11 ms·

The Dark Side of Doctoring

347 points by dy 9y ago

markroseman 9y ago
Dr. Pamela Wible has long been a very loud voice on the issue of doctor suicide. Check out her website http://www.idealmedicalcare.org http://www.idealmedicalcare.org, which includes a link to her TED talk on the subject.
protonfish 9y ago
The FAA enforces work limitations on pilots, but we schedule our health care workers like this? How are there not even civil cases against errors caused by this kind of administrative foolishness? Overworking doctors like this is insane.
- mikeleeorg 9y ago
  ER doctors work on a shift schedule, which has many documented advantages and disadvantages. Health issues are among the disadvantages. In my opinion, they can be pretty serious. Many medical specialities have concerns with depression and suicide. ER and ICU are among the two with which I have personal experience that face these issues quite acutely. If you have a loved one in one of those departments, the last thing you want to hear is that your physician may be dealing with depression and suicidal thoughts. Personally, I don't think the advantages outweigh the disadvantages. I suspect removing the shift schedule nature of emergency medicine may have a remarkable improvement. Many ER nurses and clinics have already moved away from a rotating shift schedule, and I haven't heard of any serious repercussions. I really hope emergency physicians follow suit someday. Or, find an alternative model that doesn't incur such health issues.
  - sxg 9y ago
    Can you go into more detail about this? I'm currently a medical student in the US near the end of my training, and I'm weighing multiple specialties (including ED). From my personal experience in the ED, it's actually the best schedule I've worked. Yes, it's irregular, but you're always working a fixed amount of time per shift and a fixed amount of hours per week (seems to be around 40). You know when you're on, and you know when you're off. Working three 12 hour shifts per week felt very doable. Most other specialties have call at least once a week, and there are days where you end up staying several hours longer than you expected. True weekends (Friday evening through Sunday evening off) seemed uncommon in other specialties as well. Not doubting what you're saying—I'd just like to hear more about your side of things.
    - mikeleeorg 9y ago
      I guess it depends on the person and your situation. Before we had kids, my wife's shift schedule wasn't too bad. I owned my own business and could take time off when she was free during weekdays. Now that we have kids, the shift schedule is tougher on her. Kids don't work on a shift schedule, and when they make demands of her time and I'm unable to help, she ends up sacrificing her sleep. That happens often enough that it makes any jokes about startup founders being sleep deprived, well, a joke. Somehow, she's able to rally herself and get enough energy to work through a string of night shifts, even after having to take the toddler to the pediatrician during the day if I wasn't able to. My wife also moonlights at another hospital (something she did back when I was getting my startup going and we needed the extra income). She continues to do this because she enjoys the work there (it's higher acuity). That's just our personal experience. Colleagues of hers have solved this by hiring help (au pairs, nannies, etc), which we intend to do soon. She's told me stories about some of her colleagues that don't have kids and have their own share of difficulties. One of them recently dealt with a particular tough case where a 3yo died. There's a culture in the ED where you don't take time off unless you're truly dying. Got the sniffles? Suck it up and come to work. Dealing with a traumatic experience and can't sleep because you've been crying all night? Suck it up and come to work. Hopefully that colleague finds a way to cope, because it's kind of frightening to me, as an outsider, to think of my ED doctor being that person. I can only speak to the ED specialty. I'm clueless about other medical specialities and any potential health issues around them.
      - sxg 9y ago
        Thanks for the response. I'll definitely keep that in mind as I pick a specialty. I'm only a med student right now, but I have spent a year rotating through all of the most common specialties. I have to say that the culture you describe isn't unique to the ED. I've seen it throughout the hospital. Taking time off isn't easy in any specialty. I've found this to be especially true in the niche subspecialties (especially surgical subspecialties). I work with a colorectal surgeon who is the only colorectal surgeon at her particular hospital. She's responsible for all of the patients she's ever treated and any emergencies that may need a colorectal surgeon. It's nearly impossible for her to ever take time off or even leave the city for more than a few days. An advantage that I see for ED physicians is that they're not directly tied to patients. Any ED physician can fill in for another when the need arises. I can't speak to whether that actually happens, but theoretically it's possible in the ED.
- macrael 9y ago
  There is a tradeoff that is used to justify the long hours. On the one hand, having a well rested doctor is obviously good for them to be making good decisions. But on the other hand, patient handoffs are dangerous. The more times you change the person responsible for a patient, the longer the game of telephone you are playing with their care. This has been measured as being bad for patient outcomes. Now, that doesn't seem to justify the fact that long hour shifts are placed so close together. It seems like you could give doctors a longer break in between shifts than they have. Residents have the worst of it. The attending actually do get a fair amount of time on/off. Residents already work a lot less than they did 50 years ago, some think that their training should be extended to cover the loss of density.
  - pdelbarba 9y ago
    Maybe OT, but pilots have a lot of time off between shifts and it's starting to come to light that their depression rates are much higher than anyone is comfortable admitting. This may from a different source though, since flying is very much about precise repetition and less about complex decision making (ADM is hard, but not the same level of mental stress that doctors endure), you eventually realize that you're a very highly trained bus driver.
    - killjoywashere 9y ago
      Pilots have more incentive to manage their fatigue: if they screw up, they die.
      - pdelbarba 9y ago
        It's way more complex than that though. The regulations exist because companies were pushing pilots to do more than they could handle, leading to a number of high profile crashes. Yes, the pilots are incentivized to manage fatigue but it's like any other profession, it's easy to get complacent.
    - devdas 9y ago
      Regulations for pilots currently mean that any treatment for depression means the pilot will no longer have a valid license. https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/antidepressants/ https://www.faa.gov/about/office_org/headquarters_offices/av...
- maxerickson 9y ago
  The training for airline pilots is a lot less than for doctors. A couple thousand hours of flying, many of which can be paid work (like flying an add banner).
  - pdelbarba 9y ago
    Depends on what you call training. 250 hours under a private (no payment allowed) licence, then you get your CPL. All of this is on your dime (average about $200/hr with instructor and such). The CPL phase work afterward (banner flying, flight instruction, etc) pays like garbage since the GA community is struggling significantly. To do airline work, you need minimum 1500 hours (ATP), then pilots have a sort of residency beyond that where they need to spend a month in airline training, then years as a first officer before becoming a captain (PIC). On top of this, you have the regionals where you get payed like crap before you can typically get a seat at a major airline.
    - maxerickson 9y ago
      Doctors begin their professional training after 7 or 8 years of post secondary education. Much of the time, on their own dime. They also generally work hard enough in high school to get excellent grades (do flight instructors check transcripts or just if the check clears?). It's easy to imagine doing 250 hours over 3 or 4 years while doing something else most of the time.
      - pdelbarba 9y ago
        To fly for the airlines you'll need a college degree, probably with a >3.0 GPA. I agree it's not as academically rigorous though (unless you count the USAF route). Also, most people I've seen do the 250 in as short a time as possible or go part 141 which is a sort of direct-to-CPL training program. Right now there's a shortage of airline pilots but traditionally, those 7-8 years you mention would be spent at a regional before you have a chance at making enough money to start to really service all the debt you undoubtedly have at that point. Obviously they're pretty different career paths, but they're both effectively 'trades', in a more traditional sense, that require obscene amounts of training.
douche 9y ago
This sounds like unrelenting Taylorism, trying to scrape too little butter on too much toast. If all this administrative work needs to be done, do surgeons necessarily need to do it? Can we hire more clerical specialists to offload that work onto, or more PAs or RNs to handle less specialized work? A few measly hundred million in the federal budget could probably be dredged up to subsidize medical school tuition and take some of the sting out of the long, expensive marathon of medical schooling, maybe?
logfromblammo 9y ago
It would appear that the relentless dehumanization of the skilled laborer by business interests has finally spread to the professional classes. I can't even recall how many young software companies I have sent my resume to that turned out to be in the business of building software for insurers and hospital systems that end up telling physicians how to do their jobs. Of course, the metrics all back this up as a solid plan that increases productivity and reduces expensive errors and negative outcomes due to inattention, but I know it just has to suck for the docs to have to experience exactly the same thing that has already happened to most other jobs.
aabajian 9y ago
It's worth noting that the incredible success of Epic EMR software is because it tightly controls all of the administrative billing issues, NOT because it makes clinician's lives easier. There are endless check boxes in Epic and each site has its own interface. It's a huge mess and difficult to navigate...but arguably still better than the other vendors.
- ploxiln 9y ago
  ... sounds like the medical equivalent of Jira ...
  - zdw 9y ago
    As someone who has used both, Jira is lightyears ahead of Epic, which still requires a Windows TS session to run properly, and for many administrative or complex operations still requires you to drop into the MUMPS backend environment, which is >50 years old and predates Fortran.
- markroseman 9y ago
  Absolutely it's about the administrative end and not patient care. We've got a situation in our regional health authority (Vancouver Island, BC, Canada) where they're trying to roll out a significant update/expansion to their EMR (Cerner-based) in the hospital in Nanaimo. Despite immense pressure, some docs have been now suspended for refusing to use it and switching back to paper, despite the massive increase in time it takes to provide the same patient care, and also because of notable examples where the EMR has endangered patient safety. (Google 'ihealth nanaimo' if you're curious for details, then rinse and repeat for the same story in so many other places)
  - epmatsw 9y ago
    This is a pretty shocking opinion to see expressed. Like, you may as well have said "A bunch of developers at <place> decided to go back to C89 because writing code in Rust was too slow, plus did you see the bugs in its borrow checker?" . Do you really believe that paper is a safer alternative?
bluetwo 9y ago
Where does the AMA stand on this?
- killjoywashere 9y ago
  They actively pursue minimizing the number of medical school seats and their lobbying has been tightly aligned with Republican health care policies for decades. Check out Paul Starr's The Social Transformation of American Medicine
  - deleted 9y ago
    [deleted]
