The darker side of being a doctor (2017)
drericlevi.substack.com
drericlevi.substack.com
Doctors's simply have the strongest association/union to preserve their privilege. No wonder why they easily earn way more than your average senior software engineer, lawyer or whatever around here. After the first few years from graduation, many of them go work in private sector where there's generally less stress, and 3-4 day workweeks are pretty common too, as they can afford it. Not a bad deal at all.
Here it has got to the point where young Finns pay money to go study in poorer countries like Latvia and Romania, because it's too hard to get in medical school here.
The fact is it’s extremely expensive and time consuming to train physicians. There isn’t enough space. Third and fourth year med students are going to far-flung hospitals to have hands-on experience because staying in the larger cities means they’re competing for access to training with residents.
All of this factors in to the cost and limited space of med school classes. It’s sad, but we would have to reinvent how we train physicians to address the limitations.
The underlying fact that the AMA is directly responsible for the doctor shortage in the USA is historically accurate. 20 years ago the AMA believes we were heading towards a doctor surplus and heavily lobbied and for fewer medical schools, caps on federal funding for residencies and big cuts to the available residencies.
The AMA has reversed course and no longer supports these positions but the damage has been done, both to our supply of doctors and to their own reputation. However, even today the AMA supports many policies that keep taks that other professionals could perform the sole purview of doctors (which excacerbates the suppoy problem they helped create.)
Yes. What’s difficult to believe about this? People respond to incentives. The incentive for every physician is to maintain a shortage of physicians, therefore improving the job security and earning potential of every physician. The only way this could be done is if the physicians formed some sort of cartel that could control how many people were allowed to become physicians. This is what the AMA is and what it verifiably does.
Politicians "trust the experts" and the American Medical Association says...
The flaw is the AMA is just a union for doctors not a body that represents patients in any way.
One reason you could imagine is that the health trusts determine roughly how many student doctors they are able to train and then the government limits graduation rates based on this. But I don’t know if that’s the actual reason, and it could be a half-reason, eg the number was set a long time ago and not updated.
Those bright enough go to law, IT and similar.
Speaking for my wife, she had to wade through absolutely brutal first 10 years for absolutely no good reason (she ain't no neurosurgeon, just internal medicine GP with FMH), no personal life at all at the prime of her life. 50 work week in contract (when average here is 42), reality with all required bureaucracy goes to 60-70, for everybody, consistently, unpaid (illegal here but who cares, state owns the hospital), often much more and catching up with tons of bureaucracy/billing at home.
Add night shifts, which most of us elsewhere have no experience with, that mess you up for many further days. You are a fraction of yourself, mentally and physically, for easily a week, more if you had to go through say 4-5 in a row.
These are the conditions that we put repeatedly people who have full control over life and death and health of their patients, often without further supervision, hoping they somehow magically never ever make a mistake, and when they do, folks immediately cry a murder and families sue to hell with massive dollar signs in their eyes.
You complain about that, or that you spend whole weekend being on call 48h unable to do anything really for literally 20 USD altogether (price of a canteen lunch here), including when you have to come and work 10-hour shift? You are put under pressure, shushed for being a pussy if you complain, told to toughen up since previous generations had it even tougher, and they somehow got through. Nobody mentions how horrible parents those absent folks were, how burned out they often were, quietly weeping or drinking themselves into oblivion. Well yes, those that didn't just quit, didn't go insane, didn't commit suicide, sure they got through. And now enjoy seeing young going through a bit milder version of the same. Of course there are insane amounts of money involved, but its always between insurance and hospital, doctors get less than capable IT folks for much less work. I am IT guy and consider this utterly fucked up wrong.
A good friend of ours sued the hospital (biggest public in Switzerland) for breaking basic Swiss law consistently like that, he was first but quickly gathered tons of other doctors. IIRC hospital finally caved in, a bit, but he is gone from it for good to private sector. Twice the pay, half the crap.
I could go on and on like this, a lot of doctor friends in our circles. It ain't some dream job, (at least a bit well-placed) IT job is a blessing in comparison.
/rant
It is not that IT is overpaid, it is that doctors are underpaid - at least in France.
We are the world champions of strikes and yet, somehow, doctors rarely go on strike. I do not know why.
They also know where they are going, it is not like they discover the world of medicine after 8 or 10 years.
I am happy that they are people who want to help others, but they also need to eat, sleep and party. Nobody will give them that if they do not protest.
The doctors in Nicaragua, the neighboring country, is as described in your comment, except the economy of the whole country is in shambles, and they also have to "voluntarily" participate in "government" political activities. Oh, and since the country is poor there are no immigrants waiting in line to fulfill those positions.
Hard disagree here. I don't feel I need to state the reasons. If much of a business relies upon technology that the IT people ensure is up and running for the non-IT folk, I would say that is not overpaid.
This is such a shallow opinion with no forethought into the domino effect. I won't try to make a commentary on doctors, because I am not a doctor and don't pretend to say that "doctors are ridiculously overpaid" because I know it would be a wasteful opinion that does nothing for the conversation.
This is happening across society, and I consider it a tragedy the people focused on race and sex have taken all the oxygen out of the room for a much needed discussion on class.
I’d even go so far as to say it’s encouraged (eg, BlockRock ESG) as part of a “divide and conquer” strategy by the capital class.
> too much suffering and risk for relatively little reward.
A lot of what you say is true for doctors in their first 5-10 years into their career, when employed in a hospital.
This not true for doctors which reached a certain level like „oberarzt“ and above.
This is especially not true for doctors with their own „office“ (business).
Yeah people may cry, but normally it is very hard to bring a doctor to justice even when there are quite obvious mistakes or misconduct. They are very well protected, suing a doctor not seldom takes 10 years from start to verdict, with a lot of legal costs involved.
And last but not least, it is a very secure profession. You must be really really stupid to end up jobless. So you have 5-10 years with a „ok“ salary compared to the power you invest. And 20-30 Years with a very good to exceptional salary, especially when compared to the broader population.
My sense is that the field developed in the era of independent/private practice, where the grueling hours worked was justified by high pay and minimal bureaucratic/administrative burden. Add decades of stagnant/falling pay plus death by a thousand administrative cuts and the profession no longer justifies the difficult working conditions as convincingly. Some practices are still good, others terrible. Look at the rate of physician turnover to see which is which.
