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The understaffed healthcare system works with overworked doctors on the basis that having a tired and overworked doctor is a lot of the times better than havin

• uniqueuid 3y ago
  Good point, and you can turn it around: Doctors are never "finished". They could always do more to help patients. So in contrast to aviation, where there is a clear corridor of things to do, doctors have no natural upper bound on their work.
• eviks 3y ago
  but the alternative isn't having no doctor at all, but to get more doctors, so the "basic game theory" is about why the limits on more doctors stay in place despite the higher risk of death etc.
  • Rinzler89 3y ago
    > but to get more doctors Have you found that magic fountain of endless doctors?
    • uniqueuid 3y ago
      Sure, it's very easy! Just do things that prevent burnout (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8834764/) and the job gets more attractive, drawing more students and producing less attrition: - Valuing work gives meaning (money, appreciation) - Autonomy gives feeling of control - Managing burden prevents overwork, exhaustion and fatigue
      • dirtyhippiefree 3y ago
        > Sure, it's very easy! I have issues when someone says a complicated issue can be solved easily…realistic expectations…
        • user_7832 3y ago
          The answers to some problems may be easy to know but difficult to implement, due to political/financial will etc. For eg we know how to reduce emissions, but it's still a challenge. In such cases advocacy and raising awareness can be helpful.
        • inglor_cz 3y ago
          "Easy to describe" is very different from "easy to do". It reminds me of the famous "just eat less and exercise more", the alleged simple solution to the global obesity epidemic.
      • nradov 3y ago
        Sounds good, but healthcare already constitutes 17% of US GDP. And with an aging population, spending has been growing faster than the rate of inflation. Most of the funding ultimately comes from governments, self-insured employers, and individual patients. Those groups have no appetite for spending more. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduate medical education). Every year some students graduate from accredited medical schools with an MD but are unable to practice because they don't get matched to a residency program. Congress hasn't significantly increased funding in years. https://savegme.org/ https://savegme.org/
        • novok 3y ago
          The entire medicare residency slot system seems a bit self inflicted, why hasn't an alternative system popped up? Also this is a global problem, not just the USA. You look at videos of student doctors in the UK for example and there are similar abusive schedules. https://www.youtube.com/watch?v=KE1XwEMGm0I https://www.youtube.com/watch?v=KE1XwEMGm0I
    • malux85 3y ago
      Yeah it’s called correct incentives - I look at the over work, and insane stress levels that doctors suffer and I say “NO THANKS” I am definitely not the only one
    • WalterBright 3y ago
      The AMA only allows a fixed number of seats in medical school. There also can be tiers of medical doctors. Most doctoring work is routine, and can be handled by a more of a medical tech.
      • nradov 3y ago
        False. The AMA has no regulatory or accreditation authority over medical schools. Schools can admit as many students as they want. The bottleneck right now in producing more US physicians is lack of Medicare funding for residency slots (graduate medical education). Every year some students graduate from accredited medical schools with an MD but are unable to practice because they don't get matched to a residency program. Congress hasn't significantly increased funding in years. At one point the AMA did lobby Congress to limit the number of slots but they have since reversed that stance and are now lobbying for higher residency funding. https://savegme.org/ https://savegme.org/ There are already tiers of clinicians. Much routine care can be delivered by Physician Assistants or Nurse Practitioners working under a Physician's supervision. Specific limits on their services are set at the state level.
        • beau_g 3y ago
          Why do residency programs require subsidies, are resident doctors each a large net financial loss to a hospital? I can't think of many other career paths where someone out of school is so underprepared for the job that the business could not employ them without someone else footing the bill, doesn't seem like a reasonable system that will sustain itself in the long term. I suppose pilots are a bit like this but they typically take the financial risk on themselves to some degree or get the taxpayer funded training via the military.
          • nradov 3y ago
            Hospital accounting is always messy. There's no simple way to determine whether a particular program is profitable or not; it comes down to how the accountants allocate overhead costs. But the fact that publicly owned and non-profit teaching hospitals aren't voluntarily expanding their residency training programs is strong evidence that they operate at a loss. Very few other career paths have such an extensive body of knowledge, licensing requirements, and low tolerance for errors. Law is maybe a bit similar in that new associates in most firms are worse than useless, and training them sucks up a lot of time from senior associates and partners. But law firms aren't subject to price fixing, so they have more freedom to raise their rates in order to cover those costs.