  - kyouens 9y ago
    The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamental problem. I have seen comments talking about "physician cartels" purposely encouraging a labor shortage to drive up physician pay. There is no physician cartel. Only about 15% of physicians even belong to the AMA, and only a subset of those have any political involvement at all. It just doesn't exist. One of the things that I think contributes to the general dissatisfaction of physicians in 2017 is the increasingly negative public opinion of the medical profession and the imputation that there is some sort of evil conspiracy at work. A lot of the negative opinion is misdirected. It should be aimed at the for-profit health care system itself. Most physicians I know have very little control over the things people complain about, including cost.
    - killjoywashere 9y ago
      Depends on who's complaining about a bottleneck. The AMA caters to a base that is not happy with the influx of IMGs and DOs. The AMA inflates their numbers by auto-enrolling every allopathic medical student. The AMA is equally unhappy that the government using large scale funding levers at the residency level to overwhelm their efforts to tighten supply. By using money and their exclusive access to legislate, the government creates such a Venturi effect that they suck up all the available MDs, and all the available graduates from two other pipelines: the DO programs and the IMGs. In 2017, the dissatisfaction of the 85% of physicians who don't belong to the AMA is ultimately driven by too much work. Source: am physician. Have worked primary care, seeing 40+ patients a day, now completing a specialist residency. My work as an underpaid primary care doc was enough to keep 3-5 people fully employed (reception, x-ray certified assistant (sometimes 2), office manager, owner) from 8 am to 10 pm 7 days a week, while sending overflow to others. Every one of the 85% of physicians who aren't in the AMA declined to renew their membership at some point. Many align with other orgs: almost invariably their specialty's organization, which aligns with the AMA but they are more professionally beholden to (for CME, board certification, etc). Many try to offset the ill effects of the AMA by aligning with other orgs like PSR or MSF or their local public clinics. But the AMA has a bunch of offices in DC, and has had people in those offices, paying mortgages in McLean or Chantilly, or Silver Spring, <insert DC suburb here> for a century. Those people are motivated to continue their mission of lobbying in support of the legal grip of allopathic medicine, long past their original call to arms (licensure laws to cleanse the field of snake oil salesmen).
johan_larson 9y ago
Why continue in a job that sucks that hard? Is it the money? The prestige? Family expectations? It seems like a terrible way to live.
- douche 9y ago
  As a first guess, the tens or hundreds of thousands of dollars in student loan debt that were incurred becoming educated and licensed as a surgeon in the first place.
- Jtsummers 9y ago
  The doctors I know, despite the toil and suffering, really, really like being doctors. They like what they do for other people. To a one, they are more than capable enough to jump into any other career, likely more profitable (when seen as a ratio of time/money or pain/money at least). This isn't true of all doctors, but you'll probably find that ones that suffer through like what the author (Dr. Levi) discusses find that their practice is a calling, not an occupation or job. As a calling, it's part of their identity, giving up on it just doesn't make sense to them.
- exclusiv 9y ago
  I'd imagine it's highly rewarding delivering results for patients. I have heard from doctors in my family that the administrative overhead that's been put in place has made it way less appealing than it used to be.
- 2mur 9y ago
  For me: * Golden handcuffs * Sunk cost * Rewarding mastery * Deep specialized knowledge with no other remuneration prospects for that knowledge.
- Kenji 9y ago
  Why continue going to bed too late every night? Why continue to eat unhealthy food? Why continue to work out too little? Why continue taking drugs? Why doesn't everyone just live a perfect life? It's not easy to give up things and change, even if it's ultimately for the better. Let's face it: Workaholism and burnout are addiction problems.
tejaswiy 9y ago
After working in healthcare IT, I can atleast attest to the general UI clunkiness and terrible software quality that is prevalent in the industry. Innovation in Health IT happens usually because CMS (Agency that administers Medicare, Medicaid etc) looks at the landscape and comes up with a carrot / stick rewards system to force Hospitals and practices to update their software. They generally do things like: * Hey you need to store records electronically. If you do this by X, you will get Y$. If not, you will be penalized Z$ every year after X. * Hey the system you built - It needs to actually be able to talk to other systems. If you do this by X.. you get the point. * The data you're collecting in your system is stupid. We need X, Y and Z reports to ensure you're actually using the system as we meant for you to use the system. Do this by X. Several other misc things I noticed: The industry by itself is extremely complex with business requirements that vary between hospitals, practices, labs and so on. This makes connecting systems together a nightmare. Even when you manage to integrate systems, each hospital and practice has a set of business practices (forms they collect, the way they organize information etc) that make rolling software out very hard. Configurability is king. Making everything configurable and having configuration engineers set things up makes automated testing very hard at a UI level. This leads to some sharp corners and contributes to bugs and general UX clunkiness. UX design isn't generally valued and suits / "business requirements" / timelines are prioritised over usable, stable, secure software. This is a typical UI: http://uxpajournal.org/wp-content/uploads/2014/07/smelcer3.gif http://uxpajournal.org/wp-content/uploads/2014/07/smelcer3.g... Standards are out of date and the only thing pushing innovation here is CMS doing its best. The problem with this is that they're a govt agency, so they're generally slow and they're an insurance company, so their primary motivation is to cut cost of care. Doctors are generally smart, and you can sometimes get good feedback from them, but they're already overworked and can't really vocalize what they find frustrating about software. I hate to generalize, but in my experience atleast, all other people (middle management, front-desk staff) are useless. By that I mean they just don't understand how software works. There are some smart CIOs, but they care about their position and the hospital bottom-line, so trying to sell them something that doesn't exactly line up with the CMS carrot / stick model is basically impossible.
pixelmonkey 9y ago
My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... 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." If doctors were viewed in their industry the way software engineers are viewed in ours -- as specialized skilled labor with extreme leverage and limited time -- then we would have well-supported, well-rested, and well-compensated doctors. But as it stands, we have overworked and overtired doctors buried under a mountain of clerical work, who need to slot their patient in to 15-minute "encounters" in clinic to keep the profit machine running. Meanwhile, administrators, health insurance executives, and medical equipment CEOs work 9-to-5 and earn millions. It really boggles the mind and infuriates me, as a technologist. p.s. Don't listen to any of the comment threads here that say long hours are required to reduce patient handoffs. Yes, it's true, patient handoffs cause some danger. But tired doctors make mistakes. Period. And, as this post indicates, a perpetually tired doctor burns out and either quits the profession or (worse) commits suicide, which is the worst possible outcome for the system.
- thearn4 9y ago
  I'm not a medical professional, but the whole discussion of handoff risk always seemed to me like it was side-stepping the real issue presented, which is poor documentation and/or communication between peers. Instead, the premise is offered by the AMA that handoff risk can only be minimized by insane shift lengths.
- QML 9y ago
  Do you think if the United States graduated more doctors every year, it would prevent doctors as a group from being overworked and overtired? As a college student, I often wonder why pre-med is so academically competitive despite the fact that the ambition to help others is a virtue; and whether that competitiveness to get a high GPA and MCAT score is needed at all.
k__ 9y ago
Why do we do this to people who save our life's? Why do we let them burn out?
hourislate 9y ago
Perhaps the solution to the unreasonable demands placed on Doctors/Surgeons is moving forward with A.I, Stem Cell research, Robotic surgery, etc. Technology should relieve some of the pressure.
- eplanit 9y ago
  That is one of the primary targets for IBM's Watson, and it seems ready[1][2]. More and more my subjective risk calculation favors AI for diagnosis. This one aspect I believe accounts for most of the overall time/effort spent in dealing with patients. To apply AI at the start of the process makes a lot of sense -- reduce/eliminate errors at the start and allow doctors and their time to be better used. [1] http://www.nydailynews.com/news/world/ibm-watson-proper-diagnosis-doctors-stumped-article-1.2741857 http://www.nydailynews.com/news/world/ibm-watson-proper-diag... [2] http://www.businessinsider.com/ibms-watson-may-soon-be-the-best-doctor-in-the-world-2014-4 http://www.businessinsider.com/ibms-watson-may-soon-be-the-b...
- markroseman 9y ago
  Keep in mind the technology has to fit into the existing regulatory and legal framework. Which also includes, if something goes wrong, who are you going to sue?
drewg123 9y ago
It seems like we have an undersupply of physicians. My understanding is that the AMA limits medical school admissions[1] in order to keep salaries artificially high. This naturally leads to overwork in addition to high salaries. [1] http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm http://www.usatoday.com/news/health/2005-03-02-doctor-shorta...
- EvanAnderson 9y ago
  Here's the go-to that I send people to when this comes up: https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a...
  - maxerickson 9y ago
    The why is complicated, it seems obvious enough that more doctors would be a good thing. Or at least, more practitioners. We don't need doctors with huge amounts of training to do every evaluation.
    - drewg123 9y ago
      True, but the AMA seems to fight enabling other professions (nurses, pharmacists) from taking on roles traditionally held by doctors. I rather wish software engineering had a professional association with the lobbying power of the AMA.
      - arjie 9y ago
        It would be a damned nightmare. The practitioners are dying of overwork, their patients are dying due to being treated by people who can barely stand after 36-hr days, and meanwhile the professional association comes up with a worker wellbeing plan. Incompetence on a national scale.
  - nilkn 9y ago
    Unfortunately this didn't really clear up my confusion. In particular, the points brought up by the second answer there seem relatively unresolved. Why should DO graduates be growing significantly faster in number (proportionately) than MD graduates, when traditionally an MD degree is more desirable than a DO degree, despite both being mostly equivalent? A few possible conclusions. I don't have enough knowledge to pick one. Some of my speculation might even be wrong. (A) DOs and MDs filter through different or mostly different residency pipelines. Thus, residency limits for MDs don't affect DOs, so the DO population can grow more quickly. (B) DOs and MDs do filter through mostly the same residency pipeline, and the increasing number of DO graduates is causing an increasing number of residency applicants to not be admitted to any residency program. (This malicious situation would be similar to the situation with law schools, which admit and graduate far more lawyers than the industry can possibly sustain and support in its current state.) (C) There's enough non-government funding of residency slots that residencies are not as bottlenecked as the first answer claims. If so, this re-raises the question on whether MD admission is being rate-limited to increase scarcity and thus salaries. (D) Perhaps something else I'm not thinking of.
