6 ms·

Supposedly it never used to be this nuts. It mainly came about because of one cokehead surgeon at John Hopkins who got in charge of the training program because

by rcarr 3y ago

Supposedly it never used to be this nuts. It mainly came about because of one cokehead surgeon at John Hopkins who got in charge of the training program because of his "increased productivity" and basically started forcing these insane work weeks on everyone. See here: https://en.wikipedia.org/wiki/William_Stewart_Halsted https://en.wikipedia.org/wiki/William_Stewart_Halsted The concluding line of this report[1] is absolutely amazing in that the authors still won't even recognise that he was abusive towards his trainees. After discussing his lifetime coke habit and how his "eager and enthusiastic students" would pick up his slack (e.g that he had conditioned to work ungodly hours for his approval) they write (emphasis mine): *While we are not condemning Halsted*, we are suggesting that if one carefully analyzes and critiques the motivation for the structure of the Halsted surgical residency, his addiction was a major influencing factor. Either way, any person who can pass the entrance exams should be allowed to train as a doctor or surgeon. The fact that we have artificial caps on the numbers, yet surgeons are routinely working 100 hour weeks is an absolute joke. Everyone's health suffers - both surgeon and the patient. The "wages will come down" argument is an absolute joke - at the end of the day, if there's one thing people will pay a high price for, it's "to stay alive". And if there's a second thing people will pay for, it's "to not be in pain". [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828946/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7828946/

JumpCrisscross 3y ago
> The "wages will come down" argument is an absolute joke - at the end of the day, if there's one thing people will pay a high price for, it's "to stay alive". And if there's a second thing people will pay for, it's "to not be in pain" Demand for surgery is inelastic instantaneously. That does mean it’s also induced, i.e. more surgeons will generate more surgeries. Supply and demand will still apply.
- rcarr 3y ago
  Supply and demand will apply, but there's both a massive internal backlog (at least in the UK) as well as a massive backlog internationally. Globally, the population is still growing so the demand for essential medical treatment is only going to increase for the immediately foreseeable future. And that's just essential treatment. Rightly or wrongly, demand for non-essential treatment like cosmetic surgery and probably, as technology marches onwards, performance enhancing surgery is only increasing. For example, if we created enhanced ligaments that perform better than natural ones, it's not a stretch to imagine competitive athletes having surgery to replace them. I don't think wage protection is a valid reason not to be training surgeons who have the aptitude to do it.
  - jagraff 3y ago
    If we could create (and safely implant) artificial ligaments that are even close to human ligaments that would be amazing for anyone with ligament injuries. Once you damage a ligament it never regrows, and current artificial ligaments don't last very long and can cause other health issues. At least for UCL rupture, the current state of the art surgery (Tommy John surgery) involves taking a ligament from some other part of the body and replacing the damaged ligament, which is obviously a major surgery and still doesn't work nearly as well as the original ligament.
- nico 3y ago
  > Demand for surgery is inelastic instantaneously This is not true, a lot (most?) surgery is elective and can be delayed or avoided altogether Only emergency surgery is instantaneously inelastic If more people can get the surgery they need, faster, then I see that as a positive Also, not all doctors work as surgeons or need to perform surgery. Ideally we will also train a lot more of other specialties that can help people prevent surgery
hcarvalhoalves 3y ago
> The "wages will come down" argument is an absolute joke - at the end of the day, if there's one thing people will pay a high price for, it's "to stay alive". Good argument for universal public health care. It’s absolutely dumb to have number of surgeons trained or number of patients undergoing surgery be a function of supply and demand. Enough surgeons should be trained to attend the population and it should be a normal career with normal working hours and a steady salary like any other.
- xhkkffbf 3y ago
  > Good argument for universal public health care. Doesn't always work out well. I was just in Canada and the evening news was filled with stories that the wonderful "free medical" system was shipping patients down to the US for surgery. I hope they got a good rate on bulk deal.
  - jeezfrk 3y ago
    it works for all industrialized nations... but us. the question is how much do we want to waste and how many should die?
- mech987987 3y ago
  If supply and demand don't set the number of surgeons, then who does? Currently, the American Medical Association limits the number of new doctors being trained in medical school. The AMA judges this to be enough to attend to the population. The long working hours, high wages, and continuing shortage of doctors is direct evidence that their judgement is questionable.
  - kelseyfrog 3y ago
    The equilibrium found between supply and demand implies the existence of "excess demand." For some, myself included, the choice between excess demand and efficient markets leans heavily toward reducing excess demand, despite it being less effecient.
  - hcarvalhoalves 3y ago

by rcarr 3y ago

JumpCrisscross 3y ago

> The "wages will come down" argument is an absolute joke - at the end of the day, if there's one thing people will pay a high price for, it's "to stay alive". And if there's a second thing people will pay for, it's "to not be in pain" Demand for surgery is inelastic instantaneously. That does mean it’s also induced, i.e. more surgeons will generate more surgeries. Supply and demand will still apply.

rcarr 3y ago
Supply and demand will apply, but there's both a massive internal backlog (at least in the UK) as well as a massive backlog internationally. Globally, the population is still growing so the demand for essential medical treatment is only going to increase for the immediately foreseeable future. And that's just essential treatment. Rightly or wrongly, demand for non-essential treatment like cosmetic surgery and probably, as technology marches onwards, performance enhancing surgery is only increasing. For example, if we created enhanced ligaments that perform better than natural ones, it's not a stretch to imagine competitive athletes having surgery to replace them. I don't think wage protection is a valid reason not to be training surgeons who have the aptitude to do it.
- jagraff 3y ago
  If we could create (and safely implant) artificial ligaments that are even close to human ligaments that would be amazing for anyone with ligament injuries. Once you damage a ligament it never regrows, and current artificial ligaments don't last very long and can cause other health issues. At least for UCL rupture, the current state of the art surgery (Tommy John surgery) involves taking a ligament from some other part of the body and replacing the damaged ligament, which is obviously a major surgery and still doesn't work nearly as well as the original ligament.
nico 3y ago
> Demand for surgery is inelastic instantaneously This is not true, a lot (most?) surgery is elective and can be delayed or avoided altogether Only emergency surgery is instantaneously inelastic If more people can get the surgery they need, faster, then I see that as a positive Also, not all doctors work as surgeons or need to perform surgery. Ideally we will also train a lot more of other specialties that can help people prevent surgery

hcarvalhoalves 3y ago

> The "wages will come down" argument is an absolute joke - at the end of the day, if there's one thing people will pay a high price for, it's "to stay alive". Good argument for universal public health care. It’s absolutely dumb to have number of surgeons trained or number of patients undergoing surgery be a function of supply and demand. Enough surgeons should be trained to attend the population and it should be a normal career with normal working hours and a steady salary like any other.

xhkkffbf 3y ago
> Good argument for universal public health care. Doesn't always work out well. I was just in Canada and the evening news was filled with stories that the wonderful "free medical" system was shipping patients down to the US for surgery. I hope they got a good rate on bulk deal.
- jeezfrk 3y ago
  it works for all industrialized nations... but us. the question is how much do we want to waste and how many should die?
mech987987 3y ago
If supply and demand don't set the number of surgeons, then who does? Currently, the American Medical Association limits the number of new doctors being trained in medical school. The AMA judges this to be enough to attend to the population. The long working hours, high wages, and continuing shortage of doctors is direct evidence that their judgement is questionable.
- kelseyfrog 3y ago
  The equilibrium found between supply and demand implies the existence of "excess demand." For some, myself included, the choice between excess demand and efficient markets leans heavily toward reducing excess demand, despite it being less effecient.
- hcarvalhoalves 3y ago