Young Doctors Want Work-Life Balance. Older Doctors Say That's Not the Job
wsj.com
wsj.com
It shouldn't be on us as patients to memorize the change over times between shifts to choose when to go in based on getting a rested doctor (actual advice that's traded around). The medical hazing culture is directly harmful to patients and is, in my opinion, a violation of the Hippocratic Oath.
If you want to work yourself to death in order to make a ton of money, go into fintech or join a hedge fund instead of playing with peoples' lives. If you can get into and through med school, odds are you could pick up another just as high paying profession.
Logically this is a very obvious and simple solution. But there are a few problems.
1. doctors and nurses expect to be paid a lot of money. Especially doctors, because they go into a lot of debt to get their education. 2. there IS money in the system to hire double the amount of doctors and nurses, but there’s an artificial shortage of doctors 3. there are many administrators with their hand in the cookie jar. More money should go to the people working directly with patients.
The status quo isn’t a good trade off. It’s probably the best outcome in our currently broken system though.
most serious errors crop up during shift changes. nurses forget to check a box, or get distracted and leave something out, doctors don't do a follow up, etc.
over millions of hospital hours across the US -- the 3rd most populous country in the world -- each shift change causes dozens of errors, and people sometimes die from that.
increasing them to 12 or 24 hour shifts does increase the likelihood of fatigue-based poor decisions and errors, but at a lesser amount than shift change-related errors.
Also about the availability of truck drivers and doctors:
If
- there is a constant demand for these services,
- and people are willing to pay a sufficiently large amount for the services,
- and the supply of qualified people to do the job is lower than the demand,
the salaries will go up, but also the amount of work hours that are expected will increase.
I mean that's really easy, don't be sick after 7pm, the night shift people are always worse!
and if they're not good yet, a couple years in the trenches at night, esp. Friday-Sunday, where the worst tends to come out, will make them good.
I'm not trying to be mean to you, just explaining the reality of the situation.
Is a healthcare system where nobody cares about the desires and will of the patients a healthcare system or a sinecure producing machine for people who know anatomy and physiology?
I personally will likely be fine. I did a stint in a medical library and am literate in medical research (and can therefore take on a lot of the work that doctors previously did when they had more time with patients - I can show up to appointments/procedures with very clear recommendations and advocate for them in a way that is respected as I have the credentials to be taken seriously by medical professionals). I also have a medical doctor + several NPs in my family and can be tended to outside the system if it does collapse. I'm worried about everyone else and the society in which we're raising our children and grandchildren.
Although I think this has been getting better as big companies “grew up” and mostly stopped now
More doctors working on the same amount of medical demand will be an increased supply of doctors, and so will reduce doctors salaries.
This seems like an ideal outcome for consumers, and I suspect the AMA would lobby against this. But American doctors should also be aware that their famously world class compensation might be reduced with this tradeoff.
Since demand for healthcare is growing rapidly I expect that doctors will still be well paid even if the AMA succeeds in getting Congress to add more residency program funding, and thereby increase the supply.
My housemate is a nurse specializing in ECMO. In the time I've known him, his salary and benefits have been reduced twice. He'd note at his last job how many people were leaving because the scheduling makes it impossible to take time off and the benefits were paltry and getting worse. Three separate people needed to approve his time off requests for PTO he'd earned.
I would bet good money the same thing would happen in medicine. Pay people what they're worth and give them workable hours and lots of folks who are qualified (or easily recertified) for the positions will come out of the woodwork.
They work 40-hour weeks (compared to 60-90 in Canada), and are paid overtime when they go over. Their salaries are $100,000/year+ (equivalent to USD $66,000) which seems to be fine for them and more than they would receive in Canada.
The post-medical-school phase seems to go on longer (minimum 5 years) than in Canada, which may account for some of the difference.
Their father is a GP and worked in the U.S. for about a decade. He was happy to return to Canada and not have to deal with HMOs and all the other crap. His clinic here has a single office worker handling billing for 5 or 6 doctors; in Indiana, they had at least one per doctor.
He actually said that his salary in Canada ended up being higher because of the lower administration costs, lower malpractice insurance, insurance companies refusing to pay the full invoices, etc.
These are all our systems. We built them, they serve us. We can change them if they stop serving us.
I agree but doctors should go in with open eyes that working fewer hours will require more doctors, and this will in turn drive down MD salaries.
I think that's a great idea, but that seems to be the undeniable tradeoff.
Given our aging demographic profile with increasing chronic disease burden the problem is likely to get worse. Expect higher prices and longer waits to see a doctor. A more realistic solution will probably be to shift more primary care to lower credentialed practitioners such as Physician Assistants and Nurse Practitioners.
Student loan forgiveness also creates a moral hazard. Every future generation of students will then expect that they can take out unlimited loans and if things don't work out then no worries, the debt will just magically vanish.
Why should we pay for the mistakes of silicon valley bank depositors? We should have let them get nothing over the fdic limit.
On a personal level, I got MS my very last semester in graduate school. This prevents me from doing the career I trained to do and I instead am working in a lower paying position. Because I can work at all, I'm still on the hook for all my loans even though I can't actually make use of the education I acquired. (Disability discharge is only if you can't work at all, so if you go through all of med school and get a TBI in a car accident the week after you graduate and can't practice but can still work retail, you still have to pay all that money back).
On a societal level, what about the people who were in college during the GFC? I graduated in 2010 and plenty of people graduated in '08/'09/10 who made very reasonable decisions about what to study and how much to take out in loans that got upended because our government and Wall Street can't manage their liabilities. For example, I counted on my father's help to reduce the loans I took out for undergrad, but I ended up with a ton of loans my senior year because everything crashed. Is that my fault or bad decision making? That as a 17 year old I couldn't better predict where the economy would be in 4-5 years than the adults and politicians in charge? Or the kids who've recently gone into CS after it was promised to them as a golden ticket only for the COVID years to fuck them over?
I agree that we shouldn't expect society to be on the hook for bad decisions, but painting student loans as only the result of bad decisions basically looks at the people falling through the cracks and shrugs, declaring them acceptable losses. That doesn't make people want to participate in society or engage in good faith. Which is also a problem.