electriclove 9y ago
Let's create MORE doctors.. There is no shortage of capable people interested in becoming physicians.
- JabavuAdams 9y ago
  Do you really believe we've maxed out on capable people with the interest?
  - electriclove 9y ago
    Not at all.. the supply is constrained for all the wrong reasons.
Gatsky 9y ago
Bear in mind this ENT surgeon is still in training, and probably close to 40 years old assuming he started Uni at 18. Training is often brutal because towards the end you are probably among the most important and useful people in the hospital in terms of delivering care, but also have very little control, so of course you get abused. Eg this guy has to write medical certificates as well as perform emergency life saving surgery at 2am and have crushing family meetings with patients dying from untreatable head and neck cancers. Simplistic supply and demand analysis of this issue is annoying and ignores basic economic theory. You don't want to increase doctor supply, you want to increase the capacity of the healthcare system to deliver good care (obviously?). Doctor supply is one part of that, but if you pump medical students in at one end and do nothing else, you will fail - this is what the Australian gov has done, and you can see the result here, where trainee conditions are poor (so much competition that you don't complain about conditions, power is concentrated in hospitals and senior drs in charge of training programs and hiring who align the system in their favour), and incumbent physicians like the one that committed suicide work like demons and burn out. The financial corollary is fiscal stimulus without any production capacity - GDP doesn't go up, inflation does. As always, it doesn't have to be this way, but nobody is in charge who cares enough to fix it, and all the stakeholders look after their own interests.
pc2g4d 9y ago
So... because the supply of doctors is restricted but demand for doctors grows proportionally to the population, the amount of work per doctor gradually increases and doctors, persuaded by their ethical obligation of care, put up with it as long as possible until they snap. Yeah? I just recently had a friend completely burn out of medicine, sell his house, and start traveling the world. He was brilliant, a good doctor, a good person. It's a shame he's been driven out, and so many others. I also recently had the experience of seeing a young doctor bright-eyed and busy-tailed treat me once, and then six months later see him again. The toll that those six months took on him was visible. He was just about haggard with the work. It's easy to imagine he won't last long. I feel there's an interesting parallel with teaching. Teaching and medicine both have licensure requirements, both have a strong appeal to people who care and want to make a difference in the lives of children/patients. And in both cases the profession is gradually being taken over by administrators and subject to increasingly onerous regulations. I also recently had a friend burn out of teaching. She's set to work in a completely unrelated industry now. She put up with crap for a long time due to her care for the children, but at last she couldn't take it. My libertarian side says these are two improperly functioning markets, with massive human casualties. It's a shame.
- djsumdog 9y ago
  This is what I felt when I read the article. It was surprised even the Australian system is just as overloaded as our American system. I feel like a lot of these problems could be deal with if there were simply more doctors. That being said, it's a difficult profession. Not a lot of people want to do it. Even fewer in such specialised positions as surgery, where mistakes literally cost people lives. There's no rolling back to a previous release or taking a break. Everything that happens, happen on that table with that body open. Tack on the insane costs, at least in America, for going to school to be a doctor and you also have a situation where few people feel they can afford to be GPs (even though that might be what they really want to be; and the world needs more GPs desperately) and you also have doctors who are now locked into a profession to simply paid their debts. > I just recently had a friend completely burn out of medicine, sell his house, and start traveling the world. I don't think this is a bad thing. Everyone who can afford to should really save up and take a sabbatical every few years: http://khanism.org/perspective/minimalism/ http://khanism.org/perspective/minimalism/
Mz 9y ago
From what I gather, one of the reasons physicians like Direct Primary Care is that it is a saner system than what you see in most American medical facilities. I am sort of a medical system drop out. I took my toys and went the fuck home. (No, I was not a doctor. I was a patient who could not get my needs adequately met and walked away from conventional medical treatment for my condition.) So, a lot of people assume I am very anti medicine. They think I am some crazy who just hates modern medicine. This is absolutely not true. But I do hate certain aspects of the system. I think Direct Primary Care would be a step in the right direction. If you are interested in reading a bit about that, I have written a few pieces about Direct Primary Care. http://micheleincalifornia.blogspot.com/search?q=direct+primary+care http://micheleincalifornia.blogspot.com/search?q=direct+prim...
markroseman 9y ago
One theme coming up here is the idea of just graduating more doctors, but even ignoring artificial pressures to keep supply low, it's not that simple. Many disciplines, particularly things like surgery, have a lot of requirements beyond just doctors, i.e. nurses, anaesthesia, OR's, hospitals, etc. In Canada, we have a fair number of people in certain specialties that cannot find work - think a radiation oncologist who needs some pretty specialized and expensive equipment that only exists in a few places to be useful. But also even more basic... gastroenterologists who can't get enough OR time to do scopes on their patients.
robbiep 9y ago
Here is some context for this article: Dr Levi is n Australian surgeon. He is responding to a letter from the wife of a gastroenterologist who committed suicide recently. Last week was the Royal Australasian College of Surgeons Annual scientific Congress in adelaide so physician wellbeing is well and truly on the radar, in particular following 3 suicides in the last 6-9 months of junior trainees, one of whom was a friend of mine from medical school. There is now an enquiry into Doctor suicides and wellbeing being performed at the state level in NSW and we (doctors) expect this scope to be broadened to nationwide
- Gatsky 9y ago
  I wish I could applaud this. But what sort of professional organisation waits until its members are actually dying before putting well-being in the radar? The RACS, RACP etc are sclerotic organisations run by old white men in bow ties (I've met several of them) with no real incentive to improve conditions for trainees. The only way I have seen actual change happen is when junior staff band together and effectively go on strike.
  - robbiep 9y ago
    Couldn't agree with you more re RACS, I attended their 'gala ball' at the end of their ACS last year and was sickened by the pomp and bullshit. The (female) RCS president, visiting from England, also appeared weirded out by the pomp (and that the RACS had not had a female president). Having said that within both organisations there are people who strongly and fiercely advocate for innovation and change, but you are right, they are severely sclerotic (even to the point of RACS making an absolute motza out of their trainees, they've got over $60m in the bank and our exams cost $4,000)
    - Kali909 9y ago
      I don't know too much about the RACS etc (father was a radiologist but can't recall him complaining about their equivalent in Aus too much, though it's likely the same). If you have to be a member of this, and that's government mandated, then them profiting from that arrangement is a blatant monopoly isn't it?
novalis78 9y ago
Maybe he would be much happier working at a place like the Surgery Center of Oklahoma which seems to do much better on the administrative side of things.
kendallpark 9y ago
This is a problem in medical school as well. I can't tell you how many anonymous posts have been popping up on r/medicalschool lately about being depressed, isolated, lonely, and/or suicidal. Missouri just passed the first bill of its kind to try and combat mental health issues in med school. http://krcgtv.com/news/local/medical-student-suicide-prompts-proposed-missouri-legislation http://krcgtv.com/news/local/medical-student-suicide-prompts... > The bill, also known as the Show-Me Compassionate Medical Education Act would establish a committee to study mental illness, suicide and depression in the state's six medical schools. The bill would also prohibit any medical school from restricting a study on the mental health of its students. The absolute disturbing part is right here: > While lawmakers debated the legislation, Frederick said the deans from each of the state's medical schools sent him a joint letter expressing opposition to his proposed law. In other recent news, Saint Louis University fired their med school dean that was the absolute champion of promoting the mental health of SLU's students. http://news.stlpublicradio.org/post/slus-medical-school-removes-dean-lauded-preventing-student-depression#stream/0 http://news.stlpublicradio.org/post/slus-medical-school-remo... Furthermore, as part of the licensing process, you are asked whether you were diagnosed with a mental illness in the past. There will likely be an investigation if you say yes and it could impact your career. This stigmatizes mental illness within the profession and keeps people from seeking help when they need it.
- hbosch 9y ago
  I have a friend who is graduating from med school this week and starting residency. The stories of med school drama, gossip, backstabbing and cheating are insane - on par with anything on television drama. Moving into residency, they also feel alone, exhausted and anxious... I don't know how many people manage. I think knowing a doctor, or someone becoming a doctor, has changed my perception of doctors entirely.
  - kendallpark 9y ago
    I am fortunate that my school seems to vet the students well for character. Or perhaps it's self-selecting because we do PBL which requires collaboration. We don't have the issues with backstabbing and drama that I've heard from other schools. I think my classmates are perhaps my favorite part of the med school. The scariest thing in med school is how vulnerable you are to someone with authority screwing over your entire future. Piss off an attending? Well, they could right a terrible letter for you that hurts your ability to match into the specialty you want. You could straight up witness mistreatment of a patient by a superior, report it, and have your entire future altered forever because of people above being petty or vindictive.
yakult 9y ago
According to my GP, selection for doctors include psychiatric profiling designed to select for the most compassionate. While I can see why the hospitals would want this - compassionate doctors are good PR -this seems to be a case of misaligned incentives. Those with less compassion would suffer less and cope better when surrounded by death and suffering on a daily basis. On the whole, this probably means they'll do a better job, too.
- krallja 9y ago
  What country are you in?
woodandsteel 9y ago
I wonder if there are any research projects comparing physician workload and satisfaction in various countries with various health care systems.
themantalope 9y ago
I'm a medical student at a top 20 allopathic school in the U.S. This article resonated with me. I think the part that struck me the most was his comments about time. I have diverse academic interests. I studied math and bio in undergrad. I love machine learning and software development (esp python). I lived in China to study the language for a year. All that gets sucked out of medical school though. We are expected to learn a ton of material in the first two years. Then in the second two years, we are basically working a full time job in the hospital/clinics while also studying. We are constantly evaluated. We are also expected to do research and publish papers. I've forgotten what a guilt-free day off feels like.
