3 ms·

But would it be better for the patients if they didn't work that extra? Waiting months for surgery is not good either.

by maaaats 10y ago

TuringNYC 10y ago
It is usually not because of doctor-shortages that doctors work long shifts -- it is because hand-offs create errors themselves. Think of it as a game of telephone. 8 hour shifts means 3 hand-offs. 12 hour shifts mean 2 hand-offs. One is 50% greater risk of mis-communication as the patient shifts from one doctor's shift to the other. During training, the long hours serve a double-purpose -- compressing more years of training into fewer. If residencies were 1.5x longer, more doctors would choose not to be doctors. Residents working 80 hours vs 40 helps compress the training time and let doctors get on with their lives and careers faster. Unlike in tech, medical residents get paid little for their training period. Shifting 3-6yr residencies into 6-12 year residencies would make residencies viable only for already-wealthy individuals who can withstand 4yrs undergrad + 4yrs med school + 6-12 yrs of low salaries in a captive residency. (btw, w/r/t/ shortages, it is probably due to the doctors themselves -- specialty boards such as the Board of Radiology essentially throttle the number of available training positions (residencies) per year creating artificial scarcity and keeping up their own pay.)
- chimeracoder 10y ago
  You're correct that handoffs are a common point-of-failure, and also that residency programs are already near the tipping point of financial non-viability for the non-wealthy. However, to your last point: > (btw, w/r/t/ shortages, it is probably due to the doctors themselves -- specialty boards such as the Board of Radiology essentially throttle the number of available training positions (residencies) per year creating artificial scarcity and keeping up their own pay.) The actual bottleneck on residency positions is not artificially imposed by any external group - the bottleneck is the funding for residency positions themselves. Residency programs run at a loss, which is why Medicare has had to step in to fund GME. There are a very small number of non-Medicare funded residency slots, but they're also funded through external means.
- albertTJames 10y ago
  > It is usually not because of doctor-shortages that doctors work long shifts -- it is because hand-offs create errors themselves. Think of it as a game of telephone. 8 hour shifts means 3 hand-offs. 12 hour shifts mean 2 hand-offs. One is 50% greater risk of mis-communication as the patient shifts from one doctor's shift to the other. So long shifts are due to errors ? I hardly see the logic in that... We work long shift because we are expected to work long shift, because nothing is done to prevent medical exhaustion, and because there is a strange societal archetype of the never-sleeping doctor that goes against any recent (or old) research on learning, stress management and work performance (among other). > During training, the long hours serve a double-purpose -- compressing more years of training into fewer. That is also incorrect. In every country except maybe Switzerland, residency programs last 3-5 years, whatever the number of hours worked per week, and medical errors are not the first, the second nor the 3rd cause of death in those countries... Cortisol is a brain cell killer, stress reduces our ability to learn and adapt, sleep deprivation reduces both encoding and storage of long term memory, and most research on attention shows that you cannot work more than 5 full hours per day with a NORMAL lifestyle and sleep cycle. BTW 80 hours is on small weeks in surgery, at least it was for me. > If residencies were 1.5x longer, more doctors would choose not to be doctors. I believe this also to be incorrect, there is no shortage of applicant to medical schools. Actually it would be a problem to finance residency programs..
  - TuringNYC 10y ago
    > So long shifts are due to errors ? I hardly see the logic in that... There is no logic in that, i'm not sure why you asserted that. I noted that long shifts reduce handoff errors. Consider two scenarios: Scenario 1: 8 hour shifts: Doctor 1 hands off to Doctor 2 at end of 8 hrs Doctor 2 hands off to Doctor 3 at end of 16 hrs Doctor 3 hands off to Doctor 4 (or perhaps 1) at end of 24hrs Each handoff is a game of telephone. In theory it should not be, but in reality it is. Details are missed, directions mangled, and risk accrued. Just like a technical design document going from a product manager to the development lead to the developer...things go wrong in the process. Just like with tech teams where each added person creates overhead and waste from communications overhead and mis-aligned understanding of requirements, hospitals face the same issue. Unlike technology, you dont just push a fix and rebuild -- an error such as forgetting to record a symptom on the binder/EMR could mean mis-diagnosis or death. Shifting to 12-hours shifts means just two handoffs instead of three. You dont eliminate errors, but you reduce them. In some sense, it may be better to have 4 days of 12-hour shifts than 5 days of 8 hour shifts. Of course, this is just one aspect of medical errors. There are others which may be brought on by increased shift lengths. We'd need to look at the total sum. Regarding your other point: > In every country except maybe Switzerland, residency programs last 3-5 years, whatever the number of hours worked per week, That makes no sense. If that were the case, residents would choose to work an hour a week and easily graduate in 3-5 years. But that would make for a poor doctor, as they need a certain # hours of training.

