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The real answer to this might be: more doctors. The amount of emotional and psychological trauma any one doctor encounters in a shift in a large city hospital m

The real answer to this might be: more doctors. The amount of emotional and psychological trauma any one doctor encounters in a shift in a large city hospital might be 100x what a doctor in a more rural situation might. Undersupply of doctors, higher population density, and cost-cutting have engineered a psychological crisis for the profession. There are ~29 physicians active in patient care per 10K people in the US [1]. What would it take to make it 290? [1] https://www.statista.com/topics/1244/physicians/ https://www.statista.com/topics/1244/physicians/

kwhitefoot 9y ago
The problem is that more supply means lower prices so there is a conflict in the medical profession, on the one hand everyone recognizes that tired workers make mistakes but on the other the profession is wary of dilution. In Europe it was really only the Working Time Directive that has had any real impact and the UK succeeded in negotiating an opt-out. Norway enforces working time regulations and the result is that more doctors have to be employed. About 44 per 10k according to this WHO page: http://www.who.int/gho/health_workforce/physicians_density/en/ http://www.who.int/gho/health_workforce/physicians_density/e.... However, there is also a different attitude to work here. Generally Norwegians work to live not live to work. In a population of less than five and half million it is reckoned that 100 thousand work enough extra hours a day so that they can take Friday off every week. Even those who don't typically often stop work early on a Friday and make up the time some other day. Salaried employees generally have the ability to vary their hours, can often work at home quite frequently simply because they feel like it, and so on. I realize that a lot of that is difficult to apply directly to the medical profession but the general idea that overwork is bad for you and the work surely isn't Edit: a few typos.
pmoriarty 9y ago
I'm not sure why doctors would need to wait for more doctors to be available before collectively putting their foot down and refusing to work these incredibly insane hours. It still boggles my mind that the medical profession puts up with this this horrible practice that costs the lives and physical and mental health of both doctors and patients.
- golemotron 9y ago
  > I'm not sure why doctors would need to wait for more doctors to be available before collectively putting their foot down and refusing to work these incredibly insane hours. Many get paid by the hour.
  - pmoriarty 9y ago
    If they volunteer to do it, that's something else, but I'm not sure how much choice they have, individually. From the article: "The therapist’s first question was about my sleep schedule--the likely cause of my distress, but also absolutely beyond my control." If this guy had control over his hours, he could get more sleep if he wanted to. But he talks as if he's helpless. I've also spoken to residents who seem to be totally abused and effectively forced to work crazy hours. I've read the same from others. So I'm really skeptical of how voluntary those hours are, though I'd love to be corrected by someone with more direct knowledge.
- jlg23 9y ago
  When medical staff puts "their foot down and refuses to work" patients will suffer. Most feel bound by the Hippocratic Oath[1], in some countries violation of it can be reason for stripping you of your medical license (e.g. in Germany, even though I'm not aware of any case that was handled based on the Oath - you probably violate much more concrete laws if you break the Oath). https://en.wikipedia.org/wiki/Hippocratic_Oath https://en.wikipedia.org/wiki/Hippocratic_Oath
- bobbington 9y ago
  They make it difficult because it discourages people from becoming doctors, which mean doctors get more money. Plus, it's a ton of cheap labor for hospitals. Since nobody can practice medicine without paying the toll, they can make the toll as high as they want. Government regulation of health care has major downsides.
Mathnerd314 9y ago
It's not really a doctor shortage, more like a service shortage: https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-lets-take-a-closer-look.html https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-... Generally, there's an ongoing reformation of the system. From the perspective of medical insurance, the current medical system is actually too lax, in that it certifies and retains doctors who get frequent malpractice suits. http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1174&context=jhclp http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?... http://www.medscape.com/viewarticle/833141 http://www.medscape.com/viewarticle/833141 The solution to that seems like better data on health care (utilization, treatment outcomes, etc.) and accessible analytics (databases for professionals, patients, providers, etc.) and automation of complex/risky procedures/tests (deskilling). But those take time and effort and investments, which have been made but aren't finished/stable yet (somewhere in the middle of Gartner's hype cycle). http://sloanreview.mit.edu/case-study/when-healthcare-gets-a-healthy-dose-of-data/ http://sloanreview.mit.edu/case-study/when-healthcare-gets-a... http://www.webmd.com/health-insurance/using-doctor-ratings-sites http://www.webmd.com/health-insurance/using-doctor-ratings-s... https://lukeoakdenrayner.wordpress.com/2017/05/03/the-end-of-human-doctors-understanding-automation/ https://lukeoakdenrayner.wordpress.com/2017/05/03/the-end-of... > What would it take to make it 290? Once people start trusting the system again (which they don't, currently: http://www.hhnmag.com/articles/7802-the-trust-chasm-in-healthcare-analysis-of-the-2016-trust-survey http://www.hhnmag.com/articles/7802-the-trust-chasm-in-healt...) it might be possible to charge more for services and hence employ more people. But they wouldn't be physicians, the generic trend in society is towards more specialization and more technology. A better question is: What would it take to make it 2.9 physicians per 10K people?

