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The darker side of being a doctor (2017)

• avidphantasm 3y ago
  Capitalism alienates us all.
• derelicta 3y ago
  TL;DR capitalism kills doctors.
• fennecfoxy 3y ago
  Main problems: lack of public healthcare (and only being for-profit instead) and lack of government enforcements around public healthcare. Same thing in the UK with dental (and Doctors); clinics prefer to take private patients over NHS patients because they make more money that way. Easily solved, the government just needs to 1: require a certain number or threshold of accepted patients per week to be public (and any contacts are submitted with type to government to track, same as passport travel) 2: apply harsher labour laws to clinics to prevent them from forcing their staff to work ridiculous overtime to make more money and cover availability 3: allow more medical students and have no idiotic unfair restrictions. Medical industries are critical to modern society and I definitely think that there should be no limited number of places, any student that passes entrance exams should get minor scholarships to help pay for/promote this position. We're all important to the economy but at the end of the day all comes down to medical staff when any of us get sick, no matter which industry we work in ourselves.
• user_7832 3y ago
  Most of the issues mentioned in the article and the included email are concerning, however they also oddly seem to be common in many places across the globe. The surgeon mentioned was in Australia, I have seen these issues first hand in the Netherlands and am aware of very similar of the first 2 out of 3 issues (caused by overwork/understaffing/over-fatigue etc) in Belgium, Germany, the UK, India and god knows how many other places. However, fields like aviation have strict workload limits. You cannot be on call/duty for too long because fatigue kills. Issues like alarm fatigue are studied by agencies, and folks at Boeing/Airbus then implement the findings. The question is, why is it okay for medical professionals to wear themselves down to the bone (sometimes literally, like in this article), while some other professions take care to avoid it? (Edit/PS: I added a fairly detailed self-reply below on what I think are some of the common arguments (like on the number/availability of doctors) and why they don't really fly, pun not intended.)
  • user_7832 3y ago
    (My musings/thinking-aloud): One partial hypothesis/answer is that there are far fewer pilots/cabin crew than there are doctors/medical staff, and hence it's easier to treat pilots properly. But fewer people makes it harder to let someone off if they haven't slept well so I don't really buy that. Another is that the medical profession is much more "flexible"/fluid in its needs, unlike flights scheduled in a regular manner. However, that doesn't mean it's not possible to give doctors an 8 hour workday, and substitute/bring more doctors for other shifts. In fact, this is exactly what happens in many 24-hour manufacturing plants/operations. Foxconn doesn't let a sleep deprived employee make an iPhone, but it's okay to let a sleep deprived doctor perform life-saving/potentially deadly operations? Another possibility is that "it would cost more" to have 3 docs instead of 1. Which might be supported by anecdotal evidence on how expensive things (including salaries) are in the medical field. However (especially if you're only familiar with the US healthcare system), this doesn't explain how doctors in say India are overworked. The "real" reason, I think behind all this? The first part is it's because it's "easy" to compress and push an 8 hour shift to a 24 hour shift, fatigue be damned. The costs are "hidden", it's likely even with fatigue a 99% successful operation is still 95 or 90% successful. Everyone can rationalize it and go about with their day. "Oh, unfortunately people don't always make it". Not, "there was a 20% chance they wouldn't have made it but an 80% chance it was because the doctor was fatigued." When an aircraft crashes, 300 people may die instantly. This gets front page coverage on a newspaper. However, a few deaths "here" and "there" don't really show up, even if they tally up to thousands. This is the second factor, that "hides" and normalizes occasional slip-ups. </End of this wall of text> I unfortunately don't really have a solution. I'm sure there are brilliant UX designers here on HN who could help ease and streamline the admin workload. I suppose a dedicated politician/presidential candidate somewhere could take this upon themselves to campaign for. (Seriously, the NHS was part of the discussion behind Brexit. Supporting doctors is a brilliant political strategy, the NWA didn't have a song called "Fuck the paramedics".) There have been many instances of things catching on once found successful somewhere, be it procedures like the Heimlich or concepts like Lean Manufacturing. Therefore I don't doubt that one good Harvard Review paper showing a 20% decrease in all-cause patient mortality, with trials underway in a few hospitals, is all it will take. Question is, who will bell the cat‽
  • 3y ago
• deleted 3y ago
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• orangesite 3y ago
  aka The darker side of having people who wouldn't make it through the first four weeks of med school managing health services.
  • yazzku 3y ago
    And they got MBAs instead.
• IncreasePosts 3y ago
  I know America strictly limits the number of people who can become doctors every year. Does Australia have a similar system? It seems insane to me to first limit how many there can be, and then overwork the ones you do allow to become doctors.
  • yazzku 3y ago
    >I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car. I used to have my sleeping bag, toiletries and change in the boot of my car because I didn’t know if I was going to make it home some nights. Plans change every single day at work because of emergencies. I can’t even be sure what the next hour will bring when I am on call. This is absolutely insane. Are we reading a town doctor's tale or a war tale?
  • thundergolfer 3y ago
    Though significant restrictions on supply do exist, the problem does not seem to be nearly as bad in Australia as in the USA [1]. In Australia there's ~15 medical graduates per 100k vs ~8 in USA. The doctors in Australia are still definitely overworked though. A decent number of the people I went to school with became doctors in Australia, and though we work roughly the same number of hours (~60-70hrs/week), my work in the software industry is like a stroll in the park. It was remarkable to hear my male friends who became doctors admitting that they had broken down crying in meetings with their boss because of workplace stress and exhaustion. 1. https://www.ama.com.au/ama-rounds/13-may-2022/articles/more-medical-students-not-answer-workforce-shortages https://www.ama.com.au/ama-rounds/13-may-2022/articles/more-...