    • yokaze 3y ago
      That's a straw man. We do not need "endless doctors" just more (or some way to use them more efficiently). The number of doctors are limited by the pipeline to educate them. Most countries I know, the number of people admitted to study medicine exceeds the number people wanting to study medicine vastly exceeds the positions to do so, and admissions are highly competitive. To a point, I'd say, that it is becoming ridiculous. So, there is not a lack of people wanting to become doctors, but a lack of people allowed to even start to study to become one.
    • eviks 3y ago
      If you didn't cut the "limits" from the quote, you might've found a hint on how to answer your question without any magic involved. For such a small profession the general talent pool is endless indeed unless you... limit
• yokaze 3y ago
  Sorry, that is bollocks. That is the story most people believe, and makes for a convenient story for those people actually to blame. Funnily, it is also the story most doctors themselves seem to chose to believe in. First, those are not the only choices. There is also the the option of training and hiring more doctors. 2 Probably, there is also an option of making more efficient use of doctors time, but that one is more complicated. Most of the work of doctors is not life-saving. I think, you see a standard problem of pushing shit down or up. Government lowers budget, pushes quotas down, which gets pushed down further until it reaches the bottom rank and file, the doctors. They have to "do more with less" (Not limited to public sector, see Boeing), and that works for a while, until it doesn't.
  • closewith 3y ago
    > Most of the work of doctors is not life-saving. Yes, but working out which parts are and aren't critical is the $64,000 question.
    • yokaze 3y ago
      I think, that is a bit besides the point I wanted to make. Yes, it is very hard to know a priori, what is life-saving, and what not. No, I do not wanted to suggest that the work of doctors it is not important. The common understanding of doctors (their self-understanding included) is, that their work is very important, to the point that they exploit themselves. Or allow themselves to be "exploited". In this forum, more commonly you have people here working on productive systems, which can empathize with the feeling the responsibility for the operations and not wanting to drop the ball. People with that mindset think, they may safe a patient / the system, but working oneself to exhaustion won't solve those problems. And on the contrary, the exhaustion may be a contributing factor of making things worse in various ways. One directly by your actions, the other indirectly by covering up systemic problems.
    • Turing_Machine 3y ago
      Indeed. Is that weird mole just a weird mole, or is it skin cancer?
  • 3y ago
• malux85 3y ago
  What about the meta-game, where doctors get burnt out or suicide, and that increases pressure on the remaining doctors, in a negative feedback loop. We should impose work limits on doctors, just like pilots.
  • 317070 3y ago
    What I don't understand: Say I'm a doctor, and I declare I will only work my 40 hours (or however much a full time is where you are). I will literally leave when my time is up. Oh, and I don't pick up phones outside of work. Or read emails. What will anyone else do about it? Fire me? Then they have even less doctors... It seems to me doctors do have the power to change things, even without collectivizing. But for some reason I don't understand, it doesn't seem to work out.
    • IncreasePosts 3y ago
      If you don't have your own practice, yes, they might fire you. If you're only working "part time", you're bringing in less in patient associated payments for the owners compared to people who work more. There's also the fact that doctors might prefer $700k/yr working 80 hour weeks vs $350k/yr working 40 hour weeks. A lot of people who become doctors are workaholics and were behaving in a similar manner throughout their schooling.
    • kwhitefoot 3y ago
      They would earn less money. > the power to change things, even without collectivizing. Not really it's a sort of prisoner's dilemma. The one who refuses to work stupid hours gets fired and someone else has their job. If they stood together then it might work.
      • 317070 3y ago
        But there is no one waiting for their job. In most places there is a shortage of doctors.
      • lelanthran 3y ago
• hinkley 3y ago
  I think someone also did the math and figured out that having fewer handoffs side a patient led to better outcomes so now there’s pressure to have two doctors per24 hours instead of three or four.
  • user_7832 3y ago
    That's a very good point. I think 12 hour shifts aren't necessarily bad, but even EMTs/firefighters (in some places, afaik) have downtime after their shift. Maybe work one on one off, or maybe 2 on 3 off. I suspect that's still much better than the practice of 24 hour shifts.