Oh and the “provider” discussion is worth paying attention to. Your doctor has this calculus worked out - years & energy invested, work environment & income expected, then the only viable option in your city is to be employed by a large hospital system (because hospitals get paid at least double for the same work, outcome is as expected.) But wait there’s more: you are now called “provider” by your large hospital employer who hires 2x NP employees to do the “same” work as you and pay half. Guess what direction the pricing pressure is going. In the future expect few MDs to stay in primary care because the system does not support that path. Specialty training is the future for MDs who invest time, energy, & money to excel in their field.
This is unlikely to be true.
And does the (my impression) widespread support for oh-so-rigorous qualifications for doctors reflect any real-world data about actual resulting quality of patient care? Or is it a way for prospective patients to vocalize a bunch of anxieties and emotions about medical care, plus a way for the doctors who've had to endure such treatment to say "all the noobs should have to suffer as much as I did"?
We need a range of doctors, who range in price according to quality.
That way for simple stuff, which anyone can get right, we go to a cheap, reasonable doctor.
A similar example would be if we only had uber software engineers. Each one had to have a PhD. There were no cheap and okay developers who could do say web-sites but not write a programming language from scratch.
Having a doctor available to treat you at all is still much better than having your very high standards and then not having a doctor available period.
We need doctors who are available to treat simple conditions and refer to a more qualified doctor for the complex ones. Such a job doesn't require being a genius, just people who are not complete idiots, and the qualifications required here are genius-level, not idiotproof-level.
This isn't true of the AAMC position in the US today, and when it was true in the 90s, there were many articles about an upcoming oversupply of physicians.
First, US medical school graduating classes are smaller in number than the number of available residency positions. So every year, the US is importing physicians trained in other countries.
Next, residency positions (required to practice in the US) are funded by the US government. You could readily contact your US representatives about the problem you perceive - if this a legitimate concern for you.
Additionally, US residency positions don't need to be funded by any government body, at all! Hospitals need 'simply' show that there is enough patient volume to support educating additional residents. This is another avenue where you can intervene, if this is indeed something you care about.
Lastly, 'advanced practice providers' are filling in large amounts of the deficits in physicians in primary care providers. So focusing on the number of physicians is to ignore the huge growth of NPs and PAs - some of whom can function without a physician in some parts of their practice.
I see many people blame 'the AAMC' for healthcare problems, but worry that not many appreciate the lack of a role the AAMC plays in the number of providers in America.
That's because the artificial restriction is placed on entrants to study, not qualified post-study graduates.
And it really is a purely artificial restriction: in the 90s, in SA, when affirmative action was implemented (where a C student from a particular background would get placed before an A student from a different background) didn't result in any measurable difference to the resulting quality of doctors.
We literally have a small experiment showing that allowing C students into med school doesn't affect the outcomes, and yet there is still a very limited intake into medical schools, and this is purely an artificial limitation.
It's fairly trivial to analyse population vs. medical student places and see where the problem lies - there was an expansion in training places a few years ago, but it's a pipeline problem, and doesn't get fixed overnight. If somebody really wanted to fix things, there would probably need to be some kind of accelerated training of doctors and nurses for a few years.
> Expanding the cap on medical and dental school places is complicated by the cost of training, current university and clinical placement capacity, and the current number of clinically qualified academic staff who design and deliver courses.
Furthermore, the NHS actually needs the funds to hire staff.
The core problem is that people are getting older with more complex health care requirements, that more and more conditions become treatable, that healthcare is often expensive, and that no one wants to pay for it.
lolno. Aside from the fact that AI is nowhere near good enough, we can't really build robots anywhere close to the dexterity required to do many of the physical actions. Also people like having human contact.
"Economies of scale" only works well for things like manufacture, and is much more limited for many other things. It certainly doesn't reduce the cost of actually paying a yearly salary to these people, or ensuring you have enough places (hospitals) for the to work at, which isn't cheap either. There are some small advantages one can take here on there, but in general, it scales fairly linearly. This is not just me saying that, your own link, again, says that.
Training 10 junior devs really is about 10 times as much work as training 1. Maybe slightly less because you can group some things, but not too much. And training 20 junior devs is about twice as much work as training 10.
It really is just a funding issue – which is what everyone has been saying for years. Labour wants to increase spots by abolishing non-doms – we'll see if that works when they win the election.
Otherwise feel free to stand for election and propose the n% tax hike required for all of this and see how well that goes.
But it is undeniable that doctors are paid considerably more than most other jobs. This is why.
What actually happened was cartel shit.
https://www.washingtonpost.com/archive/politics/1997/03/09/r...
And of course, residents super overworked. I think it speaks for itself that making medicine 2x - 3x more people per year would help the problem. Yes, there's a "sweet spot" where quality of doctors would drop, but there's also a sweet spot where services rendered drop due to overwork, and we're on the far side of that one
in portugal, public workers are one of the biggest lobbies
medicine
- can't be taught at (non public) private universities
- there's limited growth in class sizes/etc
- it's nearly impossible to get into due to grade inflation at high school, which means only the richer paying for private high school pass it (requires grade 19.x/20 at least)
At the same time, there's 100s of nursing schools (can't be too different can it?), there's way too many nurses and way too few doctors.
We're importing doctors from cuba and other countries to fill the gap.
Some people decide to study abroad (within EU) because yay, you study medicine in eastern europe, you may come back to work in Portugal because EU, and again only the richer people could afford this
I do know that limiting the number of doctors is one of many mechanisms to limit healthcare spending. A doctor can only see so many patients in one day.
How do you suggest we limit the demand for healthcare?
The way to decrease demand For complicated and expensive interventions to preventable problems is to increase access to preventative care.
At the hospital, they just classify your symptoms as “not critical”, refuse to admit you and kick you back to your GP, who then refuses to refer you for any investigations, I imagine because there is a gun to their head over targets etc
If your levels are high, you’re told oh it’s not severe. If it’s severe, you’re told oh it’s not critical etc
We have a system where everyone just gaslights you that you’re in fact not sick because you aren’t 3 seconds from death
But I was wondering if more physician assistants would help the doctors. Maybe they could take care of the paperwork and all those things as well.
Lastly, the gov finally acknowledged the problem and tried to suppress the "numerus closus" (limiting the number of medecine students) but the problem is now that... there's
- not enough teachers and not enough room in universities
- not enough position in hospital for "internship" (not sure if it's the right word) because theses interns have to be managed by experienced medics
- it takes a loooooong time to make a doctor
- "young" doctors don't want to spend countless hours without personal life like previous generation did... so more doctors are needed !