kwhitefoot 9y ago

The problem is that more supply means lower prices so there is a conflict in the medical profession, on the one hand everyone recognizes that tired workers make mistakes but on the other the profession is wary of dilution. In Europe it was really only the Working Time Directive that has had any real impact and the UK succeeded in negotiating an opt-out. Norway enforces working time regulations and the result is that more doctors have to be employed. About 44 per 10k according to this WHO page: http://www.who.int/gho/health_workforce/physicians_density/en/ http://www.who.int/gho/health_workforce/physicians_density/e.... However, there is also a different attitude to work here. Generally Norwegians work to live not live to work. In a population of less than five and half million it is reckoned that 100 thousand work enough extra hours a day so that they can take Friday off every week. Even those who don't typically often stop work early on a Friday and make up the time some other day. Salaried employees generally have the ability to vary their hours, can often work at home quite frequently simply because they feel like it, and so on. I realize that a lot of that is difficult to apply directly to the medical profession but the general idea that overwork is bad for you and the work surely isn't Edit: a few typos.

pmoriarty 9y ago

I'm not sure why doctors would need to wait for more doctors to be available before collectively putting their foot down and refusing to work these incredibly insane hours. It still boggles my mind that the medical profession puts up with this this horrible practice that costs the lives and physical and mental health of both doctors and patients.

golemotron 9y ago
> I'm not sure why doctors would need to wait for more doctors to be available before collectively putting their foot down and refusing to work these incredibly insane hours. Many get paid by the hour.
- pmoriarty 9y ago
  If they volunteer to do it, that's something else, but I'm not sure how much choice they have, individually. From the article: "The therapist’s first question was about my sleep schedule--the likely cause of my distress, but also absolutely beyond my control." If this guy had control over his hours, he could get more sleep if he wanted to. But he talks as if he's helpless. I've also spoken to residents who seem to be totally abused and effectively forced to work crazy hours. I've read the same from others. So I'm really skeptical of how voluntary those hours are, though I'd love to be corrected by someone with more direct knowledge.
jlg23 9y ago
When medical staff puts "their foot down and refuses to work" patients will suffer. Most feel bound by the Hippocratic Oath[1], in some countries violation of it can be reason for stripping you of your medical license (e.g. in Germany, even though I'm not aware of any case that was handled based on the Oath - you probably violate much more concrete laws if you break the Oath). https://en.wikipedia.org/wiki/Hippocratic_Oath https://en.wikipedia.org/wiki/Hippocratic_Oath
bobbington 9y ago
They make it difficult because it discourages people from becoming doctors, which mean doctors get more money. Plus, it's a ton of cheap labor for hospitals. Since nobody can practice medicine without paying the toll, they can make the toll as high as they want. Government regulation of health care has major downsides.

Mathnerd314 9y ago

It's not really a doctor shortage, more like a service shortage: https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-lets-take-a-closer-look.html https://www.nytimes.com/2016/11/08/upshot/a-doctor-shortage-... Generally, there's an ongoing reformation of the system. From the perspective of medical insurance, the current medical system is actually too lax, in that it certifies and retains doctors who get frequent malpractice suits. http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?article=1174&context=jhclp http://digitalcommons.law.umaryland.edu/cgi/viewcontent.cgi?... http://www.medscape.com/viewarticle/833141 http://www.medscape.com/viewarticle/833141 The solution to that seems like better data on health care (utilization, treatment outcomes, etc.) and accessible analytics (databases for professionals, patients, providers, etc.) and automation of complex/risky procedures/tests (deskilling). But those take time and effort and investments, which have been made but aren't finished/stable yet (somewhere in the middle of Gartner's hype cycle). http://sloanreview.mit.edu/case-study/when-healthcare-gets-a-healthy-dose-of-data/ http://sloanreview.mit.edu/case-study/when-healthcare-gets-a... http://www.webmd.com/health-insurance/using-doctor-ratings-sites http://www.webmd.com/health-insurance/using-doctor-ratings-s... https://lukeoakdenrayner.wordpress.com/2017/05/03/the-end-of-human-doctors-understanding-automation/ https://lukeoakdenrayner.wordpress.com/2017/05/03/the-end-of... > What would it take to make it 290? Once people start trusting the system again (which they don't, currently: http://www.hhnmag.com/articles/7802-the-trust-chasm-in-healthcare-analysis-of-the-2016-trust-survey http://www.hhnmag.com/articles/7802-the-trust-chasm-in-healt...) it might be possible to charge more for services and hence employ more people. But they wouldn't be physicians, the generic trend in society is towards more specialization and more technology. A better question is: What would it take to make it 2.9 physicians per 10K people?