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Comment by yjftsjthsd-h | Hacker News Reader

> 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?

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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.

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.

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.

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