    • genewitch 3y ago
      there's more than 12 times the number of people in the US. Yes i understand this is "per 100k", but this still kind of reads like "adding lanes to highways does not reduce traffic," and that means that there is some other issue. If you have more doctors, more people will go to the doctor. This is good, more people should go to the doctor, because early and preventative care reduces the overall cost burden on the system. And i don't want to put this in its own comment or even continue reading the defense of doctors (as they stand now): Women get shafted so hard by the medical community. People with mental health issues get screwed by the medical system. Both get their problems written off for non-medical reasons. There are bad practitioners just like there are bad developers and bad general contractors and bad bridge builders and bad pilots. The whole system is not very good and i don't see, necessarily, how merely adding more medical degree holding people to the mix will improve things. There isn't enough patient advocacy, there's too much friction with medical insurance (in the US). But at least the shareholders are making money.
• bryanlarsen 3y ago
  (At least some) of the new generation of doctors appears to be better about refusing overwork. AFAICT that's a large component of the doctor shortage here in Canada -- the ratio of doctors to patients is better than ever but if a doctor "only" does 40 hours a week you need more of them.
• keybored 3y ago
  > I am realising more and more that what brings me greatest distress is the relentless administrative pressure which take away the meaningful clinical engagement I have with my patients. And I wonder if this is what many young doctors are experiencing as well. Medicine used to be a meaningful pursuit. Now it has become a tiresome industry. The joy, purpose and meaning of medicine has been codified, sterilised, protocolised, industrialised and regimented. Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators. tl;dr: professional feels like a proletarian.
• deleted 3y ago
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• grepLeigh 3y ago
  The three factors mentioned (loss of control, loss of support, loss of meaning) are the pillars of occupational burnout, according to researchers like Christina Maslach. In many cases, someone experiencing occupational burnout NEEDS extended time away from their work environment to heal. In severe cases, they might not be able to return to work at full capacity for years (or ever). This creates a negative feedback loop for understaffed doctors, nurses, and other healthcare workers.
• npretorius 3y ago
  Have doctor’s unions helped before?
  • kwhitefoot 3y ago
    Why would they? Did pilot's unions campaign for strict rules regarding pilot's working hours? Or was it the FAA/CAA/etc. that did it?
• hello_computer 3y ago
  There was a philosopher who once wrote "all regimes exist under the consent of the governed." This should go double for the medical profession. They have the brains, the education--and in most cases, the money--to object, weather a fight if need be, and comfortably pivot if they lose. If the situation is intolerable, the person to blame is in the mirror. They are competitive people. The bureaucrats and administrators understand this, and use it to pull their strings--make them dance. Click. Click. Click.
• bsdz 3y ago
  Something I've never quite understood is why, in the UK, we cap the number of medical students per year. I've known very bright people who aspired to be doctors but had their applications turned down only to go on to do phds and become scientists instead. I'd rather have twice as many doctors who work sensible hours rather than the status quo burn out. Looks like there are calls to change this. https://commonslibrary.parliament.uk/research-briefings/cbp-9735/ https://commonslibrary.parliament.uk/research-briefings/cbp-...
  • 2143 3y ago
    When I was studying in the US, my roommate was studying to become a "physician assistant" — a concept I think is brilliant. I don't think there's anything similar in my own country. But I was wondering if more physician assistants would help the doctors. Maybe they could take care of the paperwork and all those things as well.
  • kvonhorn 3y ago
    Supply and demand. If you artificially cap the supply of doctors, then the doctors can ramp up their prices.
    • KittenInABox 3y ago
      I don't even think doctors want the cap, tbh. Your average emergency physician would take all the qualified help they can get.
      • lazyasciiart 3y ago
        Yes, but how many residents can each emergency physician train at once? Doctors are similar to apprentices for the last part of their training.
    • hollerith 3y ago
      That explains why doctors like the status quo. Insurers like it, too, because expensive tests and expensive procedures must be ordered by a doctor (at least if insurance is going to pay for it) and if the patient gives up on getting in to see a doctor, then the insurer does not need to pay for the expensive test or expensive procedure. In the US, employers like it, too, because they end up paying the insurance premiums for their employees.
• DonnyV 3y ago
  This is what happens when everything is financialized. There is no reason that we should be running doctors into the ground. Health professionals are a necessity in a functioning society. I know in the US Government seems to have no problem throwing money at corporations and providing endless tax breaks. But god forbid we proved a functioning health system. For the US this needs to happen. 1) Medicare For All - a universal, no pay at service, insurance system, everyone taxed at 4% for it. 2) People that have the grades to make it to medical school should get a free ride. 3) Small Private practices should come back with free digital billing with the new health insurance system. 4) Price regulation on all basic medical supplies and medicines. No more $20 tongue depressors 5) All medicines researched at public Universities will not be sold or given to private industry. They will be licensed. That money goes back into supporting this system.
  • jokethrowaway 3y ago
    Public healthcare doesn't work. They just get progressively worse and start adding expenses for the patients. The quality is terrible, despite the propaganda. The best companies were offering private healthcare with their offer. I've seen it happen in two countries, now I live in one which just made most of private healthcare (which is excellent quality) available as public. It's working well for now but they're spending a ridiculous amount of money and it's not sustainable. Doctors are happy, I'm not because my taxes increased from 12.5% to 15%. Public mismanagement is huge, they'll screw it up. The USA government needs to stop being in bed with insurance companies to make everything expensive, then your private system will be fine.
    • DonnyV 3y ago
      I didn't say Public healthcare. Only the insurance is public. The healthcare system still stays private.
    • kwhitefoot 3y ago
      > Public healthcare doesn't work. It works here.
  • IvyMike 3y ago
• GiorgioG 3y ago
  You are a body to the healthcare system. My wife is a hospice nurse and they're happy to grind you into the ground as long as it suits them.