joshuaheard 9y ago
I am a lawyer, and if this was a lawyer's story, this would be my advice for the firm. First, they need to hire more lawyers. This guy is way too busy and will make a mistake. Second, he needs a receptionist, secretary, and paralegal to support him. It is wasteful to pay him a doctor's salary to answer phones. Third, they need to streamline their record keeping so he doesn't spend so much time filling out paperwork.
- themantalope 9y ago
  >It is wasteful to pay him a doctor's salary to answer phones. This is something I don't understand. I'm a medical student, and the amount of time I've seen wasted watching older physicians type notes is staggering. Just have them dictate the notes and hire a secretary. Perhaps for legal/liability reasons doctors need to write their own notes but it's just such a waste of time, and we pay a lot for it.
  - paulcole 9y ago
    >we pay a lot for it. Do we really though? I'm assuming a doctor is a salaried position so the more busy work they get the more hours they work? Doesn't this mean their time becomes less valuable?
    - themantalope 9y ago
      It really depends. Some are completely salaried positions. Some physicians are completely private so what they earn is directly tied to how much they work. Even those who are salaried often have some kind of compensation or bonus for extra work. And even if they are salaried, having physicians type notes is not making the best use of their training and time.
- pmiller2 9y ago
  What's the medical equivalent of a paralegal? A good nurse?
  - 9y ago
andy 9y ago
What other dark side of doctoring issue can I think of? Well, the doctors and nurses at Fairmount kept me prisoner without the ability to call my friends or family, denied me water, physically tackled me and tied me down. I was not allowed to use a lawyer of my choosing. I did not hit back when they tackled me. I never committed a crime. I feel like I am being repetitive. That is completely on purpose. The dark side of doctoring is at Fairmount Behavioral Health in Philadelphia, PA. It's a hellhole and should be closed. https://surroundedbyspies.com https://surroundedbyspies.com
andy 9y ago
What other dark side of doctoring issue can I think of? Well, the doctors and nurses at Fairmount kept me prisoner without the ability to call my friends or family, denied me water, physically tackled me and tied me down. I was not allowed to use a lawyer of my choosing. I did not hit back when they tackled me. I never committed a crime. I feel like I am being repetitive. That is completely on purpose. The dark side of doctoring is at Fairmount Behavioral Health in Philadelphia, PA. It's a hellhole and should be closed.
bobbington 9y ago
Us government ruining everything. GET OUT OF MY LIFE GOVERNMENT. The government should have no say in who can practice medicine. Currently it's a criminal racket as far as I'm concerned. It requires like 15 years of higher education to be able to be a doctor!! That's so stupid, especially with google. And once they graduate, it leads to a false sense that they know it all. Government prohibiting the practice of medicine is the cause of so much ill in this country it is ridiculous. It stifles innovation. The official doctors have been known to ridicule things that were proven critical to success. For example now we know that germs cause disease. Well back in the day, they ridiculed people for belicjnf that microscopic bacteria could kill people. As a. Result doctors killed. A lot of people through their terrible practices. It still happens today.
known 9y ago
http://blogs.law.harvard.edu/abinazir/2005/05/23/why-you-should-not-go-to-medical-school-a-gleefully-biased-rant/ http://blogs.law.harvard.edu/abinazir/2005/05/23/why-you-sho...
erikb 9y ago
Life gets harder the more we dive into the financial crisis. Blue collar workers sometimes don't even get a job anymore, or work 3 at the same time just to pay rent. White collar workers work themselves to death in one job, although I have to admit it's maybe only 80% as harsh for IT as in medical. Even the rich that we all complain about lose more and more control over their money and their investments. We just don't like to see that, since who wants to admit that someone above oneself in the foodchain may also be struggling? Then we would also need to admit that the dream part of why we slave off ourselves so much will never be true as well. I don't think that we're heading into a zombie apocalypse level destruction. Highly skilled people will always have one of the best lives. But it gets harder for everybody, and no matter how much we complain there isn't anybody who can give us a better life at the moment. Everybody is losing something.
timwaagh 9y ago
a surgeon is considered replacable? they just might be the least replacable professionals out there. i don't know what he is thinking. doctors are the elite. at least where i live a surgeon can out-earn even government ministers and CEO's. indispensible. irreplacable. the rest of the industry should therefore be focussed on getting as much value out of these doctors. which means they should be focussing on taking any paperwork out of docs hands.
Ericson2314 9y ago
So clearly healthcare in the US is fucked end to end. Has anyone (government or private sector) tried or proposed some sort of trial hospital where we just clean-slate redesign and evaluate the whole thing? *Probably would need to be government as would need exceptions from tons of laws.
- markroseman 9y ago
  Or look outside the USA at dozens of other countries that may have some problems with their healthcare systems, but aren't anywhere close to as completely fucked up. Read the comments and listen to the debates, and understand that it isn't going to get better until Americans believe that the availability of healthcare shouldn't be solely dependent on income, and that "freedom" around payment and insurance shouldn't be the primary value.
kapauldo 9y ago
Hard to feel sympathy for millionaires living a life of their choosing.
- markroseman 9y ago
  My wife is a doctor, over a dozen years in practice. Tell our mortgage about how she's a millionaire. And to me, a life of her choice would likely have a lot less stress and shorter hours, and not worrying that the income would dry up if she has to stop working.
qrbLPHiKpiux 9y ago
Another modern problem is private equity in the business of health care making money hand over fist with all libiality on the individual physician. All risk shifted from the partners.
Melchizedek 9y ago
The bourgeoisie has stripped of its halo every occupation hitherto honored and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science, into its paid wage laborers. Karl Marx
Floegipoky 9y ago
Related: http://www.wbur.org/commonhealth/2017/05/12/boston-electronic-medical-records http://www.wbur.org/commonhealth/2017/05/12/boston-electroni... I always see people ragging on EMRs. They're inefficient, have poor UX, require way too much documentation, etc. These are all fair criticisms, but I don't think people spend enough time asking why. Why are all the major EMR systems shitty in exactly the same way? I think there's 2 main parts to the answer. The first is the sales process. The people selling EMRs to hospitals aren't selling their product to clinicians, they're selling their brand to the hospital administration. It's like the saying "nobody ever got fired for choosing Oracle", but far worse. The end result is years-long implementation processes, broken promises, and terrible tools that are optimized to allow the hospital to fire a few members of the low-level administrative staff (billing, coding, etc) instead of providing better care to the community they serve. The second part of this problem is overregulation. The justification is that EMRs should be able to meet a certain level of functionality. Based on personal experience working with these regulations, I'm convinced that the real reason these certifications exist is to prevent new players from entering the market. They are very much in the spirit of "well all these legacy systems do [something], so _obviously_ everybody else should too" without ever leaving room to come up with a better solution. They shackle you to terrible design choices and assume that all hospitals, from a 10-bed critical access hospital to a 500-bed academic medical center, should all be run the same way. And worst of all, they make it impossible to design a system based on what the HOSPITAL needs, because half of the system is devoted to what the GOVERNMENT needs. Kind of like how people complain about interoperability between electronic medical systems. So the government introduces legislation to mandate interoperability, by requiring implementation of poorly-defined "standards" (designed by committees comprised mostly of, you guessed it, representatives from legacy vendors). From personal experience, I can say that every. single. one. of the interfaces required for federal certification is completely unable to be reused by actual hospitals. But that's the entire purpose, that's exactly why lobbyists paid so much money to get the regulations passed in the first place! If potential new competition has to sink thousands of man-hours every year into building useless functionality, that's thousands of man-hours that didn't go into making their product competitive and disrupting the marketshare of legacy systems. Meanwhile, legacy systems are maintaining their market share, not by improving their product and helping healthcare providers do a better job. Instead they're actively creating situations where smaller hospitals are forced to choose between buying onto the licenses of larger hospitals or shutting their doors. Obviously this is all just my personal opinion.
harmonicon 9y ago
I am not a doctor, though I have many friends that are either med student or residents and do hear about the harrowing workload and stress quite a bit. I just want to point out the sentiment expressed here should all sounds very familiar to anyone who has ever had a job. The managing class (Company CEO, Hospital/University administrators) is ever in the pursuit of more profit, euphemized as "efficiency" or "optimization", at the expense on everything else. How can we squeeze the employees a little harder so we don't have to hire as many? How can we increase "productivity" so more patients can be seen(and pay up)? How can we eliminate waste (lower cost of care as much as possible so we can make more) to the patient? How can we make more money by tweaking our charging model (Insurance rewarding loyal customer by charging them more, Hospital Chargemaster etc)? Oops, I see people are complaining a lot. Let me pay some lip service about appreciating our employees and valuing our customer/patients. Heck I am feeling extra generous right now , let's put up some cheap program they can participate in. There, they should feel happy now. This is all too familiar in the corporate world. Any employees with a half a brain will get the message loud and clear: employers do NOT care. Or maybe they do, just nowhere near money. See, their incentive is aligned quite nicely: cost cutting/profit increasing actions are how they justify their pay and the profit it generates is how they pay themselves. Everything else can be sacrificed. Caring for a patient is a very intellectual, specialized and dare I say it creative task. Doctors are paid well above many other professions though one can argue it is not for the years they have to invest into training and the work hours. The point is, at the end of day they are glorified laborers, being told by their boss what to do, just like the rest of us. Prestige has shielded the medical profession for decades but now the grip of corporate America has finally caught up. And lo and behold, what scant voice and influence do we have! We absolutely do need managers/administrators. We need them to make sure companies/hospitals are running smoothly, is well funded and serve the customer well. But the lack of voice and the power imbalance in employment is suffocating. We are partners not servants or slaves. And the all consuming focus on money has got to stop. Human welfare deserve to be at the top. not profit.

