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> Maybe just maybe new young doctors should be treated (like not be worked to death) and paid properly It seems to me, the tradition of working residents to th

> Maybe just maybe new young doctors should be treated (like not be worked to death) and paid properly It seems to me, the tradition of working residents to the point of sleep exhaustion is a form of institutional hazing, perpetuated by people that endured it because "I did it, why shouldn't they?" I'm not sure how you crack that nut.

GordonS 6y ago
> I'm not sure how you crack that nut With regulation - for example, there could be a law that prevents doctors working more than 12 hours in a 24 hour period. Come to think of it, surely something like this exists already?
- salawat 6y ago
  All that does is ensure no one gets fairly compensated for 12+ hours work, and shifts the complexity down the chain to accountants as people managers try to find other ways to compensate people for their extra effort. People don't stop being sick 12 hours in. It also unfairly hamstrings smaller practices with fewer covered professionals. Work gets offloaded from the covered individual to uncovered people in order to maximize the amount of work the covered individual can get done in that time span, or people start getting really particular about what is practicing and what isn't. Hate to sound like a broken record with other folks in the thread, but nothing is fundamentally changing the game with that regulation, just who pays the complexity tax at any one time does. So ball bustingly frustrating how bloody interconnected everything is while remaining so broad it's nigh-impossible to model within the confines of your own head. I say this as someone whose occupation centers around being able to very quickly jump between distinct verticals and subsystems while maintaining the capability to project the consequences of a change in one vertical through subsequently connected verticals. Everything seems to come back to a form of dynamic equilibrium where as long as you don't stare too hard the thing behaves well, but the closer you look the chaotic it becomes.
  - GordonS 6y ago
    > All that does is ensure no one gets fairly compensated for 12+ hours work, and shifts the complexity down the chain to accountants as people managers try to find other ways to compensate people for their extra effort. People don't stop being sick 12 hours in. Sorry, but this stance seems like part of the problem. Doctors shouldn't be working more than 12 hours at a time, for rather obvious safety reasons. People don't stop being sick, sure - that means you change the system so there are more doctors working fewer hours, rather than making doctors work insane hours that risk patients and are terrible for doctors' mental health and wellbeing.
    - salawat 6y ago
      I thought I replied to you earlier. My apologies. I'm not advocating that doctors should work 12+ hour shifts. Merely that creating a regulation that caps doctoring to 12 hours max a day will tend to create an enhanced scrutiny and sensitivity to what is and is not doctoring; which will lead to unintuitive outcomes in terms of the actual effect of the regulation based on the difference between how the industry runs with it vs. How you actually think it's going to go.
      - GordonS 6y ago
        I understood what you mean: doctors shouldn't have to work 12 hour shifts, but should be able to. And I disagree with this, for 2 reasons: 1. It's unsafe to have doctors working for too long, even if they want to for some reason 2. It incentivizes management to make doctors work longer shifts (as the current situation is) I also disagree that making this change would somehow cause confusion about who is a doctor or not - there are already regulations governing the medical profession, so no ambiguity.
- catalogia 6y ago
  I think the trick is actually getting such regulation passed into law. The medical industry has considerable political influence; attempts to reform it will doubtlessly run into road blocks unless you manage to convince doctors that reform is necessary. That's the tough nut.

GordonS 6y ago

> I'm not sure how you crack that nut With regulation - for example, there could be a law that prevents doctors working more than 12 hours in a 24 hour period. Come to think of it, surely something like this exists already?

salawat 6y ago
All that does is ensure no one gets fairly compensated for 12+ hours work, and shifts the complexity down the chain to accountants as people managers try to find other ways to compensate people for their extra effort. People don't stop being sick 12 hours in. It also unfairly hamstrings smaller practices with fewer covered professionals. Work gets offloaded from the covered individual to uncovered people in order to maximize the amount of work the covered individual can get done in that time span, or people start getting really particular about what is practicing and what isn't. Hate to sound like a broken record with other folks in the thread, but nothing is fundamentally changing the game with that regulation, just who pays the complexity tax at any one time does. So ball bustingly frustrating how bloody interconnected everything is while remaining so broad it's nigh-impossible to model within the confines of your own head. I say this as someone whose occupation centers around being able to very quickly jump between distinct verticals and subsystems while maintaining the capability to project the consequences of a change in one vertical through subsequently connected verticals. Everything seems to come back to a form of dynamic equilibrium where as long as you don't stare too hard the thing behaves well, but the closer you look the chaotic it becomes.
- GordonS 6y ago
  > All that does is ensure no one gets fairly compensated for 12+ hours work, and shifts the complexity down the chain to accountants as people managers try to find other ways to compensate people for their extra effort. People don't stop being sick 12 hours in. Sorry, but this stance seems like part of the problem. Doctors shouldn't be working more than 12 hours at a time, for rather obvious safety reasons. People don't stop being sick, sure - that means you change the system so there are more doctors working fewer hours, rather than making doctors work insane hours that risk patients and are terrible for doctors' mental health and wellbeing.
  - salawat 6y ago
    I thought I replied to you earlier. My apologies. I'm not advocating that doctors should work 12+ hour shifts. Merely that creating a regulation that caps doctoring to 12 hours max a day will tend to create an enhanced scrutiny and sensitivity to what is and is not doctoring; which will lead to unintuitive outcomes in terms of the actual effect of the regulation based on the difference between how the industry runs with it vs. How you actually think it's going to go.
    - GordonS 6y ago
      I understood what you mean: doctors shouldn't have to work 12 hour shifts, but should be able to. And I disagree with this, for 2 reasons: 1. It's unsafe to have doctors working for too long, even if they want to for some reason 2. It incentivizes management to make doctors work longer shifts (as the current situation is) I also disagree that making this change would somehow cause confusion about who is a doctor or not - there are already regulations governing the medical profession, so no ambiguity.
catalogia 6y ago
I think the trick is actually getting such regulation passed into law. The medical industry has considerable political influence; attempts to reform it will doubtlessly run into road blocks unless you manage to convince doctors that reform is necessary. That's the tough nut.