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Comment by firstplacelast | Hacker News Reader

As far as I am aware, it is time at the hospital. So they can sleep a bit, but it is not much.

These are smart people, they do not want it to change. Their income would decrease if more people were trained/brought in. Have a lot of physician friends, it's awful and they complain, but are worried about wages. They do not want to make less.

A big part is the expense of undergrad+med school+low residency wages+most grew up upper-middle class and have big expectations. They're very worried about losing ground wage-wise. which is fair in my opinion...they have a de facto union/guild (like most smart people who earn a wage try to do).

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> These are smart people, they do not want it to change.

Somewhat undercut by the rampant suicide rate.

> A big part is the expense of undergrad+med school+low residency wages+most grew up upper-middle class and have big expectations.

Oh so when you say "they don't want things to change" what you mean is "they know the path to success and if they try to take care of themselves or demand decent working conditions there's a good chance they'll be fired and end up bankrupt and in a debt trap for life." Got it. That kind of explains the suicides.

Dang, I don't know if I want someone with life work balance skewed in the "sleeping odd hours, suicidal, needing the money" favor poking around in my body.

Well, ask two doctors and you'll get three opinions about work time. From my experience here in Germany:

- Doctors in training usually want to work as much as possible to finish their training as fast as possible, especially if they want to work in surgery. For instance, if you train for "general surgery", you need to do about 25 appendectomies, about 35 cholecystectomies, and so on. So in a perverse way, you need a bit of "luck" that you are working while these cases come in. More time in the hospital simply increases your luck.

- Young doctors without kids often want to work a lot to earn more money and accelerate their career.

- Older doctors with kids usually want to work less and more flexibility for choosing shifts.

Here in the US that usually means they’ve got $200-300k in student loan debt to pay off the moment they start their residency

I began US med school well over a decade ago, so my POV is dated (pre-ACA). I dropped out very early into my formal training.

However, I still keep up with three people whom completed grad school; two physicians, and one dentist (all practice medicine, now, except me).

Remembering their almost-simultaneous relief as each paid off their final $xxx,xxx student loan... the dentist still has to pay off his "Practice" financing (office), but all texted me upon the first deposits of their "first big-boy paychecks" — proud to finally be tackling this debt.

Two of the three have confided to me that "I am smarter than all three of them, having left medicine early [enough to pay off only $109k of student loans]."

I always thank medical staff, whatever the rank, for having to deal with the public. My dentist friend admits to never having-considered that his stubby fingers would have to work in tinier mouths (relative to normal hands).

C'est la vi.

> - Doctors in training usually want to work as much as possible to finish their training as fast as possible, especially if they want to work in surgery. For instance, if you train for "general surgery", you need to do about 25 appendectomies, about 35 cholecystectomies, and so on. So in a perverse way, you need a bit of "luck" that you are working while these cases come in. More time in the hospital simply increases your luck.

Sounds like a great way to incentivize tons of unnecessary surgeries as well.

Oh, you bet! Fortunately, it is not for the doctor in training to decide if these kind of surgeries are necessary. However, for smaller things in diagnostics, let's say a spinal tap or something like that, it is absolutely possible that on overeager doctor in training will do this unnecessarily, because I think they have a training quota for these as well. However, biggest risk for unnecessary surgery in Germany is still private health insurance...

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