347 points by dy 9y ago

Dr. Pamela Wible has long been a very loud voice on the issue of doctor suicide. Check out her website http://www.idealmedicalcare.org http://www.idealmedicalcare.org, which includes a link to her TED talk on the subject.

protonfish 9y ago

The FAA enforces work limitations on pilots, but we schedule our health care workers like this? How are there not even civil cases against errors caused by this kind of administrative foolishness? Overworking doctors like this is insane.

mikeleeorg 9y ago
ER doctors work on a shift schedule, which has many documented advantages and disadvantages. Health issues are among the disadvantages. In my opinion, they can be pretty serious. Many medical specialities have concerns with depression and suicide. ER and ICU are among the two with which I have personal experience that face these issues quite acutely. If you have a loved one in one of those departments, the last thing you want to hear is that your physician may be dealing with depression and suicidal thoughts. Personally, I don't think the advantages outweigh the disadvantages. I suspect removing the shift schedule nature of emergency medicine may have a remarkable improvement. Many ER nurses and clinics have already moved away from a rotating shift schedule, and I haven't heard of any serious repercussions. I really hope emergency physicians follow suit someday. Or, find an alternative model that doesn't incur such health issues.
- sxg 9y ago
  Can you go into more detail about this? I'm currently a medical student in the US near the end of my training, and I'm weighing multiple specialties (including ED). From my personal experience in the ED, it's actually the best schedule I've worked. Yes, it's irregular, but you're always working a fixed amount of time per shift and a fixed amount of hours per week (seems to be around 40). You know when you're on, and you know when you're off. Working three 12 hour shifts per week felt very doable. Most other specialties have call at least once a week, and there are days where you end up staying several hours longer than you expected. True weekends (Friday evening through Sunday evening off) seemed uncommon in other specialties as well. Not doubting what you're saying—I'd just like to hear more about your side of things.
  - mikeleeorg 9y ago
    I guess it depends on the person and your situation. Before we had kids, my wife's shift schedule wasn't too bad. I owned my own business and could take time off when she was free during weekdays. Now that we have kids, the shift schedule is tougher on her. Kids don't work on a shift schedule, and when they make demands of her time and I'm unable to help, she ends up sacrificing her sleep. That happens often enough that it makes any jokes about startup founders being sleep deprived, well, a joke. Somehow, she's able to rally herself and get enough energy to work through a string of night shifts, even after having to take the toddler to the pediatrician during the day if I wasn't able to. My wife also moonlights at another hospital (something she did back when I was getting my startup going and we needed the extra income). She continues to do this because she enjoys the work there (it's higher acuity). That's just our personal experience. Colleagues of hers have solved this by hiring help (au pairs, nannies, etc), which we intend to do soon. She's told me stories about some of her colleagues that don't have kids and have their own share of difficulties. One of them recently dealt with a particular tough case where a 3yo died. There's a culture in the ED where you don't take time off unless you're truly dying. Got the sniffles? Suck it up and come to work. Dealing with a traumatic experience and can't sleep because you've been crying all night? Suck it up and come to work. Hopefully that colleague finds a way to cope, because it's kind of frightening to me, as an outsider, to think of my ED doctor being that person. I can only speak to the ED specialty. I'm clueless about other medical specialities and any potential health issues around them.
    - sxg 9y ago
      Thanks for the response. I'll definitely keep that in mind as I pick a specialty. I'm only a med student right now, but I have spent a year rotating through all of the most common specialties. I have to say that the culture you describe isn't unique to the ED. I've seen it throughout the hospital. Taking time off isn't easy in any specialty. I've found this to be especially true in the niche subspecialties (especially surgical subspecialties). I work with a colorectal surgeon who is the only colorectal surgeon at her particular hospital. She's responsible for all of the patients she's ever treated and any emergencies that may need a colorectal surgeon. It's nearly impossible for her to ever take time off or even leave the city for more than a few days. An advantage that I see for ED physicians is that they're not directly tied to patients. Any ED physician can fill in for another when the need arises. I can't speak to whether that actually happens, but theoretically it's possible in the ED.
macrael 9y ago
There is a tradeoff that is used to justify the long hours. On the one hand, having a well rested doctor is obviously good for them to be making good decisions. But on the other hand, patient handoffs are dangerous. The more times you change the person responsible for a patient, the longer the game of telephone you are playing with their care. This has been measured as being bad for patient outcomes. Now, that doesn't seem to justify the fact that long hour shifts are placed so close together. It seems like you could give doctors a longer break in between shifts than they have. Residents have the worst of it. The attending actually do get a fair amount of time on/off. Residents already work a lot less than they did 50 years ago, some think that their training should be extended to cover the loss of density.
- pdelbarba 9y ago
  Maybe OT, but pilots have a lot of time off between shifts and it's starting to come to light that their depression rates are much higher than anyone is comfortable admitting. This may from a different source though, since flying is very much about precise repetition and less about complex decision making (ADM is hard, but not the same level of mental stress that doctors endure), you eventually realize that you're a very highly trained bus driver.
  - killjoywashere 9y ago
    Pilots have more incentive to manage their fatigue: if they screw up, they die.
    - pdelbarba 9y ago
      It's way more complex than that though. The regulations exist because companies were pushing pilots to do more than they could handle, leading to a number of high profile crashes. Yes, the pilots are incentivized to manage fatigue but it's like any other profession, it's easy to get complacent.
  - devdas 9y ago
    Regulations for pilots currently mean that any treatment for depression means the pilot will no longer have a valid license. https://www.faa.gov/about/office_org/headquarters_offices/avs/offices/aam/ame/guide/pharm/antidepressants/ https://www.faa.gov/about/office_org/headquarters_offices/av...
maxerickson 9y ago
The training for airline pilots is a lot less than for doctors. A couple thousand hours of flying, many of which can be paid work (like flying an add banner).
- pdelbarba 9y ago
  Depends on what you call training. 250 hours under a private (no payment allowed) licence, then you get your CPL. All of this is on your dime (average about $200/hr with instructor and such). The CPL phase work afterward (banner flying, flight instruction, etc) pays like garbage since the GA community is struggling significantly. To do airline work, you need minimum 1500 hours (ATP), then pilots have a sort of residency beyond that where they need to spend a month in airline training, then years as a first officer before becoming a captain (PIC). On top of this, you have the regionals where you get payed like crap before you can typically get a seat at a major airline.
  - maxerickson 9y ago
    Doctors begin their professional training after 7 or 8 years of post secondary education. Much of the time, on their own dime. They also generally work hard enough in high school to get excellent grades (do flight instructors check transcripts or just if the check clears?). It's easy to imagine doing 250 hours over 3 or 4 years while doing something else most of the time.
    - pdelbarba 9y ago
      To fly for the airlines you'll need a college degree, probably with a >3.0 GPA. I agree it's not as academically rigorous though (unless you count the USAF route). Also, most people I've seen do the 250 in as short a time as possible or go part 141 which is a sort of direct-to-CPL training program. Right now there's a shortage of airline pilots but traditionally, those 7-8 years you mention would be spent at a regional before you have a chance at making enough money to start to really service all the debt you undoubtedly have at that point. Obviously they're pretty different career paths, but they're both effectively 'trades', in a more traditional sense, that require obscene amounts of training.

douche 9y ago

This sounds like unrelenting Taylorism, trying to scrape too little butter on too much toast. If all this administrative work needs to be done, do surgeons necessarily need to do it? Can we hire more clerical specialists to offload that work onto, or more PAs or RNs to handle less specialized work? A few measly hundred million in the federal budget could probably be dredged up to subsidize medical school tuition and take some of the sting out of the long, expensive marathon of medical schooling, maybe?

logfromblammo 9y ago

It would appear that the relentless dehumanization of the skilled laborer by business interests has finally spread to the professional classes. I can't even recall how many young software companies I have sent my resume to that turned out to be in the business of building software for insurers and hospital systems that end up telling physicians how to do their jobs. Of course, the metrics all back this up as a solid plan that increases productivity and reduces expensive errors and negative outcomes due to inattention, but I know it just has to suck for the docs to have to experience exactly the same thing that has already happened to most other jobs.

aabajian 9y ago

It's worth noting that the incredible success of Epic EMR software is because it tightly controls all of the administrative billing issues, NOT because it makes clinician's lives easier. There are endless check boxes in Epic and each site has its own interface. It's a huge mess and difficult to navigate...but arguably still better than the other vendors.

ploxiln 9y ago
... sounds like the medical equivalent of Jira ...
- zdw 9y ago
  As someone who has used both, Jira is lightyears ahead of Epic, which still requires a Windows TS session to run properly, and for many administrative or complex operations still requires you to drop into the MUMPS backend environment, which is >50 years old and predates Fortran.
markroseman 9y ago
Absolutely it's about the administrative end and not patient care. We've got a situation in our regional health authority (Vancouver Island, BC, Canada) where they're trying to roll out a significant update/expansion to their EMR (Cerner-based) in the hospital in Nanaimo. Despite immense pressure, some docs have been now suspended for refusing to use it and switching back to paper, despite the massive increase in time it takes to provide the same patient care, and also because of notable examples where the EMR has endangered patient safety. (Google 'ihealth nanaimo' if you're curious for details, then rinse and repeat for the same story in so many other places)
- epmatsw 9y ago
  This is a pretty shocking opinion to see expressed. Like, you may as well have said "A bunch of developers at <place> decided to go back to C89 because writing code in Rust was too slow, plus did you see the bugs in its borrow checker?" . Do you really believe that paper is a safer alternative?

bluetwo 9y ago

Where does the AMA stand on this?