  • genewitch 3y ago
    as long as the client has money in their savings account*
• willmadden 3y ago
  The answer is simple, mandatory limits on hours and days worked. Also fix healthcare regulation and the process of becoming a doctor so there isn't a supply shortage of doctors and surgeons.
• kingkawn 3y ago
  The profession as a whole is profoundly hostile to any serious considerations of mental health, and it’s going to take many more suicides before even the smallest steps are taken toward obvious quality of life improvements.
  • genewitch 3y ago
    humanity as a whole is profoundly hostile to any serious considerations of mental health. Dr. Drew once agreed with a rant by cohost adam carolla along the lines of (this is a whisper transcription. blame me for mistranscriptions, idc) "It just doesn't make any sense to me. What's so bizarre in our culture, if you'd broken your leg when you were a kid and you needed a few years of physical therapy, you'd get it. You'd be running on it, and by the way, people would be applauding your great commitment that you go out and work out every day on your leg, and you make sure that you're going to overcome that problem, and you're going to get back up on skis again and whatever. The same thing is true with our brain, and somehow because it's our brain, no, no, no. Sorry. We'll have none of that. What would [...] tell you to do? Oh, he'd say just decide to change. You just gotta decide to change. You gotta get up, you gotta dust yourself off, you gotta take a long look in the mirror, and you gotta decide to change. I can't change for you, and all the people wishing you'd change around you aren't gonna make you change. There's only one person that can change your life, and that person's name is [...]. You want to lose weight, you're gonna have to burn more calories, and you're gonna... "
    • kingkawn 3y ago
      All true. I think doctors as possessors of the monopoly on health spending are uniquely positioned to fuck the whole society up with their own blindness to monumental aspects of health
• andoando 3y ago
  The shit we make doctors go through is unnecessarily insane. It takes 300-400k of debt and grueling 7-8 years on top of a bachelors degree, with bunch of uncertainty on where you'll be or whether you ever make it, just to start working. If you ever quit before then, any progress made counts for zero and you have to start all over again in a new field with a ton of debt. Why doesnt an MD or even credits at a medical school count toward nursing, physician assistsnt, etc? Lastly, med school is unnecessarily long. You don't need most of the material to do family medicine for example. I really don't understand how such inefficiencies could be tolerated.
  • nradov 3y ago
    I agree but the education system is starting to improve. Some schools now offer combined Baccalaureate-MD programs which can reduce the education time by up to 2 years. https://students-residents.aamc.org/medical-school-admission-requirements/medical-schools-offering-combined-baccalaureate-md-programs-state-and-program-length-2021-2022 https://students-residents.aamc.org/medical-school-admission... Tennessee now allows some physicians to practice without completing a residency program, largely as a way to attract immigrants to work in underserved communities. https://www.medscape.com/viewarticle/993693 https://www.medscape.com/viewarticle/993693
• praptak 3y ago
  "Medicine used to be a meaningful pursuit. Now it has become a tiresome industry. The joy, purpose and meaning of medicine has been codified, sterilised, protocolised, industrialised and regimented. Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators." That's textbook Marxist alienation of work. It was not supposed to happen to middle class workers though.
  • lurking15 3y ago
    Oddly enough medicine has never been more regulated and financed by government so hard to say this is some sort of marxist dynamic, more like the consequences of centralization that happened after (because of) WWII. You see this in the US/UK/Canada regardless of whether they're "socialized" it's a mess everywhere.
  • gverrilla 3y ago
    > It was not supposed to happen to middle class workers though. Don't think Marx wrote or said that. Any source?
    • praptak 3y ago
      I meant the "Marxism was about 19th century factory workers, I'm middle class so it doesn't apply to me" line of thinking.
• maCDzP 3y ago
  My not so generous and extreme take is that the medical profession has a “hero culture”. There is prestige in working your ass of and living for work. Work life balance is for the weak people who can’t take it, they are not real health professionals. They don’t have what it takes. I have seen the same culture in aid work. I find it ironic that both health professionals and aid workers are there to help people, but not for each other. Then it’s cut throat.
  • lll-o-lll 3y ago
    Yes this does seem to be the culture, at least for doctors working towards the more competitive specialties (such as surgeons). Things get much less hectic once they reach “consultant” at age 35 or so, but it’s an absolute grind until then. With no guarantee of success! If you see your GP with a bunch of extra paper on the wall, chances are they are one of the many that didn’t win the game. What’s a good alternative though? These are high paid, high status, jobs for life. Of course it’s going to be as competitive as all heck to get them. Do we shame Olympic athletes for the dedication and sacrifice they must provide to obtain their goals? I’m not saying the current system is great, but any alternative could well be worse.
    • twojobsoneboss 3y ago
      “Jobs for life” part is huge and under appreciated - there aren’t many jobs where you don’t have to worry about ageism nowadays
  • skybrian 3y ago
    Health care professionals do form unions and go on strike sometimes, which can be seen as a way of looking out for each other.
    • novok 3y ago
      Having friends on the other side of those medical union strikes, I think the hospital systems play hard ball and the unions don't get good outcomes often. My friend quit the hospital because how they were wringing her dry and pushing economical things that she found unethical. She quit and started her own private practice, makes more money, works less hours and is much happier now.
• jokethrowaway 3y ago
  This can happen in any work. But I concede, medicine is grueling - not worth the money if you ask me.
• eclectic29 3y ago
  Thanks for sharing. This is so disheartening. The other day I was debating with my friends how a doctors life is so cool that they don’t have to go though grueling coding interviews every single time they want to change jobs, don’t have to prove themselves every single quarter, don’t have to be answerable to anyone or write performance reviews or be subjected to arbitrary rubrics. Boy, I was so wrong. Every procession has its hazards. This has been a learning for me. Although I do feel that the PCP doctors in US seem to have a simpler life. They leave office at 5 and don’t take calls in the night. Happy to be corrected though.