And the problem is even more pregnant for out-of-hospital doctors (particularily outside of cities)
Right now, the gov strategy is to try to give more and more power for nurses, pharmacists to limit load on doctors (and cost for social services)... but sometimes doctors may spot specific symptoms where others may not
Hospitals cost absurdly large amounts of money, especially in the UK where there are consultancies and layers of subcontracting for everything. So the infrastructure costs of adding even a few hundred student places is astronomical.
Due to strategic underinvestment (or ideological sabotage, or governance incompetence, depending on outlook) there is now a self-reinforcing problem: not enough hospitals and staff to train doctors to beef up existing hospital staffing or work in hypothetical new hospitals even if a money firehose was turned on.
Rather than having a tall glass of concrete and doing the hard thing, which will still take decades to manifest, what the government is currently doing is a rerun of Healthcare Assistants where more care is delegated to much cheaper-to-train staff. Plus quite a bit of noise about "AI" bring used to allow them to sweat the asset of the staff they do have by, for example having one radiologist verifying AI findings rather than a pair-based system.
Which will all work "kinda ok" and let them punt the problems at least into the next government's domain when they lose the next election and can spend 5 years screaming from the Opposition benches about the mess. But you cannot do it forever (or the hail-Mary works, there's an AI revolution and you can actually run a hospital with an app, 2 agency nurses, a few smart plugs and an AWS instance).
Of course "doing the hard thing" would be easy to say if it was just the NHS, but there's the same structural degradation in everything. So you also need to spend billions on education. That's the same general problem - shortage of facilities and not enough existing staff to train new staff and the ones you do train quit. Schools are currently one something like a near-500-year replacement rate (50 per year, 24000 total) and that's without considering population growth or even the hundreds of schools that need rebuilding because they're made of RAAC. Then roads need billions to repair the accumulating damage. The railways need huge investment and staffing. Energy is the same - virtually no supply of domestic nuclear design engineers mean they get absolutely rinsed on even squinting in the direction of a drawing of reactor (though Hinkley Point C cost spiral is currently EDF's problem, not the taxpayer and green energy is actually a rare success story). Defence is similar (e.g. ships being retired because they need the staff elsewhere). At least some water networks are collapsing into a multi-billion hole after private dividend extraction. So that money firehose has a lot of work to do, even if they would turn it on. Which is ideological poison apparently.
All easily solvable:
1. * You also need a hospital (and GP surgeries etc) to be attached as well as enough senior staff to train them when they are there. *
Only for the final 2 years of a total of 7 years of study, which means if we ramp up entrants for 2025, the extra new facilities need to be ready only in 2032.
2. * That training is very intensive on trainer:trainee ratios and the senior staff are also in critically short supply *
Not a problem for a career which is regulated with a national body - simply enforce a minimum number of hours of teaching/mentorship per year to renew mambership of that body. Since the full capacity will only be needed by 2032, this can be done progressively over 7 years.
3. * are retiring by the thousands and many newer junior doctors quit or emigrate as a result of their experiences up to that point.*
Simple: you currently don't get to qualify as a practicing doctor simply by passing exams, so withhold certification until a minimum time has been spent in mentorship/public health services.
To keep salaries high.
I'm brazilian. In recent years, brazilian medical schools have been "democratized", so to speak. The number of medical schools has exploded and acceptance of doctors from neighboring south american countries has been facilitated. About 50 thousand new doctors enter the market every year.
Result? Pathetic salaries. Actual unemployment. Doctors fighting each other over the shittiest jobs with the worst working conditions. Doctors becoming Uber drivers. Complete loss of the prestige the profession once enjoyed. Rampant charlatanism and unethical conduct. Badly educated doctors who kill their patients. Dishonest doctors promising miracle cures on Instagram because that's what gets them engagement and therefore patients.
There is no reason whatsoever to become a doctor under these conditions. Too much responsibility, too little reward. You're better off doing literally anything else.
Society needs to carefully consider the needs of those who will be responsible for other people's lives. When responsibility does not equal reward, it's pointless. My society chose to treat those people with absolute contempt. The results are plain to see.
I’m from Ireland and have the same experience as most of the rest of the commentators on this thread, i.e., we have a chronic shortage of doctors – and nurses – in our health system. This has been the case for as long as I’ve been alive but it’s got much worse in the last decade or so.
It’s interesting to see how universal this problem is – aside from the odd country like Brazil where the pendulum seems to have swung too far in the opposite direction. It’d be nice to know if any country has found a happy medium.
Just imagine how bad it's going to be once the "you're set for life if you go to medical school" meme dies. It's still very much alive here in Brazil but people are already being forcibly woken up to face reality before they've even graduated. Won't be long before the new generation of students realizes that medical school is a bad choice.
The bitter truth is nobody is really going to put the "care" in health care if they're not getting paid ridiculous sums of money for it. Would you really want to slave your life away in some hospital for shitty pay? I mean that literally, medical residency is analogous to indentured servitude. Would you want to spend the best decade of your youth studying and training and working 14 hours a day only to end up poor? I've seen doctors actually kill themselves over lesser failures than that.
Very few people are that selfless and altruistic, even those who affect such a demeanor in public are likely secretly hoping it will come back to them in some way in the future. They will be bitterly disappointed when it doesn't. Even fewer are rich enough that they can sustain such caring activities out of love. Those who try discover that they are just individuals, that they don't scale, they don't form a health care system. They don't make much difference in the grand scheme of things.
Today I saw an interesting post from an older doctor. He just straight up quit medicine. Took his money, bought a bunch of trucks and now he's managing a logistics company and making several times as much money as he used to while caring for people. This is an older doctor who reaped the profits of the golden age, he had the capital to create his business. New doctors arrive at the market with 100kUSD+ debt only to find that they get paid about 10 dollars a consult if they're lucky. The only winners here are the owners of the medical schools.
The end result is that the health practice degrades overall, and social inequality strenghtens. I think nobody is happy with the former reason.
I’ve come across quite a few medical doctors who seem to lack the ability to listen to their patients – or the interest in investigating the cause of problems. I got the impression that they came from wealthy backgrounds and are the type of people who do well in exams and became doctors purely for the monetary return and social prestige. It’s disappointing to realise that I, as a system administrator, put more effort into investigating and solving IT problems for co-workers than some doctors put into investigating serious medical and health problems.
On the other hand, I’ve met a few intelligent, gifted and empathetic people who really wanted to be doctors or nurses but weren’t so good at rote memorisation. As a result, they didn’t obtain the necessary “points” to get one of the very limited places in medical courses.
The work culture of the medical profession looks horribly inefficient. What benefit do you get from buying out young doctors?