killjoywashere 9y ago
They actively pursue minimizing the number of medical school seats and their lobbying has been tightly aligned with Republican health care policies for decades. Check out Paul Starr's The Social Transformation of American Medicine
- deleted 9y ago
  [deleted]
- kyouens 9y ago
  The limiting factor to creating more skilled physicians is not medical school admissions. It's residency training slots. Most residency training slots rely on federal government funding. Pretty much everyone, including the AMA, agrees that there is a looming undersupply of physicians. There may be disagreement on the best way to address the issue, but there is little disagreement among physicians about the fundamental problem. I have seen comments talking about "physician cartels" purposely encouraging a labor shortage to drive up physician pay. There is no physician cartel. Only about 15% of physicians even belong to the AMA, and only a subset of those have any political involvement at all. It just doesn't exist. One of the things that I think contributes to the general dissatisfaction of physicians in 2017 is the increasingly negative public opinion of the medical profession and the imputation that there is some sort of evil conspiracy at work. A lot of the negative opinion is misdirected. It should be aimed at the for-profit health care system itself. Most physicians I know have very little control over the things people complain about, including cost.
  - killjoywashere 9y ago
    Depends on who's complaining about a bottleneck. The AMA caters to a base that is not happy with the influx of IMGs and DOs. The AMA inflates their numbers by auto-enrolling every allopathic medical student. The AMA is equally unhappy that the government using large scale funding levers at the residency level to overwhelm their efforts to tighten supply. By using money and their exclusive access to legislate, the government creates such a Venturi effect that they suck up all the available MDs, and all the available graduates from two other pipelines: the DO programs and the IMGs. In 2017, the dissatisfaction of the 85% of physicians who don't belong to the AMA is ultimately driven by too much work. Source: am physician. Have worked primary care, seeing 40+ patients a day, now completing a specialist residency. My work as an underpaid primary care doc was enough to keep 3-5 people fully employed (reception, x-ray certified assistant (sometimes 2), office manager, owner) from 8 am to 10 pm 7 days a week, while sending overflow to others. Every one of the 85% of physicians who aren't in the AMA declined to renew their membership at some point. Many align with other orgs: almost invariably their specialty's organization, which aligns with the AMA but they are more professionally beholden to (for CME, board certification, etc). Many try to offset the ill effects of the AMA by aligning with other orgs like PSR or MSF or their local public clinics. But the AMA has a bunch of offices in DC, and has had people in those offices, paying mortgages in McLean or Chantilly, or Silver Spring, <insert DC suburb here> for a century. Those people are motivated to continue their mission of lobbying in support of the legal grip of allopathic medicine, long past their original call to arms (licensure laws to cleanse the field of snake oil salesmen).

johan_larson 9y ago

Why continue in a job that sucks that hard? Is it the money? The prestige? Family expectations? It seems like a terrible way to live.

douche 9y ago
As a first guess, the tens or hundreds of thousands of dollars in student loan debt that were incurred becoming educated and licensed as a surgeon in the first place.
Jtsummers 9y ago
The doctors I know, despite the toil and suffering, really, really like being doctors. They like what they do for other people. To a one, they are more than capable enough to jump into any other career, likely more profitable (when seen as a ratio of time/money or pain/money at least). This isn't true of all doctors, but you'll probably find that ones that suffer through like what the author (Dr. Levi) discusses find that their practice is a calling, not an occupation or job. As a calling, it's part of their identity, giving up on it just doesn't make sense to them.
exclusiv 9y ago
I'd imagine it's highly rewarding delivering results for patients. I have heard from doctors in my family that the administrative overhead that's been put in place has made it way less appealing than it used to be.
2mur 9y ago
For me: * Golden handcuffs * Sunk cost * Rewarding mastery * Deep specialized knowledge with no other remuneration prospects for that knowledge.
Kenji 9y ago
Why continue going to bed too late every night? Why continue to eat unhealthy food? Why continue to work out too little? Why continue taking drugs? Why doesn't everyone just live a perfect life? It's not easy to give up things and change, even if it's ultimately for the better. Let's face it: Workaholism and burnout are addiction problems.

tejaswiy 9y ago

After working in healthcare IT, I can atleast attest to the general UI clunkiness and terrible software quality that is prevalent in the industry. Innovation in Health IT happens usually because CMS (Agency that administers Medicare, Medicaid etc) looks at the landscape and comes up with a carrot / stick rewards system to force Hospitals and practices to update their software. They generally do things like: * Hey you need to store records electronically. If you do this by X, you will get Y$. If not, you will be penalized Z$ every year after X. * Hey the system you built - It needs to actually be able to talk to other systems. If you do this by X.. you get the point. * The data you're collecting in your system is stupid. We need X, Y and Z reports to ensure you're actually using the system as we meant for you to use the system. Do this by X. Several other misc things I noticed: The industry by itself is extremely complex with business requirements that vary between hospitals, practices, labs and so on. This makes connecting systems together a nightmare. Even when you manage to integrate systems, each hospital and practice has a set of business practices (forms they collect, the way they organize information etc) that make rolling software out very hard. Configurability is king. Making everything configurable and having configuration engineers set things up makes automated testing very hard at a UI level. This leads to some sharp corners and contributes to bugs and general UX clunkiness. UX design isn't generally valued and suits / "business requirements" / timelines are prioritised over usable, stable, secure software. This is a typical UI: http://uxpajournal.org/wp-content/uploads/2014/07/smelcer3.gif http://uxpajournal.org/wp-content/uploads/2014/07/smelcer3.g... Standards are out of date and the only thing pushing innovation here is CMS doing its best. The problem with this is that they're a govt agency, so they're generally slow and they're an insurance company, so their primary motivation is to cut cost of care. Doctors are generally smart, and you can sometimes get good feedback from them, but they're already overworked and can't really vocalize what they find frustrating about software. I hate to generalize, but in my experience atleast, all other people (middle management, front-desk staff) are useless. By that I mean they just don't understand how software works. There are some smart CIOs, but they care about their position and the hospital bottom-line, so trying to sell them something that doesn't exactly line up with the CMS carrot / stick model is basically impossible.

pixelmonkey 9y ago

My wife is a medical resident and the issues described by this doctor are absolutely pervasive in residency. The strange part is, the overwork also seems to be pervasive among the attending physicians who have been out of residency for decades. Not just the residents. As a tech founder analyzing the system from the outside, I think this writer has nailed the core issue: "... 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." If doctors were viewed in their industry the way software engineers are viewed in ours -- as specialized skilled labor with extreme leverage and limited time -- then we would have well-supported, well-rested, and well-compensated doctors. But as it stands, we have overworked and overtired doctors buried under a mountain of clerical work, who need to slot their patient in to 15-minute "encounters" in clinic to keep the profit machine running. Meanwhile, administrators, health insurance executives, and medical equipment CEOs work 9-to-5 and earn millions. It really boggles the mind and infuriates me, as a technologist. p.s. Don't listen to any of the comment threads here that say long hours are required to reduce patient handoffs. Yes, it's true, patient handoffs cause some danger. But tired doctors make mistakes. Period. And, as this post indicates, a perpetually tired doctor burns out and either quits the profession or (worse) commits suicide, which is the worst possible outcome for the system.

thearn4 9y ago
I'm not a medical professional, but the whole discussion of handoff risk always seemed to me like it was side-stepping the real issue presented, which is poor documentation and/or communication between peers. Instead, the premise is offered by the AMA that handoff risk can only be minimized by insane shift lengths.
QML 9y ago
Do you think if the United States graduated more doctors every year, it would prevent doctors as a group from being overworked and overtired? As a college student, I often wonder why pre-med is so academically competitive despite the fact that the ambition to help others is a virtue; and whether that competitiveness to get a high GPA and MCAT score is needed at all.

k__ 9y ago

Why do we do this to people who save our life's? Why do we let them burn out?

hourislate 9y ago

Perhaps the solution to the unreasonable demands placed on Doctors/Surgeons is moving forward with A.I, Stem Cell research, Robotic surgery, etc. Technology should relieve some of the pressure.

eplanit 9y ago
That is one of the primary targets for IBM's Watson, and it seems ready[1][2]. More and more my subjective risk calculation favors AI for diagnosis. This one aspect I believe accounts for most of the overall time/effort spent in dealing with patients. To apply AI at the start of the process makes a lot of sense -- reduce/eliminate errors at the start and allow doctors and their time to be better used. [1] http://www.nydailynews.com/news/world/ibm-watson-proper-diagnosis-doctors-stumped-article-1.2741857 http://www.nydailynews.com/news/world/ibm-watson-proper-diag... [2] http://www.businessinsider.com/ibms-watson-may-soon-be-the-best-doctor-in-the-world-2014-4 http://www.businessinsider.com/ibms-watson-may-soon-be-the-b...
markroseman 9y ago
Keep in mind the technology has to fit into the existing regulatory and legal framework. Which also includes, if something goes wrong, who are you going to sue?

drewg123 9y ago

It seems like we have an undersupply of physicians. My understanding is that the AMA limits medical school admissions[1] in order to keep salaries artificially high. This naturally leads to overwork in addition to high salaries. [1] http://www.usatoday.com/news/health/2005-03-02-doctor-shortage_x.htm http://www.usatoday.com/news/health/2005-03-02-doctor-shorta...

EvanAnderson 9y ago
Here's the go-to that I send people to when this comes up: https://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-the-number-of-doctors-to-increase-current-doctors-salaries https://skeptics.stackexchange.com/questions/4561/does-the-a...
- maxerickson 9y ago
  The why is complicated, it seems obvious enough that more doctors would be a good thing. Or at least, more practitioners. We don't need doctors with huge amounts of training to do every evaluation.
  - drewg123 9y ago
    True, but the AMA seems to fight enabling other professions (nurses, pharmacists) from taking on roles traditionally held by doctors. I rather wish software engineering had a professional association with the lobbying power of the AMA.
    - arjie 9y ago
      It would be a damned nightmare. The practitioners are dying of overwork, their patients are dying due to being treated by people who can barely stand after 36-hr days, and meanwhile the professional association comes up with a worker wellbeing plan. Incompetence on a national scale.
- nilkn 9y ago
  Unfortunately this didn't really clear up my confusion. In particular, the points brought up by the second answer there seem relatively unresolved. Why should DO graduates be growing significantly faster in number (proportionately) than MD graduates, when traditionally an MD degree is more desirable than a DO degree, despite both being mostly equivalent? A few possible conclusions. I don't have enough knowledge to pick one. Some of my speculation might even be wrong. (A) DOs and MDs filter through different or mostly different residency pipelines. Thus, residency limits for MDs don't affect DOs, so the DO population can grow more quickly. (B) DOs and MDs do filter through mostly the same residency pipeline, and the increasing number of DO graduates is causing an increasing number of residency applicants to not be admitted to any residency program. (This malicious situation would be similar to the situation with law schools, which admit and graduate far more lawyers than the industry can possibly sustain and support in its current state.) (C) There's enough non-government funding of residency slots that residencies are not as bottlenecked as the first answer claims. If so, this re-raises the question on whether MD admission is being rate-limited to increase scarcity and thus salaries. (D) Perhaps something else I'm not thinking of.

electriclove 9y ago

Let's create MORE doctors.. There is no shortage of capable people interested in becoming physicians.

