitalist system"? Do you think doctors are overworking for fun?

> Do you think doctors are overworking for fun?

No, it's so the administrative staff can become further bloated as parasites upon the host of the actually productive doctors, and so the shareholders can take whatever breadcrumbs the administrative staff leaves behind.

They are overworking because they have a lobbying organization that limits the number of doctors.

This leads to higher pay and more work.

Doctor pay-per-hour-worked varies a lot by specialty. My wife gets $270k/yr on her current contract after max bonuses and paying for malpractice insurance. That comes out to about $60/hr. this is in a mid col city in the USA.

That’s in no way bad money, but per hour worked PAs and many nurses make more than that. When I worked IT support I was paid close to that. It doesn’t at all seem worth the pain.

That sounds like rough gig, but overall they are still the highest paid profession in the US by far.

What percent of doctors do you think contribute to the lobbying organization or agree with its direction?

Enough there is no counter-AMA organization anywhere close to the same size.

AMA membership by physicians have dropped from 75% in the 1950's to about 15% a few years ago. Doctors are actually not that great at advocacy which is the main reason why counter-AMA organizations don't exist imo.

A large chunk of their membership is just medical students and residents but thats primarily because they offer good savings to them like study materials.

The AMA does not represent physicians.

Which lobbying organization is that? If you're referring to the AMA then you're wrong. They have actually been lobbying Congress to increase the number of physicians by funding more residency slots.

are you robert california?

but to your point, studies have shown that handoffs kill patients. if you've got 18 people on a floor, each shift you hand off to has a statistically significant chance of screwing up one of them. So if there are 3 shift changes a day there are potentially 3 might-screw-you-up-bad rolls of the dice.

putting people on 12- or 24-hour sifts is crazy, but the sleep deprivation kills less than the shift change mistakes.

There are definitely capitalistic hospital business incentives at play here, but there is more than just that. Medicine is a notoriously supply-side gated field, and intentionally so by all practitioners. It’s one of the main drivers of the sky high pay white coats get access to after all the hoop jumping.

Speaking for the US, as it has a notorious track record for inefficiencies in its medicinal industry: the USA is getting older (aging population needing more care) with the cost of medical school higher than ever. With this, the production of doctors is unlikely to increase at a pace necessary to maintain levels of care uniformly across the board (for example, rural vs city medicine capabilities vary massively based on region).

Most hospitals attempt to use technology to squeeze more out of their doctors, as getting more doctors isn’t cheap (because there aren’t enough of them). Hospitals can’t do much to solve the doctor production shortage - that involves legislative changes and the American Medical Association (lobbying arm).

The capitalistic effects will compound all of this - but not so much in what you may be describing. If we don’t resolve things, in the medium-term future years we can see a bifurcation in medicine as we see in criminal defense law - the wealthy will have great access to world class healthcare, paid at an extreme premium, and everyone else will be out of luck. (Some would say we are already here there or rapidly approaching this state).

Is it possible intelligent people are aware of these conditions and it may be causing them to choose a different path instead of practicing medicine?

Ditto with teaching, anecdotally.

Worse yet, experienced people in these professions tend to defend the insane schedules, which I take for some sort of hazing ritual / Stockholm syndrome.

They asked if doctors are getting stupider. You provide an argument for why they could be getting stupider and pass it off as a counter-argument...

Unless the schedule was always like this. Then it wouldn’t explain them getting stupider.

No confidence at all, I wish doctors didn’t make so many mistakes and I wish doctors weren’t being ritualistically tortured. The fact that we get both just speaks to the incredible dysfunction of it all.

It sounds like a solution might consist of vastly increasing the number of doctors that get trained and residencied each year.

Reading the replies to your comment is so grim. I think, more than anything, I'm floored by the level of arrogance that permeates seemingly every conversation on HN lately. I'm spending less time here than I have in years because watching the culture of curiosity die just makes me sad.

Anyway, thank you for taking the time to share this.

May I ask why she's doing this?

It is required by the hospital. I have made her promise me we will try finding a better work-life balance hospital within a few years, but it’s hard to apply to new places with this kind of schedule