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Comment by rkomorn | Hacker News Reader

The long shifts are the most baffling thing to me. AFAIK they're also common in law enforcement.

"Hey these people make life or death decisions. You know what's going to help? Fatigue."

From the outside, it just seems insane.

Today’s doctor shortage can be traced directly to government policy in the early 80s that lasted for 25 years. They assumed we’d have too many doctors and pressured medical schools to reduce enrollment.

The lobbying by the AMA may go back to the 80s, but the 1997 "Balanced Budget Act" set the limit on residency slots.

Nice background: https://www.washingtonexaminer.com/opinion/1692395/thanks-to...

No, the “limit” is the expectation of free reimbusement by the hospitals. This is lobbying for them to get more socialized gov handouts.

how much more are you willing to pay? more law enforcement = more taxes

more shifts for docs = more $$ paying for more medical staff.

I can't speak to the police, but there have been a bunch of studies that showed that handoffs between shifts at hospitals is where things go bad. Someone doesn't document they gave an extra 2 cc of a drug to a patient, and next shift gives them more and causes issues, etc.

Basically longer shifts = more fatigue, and the number of errors caused by fatigue were still lower than hand-off related errors.

> more shifts for docs = more $$ paying for more medical staff.

I don't follow. It can't be more expensive to pay 2 doctors for 8 hour shifts than 1 doctor for 16 hours; if anything, I'd expect it to be cheaper (no overtime).

> but there have been a bunch of studies that showed that handoffs between shifts at hospitals is where things go bad. Someone doesn't document they gave an extra 2 cc of a drug to a patient, and next shift gives them more and causes issues, etc.

Hence pushing for checklists so that doesn't happen?

The docs dont get paid per hour, they are salaried, so 2 docs is double the cost of 1 doc.

This is why they are overworked, why pay 2 docs if 1 can do the work, the burnout of the doc is irrelevant as there are more docs to hire after they burn-out.

Do doctors do extra hours per week? I thought they work less days but do this crazy long shifts

sometimes, but extra hours dont get paid extra, so very little incentive to do so. there are many different models for compensation but you can think of it as a 'fixed salary with optional bonuses'.

EDIT to add:

Most places have a base + bonus structure. You get your base salary, and you see patients, for each patient seen you generate 'RVUs' which is how your group/practice generates income ( by billing insurance companies ). Once you generate enough RVUs to cover your base salary, you start accumulating 'bonus' and that gets paid out down the line using whatever formula your employer uses. There is some variation to this but for the most part groups follow a similar scheme.

EDIT #2: This is US centric, i dont know how other countries do it.

Yes I don’t get the comments about salary vs hs. You need the same amount of people. The question is if you have 3 people doing 24hs shifts or 3 people doing 3 8hs shift a day… has nothing to do with more people/salary/money is just organization of work.

Perhaps if we didn't expect superhuman schedules from doctors, doctors wouldn't command as much of a cost as they do now.

From the doctors I know, it seems like most don't get into it for the money, but they put up with it long-term because of the money. If we treated them better and increased supply, they would almost certainly cost less.

Doctors aren't paid by the hour.

One doctor is one salary and one package of benefits. Two doctors is 2x that.

> Doctors aren't paid by the hour.

Not explicitly, but do you think the salary wouldn't change in the medium to long term if the hours changed significantly? Of course, in the short term you can burn out your doctors by making them work longer.

If the supply of doctors wasn’t artificially suppressed as mentioned by comments above, it’s likely that wages would go down. Whether that would make things overall more or less costly isn’t easy to answer.

Doctors are paid in loads of different ways including profit sharing, RVU-based models, and hourly.

Two people take twice the vacation of one person, have twice the healthcare costs, etc. It is almost always cheaper to have 1 person work 16 hours than it is to have 2 people work 8 hours.

Not if you count the cost of errors.

Also, just bring in more affordable doctors from overseas. Have them take a test to qualify.

US doctor comp is much higher than any of our peer states due to industry protectionism. Other industries don't put a cap on training and licensing and haven't been so distorted.

Personally, I haven’t had a US born doctor in ages. In most areas it’s typically Chinese, Indian, or Vietnamese. Nurses it’s almost as common too.

I personally have no issues paying more taxes for better staffing.

> handoffs between shifts at hospitals is where things go bad.

It'd cost more money, but the solution here is overlapping shifts.

The reason shift handoffs go bad is it's usually a singular information dump right as the next round is getting into work mode.

Overlap by an hour, long enough to pair on a round or two, and that information is much more likely to get remembered.

I've been in hospitals a few times for shift changes and there have been a few times I've been the one to inform what the last shift was doing simply because it wasn't communicated.

We do need more shifts and almost as important we need shift overlap.

The doctor is going to have to go home some time - some patients are going to have care needs that get handed off regardless. If they are going home after 8 hours instead of 24 hours, maybe they'll be better at remembering to hand off everything properly to the next person.

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