  • Turing_Machine 3y ago
    Even PCPs sometimes have to go home with the knowledge that someone died, and (being human) wondering if there was something else they could have done. Now imagine that happening dozens or hundreds of times over the course of a career. Unless coders are working on air traffic control or something similarly critical, it's pretty rare for a bug to kill someone.
  • dogmatism 3y ago
    US PCP doctors do take calls. It's less common for them to go to the hospital to admit their own patients anymore since the rise of "hospitalists" but they still take outpatient calls and calls from the ER. Also, PCPs are subject to the most metrics/rubrics of any, and all the crap paperwork that any specialist can foist off onto them, they do. Shit rolls downhill, and PCP's are at the bottom They may stop seeing patients at 5, but they sure as shit aren't done at 5. Most are logging back in even later doing all the "paperwork" they didn't have time to do during the day. Even has a nickname: "pajama time"
  • sensanaty 3y ago
    I get what you mean, but doctors also go through a decade+ of medical school+being on rotation. Lots of devs out there (myself included) without even a bachelor's. Same reason why classical engineering fields don't do anything like leetcode, those engineers are actually accredited.
• game_the0ry 3y ago
  I don't understand why doctors that are entering the field need to be over-staffed and over-worked. I have a cousin who is an Er surgeon and she needs works 3 days a week, but that certainly was not the case when she was starting out. The work culture of the medical profession looks horribly inefficient. What benefit do you get from buying out young doctors?
  • jstummbillig 3y ago
    Discipline. (I am not saying it's worth it. I don't know.)
  • opinion-is-bad 3y ago
    Poor incentives for the existing members of the system that hold power to implement change. They already cap the number of med students to control salaries, perhaps burning out young doctors fulfills the same purpose, while also (temporarily) covering for the lack of doctors available because of the artificial limit?
  • rr808 3y ago
    Some wards with really sick people benefit from having longer shifts as you see the person progress and have fewer shift changes. Ie with 2 people doing 12 hr shifts is better than 3 people doing 8 hours shifts as the doctors and nurses see how a patient is doing and dont have to communicate to next shift. Something like ER where people come and go all day wouldn't benefit from this however.
    • jajko 3y ago
      Yes but you really don't want to be treated at the end of that 12-hour shift, quality of service drops down significantly, they are significantly more tired at that point. Doctors are just humans like rest of us, and those shifts are often brutal.
      • game_the0ry 3y ago
        That’s what I am trying to say, sleep deprivation causes people to make mistakes.
• spxneo 3y ago
  People think doctors are some super human that they can heal themselves but they are people just like you and me. It's despicable that they along with veterans are being treated with ambivalence. The most recent example of contempt towards doctors described in the article I've seen comes from South Koreans who enjoy a generous, affordable, high quality healthcare that exceeds those in North America complaining doctors make "too much" and that there isn't enough doctors.
• neilv 3y ago
  Especially since the Covid vaccine return to some normalcy for many of us, always in the back of my mind whenever dealing with healthcare providers, is that they're probably the ones that both survived and stuck through that catastrophe. And, some places, I get the impression they have fewer staff now, and greater financial challenges. > If I decide to work less, who is going to cover the hospital? If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. I accept the fact that I have a duty of care to be on call. The hospital also has a duty of care.
• treprinum 3y ago
  Enforcing duration of medical actions must be some of the most idiotic things a healthcare MBA/MPH could come up with. Forcing a surgeon to finish surgery exactly within allocated time is putting lives at risk. The factory model should never be applied to fields like these.
• wuj 3y ago
  One point I resonated with is the high administrative overhead of being a doctor. I can imagine the stress of using an outdated EMR system when the time you have for each patient is so limited. I see lots of AI companies are trying to transform the MedTech industry, but I'm unsure how much of their products useful / are actually adopted by the hospitals. Maybe some experts in that space can enlighten me on that? I also agree that running hospitals like a private business is at odds with the essence of healthcare. However, this trend might be more indicative of a broader societal shift rather than a phenomenon unique to this sector.
  • tasuki 3y ago
    > the stress of using an outdated EMR system Using an outdated EMR system is hardly a cause of stress. A more usual cause of stress is being forced to use a brand new (and unusable) EMR.
  • lukko 3y ago
    One of my old registrars co-founded this company: https://tortus.ai https://tortus.ai. They are doing a trial at Great Ormond Street at the moment - I haven't tried what they're building but it's an AI assistant that reduces some of the admin burden. I am really hopeful that systems like this will take off – the reality of being a junior doctor in the UK is that most of your time will be used on quite tedious admin tasks (documenting every patient interaction, filling forms, booking clinics etc.) using very & slow outdated computer systems. I don't think anyone expects this when they apply to medical school, and it can be quite demoralising when you start your first job.
  • quasse 3y ago
    > I see lots of AI companies are trying to transform the MedTech industry, but I'm unsure how much of their products useful / are actually adopted by the hospitals. Maybe some experts in that space can enlighten me on that? My impression (as an outsider with a partner in the medical field) is that the prime function of the "medical industry" is to generate reams and reams of documentation about "care provided" to an insanely granular level. Functionally, this information is mostly bullshit that is irrelevant to providing medical care, but it serves a very important purpose for the medical administrative class so that they can bill the patient for each bandage applied or Ibuprofen administered. AI MedTech companies mostly seem primed to increase this firehose of bullshit. Whether or not that will take the pressure off front-line medical personnel who are currently tasked with generating it remains to be seen, but you'd be hard pressed to convince me.
