Looking back on medical school, she can't believe how ridiculously easy it was and how much free time she had.
[1] where "comparatively relaxed" still means "she works harder than anyone I know in tech".
Unless they get paid by the hour, I see no reason to continue to participate in such a system. Still, it should not be allowed when lives are at stake.
It's worth noting that there have been several studies over the years investigating whether reduced hours produce better outcomes; they don't seem to. Shorter hours means more shift changes and patient handoffs, which is the source of more errors than tired residents. Also, keep in made that getting the same experience in a specialized field like neurosurgery with fewer hours per week would require extending the training program even further. It's already seven years beyond medical school, often with a one year fellowship after residency. Extending it another few years isn't really a viable option unless we significantly increase the autonomy and salary that residents receive.
Sorry, I don't buy it.
In many hospitals doctors are paid hourly, so shorter shifts wouldn't cost the hospital money.
You'll have to significantly increase resident salaries, and allow residents to move between hospitals to deal with life events. This isn't impossible, but it's politically infeasable while everyone is talking about cutting medical costs (total pay to residents would need to go up ~10-fold for this to work out). It's a bad situation today, but there isn't a simple magic wand to fix it with minor changes.
For some contrast though, before everyone cries out "save the med students, they have it harder than any one should endure"... remember there are other jobs with far greater risks, hours, and far less pay. Ever been deployed in a military unit during wartime? I've wished there was a window to jump out of several times, or that a pager beeping was the scariest thing to fear while trying to sleep - and that was in recent engagements, it was far worse for the generation before us during wartime - doctors not so much.
Once you're an attending, yes. My wife, however, is still a resident. She's doing this for $50k/year.
Just because a worse job might exist is not a justification to continue---logic and all that.
Something really needs to be done about current crony capitalistic US medical industry.
I have a few physicians in my extended family and this mirrors what I've seen from them; I don't know how you'd get board certified neurosurgeons to take q3 trauma call in more rural areas for years on end other than ''here's a boatload of money''. It's masochistic work.
Capitalism, especially our current flavor of it, has plenty of problems, but I think it's important to separate the core principals (mostly free markets, pursuit of self interest) from the pollutants (loopholes, cronyism and special interests).
Citation required. I'd venture the US is more accurately described as a hybrid socialist / mercantilist regime than a capitalist regime.
If there were twice as many doctors, the existing doctors probably wouldn't need to work 80 hours a week, and could likely cut down to 40 hours.
The other problem might be that doctors are paid extremely well in the U.S. compared to the rest of the world, and even compared to other rich first-world countries.
Proposals to expand residency run into the problem that it costs the government money. Residencies are funded at the federal level; teaching hospitals get a certain amount of money per resident to compensate for the effort required to train them. And the number of residencies funded per year has (I think?) been maintained at a pretty constant level compared for a long time, with so many new doctors per year per million people.
One option, I suppose, would be to allow self-funded residencies. Why should only the government's money be good enough? But that would probably be an option only for wealthy students, or those who are willing to go even further into debt.
Another option would be to replace residencies with something more like conventional apprenticeship. Is there any reason a new doctor has to learn the practical details of her trade at a hospital, rather than working under the supervision of an experienced doctor in private practice?
Of course, nothing like this is likely to happen. The whole medical industry is extensively regulated; those regulatory barriers are wide moats that ensure fat incomes and profits, which in turn create strong interest in keeping things as they are. Barring utter crisis, nothing is going to change.
PAs provide an instructive example, but there are many others of different sorts. Often, PA schools have stricter prerequisite experience requirements, and PA students often take the bulk of their courses with the MD students, and have maybe a semester less of courses, before clinical training. So the end effect is that a PA's actual experience is often the comparable to an MD's after a couple of years of practice. Hospitals and health care systems know this, and have been gradually replacing MDs in many areas with PAs because they're cheaper but provide similar care.
We can't afford to maintain this fiction that the only way to have something skillfully done is by the MD training model.
Depending on your residency or fellowship program, it is not unusuall to sustain 80+ hours per week. And unlike nurses, you don't get to disconnect from work when you aren't in the hospital. There are pages to answer, notes to write, labs to review, and on and on...
The mental and emotional load is tremendous and there is no room for error. it's truly a miracle more people don't end up the subject of Morbidity and Mortality presentations from botched lines and pneumos.
While they had to work incredibly hard to get into medical school, and it's harder than it's ever been, I feel like anyone born in the 90s or later is going to be at a disadvantage, because the level of stress is not only much higher than before but many just aren't prepared for the stress.
<sarcasm>However, I think that because of this, medical schools will have to change. It's just too darn hard!</sarcasm>
Getting real though: med school is f'ing hard. Reading this did not surprise me, and if anything, I was surprised that the writer did not know what he was getting into when he got in. The things he is complaining about are the same things I've heard for decades.
Also- the Helen Keller comment, while disrespectful to those that are hearing and/or sight challenged, made me laugh.
The main difference between those going to med school and the 90s and now in my opinion is a mix of the expectations by students that the increase in level of difficulty should be comparable to the transition between high school and college, or college and graduate school. It's not, and it never was. High expectations have always been the rule.
However, for the past 25 years, there have been many more immigrants or children of immigrants that work their asses off competing harder and raising the bar.
The medical schools should not lower the bar to make it less stressful. Instead, we need more medical students to matriculate to P.A. programs and nursing programs, where they can do just as much good helping many of the same patients, sometimes making similar salaries. Eventually there will be more medical schools, which will help some. Or, maybe some of these doctors that feel that they had to go through too much can work their way up and teach so that they can give their students an easier individualized and sensitive education and see where that leads.
However, imo it should always be extremely difficult to get in and to succeed. That's the point. I don't think people should commit suicide. They should just quit.
As somebody who works with pathologists, I don't find the academic part of medicine more difficult then say physics - but the pay is substantially different. This artificial labor shortage is protected by the systematic failures discussed in many of the HN comments.
None of these things are defensible.
There are deep challenges with continuity of care. How does one person hand of treatment to another person?
Imagine you and I are both working on a project. There's only one computer, you use it from 6AM to 6PM, I use it from 6PM to 6AM. We can only work on one feature at a time. How do we coordinate that handoff every day? That alone sounds like a huge pain. With a doctor, everything can super time critical, and requires just as much depth of understanding. You may have a an understanding of something that i didn't understand in the handoff. building a project, we roll back my code talk some more and do better the next day. With doctors, maybe somebody dies.
I know it's a convoluted example. I imagine most stuff is routine and can be passed around safely. But it's only routine until it isn't, and there's no way to know up front. As much as developers hate being treated like cogs, it seems like it would make doctors lives quite a bit easier. Just seems like a super hard problem. And if you don't get it right people could die. So, like, that sucks.
After one does complete residency, it does seem to get a lot easier based on observing some of her friends that didn't do fellowships, especially if the person takes a more clinical job. But after all of that effort, a lot of people become attending physicians where they are putting in just as many hours, if not more, because it is more prestigious. Those are the people that run the teaching hospitals, so it feels like there is a lot of "I survived and it made me a better physician, you can too" mentality.