One painful thing is that most people entering med school don't viscerally understand how long, painful, and expensive the process is, or how much better some of the alternatives can be: https://jakeseliger.com/2012/10/20/why-you-should-become-a-n...

It is a well-known fact that the entire industry under-invests in tech infrastructure. Congress literally paid them to do it using "meaningful use" incentives as part of the ACA, and still can't get them to invest more. Ask yourself who has better front-office CRM: your local car dealership or your doctor?

Do you think the audo dealership does it because they like spending money? No, it's because they compete and are paid based on quality of customer service, and believe (rightly) that keeping good customer records is an important part of that.

No such incentives exist in the medical industry. Everything is just "how many procedures can you do per hour". Since the industry doesn't encourage good record-keeping, it's seen as a "chore" doctors don't like doing and hence hate doing it, and try to do it as quickly as possible, before they can get back to "making money" doing hip and knee surgery, seeing more patients, etc.

The solution is really pretty simple: there needs to be meaningful competition on the (patient-perceived) quality of care. Our current insurance-driven system doesn't promote that at all. Handing customers cash, whether from employers, the government, whoever, and letting them spend it, gets the incentives a lot closer to right.

Patient-perceived quality of care isn't the right measure. Patients don't like being told that they need to exercise, lose weight, drink less alcohol, rest.

A large part of a patient-perceived score is whether they get what they want. This often isn't in the best interest of the patient. With patient-score focused medicine, you get over-prescription of pain-meds, adderall, antibiotics. You also incentivize doctors not to challenge patients with dangerous views like anti-vax.

That's perhaps true in some cases. But I think patients need to have a little more skin in the game.

Take knee surgery. My surgeon friend does 7 of these each day at $30K/surgery (he "only" gets about 10% of the charged amount). If there was even a 10% copay on this, possibly means-tested if you want to make it fair for poor people (meaning it goes up the more income/wealth you have), you'd better believe more people would choose dietetics (my mom's profession, group classes cost like $10 each) over $30K knee replacements.

You're talking about a procedure that costs roughly the yearly pretax median income of a US adult. Some people have multiple of these per life. We can play the "who pays" game all day, pushing the cost of care around on the plate, as it were, but until we stop prescribing high-cost surgeries and expensive solutions to chronic conditions, the needle isn't going to move on how much we spend on health. 20% of GDP and growing, to be exact.

I just don't think there's a way around this without forcing patients to feel a bit more pain.

> The solution is really pretty simple: there needs to be meaningful competition on the (patient-perceived) quality of care.

Competition would require at least a slight oversupply of doctors. Right now there's a shortage: we're training about 80% of the doctors we need for the current levels of procedures. Meanwhile the population is getting older and that means more procedures. This will get worse before it gets better.

So this can only happen if we increase funding quite a bit for medical training programs, essentially country-wide. 25%, absolute minimum.

> "Because the majority of doctors are overworked, exhausted, and discontent, they've normalized their misery and pretend that it's not as bad as it seems"

This quote from the study hit me.

So many people are unhappy with the amount of unproductive work they do (e.g. administration work for doctors). But no one wants to change it?

If you haven't read "Why Doctors Hate Their Computers" [0] I highly recommend it. It relates exactly to what you're talking about (in terms of boring admin work) and applies to more than just doctors.

My takeaway was that while doctors hate the very structured process and busywork, the hospital admins think it is better for the patient and better for the institution.

In some ways it makes sense. It's hard to refine and make a process consistent when every doctor does things different or doesn't properly record everything. On the other hand it removes a lot of agency from the doctors and leaves them unfulfilled.

It's mass production principles applied to "knowledge" work.

There was a time when one person would make a whole chair. I imagine it was at least somewhat fulfilling to transform a bunch of wood into a functional object.

As time went on it became clear that it was more efficient to break it into component parts, blah blah blah, assembly line. After the assembly line (but before automation) there were a lot of people "making" chairs, but I'm sure the guy fixing the right arm in place didn't feel as fulfilled as the original craftsperson.

We're getting that to some degree in hospitals now. Hospital admins want the ability to tinker with procedure, to know what's going on in a real, measured way and maximize efficiency. It just so happens that it leaves the doctors a whole hell of a lot less fulfilled.

[0] https://www.newyorker.com/magazine/2018/11/12/why-doctors-ha...

"Most doctors say it’s the level of paperwork and data input they’ve had to do since medical records went digital".

So before "digital" they didn't fill in as many records?

Checking the main article https://www.medscape.com/slideshow/2019-lifestyle-burnout-de... found:

"All that paperwork sucks all of the enjoyment out of being a doctor." -Family physician

"Fear of litigation, bad reviews, and complaints make everything worse." -Dermatologist

I can change the doctor words for any other profession and still found that any profession can argue the same thing

"All that paperwork sucks all of the enjoyment out of being a teacher / lawyer / policeman." -Family teacher / lawyer / policeman

but being the most common reason (paperwork) and want to kill themselves?

I can't / won't argue the point in detail for every profession, but would wager from personal observation that what doctors have experienced with EMR systems is immensely worse. There might be some good systems out there but what I've seen is a Kafka-esque UX nightmare that the doctors can't say "no thanks" to unless they own their own practice, which is being made harder in part because of all the red tape (digital & otherwise)

Here's the article on why doctor's hate their computers https://news.ycombinator.com/item?id=18381969. It's a UX nightmare or revenge on the ancillaries.