Another thing is the toxic culture perpetuated for allowing medicos to stroke their egos - toxic cultures about overtime are everywhere, but medical profession is a class apart.
They make the hospitals follow plenty of rules, but let them ignore labor laws in this case.
There is prestige in working your ass of and living for work. Work life balance is for the weak people who can’t take it, they are not real health professionals. They don’t have what it takes.
I have seen the same culture in aid work.
I find it ironic that both health professionals and aid workers are there to help people, but not for each other. Then it’s cut throat.
What’s a good alternative though? These are high paid, high status, jobs for life. Of course it’s going to be as competitive as all heck to get them. Do we shame Olympic athletes for the dedication and sacrifice they must provide to obtain their goals? I’m not saying the current system is great, but any alternative could well be worse.
But I wish we had more private practices where doctors had more control and optimized for patient well being.
[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3464122/ [2]: https://psnet.ahrq.gov/issue/public-opinion-resident-physici... [3]: https://thesheriffofsodium.com/2022/02/04/how-much-are-resid...
You are saying that 'it turned out to be stress from work, his hours, his fear of failing' but then 'who will ever know'.
Also why does it matter that he was such an apparent (to stress) academic high achiever? That doesn't make you immune in any way to anxiety or making other life choices that could be detrimental to your health. Understand that you are adding color to your story but really the 'loved, funny, played a mean guitar' why does that matter?
Easy answer appears to be he was pushed by others (or himself) and went into a field that he was not (mentally) able to do. After all most Physicians are not killing themselves (high achievers who go to Harvard or a less impressive school). Literally the same thing could have happened to him if he went into any number of high pressure fields or had other mental issues.
I have to yet to meet one person who says American Healthcare is wonderful, fairly priced and efficient.
It seems private Equity and mergers are slowly juicing out the system - the doctors, patients, nurses.
Its a sad state of world that we don’t allow pilots to overwork because our lives depend on it, but we allow doctors to overwork and don’t count patients dying due to them being overworked.
https://philip.greenspun.com/flying/unions-and-airlines
probably not a 1:1 comparison to health care, but the conclusion was:
> a sustainable long-term structure would be a pilot-owned airline
I kind of wonder if there could be a way for doctors to start a hospital and run it top-down from first principles.
Kind of like good engineering companies that were started and run by engineers.
There are so few doctors that getting a tired doctor is "better than nothing" as you have a greater chance of survival if you get mediocre care vs no care at all and certain death.
However, fields like aviation have strict workload limits. You cannot be on call/duty for too long because fatigue kills. Issues like alarm fatigue are studied by agencies, and folks at Boeing/Airbus then implement the findings.
The question is, why is it okay for medical professionals to wear themselves down to the bone (sometimes literally, like in this article), while some other professions take care to avoid it?
(Edit/PS: I added a fairly detailed self-reply below on what I think are some of the common arguments (like on the number/availability of doctors) and why they don't really fly, pun not intended.)
At least in the US, there's a kind of masochistic pride in the physician community, that everything he described in his essay is laudable, noble, to be emulated. Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better. And he's holding up the lack of mental illness diagnosis as if it's something to be proud of, as opposed to never being diagnosed with say, cardiovascular disease or cancer. He's proud he's never sought help or tried to change anything. Sure he mentions problems with patient care in passing, but what he's really upset about is "just being another employee".
In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those services (note the comment about denying other physicians income). The AMA and physicians union (yes it's a union) basically guarantees this in lieu of having real competition, decreased income, and so forth.
Why is it different in something like aviation? My guess is because the failures are more visible, they're on the nightly news, people are there posting pictures on social media? For whatever reason, I don't think pilot organizations ever managed to remove themselves from scrutiny in the same way as physicians did. We see pilots as highly skilled professionals, but part of a system, with alternatives, and the subject of fair scrutiny from outsiders who are not pilots: engineers, safety experts, investigators and so forth. In my experience when these kinds of issues come up in healthcare though, everyone defers to physician groups themselves, as if no one else has expertise enough to scrutinize them.
I imagine too at some level, part of the issue is that the pilots themselves are subject to their own mistakes: if a pilot crashes a plane, they take themselves out at the same time. If a surgeon makes a mistake and kills a patient, they still walk home and can rationalize whatever they want, all they want.
I'm growing unsympathetic to these types of essays (the one linked). If physicians want me to empathize with them more, maybe they should stop stigmatizing mental unwellness and recognize it in themselves. Maybe they as a professional group should admit that others could take on some of the load, maybe even better in some situations. It feels a bit like they create a mess out of selfish greed or ego and then expect me to feel bad for them.
c.f.
"...everything is rushed, and mistakes are bound to occur."
"I am realising more and more that what brings me greatest distress is the relentless administrative pressure which take away the meaningful clinical engagement I have with my patients."
"I was burned out and I couldn’t control my emotions at work and at home. I’m not inherently an offensive or rude person, I’m just a person pushed to the limits and set to fail because of the circumstances around my work."
> In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those service
This is Australia, which does not have artificial restrictions on the supply of doctors to the same extent. On the other hand, they don't have a surplus of surgeons nor can nurse practitioners do the work
> (note the comment about denying other physicians income).
Yah, he's saying that if he doesn't come in, the backlog gets worse, and other people don't get paid.
> He's proud he's never sought help or tried to change anything.
He says he would like to seek support, but highlights the structural problems that prevent it:
"I know where I can get support, but practically, when and how am I going to get that support?"
"In addition, doctors who scream for help may be formally reported, therefore having restrictions placed on their practice and then incurring higher medical indemnity fees in some situations. Trainees who ask for help may be labelled as underperforming and have to be commenced on probation or remediation. We may not have practical access to the support that are often advertised."
I absolutely am in agreement with you that the things done to artificially lower the supply of residency training in the US are terrible. But those criticisms don't seem to apply to this essay.
But the question is why does the rest of society insist that pilots be properly rested but not doctors? I'm sure a lot of pilots would also work crazy amounts of overtime if allowed.
He sounds like the kind of person that brags about being mentally sound but is secretly addicted to benzos. Always advocate for yourself!
Meanwhile a tired pilot is more binary, it either can have 100% passenger survivability if things go well or 100% fatality if things go tits up, meaning the risk are too high to take chances.
It's basic game theory.
First, those are not the only choices. There is also the the option of training and hiring more doctors. 2
Probably, there is also an option of making more efficient use of doctors time, but that one is more complicated.
Most of the work of doctors is not life-saving.
I think, you see a standard problem of pushing shit down or up. Government lowers budget, pushes quotas down, which gets pushed down further until it reaches the bottom rank and file, the doctors.
