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I practice, but most of this article rings true for me as well, and I think most of my colleagues would consider me pretty idealistic. Residency training is mo

by logjam 15y ago

I practice, but most of this article rings true for me as well, and I think most of my colleagues would consider me pretty idealistic. Residency training is mostly cheap labor for hospitals. Working 36 hours straight every third or fourth night (common when I was a resident) saves teaching hospitals from hiring night floats or other coverage. Trying to make any kind of important decision for another human's medical care after you've been up for 24 hours is like trying to do so after several shots of alcohol. Such a schedule does not teach efficiently, endangers patients, and stresses the mental and physical health of physicians. There have been new work rules supposedly limiting residents to 80 hour work weeks, but they are routinely ignored. Physicians spend most of their time trying to bring order to chaos. Regardless of a physician's specialty, I daresay each was shocked to learn how much time he/she spends basically just trying to simply coax new behaviors in patients - as such, performing at some level as psychiatrists (who I respect greatly - tough work). That's the challenge; everything else is pretty much plumbing. Either you find that work interesting (and it can be) or you soon get pretty burned out dealing with humans as they are, and they are obviously at their (usually temporary) worst much of the time when they need medical care. My own colleagues are the best people I know - I still see the driving compassion there on a daily basis, and I think that's true for the great majority of docs. On the other hand, I've met a few physicians who would be happiest in concentration camps performing medical experiments on the inmates.

mahyarm 15y ago
It's ironic that it doesn't have to be this way at all. It's counter productive other than it makes someone richer. Doctors want to keep their high prices with artificial barriers such as these and the glamor keeps the supply relatively high.
- inportb 15y ago
  Yeah, it does make the lawyers and insurance vendors richer... (no offense intended; wealth is good!)
- fossuser 15y ago
  The long hours and over working is more a factor of a hospital trying to save money than having anything to do with supposed 'price controls' being purposefully set up by doctors. The price comes mostly as a factor of the extremely expensive education (both in cost and time) that is necessary. If you want talented people in any field, especially one with such a laboring path of entry, you have to pay them well.
  - mahyarm 15y ago
    If the kids had choices, they would not choose hospitals where shifts are 40 hours long and only sleep of 6 hours out of those 40 every thing else being equal. They don't, because of the power that the hospitals have over residents in granting their licence and the cultural ubiquity in practice. Similarly, there are very limited spaces to enter medical school and it's extremely difficult to enter. How many new orthodontists are trained in a year? Under a 100? In a country of 300 million people? On top of that, medical school is very expensive. On top of that, you have to go to university for 3-4 years before you can even enter med school. Imagine if engineering degrees were like that, because they could of been. Similarly with accounting or finance. Maybe they're not because the math heavy nature is enough of a barrier, even the simple math of accounting. American medical schools (and doctor associations) could choose to structure their curriculums to be similar to an engineering degree, admit high school students and make the education be 5-6 years long, teach in the summer, whatever. I'm fairly sure the UK does that, and I'm not sure if they haze their residents too with 40 hour shifts. They can also release the spigot, hire more teachers and teach more students to increase the supply of doctors. The increased supply of doctors will lead in a decrease of overall doctor wages and decrease health care costs. That along with an FDA drug approval process that doesn't cost 200 million and more clearly defined and easy to avoid malpractice rules (as in it's not easy to commit malpractice by mistake) would lead to huge systemic decreases in US health care costs alone. Don't tell me it's about wanting the best, because treating people with sleep deprived residents is negligent. That is no where near the best care for any sort of patient. The best will just walk away once they know that they can make more money doing less work in i-banking, tech, petroleum, engineering, or business in far nicer environments, and they do by droves.

by logjam 15y ago

mahyarm 15y ago

It's ironic that it doesn't have to be this way at all. It's counter productive other than it makes someone richer. Doctors want to keep their high prices with artificial barriers such as these and the glamor keeps the supply relatively high.

inportb 15y ago
Yeah, it does make the lawyers and insurance vendors richer... (no offense intended; wealth is good!)
fossuser 15y ago
The long hours and over working is more a factor of a hospital trying to save money than having anything to do with supposed 'price controls' being purposefully set up by doctors. The price comes mostly as a factor of the extremely expensive education (both in cost and time) that is necessary. If you want talented people in any field, especially one with such a laboring path of entry, you have to pay them well.
- mahyarm 15y ago
  If the kids had choices, they would not choose hospitals where shifts are 40 hours long and only sleep of 6 hours out of those 40 every thing else being equal. They don't, because of the power that the hospitals have over residents in granting their licence and the cultural ubiquity in practice. Similarly, there are very limited spaces to enter medical school and it's extremely difficult to enter. How many new orthodontists are trained in a year? Under a 100? In a country of 300 million people? On top of that, medical school is very expensive. On top of that, you have to go to university for 3-4 years before you can even enter med school. Imagine if engineering degrees were like that, because they could of been. Similarly with accounting or finance. Maybe they're not because the math heavy nature is enough of a barrier, even the simple math of accounting. American medical schools (and doctor associations) could choose to structure their curriculums to be similar to an engineering degree, admit high school students and make the education be 5-6 years long, teach in the summer, whatever. I'm fairly sure the UK does that, and I'm not sure if they haze their residents too with 40 hour shifts. They can also release the spigot, hire more teachers and teach more students to increase the supply of doctors. The increased supply of doctors will lead in a decrease of overall doctor wages and decrease health care costs. That along with an FDA drug approval process that doesn't cost 200 million and more clearly defined and easy to avoid malpractice rules (as in it's not easy to commit malpractice by mistake) would lead to huge systemic decreases in US health care costs alone. Don't tell me it's about wanting the best, because treating people with sleep deprived residents is negligent. That is no where near the best care for any sort of patient. The best will just walk away once they know that they can make more money doing less work in i-banking, tech, petroleum, engineering, or business in far nicer environments, and they do by droves.