But would it be better for the patients if they didn't work that extra? Waiting months for surgery is not good either.

by maaaats 10y ago

But would it be better for the patients if they didn't work that extra? Waiting months for surgery is not good either.

It is usually not because of doctor-shortages that doctors work long shifts -- it is because hand-offs create errors themselves. Think of it as a game of telephone. 8 hour shifts means 3 hand-offs. 12 hour shifts mean 2 hand-offs. One is 50% greater risk of mis-communication as the patient shifts from one doctor's shift to the other. During training, the long hours serve a double-purpose -- compressing more years of training into fewer. If residencies were 1.5x longer, more doctors would choose not to be doctors. Residents working 80 hours vs 40 helps compress the training time and let doctors get on with their lives and careers faster. Unlike in tech, medical residents get paid little for their training period. Shifting 3-6yr residencies into 6-12 year residencies would make residencies viable only for already-wealthy individuals who can withstand 4yrs undergrad + 4yrs med school + 6-12 yrs of low salaries in a captive residency. (btw, w/r/t/ shortages, it is probably due to the doctors themselves -- specialty boards such as the Board of Radiology essentially throttle the number of available training positions (residencies) per year creating artificial scarcity and keeping up their own pay.)

chimeracoder 10y ago
You're correct that handoffs are a common point-of-failure, and also that residency programs are already near the tipping point of financial non-viability for the non-wealthy. However, to your last point: > (btw, w/r/t/ shortages, it is probably due to the doctors themselves -- specialty boards such as the Board of Radiology essentially throttle the number of available training positions (residencies) per year creating artificial scarcity and keeping up their own pay.) The actual bottleneck on residency positions is not artificially imposed by any external group - the bottleneck is the funding for residency positions themselves. Residency programs run at a loss, which is why Medicare has had to step in to fund GME. There are a very small number of non-Medicare funded residency slots, but they're also funded through external means.
albertTJames 10y ago
> It is usually not because of doctor-shortages that doctors work long shifts -- it is because hand-offs create errors themselves. Think of it as a game of telephone. 8 hour shifts means 3 hand-offs. 12 hour shifts mean 2 hand-offs. One is 50% greater risk of mis-communication as the patient shifts from one doctor's shift to the other. So long shifts are due to errors ? I hardly see the logic in that... We work long shift because we are expected to work long shift, because nothing is done to prevent medical exhaustion, and because there is a strange societal archetype of the never-sleeping doctor that goes against any recent (or old) research on learning, stress management and work performance (among other). > During training, the long hours serve a double-purpose -- compressing more years of training into fewer. That is also incorrect. In every country except maybe Switzerland, residency programs last 3-5 years, whatever the number of hours worked per week, and medical errors are not the first, the second nor the 3rd cause of death in those countries... Cortisol is a brain cell killer, stress reduces our ability to learn and adapt, sleep deprivation reduces both encoding and storage of long term memory, and most research on attention shows that you cannot work more than 5 full hours per day with a NORMAL lifestyle and sleep cycle. BTW 80 hours is on small weeks in surgery, at least it was for me. > If residencies were 1.5x longer, more doctors would choose not to be doctors. I believe this also to be incorrect, there is no shortage of applicant to medical schools. Actually it would be a problem to finance residency programs..
- TuringNYC 10y ago
  > So long shifts are due to errors ? I hardly see the logic in that... There is no logic in that, i'm not sure why you asserted that. I noted that long shifts reduce handoff errors. Consider two scenarios: Scenario 1: 8 hour shifts: Doctor 1 hands off to Doctor 2 at end of 8 hrs Doctor 2 hands off to Doctor 3 at end of 16 hrs Doctor 3 hands off to Doctor 4 (or perhaps 1) at end of 24hrs Each handoff is a game of telephone. In theory it should not be, but in reality it is. Details are missed, directions mangled, and risk accrued. Just like a technical design document going from a product manager to the development lead to the developer...things go wrong in the process. Just like with tech teams where each added person creates overhead and waste from communications overhead and mis-aligned understanding of requirements, hospitals face the same issue. Unlike technology, you dont just push a fix and rebuild -- an error such as forgetting to record a symptom on the binder/EMR could mean mis-diagnosis or death. Shifting to 12-hours shifts means just two handoffs instead of three. You dont eliminate errors, but you reduce them. In some sense, it may be better to have 4 days of 12-hour shifts than 5 days of 8 hour shifts. Of course, this is just one aspect of medical errors. There are others which may be brought on by increased shift lengths. We'd need to look at the total sum. Regarding your other point: > In every country except maybe Switzerland, residency programs last 3-5 years, whatever the number of hours worked per week, That makes no sense. If that were the case, residents would choose to work an hour a week and easily graduate in 3-5 years. But that would make for a poor doctor, as they need a certain # hours of training.