They have to "do more with less" (Not limited to public sector, see Boeing), and that works for a while, until it doesn't.
We should impose work limits on doctors, just like pilots.
> Meanwhile a tired pilot is more binary, it either can have 100% passenger survivability if things go well or 100% fatality if things go tits up, meaning the risk are too high to take chances.
This isn't how the math works. A tired pilot either kills or doesn't kill their passengers on a given flight the same way that a tired doctor either kills or doesn't kill their patient in a given operation. In both cases it's 100% survive or 0% survive.
Pilots aside, we also have laws about keeping truck drivers from driving too many hours, and accidents involving drowsy truck drivers are unlikely to have fatality counts measured in the hundreds.
The difference between doctors and pilots/truckers isn't in the amount of risk involved, it's that surgeries are expected to have a non-zero fatality rate. A doctor can do their job perfectly and still lose a patient, so it's harder to prove that the fatality rate would be lower if we gave surgeons more rest. When a truck driver falls asleep at the wheel and kills someone it's obvious because they did something provably illegal or unsafe right before the crash. When a surgeon fails it's a lot harder to prove it was preventable.
Many operations are elective. In such cases, having a tired surgeon or nurse may be worse than delaying the procedure, or even skipping it.
https://www.bmj.com/content/353/bmj.i2139
https://pubmed.ncbi.nlm.nih.gov/28186008/
https://journals.lww.com/journalpatientsafety/Fulltext/2013/...
Time to push for a change. And time to call some people and ask whether they are truly ok right now.
One issue is the type of person attracted to the profession. They're incredibly academically talented, not driven by money, and desire status and recognition. Surgeons are the most extreme cases of this personality type, as they're harder jobs to get and have a lot of pressure. These people are the types who get their head done, roll up their sleeves, and get on with things. They're not used to asking for help or additional resources. They're the sort of people who care for others! Medicine self-selects for martyrs.
In addition, you have so many hoops to jump through (training, specialisations, etc) with significant time investment that can be lost in moments by pissing off training directors or other senior doctors. My partner ends up working more than her contracted hours because her bosses expect her to, although they would never explicitly enforce stricter rules. If she works her contracted hours she can kiss a consultant job (UK equivalent of attending) goodbye as her bosses won't provide a reference for the role.
Because the stakes in medicine are literally life and death, meaning that it is heavily regulated. There are horror stories around the GMC, the UK regulator, and doctors are terrified of being investigated. They adopt a legalistic mentality where they only treat if they're sure that they won't get prosecuted. It's very different from aviation with its no blame culture.
Finally, another factor that is making medicine so tough is that it is a success story! People live longer, and pathologies that were once fatal can be managed with ever more complex treatments. As demographics lean to older populations, then the demand keeps increasing.
This risk of iatrogenic harm has been used to justify long hours, particularly for residents in teaching hospitals. I'm not saying that it's necessarily a good idea or that there are no better alternatives, just explaining some of the rationale.
It is not at all surprising to me that these kind of hand offs result in things being missed, and equally obvious that decreasing the patients per provider and increasing hand off window hours would at least reduce some of those errors, if not outright improve them. Bonus points for putting the peak of handoffs into late morning hours, where much more of the decision making is completed.
Of course, the only way to do that is to either:
1) drag hours out longer, which I think lots of MDs would be fine with if they weren’t expected to turn around and do it again in 18-36 hours, requiring increased staffing
Or 2) increase staffing all around and just maintain more reasonable ratios
My best friend from high school became an MD and I witnessed doctors in training being proud of powering through extremely long, back to back shifts with little rest.
Meanwhile, as an engineer I've seen short and strict shift limits on employees operating machinery like trucks and forklifts. Under the obvious principle that insufficient sleep impairs judgement, put lives at risk and creates massive liability.
Phobias apart, we simply do not expect to die, when we fly. In contrast, we openly consider % survival rates of medical procedures. These rates have human error already baked in, and would be lower if humans made less errors. And then there is the primal fear of not getting help, if needed, because no help was available, which certainly works on our collective will to action here.
A 50% survival procedure for medicine might work, because it's either that or death. Aviation is always a few plane malfunctions (not even outright crashes) in quick succession away from the entire industry crashing.
A partly-privatised healthcare system only works when all agree to balance the intangible long-term benefits of universal healthcare with tangible private-sector financial-gain. I don't see this happening when the private sector is seen as the panacea of all social-ills and when universal healthcare isn't seen a means to increase productivity.
I think the answer here is that if you there aren't enough pilots, schedules can be reduced. You can't scale back (in any ethical way, anyway) the demand for healthcare. People will just die at a higher rate and outcomes will worsen.
Hospitals are mostly held as public services, and having more doctors better handled arguably costs more (in training, infra, shift management etc). Gov gets to decide if it wants to pay more, or even change the status quo and bails on it.
It's the same deal for teachers in public schools and other public servants, their mental health management is lagging, their salaries and treatment as well, dispatch and promotions are a PITA etc.
I don't think govs are inherently bad at it, just that there's no check and balances most of the time. Same way private companies are bad at self regulation and need an external force to get regulated. Mandatory unionizing and better avenues to sue for better conditions could be an answer?
A pilot isn’t in charge of a deteriorating situation, then doing something could make things worse below the base line (a tiredness induced mistake) so therefore make sure the only do stuff when fit to do so?
Note I’ve used questions on both of these examples as it’s more of a half thought and a feeling that a statement or fully fleshed out thought.
I guess the summary is, I’d rather have a tired doctor work on me in an emergency than no doctor work on me. I’d rather not fly on the plane than have a dangerously tired pilot fly the plane.
That’s being said the system clearly needs improving and we need more medical professionals to balance the work load.
https://www.europarl.europa.eu/meetdocs/2014_2019/documents/...
Another is that the medical profession is much more "flexible"/fluid in its needs, unlike flights scheduled in a regular manner. However, that doesn't mean it's not possible to give doctors an 8 hour workday, and substitute/bring more doctors for other shifts. In fact, this is exactly what happens in many 24-hour manufacturing plants/operations. Foxconn doesn't let a sleep deprived employee make an iPhone, but it's okay to let a sleep deprived doctor perform life-saving/potentially deadly operations?
Another possibility is that "it would cost more" to have 3 docs instead of 1. Which might be supported by anecdotal evidence on how expensive things (including salaries) are in the medical field. However (especially if you're only familiar with the US healthcare system), this doesn't explain how doctors in say India are overworked.
