4 ms·

In the US, patient time is eroded by system/admin friction, I'm hoping that has entered public consciousness by now. from colleagues in the UK: their headline

In the US, patient time is eroded by system/admin friction, I'm hoping that has entered public consciousness by now. from colleagues in the UK: their headline demand is “pay restoration,” but the underlying grievances are much broader: when understaffing becomes normal operating procedure, every absence is a freaking emergency. nights and on-call work are intense enough already; broken sleep and persistent overload should not be normal too. The AMA has taken protectionist positions before, including opposing expansion—fair criticism. But opposing expansion can also mean opposing inadequately funded or structured training. And, as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers? My point is: it has more and more directly to do with patients than it may seem - being able to do the work properly, with enough time and capacity for the clinical judgement we've been trained for to be fully deployed... leads to better patient outcomes and safety.

DANmode 2mo ago
You’ve underlined the problem. From the first week of school, you are all taught that the good doctor is the one that can stay awake and autopilot paperwork for 48+ hours. That’s a nonstarter - it’s simply broken from the beginning. > to be fully deployed... leads to better patient outcomes and safety. Respectfully: no. There is no other human resource-planning concept on the planet that says using 100% of resources all of the time, or running to failure, is the safest method for the customer (patient). You guys messed up; your members are noticing, but instead of spending time cleaning up your own house, you want to educate the public? No: get your stumbling behemoth of an “organization” under control, please.
- theotherzod 2mo ago
  apologies for the confusion, by "fully deployed" I meant fully able to exercise clinical judgement - which requires adequate rest. If understaffing forces back-to-back night shifts and that becomes standard, well you clearly recognize the risk to patient safety just as well. My point is - putting hard limits and minimums on rest, forces staffing choices and this is something physician collective bargaining/organising can help with and it concerns you as a patient. Regarding "the good doctor" and accepting a near-constant state of fatigue... this is not a personal choice, and it shouldn't be treated as such (wrapped into the box of "the price of this qualification/profession" type of stories). From my experience and I don't claim to be the authority on understanding all aspects of this problem, it's 1. part structural - not enough people (AMA's anti-expansion positions really didn't help here, true) and high demand... and 2. part cultural: medicine has normalised "heroic" endurance which makes it convenient to focus on economics and not see fatigue for what it is - safety risk. The cultural narrative isn't exclusive to medicine. anyway, I hope community appreciates a perspective from the other side of that organisation, I was hoping to illustrate we ultimately share the same goal - better patient outcomes and safety.
  - DANmode 2mo ago
    Do you share the same goal enough to walk until it’s more people are being cared for properly? Not trying to personally attack - it’s a question I’d like to gently ask anyone who empathizes from within. Unfortunately there’s only so much individuals can do - we must lean on each other to really review.
  - DANmode 2mo ago
    > If understaffing forces Nope. If allowing sufficient staff to graduate such that hospitals are staffed isn’t on your todo list as an organization, then there had better be money allocated to ensure you can pay people to show up. Chronic (decades) understaffing while profits remain at record highs means you kept too much money. It doesn’t take an accountant to do that math. I have an idea of where to get the money, too: the ever-increasing revenue streams, ever-increasing admin pay, and ever-increasing shareholder payout, again, at minimum until the organization is operating at a bare minimum for a first-world country, able to do basic things like childbirth better than nations with comparatively no money...
DANmode 2mo ago
> as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers? For the same reason Americans don’t care much about the (often very valid) complaints of Congresspeople, you’ll want to start ensuring better service before you start asking for us to care and make noise for you.

DANmode 2mo ago

You’ve underlined the problem. From the first week of school, you are all taught that the good doctor is the one that can stay awake and autopilot paperwork for 48+ hours. That’s a nonstarter - it’s simply broken from the beginning. > to be fully deployed... leads to better patient outcomes and safety. Respectfully: no. There is no other human resource-planning concept on the planet that says using 100% of resources all of the time, or running to failure, is the safest method for the customer (patient). You guys messed up; your members are noticing, but instead of spending time cleaning up your own house, you want to educate the public? No: get your stumbling behemoth of an “organization” under control, please.

theotherzod 2mo ago
apologies for the confusion, by "fully deployed" I meant fully able to exercise clinical judgement - which requires adequate rest. If understaffing forces back-to-back night shifts and that becomes standard, well you clearly recognize the risk to patient safety just as well. My point is - putting hard limits and minimums on rest, forces staffing choices and this is something physician collective bargaining/organising can help with and it concerns you as a patient. Regarding "the good doctor" and accepting a near-constant state of fatigue... this is not a personal choice, and it shouldn't be treated as such (wrapped into the box of "the price of this qualification/profession" type of stories). From my experience and I don't claim to be the authority on understanding all aspects of this problem, it's 1. part structural - not enough people (AMA's anti-expansion positions really didn't help here, true) and high demand... and 2. part cultural: medicine has normalised "heroic" endurance which makes it convenient to focus on economics and not see fatigue for what it is - safety risk. The cultural narrative isn't exclusive to medicine. anyway, I hope community appreciates a perspective from the other side of that organisation, I was hoping to illustrate we ultimately share the same goal - better patient outcomes and safety.
- DANmode 2mo ago
  Do you share the same goal enough to walk until it’s more people are being cared for properly? Not trying to personally attack - it’s a question I’d like to gently ask anyone who empathizes from within. Unfortunately there’s only so much individuals can do - we must lean on each other to really review.
- DANmode 2mo ago
  > If understaffing forces Nope. If allowing sufficient staff to graduate such that hospitals are staffed isn’t on your todo list as an organization, then there had better be money allocated to ensure you can pay people to show up. Chronic (decades) understaffing while profits remain at record highs means you kept too much money. It doesn’t take an accountant to do that math. I have an idea of where to get the money, too: the ever-increasing revenue streams, ever-increasing admin pay, and ever-increasing shareholder payout, again, at minimum until the organization is operating at a bare minimum for a first-world country, able to do basic things like childbirth better than nations with comparatively no money...

DANmode 2mo ago

> as the other commenter said—thank you—don’t physicians deserve to pool bargaining power like other workers? For the same reason Americans don’t care much about the (often very valid) complaints of Congresspeople, you’ll want to start ensuring better service before you start asking for us to care and make noise for you.