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> When an 80-hour workweek for residents was first rolled out in New York state in 1989, surgical trainees were exempt Imagine if the US could double its resid

• Melting_Harps 3y ago
  > Imagine if the US could double its residencies instead of artificially limiting them! I really wish we could place all the blame on the AMA, because I wish it was just a matter of mandating the doubling medical licenses and spots available at medical school/residency and be done with it: something probably thought to be impossible until all the strikes and union walk-outs as of late, particularly in the medical field. But I've seen this first hand since I was a Bio undergrad: pre-med students were on adderall and ritalin since HS and the things these guys subject themselves to is altogether something else. We were all on 'something' to keep up with the school/work load (it was an impacted major with major cutbacks to the entire departmetn) but their's is even more cut throat and they looked like zombies to super hyper during a lecture--it was jarring as I wanted to just take notes after working a catering shift and coming down myself. I won't go into hat much detail, because I have been talking about this for nearly a decade to those near and dear to me after some heavy situations with relationships with nurses, but the whole medical system rewards perverse incentives in the US (and later I found in Germany as well, especially after COVID). I went from being convinced med students were really after money and glory to compensate from some shortcomings to eventually feeling incredibly sorry of the incredibly dark form of debt servitude/bondage they subject themselves to for most of their careers. The substance abuse is something that I sincerly hope they speak to those considering go through the process at the HS level, because it has claimed so many lives and ruined so many families in the process. The opioid crisis made the public aware that substance abuse by physicians was increasing because of how addictive they were, but the drug use/abuse was always there: cocaine, speed, and other SSRIs are common use in residency in order to keep up with the rigorous schedule and demands that come with it. These people should be venerated for even considering taking the immense burden of dealing with matters of life and death, the fact that we have a system that punishes them for seeking help for mental health issues (revoking medical license) rather than have empathy and compassion should be a real eye opener. Every medical professional I've known who has or is considering having children has always said they want their children to study art or philosophy instead... that should say it all. I really felt the weight of this, and the subsequent sadness when I saw what my Orthopedic specialist (surgeon) has gone through before, during and after COVID: I'm genuinely glad her career has taken off, but the candid conversation I had with her back in 2019 when she was unknown makes so sad to see what it cost her.
  • pauldenton 3y ago
    It's not just doubling the medical licenses and slots in the system, it's about breaking the grip of "Doctor required to be present" behavior. Meaning more work in the hands of nurses, ultrasound technicians and other medical staff that aren't doctors but are working in the hospital.
    • colonelpopcorn 3y ago
      That would require the dismantling or restructuring of malpractice law and litigation. The reason a doctor is required to be present is so that an individual can be held responsible to their Hippocratic oath when patients get litigious. Non-board certified staff, AFAIK, don't need to take a Hippocratic oath nor do they need to carry the burden of insurance the same way a doctor or nurse practitioner does.
      • ImPostingOnHN 3y ago
        Many doctors don't actually take the hippocratic oath (some make up their own, like wedding vows) and it wouldn't carry any actual legal force, either. It's like the american pledge of allegiance.
    • ProllyInfamous 3y ago
      I think this is the partial reason, over the past decade, many programs have changes from "Masters"-level to "Doctorate"-level (e.g. NP, PT).
  • ethanbond 3y ago
    All of the intensity leading up to and through med school is also generated by the artificially competitive residency system. Pretty obvious. Med students are not born leagues more competitive than people who go into other high-performing industries. Edit: I said here “all” the intensity is due to this, which isn’t fair. It’s a lucrative job with lots of necessary education so it’ll be both difficult and competitive regardless. The “extraordinary” features of the medical track compared to any other lucrative field, starting from high school onward though, is generated by the residency bottleneck.
• Am4TIfIsER0ppos 3y ago
  Americans keep telling me that their medical system is grossly unregulated so how can that be? FYI the government here directly sets the number of spaces available for training doctors, dentists, and veterinarians and still complains that there is a shortage.
  • jostylr 3y ago
    The medical system is not grossly unregulated. It is not centrally regulated in DC though there is a lot of regulation from there. It is states and localities that regulate it. For example, in some places, a medical professional can add an MRI without much more permission than safety concerns. But in most places, it needs to be negotiated with the various hospital systems, etc. This obviously drives costs up. Ambulance companies need to get permission from other ambulance companies to add an ambulance. These are just a couple of the examples I have come across, but I am sure there are many other examples. Government in the US pays 60% of the medical costs in the US. State licensing applies to all levels of healthcare, not just doctors. Doing minor in home care requires some kind of nursing credential with a supervising doctor-type. The common experience of patients is that they are interacting with private health systems and insurance companies. These systems are grotesquely obscure with prices and it feels like one is being fed to the wolves of capitalism unlike in almost any other market experience in the US. This makes it feel like it is unregulated. But, of course, this can only happen because the government has, by force of law and gun, created a medical cartel, limiting options, prices, and divergent practices.
  • jpadkins 3y ago
    The AMA, a professional guild (and convicted monopolists), set the residency cap in the USA, not the government.
    • EvanAnderson 3y ago
      To be accurate the US Congress set the cap. The AMA lobbied for it.
  • nsvd 3y ago
    Some would say it's over-regulated. In either case, there is certainly a large amount of unhealthy regulatory capture that benefits private companies.