The "real" reason, I think behind all this? The first part is it's because it's "easy" to compress and push an 8 hour shift to a 24 hour shift, fatigue be damned. The costs are "hidden", it's likely even with fatigue a 99% successful operation is still 95 or 90% successful. Everyone can rationalize it and go about with their day. "Oh, unfortunately people don't always make it".
Not, "there was a 20% chance they wouldn't have made it but an 80% chance it was because the doctor was fatigued."
When an aircraft crashes, 300 people may die instantly. This gets front page coverage on a newspaper. However, a few deaths "here" and "there" don't really show up, even if they tally up to thousands. This is the second factor, that "hides" and normalizes occasional slip-ups.
</End of this wall of text> I unfortunately don't really have a solution. I'm sure there are brilliant UX designers here on HN who could help ease and streamline the admin workload.
I suppose a dedicated politician/presidential candidate somewhere could take this upon themselves to campaign for. (Seriously, the NHS was part of the discussion behind Brexit. Supporting doctors is a brilliant political strategy, the NWA didn't have a song called "Fuck the paramedics".)
There have been many instances of things catching on once found successful somewhere, be it procedures like the Heimlich or concepts like Lean Manufacturing. Therefore I don't doubt that one good Harvard Review paper showing a 20% decrease in all-cause patient mortality, with trials underway in a few hospitals, is all it will take. Question is, who will bell the cat‽
Why would you do this? Some of the most basic labour jobs have better employment terms than this.
> You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital?
Yes, I did ask. But covering the hospital isn't your problem, that's a hospital management problem.
> If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered.
It's the hospital that's allowing patients to go uncovered if they don't employ enough doctors for a reasonable workload.
The author goes on to detail just how unreasonable the workload is.
> As a surgeon I spent a year in a hospital where I smiled on the way to work and I am so grateful for my job. I looked forward to long days because I knew what I was doing was significant.
So there are cases where it can be enjoyable, yet ...
> Another year in another hospital, I dreaded going to work. I hated being on call....Same surgeon, different jobs.
I don't see why you'd choose to work at the dreadful job. Isn't surgery a skilled labour job that is in high demand? How can they not demand more control over their working environment?
I'm guessing, but maybe it's possible that they're conditioned to accept increasingly stressful environments from the first day of med school. So that by the time they're surgeons, they're so conditioned that the idea of refusing the unreasonably stressful load is not even fathomable. Maybe there's even a certain amount of egotistical satisfaction that comes from being able to hack it.
You are right, it shouldn't be their problem, and we should work on making sure they're (especially surgeons for christ's sake) well rested and as stress free as you can be in a field like medicine, but what's the alternative for them and their patients right now?
You can’t just job hop like in tech?
It’s like everyone on this site views the whole world through a super narrow “tech worker” lense and assume every job works the same and everyone has the same motivations as people in tech
That's not a good reason to be overworked to the point of extreme misery and possibly suicide.
You can care about your patients, do critical work, and still have a workload that is reasonable.
As the author said, there was one job that was much more enjoyable. I'm sure they cared about the patients in that job just as much as they cared about the patients in the miserable job.
There has to be a way for docs to organize in larger groups and demand better, including striking when it comes to it.
In many cases, someone experiencing occupational burnout NEEDS extended time away from their work environment to heal. In severe cases, they might not be able to return to work at full capacity for years (or ever). This creates a negative feedback loop for understaffed doctors, nurses, and other healthcare workers.
The experience that the author describes is not much different than a fancy lawyer's or that of a Wall Street finance person. They all knew about the long hours, but money is more attractive...
In the U.S., some hospitals are seeing residents and fellows truly refusing to accept the status quo—they are voting to unionize in hopes they will be able to finally upend the exploitative system (at least for trainees).
For the US this needs to happen.
1) Medicare For All - a universal, no pay at service, insurance system, everyone taxed at 4% for it.
2) People that have the grades to make it to medical school should get a free ride.
3) Small Private practices should come back with free digital billing with the new health insurance system.
4) Price regulation on all basic medical supplies and medicines. No more $20 tongue depressors
5) All medicines researched at public Universities will not be sold or given to private industry. They will be licensed. That money goes back into supporting this system.
https://www.google.com/search?q=what+make+up+GDP+healthcare+...
They just get progressively worse and start adding expenses for the patients. The quality is terrible, despite the propaganda. The best companies were offering private healthcare with their offer.
I've seen it happen in two countries, now I live in one which just made most of private healthcare (which is excellent quality) available as public. It's working well for now but they're spending a ridiculous amount of money and it's not sustainable. Doctors are happy, I'm not because my taxes increased from 12.5% to 15%.
Public mismanagement is huge, they'll screw it up.
The USA government needs to stop being in bed with insurance companies to make everything expensive, then your private system will be fine.
It works here.
It seems insane to me to first limit how many there can be, and then overwork the ones you do allow to become doctors.
The doctors in Australia are still definitely overworked though. A decent number of the people I went to school with became doctors in Australia, and though we work roughly the same number of hours (~60-70hrs/week), my work in the software industry is like a stroll in the park.
It was remarkable to hear my male friends who became doctors admitting that they had broken down crying in meetings with their boss because of workplace stress and exhaustion.
1. https://www.ama.com.au/ama-rounds/13-may-2022/articles/more-...
And i don't want to put this in its own comment or even continue reading the defense of doctors (as they stand now): Women get shafted so hard by the medical community. People with mental health issues get screwed by the medical system. Both get their problems written off for non-medical reasons. There are bad practitioners just like there are bad developers and bad general contractors and bad bridge builders and bad pilots. The whole system is not very good and i don't see, necessarily, how merely adding more medical degree holding people to the mix will improve things. There isn't enough patient advocacy, there's too much friction with medical insurance (in the US).
But at least the shareholders are making money.
This is absolutely insane. Are we reading a town doctor's tale or a war tale?
Yes, I know, certain medical specialties are very competitive, but (IMO) they should be forced to admit you if you pay for the training. For instance, if I could be a radiologist, I would. But I dont want to be any other kind of doctor. They could say "ok, you will be eligible for radiology residency upon earning an MD and completing some standardized program proving you learned the book-side of radiology. Upon completion of that, (and , say 1 year of generalist MD work), then some radiology residency essentially has to admit you. Not interview for it, and jump up and down like a puppy, and based on how likeable you are, maybe, they let you in.
This could open the door for non-traditional doctors in general: Word could get around, "hey, this podiatry program is cool, 2 years training, 1 year public service, and you could earn $200k", knowing what kind of dr you will be might have an interesting effect in attracting people who otherwise would have never considered it (to fill the unpopular specialist roles like podiatry or psychiatry).