• vehementi 3y ago
  I wonder why this guy has a plug for that home doctor book which looks reeeeally sketchy. I went looking for reviews of it and reddit is filled by spam from just one reddit user
• hakdbha 3y ago
  [dead]
• Havoc 3y ago
  I didn't even consider surgeon as an option. The idea of a life being dependent on my steady hand, skill and knowledge is terrifying. Literally I'm having a bad day, mess up, someone dies? ...having people brave enough to take that on drown in red tape is a shameful black mark on society.
• worik 3y ago
  Doctors meet better unions in that country Senior doctors in New Zealan have one of the most powerful unions in the country Junior doctors are catching up It is still a punishing career, but not like that.
  • H8crilA 3y ago
    In many countries doctors' unions actually encourage this sort of stuff, by restricting the number of spots in medical degrees. Making sure there are as few juniors as possible, making their life more miserable than it needs to be - this sort of stuff.
    • psychlops 3y ago
      The goal of a union is to put a fence around the employers and drive wages up. Mission accomplished.
      • worik 3y ago
        > The goal of a union is to put a fence around the employers and drive wages up Feeding the troll: The role of a union is to represent the interests of their members
        • psychlops 3y ago
          Fair enough, I'll revise my statement: the side effect of a union is to put a fence around the employers and drive wages up. While you've identified their stated purpose, I can assure you after having been in multiple unions that they serve themselves first, then their members.
          • worik 3y ago
            Yes > I can assure you after having been in multiple unions that they serve themselves first, then their members. The doctor's union for senior doctors in New Zealand is an exception to that rule. I have had similar experiences as you with unions I have belonged to, but still, they were useful when I got into a dispute with those evil powerful people who had the power over me. But you are not wrong
• skybrian 3y ago
  It's side point, but I'm wondering, why does the blog post start with a link to a book? It looks like an interesting book, but I don't see the relationship. Has Substack started running advertising?
• deleted 3y ago
  [deleted]
• akomtu 3y ago
  "We hoped our machines would automate our work and make us free. Instead they turned us into automatas."
• seabombs 3y ago
  There's been a critical spotlight on Australia's medical industry lately. Like gouging the medicare system or skirting regulations to profiteer off the insane demand for semiglutide weight loss drugs like Ozempic (couple of links below). If you were a young, idealistic doctor (or an experienced idealistic doctor) I could imagine feeling incredibly disheartened when you see this kind of thing going on around you. For the regulators I think the challenge they have is how to minimise the damage of the "bad" medical professionals (or weed them out of the system entirely) while not crushing the spirit of the good ones. I certainly don't know the answer. https://www.abc.net.au/news/2024-04-08/price-of-pain-doctors-medical-billing-investigation-four-corners/103675900 https://www.abc.net.au/news/2024-04-08/price-of-pain-doctors... https://www.abc.net.au/news/2024-04-01/cowboy-pharmacist-behind-a-replica-ozempic-and-mounjaro-scam/103644794 https://www.abc.net.au/news/2024-04-01/cowboy-pharmacist-beh... Also not that it really changes anything but the linked article says it was written in 2024, though Dr Bryant's death was in 2017: https://www.brisbanetimes.com.au/national/queensland/i-didnt-see-it-coming-wife-of-brisbane-doctor-writes-letter-about-his-suicide-20170511-gw2ef2.html https://www.brisbanetimes.com.au/national/queensland/i-didnt...
  • robbiep 3y ago
    The first things you talk about have nothing to do with the second things you talk about, but I can see how they can be lumped together. The truth is the medical sector in Australia is always under intense scrutiny, and rightly so. Currently the biggest systemic threat to our healthcare system (in my opinion) is underpayment/underinvestment in general practice which is having a critical effect on new trainees entering GP. Dr Levi is a well known Melbourne ENT surgeon who has been extensively involved in doctor wellbeing initiatives, including starting Socks for Docs day. It looks like he just discovered substack and has started writing - I am sure I have seen this exact essay from him previously, which is where we get the discordance of him talking about the 2017 death as though it happened last week.
• psychlops 3y ago
  If they didn't artificially restrict the supply of doctors the demand would be met.
• tejohnso 3y ago
  > I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off. Why would you do this? Some of the most basic labour jobs have better employment terms than this. > You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? Yes, I did ask. But covering the hospital isn't your problem, that's a hospital management problem. > If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. It's the hospital that's allowing patients to go uncovered if they don't employ enough doctors for a reasonable workload. The author goes on to detail just how unreasonable the workload is. > As a surgeon I spent a year in a hospital where I smiled on the way to work and I am so grateful for my job. I looked forward to long days because I knew what I was doing was significant. So there are cases where it can be enjoyable, yet ... > Another year in another hospital, I dreaded going to work. I hated being on call....Same surgeon, different jobs. I don't see why you'd choose to work at the dreadful job. Isn't surgery a skilled labour job that is in high demand? How can they not demand more control over their working environment? I'm guessing, but maybe it's possible that they're conditioned to accept increasingly stressful environments from the first day of med school. So that by the time they're surgeons, they're so conditioned that the idea of refusing the unreasonably stressful load is not even fathomable. Maybe there's even a certain amount of egotistical satisfaction that comes from being able to hack it.
  • sensanaty 3y ago
    I know a few doctors, and you have to keep in mind a lot of them are good people trying to help others as much as they can. They put up with overworking because at the end of the day, they want to be there for their patients as much as they can be, and if it's not them then people would literally not get the chance to see a doctor at all. You are right, it shouldn't be their problem, and we should work on making sure they're (especially surgeons for christ's sake) well rested and as stress free as you can be in a field like medicine, but what's the alternative for them and their patients right now?
  • ndjshe3838 3y ago
    Because they actually care about the patients and the work is critical? You can’t just job hop like in tech? It’s like everyone on this site views the whole world through a super narrow “tech worker” lense and assume every job works the same and everyone has the same motivations as people in tech
• l8rlump 3y ago
  Interested to know if this is also the situation in places where the medical care isn’t free/price-controlled/subsidised, as it is in Australia?