  • kwhitefoot 3y ago
    Did they really study how doctors and other staff work in enough countries?
• hello_computer 3y ago
  Not so sure about that. According to a few studies, medical error is the 3rd leading cause of death, behind heart disease and cancer. Many operations are elective. In such cases, having a tired surgeon or nurse may be worse than delaying the procedure, or even skipping it. https://www.bmj.com/content/353/bmj.i2139 https://www.bmj.com/content/353/bmj.i2139 https://pubmed.ncbi.nlm.nih.gov/28186008/ https://pubmed.ncbi.nlm.nih.gov/28186008/ https://journals.lww.com/journalpatientsafety/Fulltext/2013/09000/A_New,_Evidence_based_Estimate_of_Patient_Harms.2.aspx https://journals.lww.com/journalpatientsafety/Fulltext/2013/...
  • james-redwood 3y ago
    This has been extensively debunked. Read the original methods of the BMJ article that you linked. They took every single minor error, like prescribing medicine 15 minutes late, and if the patient died, even of an aggressive cancer that they had already, it would be counted in the 'medical error that caused the death' statistic. https://www.nytimes.com/2016/08/16/upshot/death-by-medical-error-adding-context-to-some-scary-numbers.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=1&pgtype=sectionfront&_r=0 https://www.nytimes.com/2016/08/16/upshot/death-by-medical-e... https://www.medscape.com/viewarticle/863788?scode=msp&st=fpf&socialSite=google&icd=login_success_gg_match_fpf&form=fpf https://www.medscape.com/viewarticle/863788?scode=msp&st=fpf... https://sciencebasedmedicine.org/medical-errors-2020/ https://sciencebasedmedicine.org/medical-errors-2020/
    • hello_computer 3y ago
      Of course practicing doctors and nurses are going to swear up and down that it isn't true. They are the perpetrators. Ask any person who has had to spend time in a hospital recently, and watch your "de-bunked" turn back into a "re-bunked." These jokers can't even keep the charts straight. It is fast-food-tier service for a life-and-death commodity.
  • Mtinie 3y ago
    …but if you postpone a procedure, the medical facility they work at isn’t able to keep up with their revenue targets. /s
• novok 3y ago
  IMO this is doctors acting as enablers of a toxic administration. They need to refuse outright to not work crazy hours and force the system & administration to come to a crisis. The admins are not working those hours and thus do not feel the consequences of their actions and by enabling their bad behavior they are not getting consequences from their bosses, which are politicians and customers.
  • ysofunny 3y ago
    I think it's a matter of the 'tradinionalist' mindset in doctor education most doctors will think "well, I went through a hardcore intesnse experience in medical school, therefore that's how it should be" I'm saying they've normalized overwork as part of their specific subculture of modern medical professionals. they really believe they won't be as good doctors without this arguably abusive overwork system it's yet another group of people who all belive in some form of the "no pain, no gain" mindset; the issue is these groups don't give nobody anything unless there's some harm or pain involved
• lolinder 3y ago
  > If your operations have a 90% survivability rate it could still be considered a success despite those 10% they end up killing, because 90% is a lot better than 0%. > Meanwhile a tired pilot is more binary, it either can have 100% passenger survivability if things go well or 100% fatality if things go tits up, meaning the risk are too high to take chances. This isn't how the math works. A tired pilot either kills or doesn't kill their passengers on a given flight the same way that a tired doctor either kills or doesn't kill their patient in a given operation. In both cases it's 100% survive or 0% survive. Pilots aside, we also have laws about keeping truck drivers from driving too many hours, and accidents involving drowsy truck drivers are unlikely to have fatality counts measured in the hundreds. The difference between doctors and pilots/truckers isn't in the amount of risk involved, it's that surgeries are expected to have a non-zero fatality rate. A doctor can do their job perfectly and still lose a patient, so it's harder to prove that the fatality rate would be lower if we gave surgeons more rest. When a truck driver falls asleep at the wheel and kills someone it's obvious because they did something provably illegal or unsafe right before the crash. When a surgeon fails it's a lot harder to prove it was preventable.
  • naet 3y ago
    It's a little different because an unflown airplane doesn't kill people, but an untreated medical condition does. Sometimes it can happen extremely quickly, but also be largely preventable with proper and timely intervention (like with a burst appendix).