For instance, there are only about 20k people who score > 510 on the MCAT per year (the average matriculant has about a 512). And remember that includes US & Canada.
While I know there are a lot of people rejected from medical school each year, some probably should not be accepted to medical school. I think we could probably increase the number of seats by about 20%.
The American and Canadian medical schools place a high bar on accepting students, so nearly everyone who is accepted graduates. It's uncommon for medical students to perform poorly.
But this isn't true everywhere. Some places prefer to admit many students and let them sink-or-swim.
The article clearly shows the skills necessary to work as a doctor are a lot wider than academic ability.
One pleasure/pain of being a software developer is that there is less gatekeeping.
There are things other than academics, but that makes the pool even smaller.
Where does the article show this?
Also, PCPs are subject to the most metrics/rubrics of any, and all the crap paperwork that any specialist can foist off onto them, they do. Shit rolls downhill, and PCP's are at the bottom
They may stop seeing patients at 5, but they sure as shit aren't done at 5. Most are logging back in even later doing all the "paperwork" they didn't have time to do during the day. Even has a nickname: "pajama time"
Now imagine that happening dozens or hundreds of times over the course of a career.
Unless coders are working on air traffic control or something similarly critical, it's pretty rare for a bug to kill someone.
Same reason why classical engineering fields don't do anything like leetcode, those engineers are actually accredited.
I also agree that running hospitals like a private business is at odds with the essence of healthcare. However, this trend might be more indicative of a broader societal shift rather than a phenomenon unique to this sector.
I am really hopeful that systems like this will take off – the reality of being a junior doctor in the UK is that most of your time will be used on quite tedious admin tasks (documenting every patient interaction, filling forms, booking clinics etc.) using very & slow outdated computer systems. I don't think anyone expects this when they apply to medical school, and it can be quite demoralising when you start your first job.
My impression (as an outsider with a partner in the medical field) is that the prime function of the "medical industry" is to generate reams and reams of documentation about "care provided" to an insanely granular level. Functionally, this information is mostly bullshit that is irrelevant to providing medical care, but it serves a very important purpose for the medical administrative class so that they can bill the patient for each bandage applied or Ibuprofen administered.
AI MedTech companies mostly seem primed to increase this firehose of bullshit. Whether or not that will take the pressure off front-line medical personnel who are currently tasked with generating it remains to be seen, but you'd be hard pressed to convince me.
But yep I do worry about any kind of generative AI in this context.
https://www.ama-assn.org/practice-management/sustainability/...
AI can partially automate the scribe jobs to deliver a minor productivity boost or cost savings. But the near-term prospects for using AI to automate care delivery look pretty dim.
Using an outdated EMR system is hardly a cause of stress. A more usual cause of stress is being forced to use a brand new (and unusable) EMR.
The explanation of the situation is not a mythical cartel, but the simple facts: - Any additional place for a medical student at a university costs a lot of money, and nobody wants to spend money to fund its creation. - The people in developed countries get on average older and need more medical service and consequently more working hours of doctors. - The quote of women among students is constantly growing. In my country Germany we had ca. 70% men and 30% women among students like 30-40 years ago. Now the quote is like 70% women and 30% men. Nothing bad at that, but a lot of female students get soon a family, a bunch of children and since that never ever work full time anymore.
Stastitically we got so much doctors as never before in the history, but the sum of working hours in the country is lower, while the needs are getting higher because of olding population.
Healthcare providers spent the most money lobbying the US government for decades:
https://www.opensecrets.org/federal-lobbying/top-spenders?cy...
I'm not sure I will give up anesthesiology 100%, in the end I'd like to combine and work on "medtech". Currently I work with automotive radar.
Feel free to reach out!
That field is quite a mess. There's a oligopoly of few large vendors with low quality products but high quality politics and sales. Although as a working physicians you're probably familiar at least with the results.
Edit: Further discussion, including EHR system developers, here: https://news.ycombinator.com/item?id=39186252
Having been on the user side could be a major upside for improving the efficiency of the systems, but I'm afraid the business model of EHRs don't really allow for improving the systems much.
The business models of EHR's I'm not that familiar with, I will read the thread you provided, thanks! It sounds like you have experience working with EHR development?
Not first hand, but I followed it quite closely when we as activists tried to prevent Finnish healthcare from getting an Epic based system (that turned out to be exactly the disaster we predicted).
Reality is that many doctors in a hospital work 120% already. This either kills the doctors or the patients.
The issue is that most doctors genuinely want to help their patients and feel some kind of personal responsibility and thus, can easily be exploited by the healthcare system to work longer hours. If they don’t do it, patients die, because there is no one else taking care of these patients.
[1] Sorting by Latest available data (2020–2023 https://en.wikipedia.org/wiki/List_of_countries_and_dependen...
If you were a young, idealistic doctor (or an experienced idealistic doctor) I could imagine feeling incredibly disheartened when you see this kind of thing going on around you.
For the regulators I think the challenge they have is how to minimise the damage of the "bad" medical professionals (or weed them out of the system entirely) while not crushing the spirit of the good ones. I certainly don't know the answer.
https://www.abc.net.au/news/2024-04-08/price-of-pain-doctors...
https://www.abc.net.au/news/2024-04-01/cowboy-pharmacist-beh...
Also not that it really changes anything but the linked article says it was written in 2024, though Dr Bryant's death was in 2017: https://www.brisbanetimes.com.au/national/queensland/i-didnt...
The truth is the medical sector in Australia is always under intense scrutiny, and rightly so.
Currently the biggest systemic threat to our healthcare system (in my opinion) is underpayment/underinvestment in general practice which is having a critical effect on new trainees entering GP.
Dr Levi is a well known Melbourne ENT surgeon who has been extensively involved in doctor wellbeing initiatives, including starting Socks for Docs day. It looks like he just discovered substack and has started writing - I am sure I have seen this exact essay from him previously, which is where we get the discordance of him talking about the 2017 death as though it happened last week.
Senior doctors in New Zealan have one of the most powerful unions in the country
Junior doctors are catching up
It is still a punishing career, but not like that.
Feeding the troll: The role of a union is to represent the interests of their members
Is this an ad? It doesn’t look like normal ad placement. It looks like the author of the article is promoting it.
And it seems really quacky.
I wish substack was clearer on whether this product is endorsed by the author of the article.