• josiahashle710 3y ago
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• aaron695 3y ago
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• User23 3y ago
  It was depressing realizing that our medical system is ordered against the benefit of the two principals, the patient and the doctor.
• pyuser583 3y ago
  There’s a blurb underneath the title linking to third party page. This page is selling a really quacky looking book, that has no obvious connection to the author of this article. Is this an ad? It doesn’t look like normal ad placement. It looks like the author of the article is promoting it. And it seems really quacky. I wish substack was clearer on whether this product is endorsed by the author of the article.
• ayakang31415 3y ago
  I would like to ask anyone who knows medical policies: can we not have cap on accepted medical school matriculants each year? Can we have a system where if you are qualified to attend medical school, let as many of them attend as they can so free market mechanism plays in this career path just like we have in graduate school?
  • droopyEyelids 3y ago
    This will get you started: https://www.niskanencenter.org/the-planning-of-u-s-physician-shortages/ https://www.niskanencenter.org/the-planning-of-u-s-physician...
• circadiancode 3y ago
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• akokanka 3y ago
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• beryilma 3y ago
  I have no sympathy for doctors. They are a part of an exploitative system, and they know and accept it. Most of them are in it for money, in the first place. The experience that the author describes is not much different than a fancy lawyer's or that of a Wall Street finance person. They all knew about the long hours, but money is more attractive...
  • amarshall 3y ago
    Many only accept it because there is little choice but do so if they wish to pursue the profession. Despite what you may think, many are not in it for the money, but genuinely enjoy their work (but wish it was fewer hours) and helping patients. In the U.S., some hospitals are seeing residents and fellows truly refusing to accept the status quo—they are voting to unionize in hopes they will be able to finally upend the exploitative system (at least for trainees).
• jimmar 3y ago
  A brain surgeon saved my sister's life. In the days after her recovery, my dad ran into her surgeon eating in the hospital cafeteria at 11pm. My dad asked him when his shift ended and the surgeon just looked at him and said, "I live at the hospital." There was just so much work he had to do. Rewarding work, but grueling.
  • hipjiveguy 3y ago
    That was very funny - I laughed out loud :D
• p1dda 3y ago
  I am a working physician (50+) that is currently in training to become an IT professional, preferably working with development of new patient records systems. Being a physician is just not very intellectually challenging, more emotionally challenging, programming is in my mind a real challenge. Any others with experience of changing fields?
  • bobowzki 3y ago
    I'm an anesthesiologist. Two years ago I switched to doing 100% software engineering. I had already worked in software, but not full time. There were many reasons. More time with my family was a big one. Work not being intellectually challenging was a another.
    • p1dda 3y ago
      Having worked in software before must have made it easier to change profession? I have not so I think I need formal training, I am a programming hobbyist writing in python and did some SQL for databases for research. I guess I need to have really tough problems to solve, when I succeed, there is almost nothing like it, the feeling of accomplishment.
      • bobowzki 3y ago
        I had already contributed to some open source projects and had also done some fairly large freelance projects. I'm sure this made me more hireable. I'm not sure I will give up anesthesiology 100%, in the end I'd like to combine and work on "medtech". Currently I work with automotive radar. Feel free to reach out!
        • p1dda 3y ago
          Thank you for the response! I also feel this way, I still like some aspects of being a physician. I think it's just the way some of us are built: we thrive on learning new things, we enjoy challenges and we get bored when stuff gets too easy. Automotive radar sounds exciting as well! I will look for open source projects, it might be a great way to get work experience, thanks for the tip!
• personomas 3y ago
  > I have lost control of my days. I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off. When I was preparing for surgical exams, I’d be working and studying from 6.30am to 10pm everyday, seeing my family only on the weekends for lunch. I had worked in a hospital network that covered 4 campuses and drove 500kms a week when covering these sites. I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car. We have to stop Medicare. It's not sustainable.
  • BHSPitMonkey 3y ago
    How would ending Medicare change the conditions in your quote?
    • personomas 3y ago
      Because the health care system is dramatically overwhelmed. There are not enough doctors for the demand.
      • stevenhuang 3y ago
        What a weird way to frame the problem. Why not increase the supply of doctors instead of reducing demand, whatever that means?
        • personomas 3y ago
          > Why not increase the supply of doctors instead of reducing demand, whatever that means? Because that's not sustainable. We can't throw unlimited human resources at health care. We have other issues and societal problems to focus on. We can only create so many doctors, because its expensive to lock down a smart and ambitious mind for so many years. Opening up healthcare for free for old people is like opening up an untapped fire hose. This is insanity. Has anyone ever to stopped to think what work life is like for these doctors and for other health care workers? These people should be able to have a social life, a family, and be able to live out there lives.
• xkcd1963 3y ago
  It seems the two better solutions are either government financed hospitals, which are always hopelessly overpatient but as a doctor you are more free, because they usually don't get paid much and anyone who works in a gov hospital is upmost welcome. And the other option are overpriced private hospitals where you don't have so much financial pressure. "Patient satisfaction officers, Theatre Utilisation officers, Patient Flow Coordinators. These are all business roles" Forget all this nonsense the man who saves lives is the surgeon and doctor. People are very grateful to the people who actually save their life.
• throwaway20222 3y ago
  One of my friends I grew up with was “that kid;” smartest in the community, funny, played a mean guitar. Everyone loved him. Top of class. Harvard. Harvard med. Top placement for residency. Something happened during that time and he killed himself. It was absolutely unexpected from all of his friends. Shocking to say the least. Apparently it turned out to be stress from work, his hours, his fear of failing. Who will ever know, but it has been many years and it still stings.
  • billfruit 3y ago
    Can't medical doctors have duty time limits like aircrews. Wouldn't that alleviate some of the overwork.
