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These threads always have lots of people jumping on doctors and their decisions/callousness/lack-of-reason/missing up-to-date-into/etc.etc.etc. My wife is a phy

by HEmanZ 4y ago

These threads always have lots of people jumping on doctors and their decisions/callousness/lack-of-reason/missing up-to-date-into/etc.etc.etc. My wife is a physician (OBGYN) at a major city hospital that primarily serves a very poor population. I'd like to share her schedule, and see if you think what kind of care you could perform under these circumstances, or how up-to-date you could stay in field: Monday - Friday - Wake up at 4:30 AM - Get to hospital by 5AM to start rounding on patients - Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day) - Come home and do about an hour of notes, 16 hour work day - At least once per week, wake up in the middle of the night to deliver a patient who asked for that kind of continuity of care. 24 hour work day Saturday: - Wake up around 5am to be in by 6am to start the day - Work inpatient, usually without time for a 15min break for food, until 10AM SUNDAY (28-30 hours shift) Repeat 49 weeks/year (days of 24/hr shift can vary and she usually gets one weekend off/month). Her average time at the hospital last year was 96 hours/week. She is not a resident. How much confidence do you have that you'd be able to stay up-to-date in your field, or make recommendations that aren't ultra-standard, with this kind of schedule?

TheBlight 4y ago
Is it possible intelligent people are aware of these conditions and it may be causing them to choose a different path instead of practicing medicine?
- myself248 4y ago
  Ditto with teaching, anecdotally. Worse yet, experienced people in these professions tend to defend the insane schedules, which I take for some sort of hazing ritual / Stockholm syndrome.
AngriestLettuce 4y ago
I don't see how your wife's unreasonable work schedule is supposed to make me feel better about the poor quality of health care I receive. If anything, it makes me question her judgement more, that's just not healthy. How are unhealthy people supposed to educate people on health?
- afandian 4y ago
  It's likely not her choice. In the UK medical professionals are doing the sensible thing, and leaving the profession. I'm sure most of them would much rather stay, but they're making the rational choice as individuals. That's not the best choice for patients as a group though. There's a serious under-staffing, under-pay and conditions crisis.
  - feet 4y ago
    So if doctors are intelligent, why do they put up with such a horrible system? Surely they have some sort of power in these scenarios?
    - afandian 4y ago
      Yes, they are striking in the UK.
    - HEmanZ 4y ago
      They have very little power in most primary care specialties. The expectation from hospitals is you will work this hard or they won’t hire you. Hospitals are more than happy to just dump more hours onto their over-exhausted doctors rather than hire new ones who ask for fewer hours. The expectation from other doctors is you will work this hard because if you don’t, someone else will have to pick up the slack. Also, most of them sign as part of their contract basically “I’ll show up outside of contracted time if it is necessary for patient safety”, turns out this is like 50% of the time because they’re so understaffed
      - feet 4y ago
        Have they not realized that they can unionize?
    - lukas099 4y ago
      Doctors have invested huge sums of time, money, and effort into getting the qualifications needed to perform their jobs, and there are few alternative jobs they can transition into if they are given a bad deal.
canadiantim 4y ago
> Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day) Honestly, that makes me agree with the parent comment that the medical profession must be getting stupider to not let a doctor take a break or eat a meal on a 15 hour day.
- bobkazamakis 4y ago
  do you see "getting stupider" as synonymous with "less profitable in a capitalist system"? Do you think doctors are overworking for fun?
  - epicureanideal 4y ago
    > Do you think doctors are overworking for fun? No, it's so the administrative staff can become further bloated as parasites upon the host of the actually productive doctors, and so the shareholders can take whatever breadcrumbs the administrative staff leaves behind.
  - marnett 4y ago
    There are definitely capitalistic hospital business incentives at play here, but there is more than just that. Medicine is a notoriously supply-side gated field, and intentionally so by all practitioners. It’s one of the main drivers of the sky high pay white coats get access to after all the hoop jumping. Speaking for the US, as it has a notorious track record for inefficiencies in its medicinal industry: the USA is getting older (aging population needing more care) with the cost of medical school higher than ever. With this, the production of doctors is unlikely to increase at a pace necessary to maintain levels of care uniformly across the board (for example, rural vs city medicine capabilities vary massively based on region). Most hospitals attempt to use technology to squeeze more out of their doctors, as getting more doctors isn’t cheap (because there aren’t enough of them). Hospitals can’t do much to solve the doctor production shortage - that involves legislative changes and the American Medical Association (lobbying arm). The capitalistic effects will compound all of this - but not so much in what you may be describing. If we don’t resolve things, in the medium-term future years we can see a bifurcation in medicine as we see in criminal defense law - the wealthy will have great access to world class healthcare, paid at an extreme premium, and everyone else will be out of luck. (Some would say we are already here there or rapidly approaching this state).
brnt 4y ago
May I ask why she's doing this?
- HEmanZ 4y ago
  It is required by the hospital. I have made her promise me we will try finding a better work-life balance hospital within a few years, but it’s hard to apply to new places with this kind of schedule
reb 4y ago
Reading the replies to your comment is so grim. I think, more than anything, I'm floored by the level of arrogance that permeates seemingly every conversation on HN lately. I'm spending less time here than I have in years because watching the culture of curiosity die just makes me sad. Anyway, thank you for taking the time to share this.
cjbgkagh 4y ago
No confidence at all, I wish doctors didn’t make so many mistakes and I wish doctors weren’t being ritualistically tortured. The fact that we get both just speaks to the incredible dysfunction of it all.
avgcorrection 4y ago
They asked if doctors are getting stupider. You provide an argument for why they could be getting stupider and pass it off as a counter-argument... Unless the schedule was always like this. Then it wouldn’t explain them getting stupider.
vkou 4y ago
It sounds like a solution might consist of vastly increasing the number of doctors that get trained and residencied each year.