Is an absent doctor really worse than an exhausted one? I mean, there's obvious situations in which this is the case, but is it true on average? If someone arrives at the hospital and dies because there is no doctor available, only for that doctor to go and save 3 people that might have otherwise died the next day because they're not exhausted, should we make that tradeoff?
tl;dr: professional feels like a proletarian.
"It just doesn't make any sense to me. What's so bizarre in our culture, if you'd broken your leg when you were a kid and you needed a few years of physical therapy, you'd get it. You'd be running on it, and by the way, people would be applauding your great commitment that you go out and work out every day on your leg, and you make sure that you're going to overcome that problem, and you're going to get back up on skis again and whatever. The same thing is true with our brain, and somehow because it's our brain, no, no, no. Sorry. We'll have none of that. What would [...] tell you to do? Oh, he'd say just decide to change. You just gotta decide to change. You gotta get up, you gotta dust yourself off, you gotta take a long look in the mirror, and you gotta decide to change. I can't change for you, and all the people wishing you'd change around you aren't gonna make you change. There's only one person that can change your life, and that person's name is [...]. You want to lose weight, you're gonna have to burn more calories, and you're gonna... "
I see the same thing in tech. Engineers used to be empowered and productively making things that empowered everyone, and now they're disempowered, broken to the saddle of whatever the tech oligarchs are fancying today.
It’s time to open more med schools and accept more doctors. Telling me a 27 instead of a 26 on the mcat makes you somehow a way better doctor is nonsense.
Also I’ve suffered a misdiagnosis that ruined my life in my early years so it’s not like doctors are heroes either. We never hear about the failures only the successful stuff at the bleeding(heh) edge.
They make mistakes, they’re just humans.
Everyone glorifies their profession but what about the people who suffer misdiagnosis? Have to live the rest of their life in misery because of incompetence.
A Doctor can be also a doctor of philosophy or something else. I am both a physician and a doctor, and I feel it is important to make a distinction. It's also as a respect to the PhDs who are usually in the traditional procession of the universities AHEAD of the medical doctors.
As a doctor myself, I believe it's difficult for a non-doctor to understand our problems. Saving lives (in quantity and quality) is both very rewarding and demanding but those two feelings cancel each other out, hopefully leaving a small positive residual. The effort is usually disconnected with it's financial reward (eg an easy, a-few-minutes case can be paid the same as another that devastated you) and that is inevitable. The medical administration, both public and private, is totally inefficient, if not provocative (eg providing 10 minutes for a whole patient visit so that the pay seems attractive).
In the end, I believe the doctor himself should take advantage of the degrees medical profession freedom, make some choices and/or navigate himself in the medical system in order to balance work, salary and life, starting from the specialty (eg surgeon vs internist etc) and continuing during his whole career.
That's textbook Marxist alienation of work. It was not supposed to happen to middle class workers though.
But I concede, medicine is grueling - not worth the money if you ask me.
Sunk cost fallacy is what keeps these doctors stuck. They get addicted to the lifestyle, income, and prestige after years low on the totem pole. The workload seems manageable until the reality of boundaries being crossed involves having to choose. We only have 24 hours in a day.
This is not just a medical industry issue. The tech industry is inherently prone to burnout when potential rewards can exceed even that of a doctor. I know too many stories of drug-induced burnout while trying to keep up a certain lifestyle. We all have a choice, and we need to check in with ourselves to make sure we are not losing more than we gain.
We have to stop Medicare. It's not sustainable.
Why not increase the supply of doctors instead of reducing demand, whatever that means?
The most recent example of contempt towards doctors described in the article I've seen comes from South Koreans who enjoy a generous, affordable, high quality healthcare that exceeds those in North America complaining doctors make "too much" and that there isn't enough doctors.
Same thing in the UK with dental (and Doctors); clinics prefer to take private patients over NHS patients because they make more money that way.
Easily solved, the government just needs to 1: require a certain number or threshold of accepted patients per week to be public (and any contacts are submitted with type to government to track, same as passport travel) 2: apply harsher labour laws to clinics to prevent them from forcing their staff to work ridiculous overtime to make more money and cover availability 3: allow more medical students and have no idiotic unfair restrictions.
Medical industries are critical to modern society and I definitely think that there should be no limited number of places, any student that passes entrance exams should get minor scholarships to help pay for/promote this position.
We're all important to the economy but at the end of the day all comes down to medical staff when any of us get sick, no matter which industry we work in ourselves.
This one hanging under the current top comment as an example:
"It's the same in the US, Italy, etc Doctors are a cartel receiving a monopoly from the State. That's all there is to it, really"
Forgetting the reasons (sure - it's all some grand program by the AMA et al to keep up current Physician pay) for a second thinking that if you can just churn them out like you do 'coders' with some quick program that doesn't require many many years of training and residency programs as well as hospitals and other infrastructure. And of course the cost to do all of this.
In almost typical HN fashion it's always a scam. Everyone else is getting away with being overpaid and undertaxed except top software engineers who of course deserve the pay they are getting.
The particular Physician in question is in Australia and is a surgeon. So you want to just be able to pluck people at random and give them a chance to be a surgeon as if there isn't something special that is required for that specialty.
Also, that Surgeon details some of his bad experiences but not how often that has happened. And doesn't even detail what he has done in terms of fixing it with the hospital administrators just continues to be a martyr getting beaten up by the system. Not claiming it's his job to try and get change at his hospital. But by the same token this idea that he has to do what he does or 'people will die' does not fly. Your own health and sanity is more important than that (as is your families).
...having people brave enough to take that on drown in red tape is a shameful black mark on society.
And, some places, I get the impression they have fewer staff now, and greater financial challenges.
> If I decide to work less, who is going to cover the hospital? If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. I accept the fact that I have a duty of care to be on call.
The hospital also has a duty of care.
"Patient satisfaction officers, Theatre Utilisation officers, Patient Flow Coordinators. These are all business roles" Forget all this nonsense the man who saves lives is the surgeon and doctor. People are very grateful to the people who actually save their life.
Why doesnt an MD or even credits at a medical school count toward nursing, physician assistsnt, etc?
Lastly, med school is unnecessarily long. You don't need most of the material to do family medicine for example.
I really don't understand how such inefficiencies could be tolerated.
https://students-residents.aamc.org/medical-school-admission...
Tennessee now allows some physicians to practice without completing a residency program, largely as a way to attract immigrants to work in underserved communities.
A medical student keeps a journal, becomes a doctor, hates his life, publishes his journal. One post I am laughing my ass off, the next I am in tears. It changed my perspective entirely and I recommend anyone read it.