    • sambazi 3y ago
      it's not like the whole profession has the same contract, but working hours in public healthcare should be regulated, i agree
    • huytersd 3y ago
      Can’t IT workers?
    • nicomeemes 3y ago
      There is such a restriction, at least for NY. It was prompted by a wealthy businessman (naturally): https://en.wikipedia.org/wiki/Libby_Zion_Law https://en.wikipedia.org/wiki/Libby_Zion_Law
    • SJC_Hacker 3y ago
      Last I heard (this was early 2010s) at least it Texas, it was capped at 80 hours/week for residents. Seems like a lot but probably better than the 100+ they used to pull.
      • cfu28 3y ago
        80 hours a week, averaged over a month. So individual weeks can still easily go over to 100+
• throwdoc 3y ago
  Another worst thing is that developed world sucks necessary doctors out of undeveloped world. No human right concerns whatsoever. UN as always useless
• tsoukase 3y ago
  I think the doctor that commited suicide suffered from an acute depressive episode, so the outcome could be prevented by catching it early, taking a break etc As a doctor myself, I believe it's difficult for a non-doctor to understand our problems. Saving lives (in quantity and quality) is both very rewarding and demanding but those two feelings cancel each other out, hopefully leaving a small positive residual. The effort is usually disconnected with it's financial reward (eg an easy, a-few-minutes case can be paid the same as another that devastated you) and that is inevitable. The medical administration, both public and private, is totally inefficient, if not provocative (eg providing 10 minutes for a whole patient visit so that the pay seems attractive). In the end, I believe the doctor himself should take advantage of the degrees medical profession freedom, make some choices and/or navigate himself in the medical system in order to balance work, salary and life, starting from the specialty (eg surgeon vs internist etc) and continuing during his whole career.
• moomoo11 3y ago
  The sooner this type of job is automated the better imo. What’s the point of having people working so hard they end up dying? Also I’ve suffered a misdiagnosis that ruined my life in my early years so it’s not like doctors are heroes either. We never hear about the failures only the successful stuff at the bleeding(heh) edge. They make mistakes, they’re just humans. Everyone glorifies their profession but what about the people who suffer misdiagnosis? Have to live the rest of their life in misery because of incompetence.
• WA 3y ago
  The sad thing is that there is an optimal number for working hours for employees in "potential emergency jobs". It is around 85% or so. (I forgot the source, I think it was Gerd Gigerenzer on managing risks.) This way, they can handle most emergencies in a good way. Reality is that many doctors in a hospital work 120% already. This either kills the doctors or the patients. The issue is that most doctors genuinely want to help their patients and feel some kind of personal responsibility and thus, can easily be exploited by the healthcare system to work longer hours. If they don’t do it, patients die, because there is no one else taking care of these patients.
• nusuth31416 3y ago
  Psychiatrist here. What the author of the article describes sounds familiar to doctors in many specialties. Happily, I am not that far from retirement. You can't imagine how many burnt out doctors there are everywhere.
• sanbor 3y ago
  Just wanted to share that Cuba is the country with most "doctors per 10k people" with a ratio of 84.2 doctors. In comparison, USA has 26.1 and Australia 41. I just find it very interesting that Cuba has 300% more doctors than USA. [1] Sorting by Latest available data (2020–2023 https://en.wikipedia.org/wiki/List_of_countries_and_dependencies_by_number_of_physicians https://en.wikipedia.org/wiki/List_of_countries_and_dependen...
• RecycledEle 3y ago
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• tomohawk 3y ago
  This is what happens when the people doing the actual good work are looked at purely as a cost. The administration that is brought about to contain that cost will end up costing way more than any possible cost savings they could theoretically get. Putting the force of government behind that administration just makes it that much worse. I see the same thing in tech. Engineers used to be empowered and productively making things that empowered everyone, and now they're disempowered, broken to the saddle of whatever the tech oligarchs are fancying today.
• nojvek 3y ago
  > I went into medicine knowing that I will have to sacrifice much for the sake of my patients. What I am realising is that today in modern medicine, a doctor is just one of the many commodities in this complex industry. It’s no longer about the patient. It’s about the business of hospitals. Patient satisfaction officers, Theatre Utilisation officers, Patient Flow Coordinators. These are all business roles. I have to yet to meet one person who says American Healthcare is wonderful, fairly priced and efficient. It seems private Equity and mergers are slowly juicing out the system - the doctors, patients, nurses. Its a sad state of world that we don’t allow pilots to overwork because our lives depend on it, but we allow doctors to overwork and don’t count patients dying due to them being overworked.
  • m463 3y ago
    You remind me of an old article I read: https://philip.greenspun.com/flying/unions-and-airlines https://philip.greenspun.com/flying/unions-and-airlines probably not a 1:1 comparison to health care, but the conclusion was: > a sustainable long-term structure would be a pilot-owned airline I kind of wonder if there could be a way for doctors to start a hospital and run it top-down from first principles. Kind of like good engineering companies that were started and run by engineers.
  • d0gsg0w00f 3y ago
    Re pilots vs doctors: pilots would be the equivalent of elective surgery, i.e., it can wait. There are so few doctors that getting a tired doctor is "better than nothing" as you have a greater chance of survival if you get mediocre care vs no care at all and certain death.
    • nojvek 3y ago
      Right. And we have so few doctors because we artificially cap the number of doctors instead of letting free market dictate how many doctors we can have.
    • rtaylorgarlock 3y ago
      Ironically, the reason my wife, a physician, gets to see her dad, a private pilot, most often is when he's flying medical teams to harvest organs from organ donors. 'Agreed' to your points, at least in part ;)
• spacecadet 3y ago
  lol people took "Uber" too seriously. There is a privilege problem that is exacerbating a climate problem. I blame the tech industry and its lust to disrupt.
