Excessive working hours are used as an excuse by medical cartel to justify practices that drive down the supply of providers through licensing requirements, and drive up salaries for doctors and everybody else up the chain. "See how hard we are working and how long we had to stay in school? We deserve to charge $500 for a 10 minute visit". "An acne cream that Europeans get over the counter for $5? We studied for 10 years and we know best what's safest for patients, so they HAVE to go to us first to get a $300 prescription." This is literally the arguments that medical associations have been using to lobby state and federal agencies to keep the status quo.

What needs to be done is a dramatic shift of power away from doctors in the medical industry. Flooding of medical labor markets with mid-levels - nurses, PAs, RAs, PTs - and relaxing respective scope of practice laws. Physicians will fight to death against new competition, even if it means killing themselves with unreasonable working hours.

https://www.auntminnie.com/Forum/tm.aspx?m=581583

"Don’t teach your mid levels procedures... Ultimately, a mid level that can do procedures, even easy ones, are your competitors."

https://www.politico.com/agenda/story/2017/10/25/doctors-sal...

Excellent comment. The AAMC and AACOM quite literally fit the definitions of cartels, artificially restricting the supply of medical doctors.

Also, it's the 21st century - why do doctors (more specifically, hospitals) generally work 9-5 M-F? Viruses and bacteria don't take the weekends off. Not to mention when people need to see a specialist, they need to wait weeks or even months for an appointment. Why? It's absurd. With a larger supply of doctors and something like 7am-10pm daily hours, it would result in a massive net benefit to society.

“...it's the 21st century - why do doctors (more specifically, hospitals) generally work 9-5 M-F”

What country do you live in? In the USA hospitals are open and staffed for emergencies 24/7/365. I’m a Radiology Technologist who works in an ER and Surgery- and I’ve never worked less than 48 hrs per week. I work 2300hrs-0700hrs. If you are talking about viruses and bacteria, that’s usually not an emergency issue and yes, you CAN wait until normal business hours (unless you’re septic)

I live in the USA. Oh, you mean the same ER that will slap you with a several thousand dollar invoice (only after the services are provided, of course) after a 3 hour wait? Well that's a related but different story I won't get into at this time.

If I have have an infected tear duct (in fact, I do) requiring a visit to an ENT specialist (for example), it's frankly absurd that the next appointment requires a 2-6 week wait. And then it also affects the work day because ENTs docs are only available 9-5.

Why aren't there two shifts of doctors: 7am - 3pm, and (as an example) 12pm-8pm? At least I work a computer-based job; what about a construction worker or other blue-collar worker who has to take an entire day off because they can't log in and continue work remotely (and if you know blue collar folks, this is the reason many will skip preventative care until they are critically ill)?

Your argument seems to be "well you won't lose the eye or go blind so it's fine" and that simply isn't how we should be viewing healthcare.

And just for posterity's sake, I've spent years at hospitals and medical device companies, my background is in biomedical engineering, and I'm not what you'd consider a layman in this area.

"The AAMC strongly supports bipartisan GME legislation introduced in both the House of Representatives and the Senate, the Resident Physician Shortage Reduction Act of 2019 (H.R. 1763, S. 348)" - https://news.aamc.org/for-the-media/article/gme-funding-doct...

"Flooding of medical labor markets with mid-levels - nurses, PAs, RAs, PTs - and relaxing respective scope of practice laws"

Well, I don't have any insider knowledge, but from a healthcare consumer perspective, it sure seems like doctors have gotten scarce and NPs are doing everything these days.

I don't know how the money flows in a group practice with one doctor and everybody else is not, but I'd be curious about how it works.

Never understood why this doesnt get any press. Its absurd

It gets press, but it also a legitimate training technique in many fields. There is something to be said for living and breathing nothing but your job for a period of time. Stress and the ability to perform despite stress is also something that must be learned through experience. Doctors, attorneys, the entire military ... the juniors are run through a few years of long hours and horrible conditions. The downsides have to be weighed against the training value.

You still need sleep to form long term memories and make good decisions. Sleep deprivation is inhumane to the students and deadly to patients. There is no excuse.

You do realize that this isn't the entire training scheme? This is one stage of a multi-year process, starting long before med school. The most effective thing for patients would be to never be treated by trainee doctors but that isn't a practical option.