by HEmanZ 4y ago

TheBlight 4y ago

Is it possible intelligent people are aware of these conditions and it may be causing them to choose a different path instead of practicing medicine?

myself248 4y ago
Ditto with teaching, anecdotally. Worse yet, experienced people in these professions tend to defend the insane schedules, which I take for some sort of hazing ritual / Stockholm syndrome.

AngriestLettuce 4y ago

I don't see how your wife's unreasonable work schedule is supposed to make me feel better about the poor quality of health care I receive. If anything, it makes me question her judgement more, that's just not healthy. How are unhealthy people supposed to educate people on health?

afandian 4y ago
It's likely not her choice. In the UK medical professionals are doing the sensible thing, and leaving the profession. I'm sure most of them would much rather stay, but they're making the rational choice as individuals. That's not the best choice for patients as a group though. There's a serious under-staffing, under-pay and conditions crisis.
- feet 4y ago
  So if doctors are intelligent, why do they put up with such a horrible system? Surely they have some sort of power in these scenarios?
  - afandian 4y ago
    Yes, they are striking in the UK.
  - HEmanZ 4y ago
    They have very little power in most primary care specialties. The expectation from hospitals is you will work this hard or they won’t hire you. Hospitals are more than happy to just dump more hours onto their over-exhausted doctors rather than hire new ones who ask for fewer hours. The expectation from other doctors is you will work this hard because if you don’t, someone else will have to pick up the slack. Also, most of them sign as part of their contract basically “I’ll show up outside of contracted time if it is necessary for patient safety”, turns out this is like 50% of the time because they’re so understaffed
    - feet 4y ago
      Have they not realized that they can unionize?
  - lukas099 4y ago
    Doctors have invested huge sums of time, money, and effort into getting the qualifications needed to perform their jobs, and there are few alternative jobs they can transition into if they are given a bad deal.

canadiantim 4y ago

> Sometimes work inpatient all day sometimes clinic thrown in, but usually not done working until 7 PM, without even a 15 min break or a chance to eat a meal (15 hour day) Honestly, that makes me agree with the parent comment that the medical profession must be getting stupider to not let a doctor take a break or eat a meal on a 15 hour day.

bobkazamakis 4y ago
do you see "getting stupider" as synonymous with "less profitable in a capitalist system"? Do you think doctors are overworking for fun?
- epicureanideal 4y ago
  > Do you think doctors are overworking for fun? No, it's so the administrative staff can become further bloated as parasites upon the host of the actually productive doctors, and so the shareholders can take whatever breadcrumbs the administrative staff leaves behind.
- marnett 4y ago
  There are definitely capitalistic hospital business incentives at play here, but there is more than just that. Medicine is a notoriously supply-side gated field, and intentionally so by all practitioners. It’s one of the main drivers of the sky high pay white coats get access to after all the hoop jumping. Speaking for the US, as it has a notorious track record for inefficiencies in its medicinal industry: the USA is getting older (aging population needing more care) with the cost of medical school higher than ever. With this, the production of doctors is unlikely to increase at a pace necessary to maintain levels of care uniformly across the board (for example, rural vs city medicine capabilities vary massively based on region). Most hospitals attempt to use technology to squeeze more out of their doctors, as getting more doctors isn’t cheap (because there aren’t enough of them). Hospitals can’t do much to solve the doctor production shortage - that involves legislative changes and the American Medical Association (lobbying arm). The capitalistic effects will compound all of this - but not so much in what you may be describing. If we don’t resolve things, in the medium-term future years we can see a bifurcation in medicine as we see in criminal defense law - the wealthy will have great access to world class healthcare, paid at an extreme premium, and everyone else will be out of luck. (Some would say we are already here there or rapidly approaching this state).

brnt 4y ago

May I ask why she's doing this?

HEmanZ 4y ago
It is required by the hospital. I have made her promise me we will try finding a better work-life balance hospital within a few years, but it’s hard to apply to new places with this kind of schedule

reb 4y ago

Reading the replies to your comment is so grim. I think, more than anything, I'm floored by the level of arrogance that permeates seemingly every conversation on HN lately. I'm spending less time here than I have in years because watching the culture of curiosity die just makes me sad. Anyway, thank you for taking the time to share this.

cjbgkagh 4y ago

No confidence at all, I wish doctors didn’t make so many mistakes and I wish doctors weren’t being ritualistically tortured. The fact that we get both just speaks to the incredible dysfunction of it all.

avgcorrection 4y ago

They asked if doctors are getting stupider. You provide an argument for why they could be getting stupider and pass it off as a counter-argument... Unless the schedule was always like this. Then it wouldn’t explain them getting stupider.

vkou 4y ago

It sounds like a solution might consist of vastly increasing the number of doctors that get trained and residencied each year.