The whole problem is that the industry views this as a cost center.

It is something doctors don't want, nobody wants to spend money on it, and the EMR vendors know this, so they try to use legal mechanisms (ACA) to require doctors to buy their stuff, vs. competing in an free/open market such as tools like Gmail, Twitter, etc.

Look at incentives. This whole thing is so obvious. Nobody in health wants better records because the current industry provides no economic incentives whatsoever for the industry to keep them.

It doesn't actually say anywhere that they want to kill themselves except for the title. This is bad article. That being said it seems to be implying their depression is higher, stress is higher, and satisfaction is lower. I think the reason could be that they are spending the entire visit collecting data and not really treating or developing a rapport with the patient. I personally feel that most of my doctors visits over the past 10 years have been very impersonal and they were rushing to get me out. This is a stark contrast to the family practitioner I had for 20 years prior who felt like a family member. I actually don't go to the doctors hardly anymore due to bad experiences with them and never feeling like I'm getting adequate care. I'm sure doctors are aware of this and since many got into the profession specifically to help people I'm sure it takes a toll on them psychologically when they feel they can't do their job. The solution to this is more automated data collection IMO.

Bad journalism is par for the course from nypost.

> Nazario says that while burnout is common among workers, for doctors, it can seem worse because all the schooling and training they’ve undergone can feel like a waste when most of their day is spent typing codes into their medical software.

> “It’s almost like being a cog in a wheel, where they’re going through the motions of what’s necessary, not necessarily using all the knowledge that she or he has gained in the years of training,” Nazario says.

Sounds a whole lot like software engineering. I am guessing that this is how many people with specialized skill sets feel once they've maintained a job utilizing that skill set for some length of time.

Software engineering has nothing like the licensing and education requirements medicine does. You do not have to spend seven post-grad years to become a software engineer, or take out four years of post-grad loans.

And yet, software (as an industry) mostly works.

Something to consider.

What I’m seeing is that you’d be fine to let someone who got disillusioned with the career/salary prospects of holding a useless degree take a 2 month course on the Paleo diet, and then remove one of your kidneys.

Here's what would happen in reality:

Doctors need insurance against medical malpractice and other forms of liability. So the insurance companies would develop their own form of standardization/credentialing, much like what happens in other industries like construction or shipping, to determine what are actually the highest risk factors for liability and other losses. You wouldn't be able to get insurance without following these guidelines.

The advantage of this system is that it's not written into law, making it much, much easier for it to change and evolve over time. Insurers would compete for business by pushing up against the minimum allowable standards and innovation would occur.

The thing I think people forget, is that legislated mandates are by their very nature, extremely hard to change. Regulations of the sort the FCC uses are easier, as they can be done by the agency itself, but they have their own problems.

I just don't think it requires MD-level training to do everything we need doctors to do today. Nurse practitioners and other less-credentialed peers are already taking up a lot of workload in medical offices and costs are still exploding.

That's a different topic entirely, one that's worth discussing: would medicine still work without the system that we have?

But the question that is being discussed here is not that question.

it's worse in the sense of: imagine you are primarily evaluated on adherence to an unintuitive and complex style guide plus some dumb metric like "lines of code added", and your pay can be withheld temporarily or permanently (for a given year) if you don't meet your targets

I have a rule that whenever we have a problem or controversy in the US, one of the things we should do is look at what the situation is in other countries, and in particular see if they are doing things better there.

With that in mind, what is physician morale like in other countries, especially Western European ones? And if it is, as I suspect, significantly better, then what is the reason?

I have a friend who is a doctor pharmacist. Every time we meet I feel genuinely bad for her. She works 12 hour days, in what basically is retail. She is required to push vaccinations and meet quotas. Stands all day, can't step out for lunch. It gets insanely repetitive.

Honestly, I would not be able to do it.

I was on friendly terms with my primary physician and he was also miserable. Insurance kept fighting his decisions to save money. He was getting pushed to see more patients and become more efficient. He often told me he is not happy in medicine and was jealous of me getting a CS degree and considered it himself, but felt too old.

I've had health issues over the years and only met one passionate doctor in Palo Alto, that was wealthy enough to pursue whatever he wanted in medicine.

However, I feel as we push for more efficiency people everywhere will have a lower satisfaction and higher burnout. They may initially be excited to work harder for higher pay but eventually they will realize they miss being able to have a slower day and chat with other people.

Are there any rogue doctors who don't fill out paperwork?

All of us using EMRs don't fill out paperwork anymore. We just copy-paste. Unfortunately admins think you can quantify stuff by making more measurements. But that's so amusing if you just talk to a few patients. It's like trying to quantify the quality of poetry.There is a HUGE gap between the patient's experience and the actual disease. That's why our ERs are clogged with people who think they are sick. Getting through that thick layer of emotion and still communicating with the patient is hard work.And it often fails. It's like the policeman who comes to the scene of an accident and tries to get the story of what happened from the accident victim (if she/he can even talk). Even if the victim is capable of speaking, the emotional turmoil renders the story moot. And amid all this chaos, they expect us to make cost effective diagnostic decisions? where one slip up can lead to an error of omission or an error of commission? and then a law suit? And if you are an employed physician, there is a bean counter looking to make you word harder. Even if you are part of a private group practice, the old guys take a cut of your money while you sweat, cry and bleed.