Yes. What's your point? Hopefully it's not that since patients are going to be treated by students, we may as well give up and have them treated by sleep-deprived students, or that sanity in one phase of the training process excuses insanity in another. But if you're not trying to make one of those arguments, I don't know how your comment is relevant.

The military is trying to mold you the same to make you replaceable and obeisant. Doctors don't need to be all the same.

Replaceable and obeisant? You've watched too many movies. Skills learned while under stress will be with you when you are under stress again later. A doctor is trained under stress so that in the future, when their patients are about to die in front of them, that they react as trained. A doctor will see more blood, more death, than most soldiers. The parallels in stressed training are not insignificant, and have nothing to do with obedience.

That's just not true. Being trained in a relentlessly stressful environment means that you're less likely to be creative, thoughtful, and empathetic in the solutions you come up with. It can also lead to learned helplessness -- a sense that things must be done the way they've always been done, because there's just not enough time and space from others to do things properly.

During residency they are dealing with patients dying in front of them. The stress is already there. I don't see why being sleep deprived is a benefit.

Basic training is literally about making them think and act certain way. It is literally about them all teaching exactly same set of super basic skills so that the soldiers are replaceable by the end by each other. There is reason why soldiers personality changes after basic training (that is what their families and partners say).

More complex skills are not taught in basic training, but later in specializations.

Under stress and duress and lack of sleep, people learn less. Moreover, while soldiers do in fact have to work in difficult physical conditions in action, doctors don't.

And I am not even sure what death on itself has to do with it. Conditions of encountering it are incredibly different in both professions.

“...Moreover, while soldiers do in fact have to work in difficult physical conditions in action, doctors don't. And I am not even sure what death on itself has to do with it. Conditions of encountering it are incredibly different in both professions.”

Try working in an inner city ER at night when it can often feel very similar to a war zone. Instead of sandbags and soldiers with rifles we’re surrounded by bulletproof glass and police officers.

That is nonsense argument. Doctors don't sleep in barracks or on grass, they go home to families. They eat what they choose to eat. They don't dig latrines. They don't have periods (days) of boredom full of made up work combining with short intensive assignments. They can leave the job.

Soldiers are not surrounded by bullet proof glass nor by police officers.

Gets lots of press. Google doctor interns lack of sleep for a litany of deeply-researched news articles.

Hospitals are being privatised and private universities dominate medical education. Where’s the political pressure point?

It gets press but only so many ways to report the same story for years on end.

> Consider the plight of the medical student though.

While not as bad, ML/NLP/CV/AI grad school is still pretty bad. Maybe 60-70% of what med students (more specifically, residents) go through.

No way. It's not even close. And I say this as a PhD candidate in one of these fields at Stanford. Grad school is what you make of it, to a large extent. There's definitely toxicity, but it's not as systematic or ritualized to the extent that it is in medicine. In grad school, you have wide leeway over who you work with, and you can distance yourself from the toxic personalities if that's what you want to do without taking a career hit. That's not really possible in medicine.

At a top tier university, sure. Try a department with 20% faculty turnover where all the junior faculty leave before the third year review as soon as they get their NSF CAREER award and you don’t know if you’re getting paid in the summers.

Yeah, med school is the only “brainy” career path that endures military-style hazing on a ritualized and widespread basis.

To be precise: med school is (comparatively) a walk in the park. Years 3 and 4 of med school are a sort of "residency lite" where you rotate in different specialties, but the doctors don't really expect you to be useful, so it's fairly low-pressure other than odd hours. Study up so you can know what you're talking about, don't get in people's way, and you'll be fine. Residency is when the 80+hrs/week institutional hazing happens.

Yes, “medicine” would have been the correct term.

>While not as bad, ML/NLP/CV/AI grad school is still pretty bad.

Uhhhhh what? I'm in grad school right now. I feel... a lot better-off than any medical student or resident I've ever met, or even than my wife, who's a high-school science teacher (God help her!).

Currently getting a PhD at respectable grad school, my Girlfriend is currently at medical school. She has it way harder than I ever have, medical school is just on another level.

Graduate school is probably worse because it's not time boxed and what you're trying to do may not actually be possible. When you leave your medical residency for the day you don't have the option to continue working.

Wife is in surgery residency, they do a lot of research projects, there is a lot of work to take home

It never ends. Wife is an attending surgeon, and she's currently working on refining a grant proposal at 9pm on Sunday =).

It's done to keep supply down. Medical costs are high partially because of lack of doctors willing to put up with this. Talk to the AMA.