• dade_ 3y ago
  The shocking side of becoming a doctor: https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt https://en.wikipedia.org/wiki/This_Is_Going_to_Hurt A medical student keeps a journal, becomes a doctor, hates his life, publishes his journal. One post I am laughing my ass off, the next I am in tears. It changed my perspective entirely and I recommend anyone read it.
• greenie_beans 3y ago
  i was in the waiting room for surgery, sitting in front of the vending machine. i saw surgeons come out there to get their lunch from the vending machine. i thought about how hangry i can get trying to code around lunch time. also thought it was wrong that i got an hour lunch break and they don't.
• jgalt212 3y ago
  Yes, not enough doctors. Allow more doctors seems like a good partial solution to the elite overproduction problem.
• Aeolun 3y ago
  I always find it odd when I see doctors saying stuff like "I have a duty of care, so I work 24/7 if I need to." I dunno about doctors, but after 12 hours of work my mind is toast, and I wouldn't trust myself to operate a toaster. I find it really hard to imagine the same thing does not apply to them. Is an absent doctor really worse than an exhausted one? I mean, there's obvious situations in which this is the case, but is it true on average? If someone arrives at the hospital and dies because there is no doctor available, only for that doctor to go and save 3 people that might have otherwise died the next day because they're not exhausted, should we make that tradeoff?
• itqwertz 3y ago
  No sympathy from this software engineer/developer. Especially since i have seen burnout in my closest friends and mildly in myself. Sunk cost fallacy is what keeps these doctors stuck. They get addicted to the lifestyle, income, and prestige after years low on the totem pole. The workload seems manageable until the reality of boundaries being crossed involves having to choose. We only have 24 hours in a day. This is not just a medical industry issue. The tech industry is inherently prone to burnout when potential rewards can exceed even that of a doctor. I know too many stories of drug-induced burnout while trying to keep up a certain lifestyle. We all have a choice, and we need to check in with ourselves to make sure we are not losing more than we gain.
• Vaslo 3y ago
  Nextdoor neighbor is an orthopedic surgeon. He says it is basically impossible to clear your schedule in any meaningful way. You have to just push yourself to have balance and know that sometimes the high salary and not helping all the patients you want is a trade off to some work life balance. He looks exhausted sometimes but makes as much time for his family as he can. It’s time to open more med schools and accept more doctors. Telling me a 27 instead of a 26 on the mcat makes you somehow a way better doctor is nonsense.
• kensai 3y ago
  Shouldn't the title be "The darker side of being a physician"? A Doctor can be also a doctor of philosophy or something else. I am both a physician and a doctor, and I feel it is important to make a distinction. It's also as a respect to the PhDs who are usually in the traditional procession of the universities AHEAD of the medical doctors.
• gist 3y ago
  Typical large amount HN uniformed comments where people espouse what they think and either don't or only lightly back up what they are saying in any meaningful way. Thinking there are just simple solutions to a very complex and entrenched issue. This one hanging under the current top comment as an example: "It's the same in the US, Italy, etc Doctors are a cartel receiving a monopoly from the State. That's all there is to it, really" Forgetting the reasons (sure - it's all some grand program by the AMA et al to keep up current Physician pay) for a second thinking that if you can just churn them out like you do 'coders' with some quick program that doesn't require many many years of training and residency programs as well as hospitals and other infrastructure. And of course the cost to do all of this. In almost typical HN fashion it's always a scam. Everyone else is getting away with being overpaid and undertaxed except top software engineers who of course deserve the pay they are getting. The particular Physician in question is in Australia and is a surgeon. So you want to just be able to pluck people at random and give them a chance to be a surgeon as if there isn't something special that is required for that specialty. Also, that Surgeon details some of his bad experiences but not how often that has happened. And doesn't even detail what he has done in terms of fixing it with the hospital administrators just continues to be a martyr getting beaten up by the system. Not claiming it's his job to try and get change at his hospital. But by the same token this idea that he has to do what he does or 'people will die' does not fly. Your own health and sanity is more important than that (as is your families).
• galahad_ 3y ago
  It's a bit scary how mostly smart people writing here seriously believe doctors are a "cartel" blocking preparing of new doctors. It's scary how you just ignore obvious facts like that the problem is present in any developed country. You really believe there is an international mighty cartel of doctors, what could influence like governments and private universities as well? Even would it be so, who would benefit from the lack of doctors? It's bad for simple doctors, because the workload is greater, it's bad for doctors in leading positions, because finding new staff for their teams is more difficult, and it's bad for patients, because the doctors are chronically tired and worn out and in some areas they even got a problem just to get an appointment soon enough, because local doctors are overloaded and got a full shedule for many months in the future. The explanation of the situation is not a mythical cartel, but the simple facts: - Any additional place for a medical student at a university costs a lot of money, and nobody wants to spend money to fund its creation. - The people in developed countries get on average older and need more medical service and consequently more working hours of doctors. - The quote of women among students is constantly growing. In my country Germany we had ca. 70% men and 30% women among students like 30-40 years ago. Now the quote is like 70% women and 30% men. Nothing bad at that, but a lot of female students get soon a family, a bunch of children and since that never ever work full time anymore. Stastitically we got so much doctors as never before in the history, but the sum of working hours in the country is lower, while the needs are getting higher because of olding population.
  • myroon5 3y ago
    > influence governments Healthcare providers spent the most money lobbying the US government for decades: https://www.opensecrets.org/federal-lobbying/top-spenders?cycle=a https://www.opensecrets.org/federal-lobbying/top-spenders?cy...
• husamia 3y ago
  I've aspired to become a doctor since I was a boy, I have managed to carve out a unique career out of medicine and I get to work at home and I have a lot of support, I spend hours working on what I love. I work with doctors who tell me I would make a great doctor. I think there is just too much resistance to getting into medical school.