3 ms·

> Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better c.f. "...everyt

by mlyle 3y ago

> Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better c.f. "...everything is rushed, and mistakes are bound to occur." "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." "I was burned out and I couldn’t control my emotions at work and at home. I’m not inherently an offensive or rude person, I’m just a person pushed to the limits and set to fail because of the circumstances around my work." > In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those service This is Australia, which does not have artificial restrictions on the supply of doctors to the same extent. On the other hand, they don't have a surplus of surgeons nor can nurse practitioners do the work > (note the comment about denying other physicians income). Yah, he's saying that if he doesn't come in, the backlog gets worse, and other people don't get paid. > He's proud he's never sought help or tried to change anything. He says he would like to seek support, but highlights the structural problems that prevent it: "I know where I can get support, but practically, when and how am I going to get that support?" "In addition, doctors who scream for help may be formally reported, therefore having restrictions placed on their practice and then incurring higher medical indemnity fees in some situations. Trainees who ask for help may be labelled as underperforming and have to be commenced on probation or remediation. We may not have practical access to the support that are often advertised." I absolutely am in agreement with you that the things done to artificially lower the supply of residency training in the US are terrible. But those criticisms don't seem to apply to this essay.

lazyasciiart 3y ago
> which does not have artificial restrictions on the supply of doctors to the same extent Yes it does. One of the really interesting questions is actually why the same problems have been created in so many otherwise-different systems. Edit: a post giving details on the Australian medical training constraints https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/FlagPost/2022/May/Medical_places https://www.aph.gov.au/About_Parliament/Parliamentary_depart...
- mlyle 3y ago
  > > to the same extent Your source says that the government sets (indirectly) a limit on the number of places at most public universities, but there are private, full-fee universities that are not so limited. Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough. Compare to the US, where congress basically directly controls the number of residency slots and has failed to increase them really at all to keep up with increasing population and increasing need for medical services.
  - lll-o-lll 3y ago
    This is just wrong. The supply is absolutely artificially capped, particularly for positions like surgeons. This is controlled by the Royal Australasian College of Surgeons in combination with government funding. There is no “private, full-fee universities that are not so limited” alternate path; don’t make stuff up. Source: Brother in law who is a surgeon.
    - mlyle 3y ago
      > This is just wrong. The supply is absolutely artificially capped, particularly for positions like surgeons. I feel like you don't understand the distinction about positions at universities for initial medical training vs. internship and residencies, which I believe I discussed fairly above. see > > Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough. "Disparate agencies" isn't great phrasing, though, as what I really mostly meant was "each province".
      - lazyasciiart 3y ago
        To start with, you’re overestimating the role of full fee paying university places, Australia doesn’t have provinces, and the intern year is not equivalent to an American internship - that’s the registrars, and there are fewer of those than internships. (This is the position you need to get in order to begin any specialty training, such as surgery. They are very explicitly managed and funded by the federal government. https://www.anao.gov.au/work/performance-audit/administration-medical-specialist-training-program https://www.anao.gov.au/work/performance-audit/administratio...) More generally, Australia does have states and territories, but the federation model is far more centralized than the US: for instance, public hospital funding is a shared pool coordinated by federal agreement. https://www.publichospitalfunding.gov.au/victoria-basis-national-health-reform-payments-2021-22 https://www.publichospitalfunding.gov.au/victoria-basis-nati... While the vast majority of internships are at public hospitals, the federal government also pays directly to create a relatively small number of internships at private hospitals. But of course this is all largely irrelevant because about one third of doctors in Australia completed all of their training in another country, and were then awarded a visa based largely on their profession being listed as a national priority under the system managed by the federal government.

by mlyle 3y ago

lazyasciiart 3y ago

> which does not have artificial restrictions on the supply of doctors to the same extent Yes it does. One of the really interesting questions is actually why the same problems have been created in so many otherwise-different systems. Edit: a post giving details on the Australian medical training constraints https://www.aph.gov.au/About_Parliament/Parliamentary_departments/Parliamentary_Library/FlagPost/2022/May/Medical_places https://www.aph.gov.au/About_Parliament/Parliamentary_depart...

mlyle 3y ago
> > to the same extent Your source says that the government sets (indirectly) a limit on the number of places at most public universities, but there are private, full-fee universities that are not so limited. Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough. Compare to the US, where congress basically directly controls the number of residency slots and has failed to increase them really at all to keep up with increasing population and increasing need for medical services.
- lll-o-lll 3y ago
  This is just wrong. The supply is absolutely artificially capped, particularly for positions like surgeons. This is controlled by the Royal Australasian College of Surgeons in combination with government funding. There is no “private, full-fee universities that are not so limited” alternate path; don’t make stuff up. Source: Brother in law who is a surgeon.
  - mlyle 3y ago
    > This is just wrong. The supply is absolutely artificially capped, particularly for positions like surgeons. I feel like you don't understand the distinction about positions at universities for initial medical training vs. internship and residencies, which I believe I discussed fairly above. see > > Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough. "Disparate agencies" isn't great phrasing, though, as what I really mostly meant was "each province".
    - lazyasciiart 3y ago
      To start with, you’re overestimating the role of full fee paying university places, Australia doesn’t have provinces, and the intern year is not equivalent to an American internship - that’s the registrars, and there are fewer of those than internships. (This is the position you need to get in order to begin any specialty training, such as surgery. They are very explicitly managed and funded by the federal government. https://www.anao.gov.au/work/performance-audit/administration-medical-specialist-training-program https://www.anao.gov.au/work/performance-audit/administratio...) More generally, Australia does have states and territories, but the federation model is far more centralized than the US: for instance, public hospital funding is a shared pool coordinated by federal agreement. https://www.publichospitalfunding.gov.au/victoria-basis-national-health-reform-payments-2021-22 https://www.publichospitalfunding.gov.au/victoria-basis-nati... While the vast majority of internships are at public hospitals, the federal government also pays directly to create a relatively small number of internships at private hospitals. But of course this is all largely irrelevant because about one third of doctors in Australia completed all of their training in another country, and were then awarded a visa based largely on their profession being listed as a national priority under the system managed by the federal government.