JabavuAdams 9y ago
Do you really believe we've maxed out on capable people with the interest?
- electriclove 9y ago
  Not at all.. the supply is constrained for all the wrong reasons.

Gatsky 9y ago

Bear in mind this ENT surgeon is still in training, and probably close to 40 years old assuming he started Uni at 18. Training is often brutal because towards the end you are probably among the most important and useful people in the hospital in terms of delivering care, but also have very little control, so of course you get abused. Eg this guy has to write medical certificates as well as perform emergency life saving surgery at 2am and have crushing family meetings with patients dying from untreatable head and neck cancers. Simplistic supply and demand analysis of this issue is annoying and ignores basic economic theory. You don't want to increase doctor supply, you want to increase the capacity of the healthcare system to deliver good care (obviously?). Doctor supply is one part of that, but if you pump medical students in at one end and do nothing else, you will fail - this is what the Australian gov has done, and you can see the result here, where trainee conditions are poor (so much competition that you don't complain about conditions, power is concentrated in hospitals and senior drs in charge of training programs and hiring who align the system in their favour), and incumbent physicians like the one that committed suicide work like demons and burn out. The financial corollary is fiscal stimulus without any production capacity - GDP doesn't go up, inflation does. As always, it doesn't have to be this way, but nobody is in charge who cares enough to fix it, and all the stakeholders look after their own interests.

pc2g4d 9y ago

So... because the supply of doctors is restricted but demand for doctors grows proportionally to the population, the amount of work per doctor gradually increases and doctors, persuaded by their ethical obligation of care, put up with it as long as possible until they snap. Yeah? I just recently had a friend completely burn out of medicine, sell his house, and start traveling the world. He was brilliant, a good doctor, a good person. It's a shame he's been driven out, and so many others. I also recently had the experience of seeing a young doctor bright-eyed and busy-tailed treat me once, and then six months later see him again. The toll that those six months took on him was visible. He was just about haggard with the work. It's easy to imagine he won't last long. I feel there's an interesting parallel with teaching. Teaching and medicine both have licensure requirements, both have a strong appeal to people who care and want to make a difference in the lives of children/patients. And in both cases the profession is gradually being taken over by administrators and subject to increasingly onerous regulations. I also recently had a friend burn out of teaching. She's set to work in a completely unrelated industry now. She put up with crap for a long time due to her care for the children, but at last she couldn't take it. My libertarian side says these are two improperly functioning markets, with massive human casualties. It's a shame.

djsumdog 9y ago
This is what I felt when I read the article. It was surprised even the Australian system is just as overloaded as our American system. I feel like a lot of these problems could be deal with if there were simply more doctors. That being said, it's a difficult profession. Not a lot of people want to do it. Even fewer in such specialised positions as surgery, where mistakes literally cost people lives. There's no rolling back to a previous release or taking a break. Everything that happens, happen on that table with that body open. Tack on the insane costs, at least in America, for going to school to be a doctor and you also have a situation where few people feel they can afford to be GPs (even though that might be what they really want to be; and the world needs more GPs desperately) and you also have doctors who are now locked into a profession to simply paid their debts. > I just recently had a friend completely burn out of medicine, sell his house, and start traveling the world. I don't think this is a bad thing. Everyone who can afford to should really save up and take a sabbatical every few years: http://khanism.org/perspective/minimalism/ http://khanism.org/perspective/minimalism/

Mz 9y ago

From what I gather, one of the reasons physicians like Direct Primary Care is that it is a saner system than what you see in most American medical facilities. I am sort of a medical system drop out. I took my toys and went the fuck home. (No, I was not a doctor. I was a patient who could not get my needs adequately met and walked away from conventional medical treatment for my condition.) So, a lot of people assume I am very anti medicine. They think I am some crazy who just hates modern medicine. This is absolutely not true. But I do hate certain aspects of the system. I think Direct Primary Care would be a step in the right direction. If you are interested in reading a bit about that, I have written a few pieces about Direct Primary Care. http://micheleincalifornia.blogspot.com/search?q=direct+primary+care http://micheleincalifornia.blogspot.com/search?q=direct+prim...

markroseman 9y ago

One theme coming up here is the idea of just graduating more doctors, but even ignoring artificial pressures to keep supply low, it's not that simple. Many disciplines, particularly things like surgery, have a lot of requirements beyond just doctors, i.e. nurses, anaesthesia, OR's, hospitals, etc. In Canada, we have a fair number of people in certain specialties that cannot find work - think a radiation oncologist who needs some pretty specialized and expensive equipment that only exists in a few places to be useful. But also even more basic... gastroenterologists who can't get enough OR time to do scopes on their patients.

robbiep 9y ago

Here is some context for this article: Dr Levi is n Australian surgeon. He is responding to a letter from the wife of a gastroenterologist who committed suicide recently. Last week was the Royal Australasian College of Surgeons Annual scientific Congress in adelaide so physician wellbeing is well and truly on the radar, in particular following 3 suicides in the last 6-9 months of junior trainees, one of whom was a friend of mine from medical school. There is now an enquiry into Doctor suicides and wellbeing being performed at the state level in NSW and we (doctors) expect this scope to be broadened to nationwide

Gatsky 9y ago
I wish I could applaud this. But what sort of professional organisation waits until its members are actually dying before putting well-being in the radar? The RACS, RACP etc are sclerotic organisations run by old white men in bow ties (I've met several of them) with no real incentive to improve conditions for trainees. The only way I have seen actual change happen is when junior staff band together and effectively go on strike.
- robbiep 9y ago
  Couldn't agree with you more re RACS, I attended their 'gala ball' at the end of their ACS last year and was sickened by the pomp and bullshit. The (female) RCS president, visiting from England, also appeared weirded out by the pomp (and that the RACS had not had a female president). Having said that within both organisations there are people who strongly and fiercely advocate for innovation and change, but you are right, they are severely sclerotic (even to the point of RACS making an absolute motza out of their trainees, they've got over $60m in the bank and our exams cost $4,000)
  - Kali909 9y ago
    I don't know too much about the RACS etc (father was a radiologist but can't recall him complaining about their equivalent in Aus too much, though it's likely the same). If you have to be a member of this, and that's government mandated, then them profiting from that arrangement is a blatant monopoly isn't it?

novalis78 9y ago

Maybe he would be much happier working at a place like the Surgery Center of Oklahoma which seems to do much better on the administrative side of things.

kendallpark 9y ago

This is a problem in medical school as well. I can't tell you how many anonymous posts have been popping up on r/medicalschool lately about being depressed, isolated, lonely, and/or suicidal. Missouri just passed the first bill of its kind to try and combat mental health issues in med school. http://krcgtv.com/news/local/medical-student-suicide-prompts-proposed-missouri-legislation http://krcgtv.com/news/local/medical-student-suicide-prompts... > The bill, also known as the Show-Me Compassionate Medical Education Act would establish a committee to study mental illness, suicide and depression in the state's six medical schools. The bill would also prohibit any medical school from restricting a study on the mental health of its students. The absolute disturbing part is right here: > While lawmakers debated the legislation, Frederick said the deans from each of the state's medical schools sent him a joint letter expressing opposition to his proposed law. In other recent news, Saint Louis University fired their med school dean that was the absolute champion of promoting the mental health of SLU's students. http://news.stlpublicradio.org/post/slus-medical-school-removes-dean-lauded-preventing-student-depression#stream/0 http://news.stlpublicradio.org/post/slus-medical-school-remo... Furthermore, as part of the licensing process, you are asked whether you were diagnosed with a mental illness in the past. There will likely be an investigation if you say yes and it could impact your career. This stigmatizes mental illness within the profession and keeps people from seeking help when they need it.

hbosch 9y ago
I have a friend who is graduating from med school this week and starting residency. The stories of med school drama, gossip, backstabbing and cheating are insane - on par with anything on television drama. Moving into residency, they also feel alone, exhausted and anxious... I don't know how many people manage. I think knowing a doctor, or someone becoming a doctor, has changed my perception of doctors entirely.
- kendallpark 9y ago
  I am fortunate that my school seems to vet the students well for character. Or perhaps it's self-selecting because we do PBL which requires collaboration. We don't have the issues with backstabbing and drama that I've heard from other schools. I think my classmates are perhaps my favorite part of the med school. The scariest thing in med school is how vulnerable you are to someone with authority screwing over your entire future. Piss off an attending? Well, they could right a terrible letter for you that hurts your ability to match into the specialty you want. You could straight up witness mistreatment of a patient by a superior, report it, and have your entire future altered forever because of people above being petty or vindictive.

yakult 9y ago

According to my GP, selection for doctors include psychiatric profiling designed to select for the most compassionate. While I can see why the hospitals would want this - compassionate doctors are good PR -this seems to be a case of misaligned incentives. Those with less compassion would suffer less and cope better when surrounded by death and suffering on a daily basis. On the whole, this probably means they'll do a better job, too.

krallja 9y ago
What country are you in?

woodandsteel 9y ago

I wonder if there are any research projects comparing physician workload and satisfaction in various countries with various health care systems.

