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Tuesday, March 14. 2017
Only the weak would complain. They need the clinical experience as fast as they can get it. Furthermore, they need to learn how to function under stress and without adequate sleep. Physical and mental endurance need to be learned. When a multi-car crash results in 10 victims in your ER at 3 am and you're on duty, there is no choice but to rise to the occasion. That takes practice, and it is why older doctors are wiser. They have put in the hours. They can find their second wind because they have done it many times.
Nobody in America wants a doctor who would say "I've worked my 8 hours" or "I'm too tired." Maybe they are thinking of socialized medicine or unionized medicine, because those authors seem to feel that working long and hard is something terrible instead of something wonderful. Some people are not aware than some surgical procedures can take over 10 hours to complete, and, just then, an emergency comes into the OR.
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There's a certain tension between the actual patients and the doctor's training in stress. We want doctors who can function under stressful conditions, but at the same time, if I'm in a single car accident and come into the ER at a low-traffic time, I'm not sure I want to be seen by a doctor who's been up for 45 hours out of the last 48 and was awakened from a sound sleep three minutes ago. Even if the experience is good for the doctor's future patients, it might not be great for me.
If you are anywhere outside a metropolitan area or dense suburban are, you woke up a doctor at 3 am with your car crash or your chest pain. Often, he or she not only had to wake up but had to get dressed and to drive.
That's the way it is.
Well, that's cold comfort if I'm in an ER with a doctor with inadequate sleep and compromised mental functioning, not because I'm one of the relatively few who live in a rural area, but because it's policy to make sure residents and interns are usually in that state.
At the same time there's merit to the idea of training doctors by stressing them maximally and making them perform. But like I say, it is a tradeoff.
Legal associates and junior Wall Streeters work the same kinds of hours, weekends etc.
At times, so do farmers. Where did we get the idea that long work is a bad thing instead of a blessing?
There's working hard and working as slaves. I remember doing 36 hour shifts every other night in the NICU and PICU. There was little or no supervision at night, sink or swim. And I made a whole $1.80 per hour!
But it's a lot better now. There are attendings and fellows in-house to supervise or when SHTF which happened a lot. The good old days produced some great Docs, but it also pointed out the glaring insufficiencies of the mediocre ones. And I don't recall anyone getting the boot out of residency.
Oh please. I'd like to hear someone make the same argument for making airline pilots work 80 hour weeks. Would you happily climb aboard an airliner piloted by sleep deprived personnel? No, I don't think so.
Doctors put patients at risk by making residents work stupid hours mainly to make "doctoring" a hard field to break into. To keep the supply of doctors low to keep their pay up. Won't last forever tho. Expert computer programs run by Nurses and robotic surgery will eventually break the monopoly....
The reason there are so few Docs is that the govt pays for their training through social security. The govt. sets the numbers not the marketplace. It has nothing to do with the work hours.
And Doctors are not in charge of making residents work those long hours.
Medicare...but that's almost the same thing.
(I hope this is not a duplicate. When I tried to submit it before, I got a red-text failure(?) message "Your comment did not contain a Session-Hash...")
"Nobody in America wants a doctor who would say 'I've worked my 8 hours' or 'I'm too tired.'"
Nobody? I am receptive to the idea of getting most of my medical care from someone who would say this. And though I'm not any kind of medical professional, I'm not completely ignorant of the tradeoffs involved. I spent a summer and more doing lab work in a virology and manual-DNA-sequencing lab way back when I was an undergrad. I got a biology BS degree --- very much not premed-oriented, but nonetheless I couldn't avoid learning a thing or two about how stuff works. Since then --- and even before then, in my after-school jobs during high school --- I have done various complicated computer programming, which is often limited by human error. And I know more than average about economics and about the history of medicine.
Now, I'm not enthusiastic about addressing irresponsible practices in the centrally-imposed medical guild system by adding even more central state command and control to the system. And, alas, that is what I expect --- indeed, not just average mediocre command and control, but command and control driven by lobbying and yellow journalism and well-past-its-prime bloated technocracy -- is the most likely response to the current criticism. So whatever changes are likely to be made in this regard in the near future are likely to be so perverse that they're unwelcome to me. But if I was free to shop for medical services in a more classically liberal system, I'd consider it a selling point for an organization if their work was organized like a high-quality organization in an ordinary free market line of business with low barriers to competitive entry, rather than like a state-gated guild system with extensive hazing for candidates before they're allowed to compete with the senior members.
Gung-ho attitudes do have their place even in demanding error-prone work. I have seen old family history video (converted from much older film) of working desperately to cope with a serious disaster in a natural-resources extraction operation. Given the emergency, people naturally and appropriately went very much the opposite direction from stopping after eight hours of work, and people naturally and appropriately did difficult risky things to try to cope with the problem while exhausted and otherwise imperfectly prepared. It is apparent in the film and it is apparent in the way the family talks about it today how much they are expected to be admired for it, and I do admire them for it. But valorizing routine day to day exhausted disorganized gung ho is not excusable just because we naturally honor desperate work when a once-in-a-decade crisis makes it unusually suitable. Routine gratuitous sloppiness is the kind of thing that is easier to force on one's customers under artificial legally-imposed scarcity when thoughtful sensible people who might want to organize their work differently are prevented from law from competing freely for customers.
"Nobody in America wants a doctor who would say "I've worked my 8 hours"
That's what you are going to get unless things in Medicine change back to the older ways. General Surgery, my field, is desperately short of new members. I talked to a woman surgeon in San Francisco a few years ago who told me she did not know a surgeon there under the age of 60. I have taught medical students for 15 years after retiring. The only popular surgical fields now, that I know of, are breast surgery (women) which has no emergency call and trauma surgery which is shift work like ER.
I ran a trauma center for 7 years and finally retired after my second 40 hour stretch in a month when I was 55. My divorce was, I'm sure, due to the disappointment of my wife that practice was no easier than residency.
nonsense, they are exploited. They work those hours because they know they'll never get a job that pays back their hundreds of thousands of dollars in student loans if they don't.
It's no different from London banks forcing interns to work 20+ hour work days, or Silicon Valley IT firms, where it happens as well.
And no doubt it's the primary cause of a lot of medical errors in ERs.
Most doctors I've seen/known over the years are glad once that period is over and they can start working a regular (for a doctor) 4-5 hours a day, 3 days a week, and still make the same income that your average person does working 10-12 hours a day, 5 days a week.
I recall the night I felt I had become a physician (which was six months into my pediatric residency). I was called to the NICU around 3 a.m., when an infant post-cardiac surgery was dying. I resuscitated her working almost automatically and only after reviving her did I look up to realize that my supervising residents were just running in. Then, I saw my attending at the door with a camel's hair coat over his pajamas: he smiled when he saw that I had saved the child. It occurred to me then that I had become a physician.
There are more examples like this. And unlike the comments above, I didn't need to pay back big loans (had generous scholarships from my medical school), nor did I feel enslaved.
A truly great profession and when I later had to solo it on an Indian reservation, I knew I could save a man with a crushed chest or a woman in active labor with no prenatal care, or a boy with snake bite no matter what time of day or night.
"Nobody in America wants a doctor who would say 'I've worked my 8 hours' or 'I'm too tired.'"
While there should be a general working norm in any occupation for the sake of personal health, sanity and family stability (after all, I doubt we want doctors who are routinely too tired to be treating us), I absolutely agree that true professionals cannot be bound by a 40-hours-a-week union mindset.
When I was a serving officer in the Canadian Army, I took it as an absolute given that I was an officer 24 hours a day, seven days a week, 12 months a year and could, at any time, be expected to work as long as the operational requirements of a mission demanded.