themantalope 9y ago

I'm a medical student at a top 20 allopathic school in the U.S. This article resonated with me. I think the part that struck me the most was his comments about time. I have diverse academic interests. I studied math and bio in undergrad. I love machine learning and software development (esp python). I lived in China to study the language for a year. All that gets sucked out of medical school though. We are expected to learn a ton of material in the first two years. Then in the second two years, we are basically working a full time job in the hospital/clinics while also studying. We are constantly evaluated. We are also expected to do research and publish papers. I've forgotten what a guilt-free day off feels like.

joshuaheard 9y ago

I am a lawyer, and if this was a lawyer's story, this would be my advice for the firm. First, they need to hire more lawyers. This guy is way too busy and will make a mistake. Second, he needs a receptionist, secretary, and paralegal to support him. It is wasteful to pay him a doctor's salary to answer phones. Third, they need to streamline their record keeping so he doesn't spend so much time filling out paperwork.

themantalope 9y ago
>It is wasteful to pay him a doctor's salary to answer phones. This is something I don't understand. I'm a medical student, and the amount of time I've seen wasted watching older physicians type notes is staggering. Just have them dictate the notes and hire a secretary. Perhaps for legal/liability reasons doctors need to write their own notes but it's just such a waste of time, and we pay a lot for it.
- paulcole 9y ago
  >we pay a lot for it. Do we really though? I'm assuming a doctor is a salaried position so the more busy work they get the more hours they work? Doesn't this mean their time becomes less valuable?
  - themantalope 9y ago
    It really depends. Some are completely salaried positions. Some physicians are completely private so what they earn is directly tied to how much they work. Even those who are salaried often have some kind of compensation or bonus for extra work. And even if they are salaried, having physicians type notes is not making the best use of their training and time.
pmiller2 9y ago
What's the medical equivalent of a paralegal? A good nurse?
- 9y ago

andy 9y ago

What other dark side of doctoring issue can I think of? Well, the doctors and nurses at Fairmount kept me prisoner without the ability to call my friends or family, denied me water, physically tackled me and tied me down. I was not allowed to use a lawyer of my choosing. I did not hit back when they tackled me. I never committed a crime. I feel like I am being repetitive. That is completely on purpose. The dark side of doctoring is at Fairmount Behavioral Health in Philadelphia, PA. It's a hellhole and should be closed. https://surroundedbyspies.com https://surroundedbyspies.com

andy 9y ago

bobbington 9y ago

Us government ruining everything. GET OUT OF MY LIFE GOVERNMENT. The government should have no say in who can practice medicine. Currently it's a criminal racket as far as I'm concerned. It requires like 15 years of higher education to be able to be a doctor!! That's so stupid, especially with google. And once they graduate, it leads to a false sense that they know it all. Government prohibiting the practice of medicine is the cause of so much ill in this country it is ridiculous. It stifles innovation. The official doctors have been known to ridicule things that were proven critical to success. For example now we know that germs cause disease. Well back in the day, they ridiculed people for belicjnf that microscopic bacteria could kill people. As a. Result doctors killed. A lot of people through their terrible practices. It still happens today.

known 9y ago

http://blogs.law.harvard.edu/abinazir/2005/05/23/why-you-should-not-go-to-medical-school-a-gleefully-biased-rant/ http://blogs.law.harvard.edu/abinazir/2005/05/23/why-you-sho...

erikb 9y ago

Life gets harder the more we dive into the financial crisis. Blue collar workers sometimes don't even get a job anymore, or work 3 at the same time just to pay rent. White collar workers work themselves to death in one job, although I have to admit it's maybe only 80% as harsh for IT as in medical. Even the rich that we all complain about lose more and more control over their money and their investments. We just don't like to see that, since who wants to admit that someone above oneself in the foodchain may also be struggling? Then we would also need to admit that the dream part of why we slave off ourselves so much will never be true as well. I don't think that we're heading into a zombie apocalypse level destruction. Highly skilled people will always have one of the best lives. But it gets harder for everybody, and no matter how much we complain there isn't anybody who can give us a better life at the moment. Everybody is losing something.

timwaagh 9y ago

a surgeon is considered replacable? they just might be the least replacable professionals out there. i don't know what he is thinking. doctors are the elite. at least where i live a surgeon can out-earn even government ministers and CEO's. indispensible. irreplacable. the rest of the industry should therefore be focussed on getting as much value out of these doctors. which means they should be focussing on taking any paperwork out of docs hands.

Ericson2314 9y ago

So clearly healthcare in the US is fucked end to end. Has anyone (government or private sector) tried or proposed some sort of trial hospital where we just clean-slate redesign and evaluate the whole thing? *Probably would need to be government as would need exceptions from tons of laws.

markroseman 9y ago
Or look outside the USA at dozens of other countries that may have some problems with their healthcare systems, but aren't anywhere close to as completely fucked up. Read the comments and listen to the debates, and understand that it isn't going to get better until Americans believe that the availability of healthcare shouldn't be solely dependent on income, and that "freedom" around payment and insurance shouldn't be the primary value.

kapauldo 9y ago

Hard to feel sympathy for millionaires living a life of their choosing.

markroseman 9y ago
My wife is a doctor, over a dozen years in practice. Tell our mortgage about how she's a millionaire. And to me, a life of her choice would likely have a lot less stress and shorter hours, and not worrying that the income would dry up if she has to stop working.

qrbLPHiKpiux 9y ago

Another modern problem is private equity in the business of health care making money hand over fist with all libiality on the individual physician. All risk shifted from the partners.

Melchizedek 9y ago

The bourgeoisie has stripped of its halo every occupation hitherto honored and looked up to with reverent awe. It has converted the physician, the lawyer, the priest, the poet, the man of science, into its paid wage laborers. Karl Marx

Floegipoky 9y ago

Related: http://www.wbur.org/commonhealth/2017/05/12/boston-electronic-medical-records http://www.wbur.org/commonhealth/2017/05/12/boston-electroni... I always see people ragging on EMRs. They're inefficient, have poor UX, require way too much documentation, etc. These are all fair criticisms, but I don't think people spend enough time asking why. Why are all the major EMR systems shitty in exactly the same way? I think there's 2 main parts to the answer. The first is the sales process. The people selling EMRs to hospitals aren't selling their product to clinicians, they're selling their brand to the hospital administration. It's like the saying "nobody ever got fired for choosing Oracle", but far worse. The end result is years-long implementation processes, broken promises, and terrible tools that are optimized to allow the hospital to fire a few members of the low-level administrative staff (billing, coding, etc) instead of providing better care to the community they serve. The second part of this problem is overregulation. The justification is that EMRs should be able to meet a certain level of functionality. Based on personal experience working with these regulations, I'm convinced that the real reason these certifications exist is to prevent new players from entering the market. They are very much in the spirit of "well all these legacy systems do [something], so _obviously_ everybody else should too" without ever leaving room to come up with a better solution. They shackle you to terrible design choices and assume that all hospitals, from a 10-bed critical access hospital to a 500-bed academic medical center, should all be run the same way. And worst of all, they make it impossible to design a system based on what the HOSPITAL needs, because half of the system is devoted to what the GOVERNMENT needs. Kind of like how people complain about interoperability between electronic medical systems. So the government introduces legislation to mandate interoperability, by requiring implementation of poorly-defined "standards" (designed by committees comprised mostly of, you guessed it, representatives from legacy vendors). From personal experience, I can say that every. single. one. of the interfaces required for federal certification is completely unable to be reused by actual hospitals. But that's the entire purpose, that's exactly why lobbyists paid so much money to get the regulations passed in the first place! If potential new competition has to sink thousands of man-hours every year into building useless functionality, that's thousands of man-hours that didn't go into making their product competitive and disrupting the marketshare of legacy systems. Meanwhile, legacy systems are maintaining their market share, not by improving their product and helping healthcare providers do a better job. Instead they're actively creating situations where smaller hospitals are forced to choose between buying onto the licenses of larger hospitals or shutting their doors. Obviously this is all just my personal opinion.

harmonicon 9y ago

I am not a doctor, though I have many friends that are either med student or residents and do hear about the harrowing workload and stress quite a bit. I just want to point out the sentiment expressed here should all sounds very familiar to anyone who has ever had a job. The managing class (Company CEO, Hospital/University administrators) is ever in the pursuit of more profit, euphemized as "efficiency" or "optimization", at the expense on everything else. How can we squeeze the employees a little harder so we don't have to hire as many? How can we increase "productivity" so more patients can be seen(and pay up)? How can we eliminate waste (lower cost of care as much as possible so we can make more) to the patient? How can we make more money by tweaking our charging model (Insurance rewarding loyal customer by charging them more, Hospital Chargemaster etc)? Oops, I see people are complaining a lot. Let me pay some lip service about appreciating our employees and valuing our customer/patients. Heck I am feeling extra generous right now , let's put up some cheap program they can participate in. There, they should feel happy now. This is all too familiar in the corporate world. Any employees with a half a brain will get the message loud and clear: employers do NOT care. Or maybe they do, just nowhere near money. See, their incentive is aligned quite nicely: cost cutting/profit increasing actions are how they justify their pay and the profit it generates is how they pay themselves. Everything else can be sacrificed. Caring for a patient is a very intellectual, specialized and dare I say it creative task. Doctors are paid well above many other professions though one can argue it is not for the years they have to invest into training and the work hours. The point is, at the end of day they are glorified laborers, being told by their boss what to do, just like the rest of us. Prestige has shielded the medical profession for decades but now the grip of corporate America has finally caught up. And lo and behold, what scant voice and influence do we have! We absolutely do need managers/administrators. We need them to make sure companies/hospitals are running smoothly, is well funded and serve the customer well. But the lack of voice and the power imbalance in employment is suffocating. We are partners not servants or slaves. And the all consuming focus on money has got to stop. Human welfare deserve to be at the top. not profit.