Hospitals and contractors are great examples of professional fields where job roles are well-defined and the hours worked are carefully tracked. When contractors get too busy, they tell clients their project is delayed. When ER or ICU resources are maxed out, they stop accepting patients and send them to other nearby hospitals. When clinics are fully booked, they stop making appointments.

I understand what you’re saying about a problem solving mindset, but that is not the issue in burnout. The issue is unrealistic volumes and deadlines that encroach too far into the rest of your life.

Personal boundaries exist in medicine, in fact they are essential to surviving a career in medicine. There will always be more sick, injured, and dying people. The hospital has the mission to save them all if it can. An individual doctor or nurse has to understand that they personally cannot. Or they will burn out very fast.

Overworked tech companies could benefit from some perspective from the medical field. Is someone going to die if your feature misses its ship date? Probably not. People die in ERs every day, but guess what: ER staff still work a fixed set of hours, take vacations, etc.

Contractors is overly broad but plenty of contractors work overtime and very long, stressful hours including weekends and holidays.

Hospitals on the other hand, you're just downright wrong about that. Not only in general do hospital staff work 12 hour shifts including being on-call and having to work abrupt hours, especially over the past year their hours have been absolutely ridiculous. This includes nurses and MDs.

Feel free to review some studies on this issue, it's not hard to find nor is it some kind of secret. Basic Google search pops this up within the first few results:

https://www.researchgate.net/publication/200130302_The_Worki...

That study shows that in fact, nurses work their regularly scheduled shift less than 50% of the time, and 81% of their shifts involve overtime even though only 7% of it is scheduled in advance.

Here is a study looking at work hours among surgeons and physicians:

https://forums.ucdavis.edu/local_resources/docs/Freischlag-S...

It paints a very different picture from the idea that medical staff work very strict and well regulated hours. Their working hours are very chaotic and extreme.

I don’t need studies, I have a number of friends and family who are doctors and nurses.

You completely missed my point, which is that it is ridiculous for tech companies to compare themselves to a profession that faces literally life and death situations. Comparing to “the past year” (i.e. a historic global pandemic) just highlights the absurdity.

Your OKRs are not COVID patients!

My ancedote, and general data, agrees with the other person that your ancedote is wrong and healthcare is one of the most abusive environments in terms of nursing staff levels, hours, and quality of care. It's like you live in a different world.

Healthcare was easily the most toxic environment I ever worked in as well. The CTO literally was happy to quote that he treated it like a sweatshop because thats how you got the most value out of your human resources.

We literally had contractors fall asleep at the wheel and die driving between sites during marathon crunches where people got written up for leaving to eat / sleep.

My wife is a nurse at a huge national hospital. You're very wrong. 12 hours shifts turn into 13-14 hour shifts. They're so short staffed right now they're offering double pay + cash lump sums that equate it to triple/quadruple pay. But they pay lower than clinics and other hospitals in the area. They don't turn away patients.

You’re not reading what I’m writing. The fact that you know how long your wife’s shift is supposed to be is my point. The fact that nurses are being paid extra money for extra time is my point.

Engineers in Silicon Valley don’t clock in for a 12 hour shift. They are put on salary and any discussion of schedule is discouraged in favor of talking about “hustle” and “team players.”[1]

My point is not “health care workers don’t work hard.” My point is that they are set up with schedules and structure, which tech companies avoid… and then try to point at health care workers or “contractors” to justify the chaos.

Also I bet your wife is not working so hard just so the hospital can meet its financial goals. If she is like most nurses she is motivated by patient care and probably hates the administration, who are usually seen as bean counters who (if anything) impede care. Again, compare to tech companies who build myths around founders and corporate missions to obscure the purely financial stakes of their work.

[1] I know that not all companies operate this way, not all managers do this, not all engineers experience this. But there is obviously some sort of shared experience among a lot of people that the blog post at the top of the main thread is tapping into.

My wife's schedule is 12 hours: 7 to 7. Except nine out of ten times she's there until 8 or 9. It's "scheduled" but much closer to BAT times then sun revolution times. Any talk of schedule is discouraged and nurses are fired very quickly if they don't become "team players". Engineers in the valley have a lot more leeway because hiring is a lot harder. I can actively push back against my managers. My wife would be fired on the spot.

You're making numerous points and your later ones are good ones. But the working conditions for front line workers, including but not limited to their scheduling, hours, pay, etc, are all terrible.

>tech companies to compare themselves to a profession that faces literally life and death situations

I think you have a narrowly defined scope of “tech”. What about the software that controls the Da Vinci robot in the operating room? Do you want someone to say “eh, code quality checks aren’t my job?” Or the person writing flight software for aircraft? Or the safety critical software for a power plant?

The point being, yes, perspective is important but it’s a difference of degree not of kind.

The point being you aren't changing the code of a robot while it's being used.

There’s a time delay that separates these things. That completely changes your approach.

Fair enough on the Da Vinci robot because it's a turn-key product. But I can tell you that people change production code on the fly in safety-critical applications (particularly in the industrial controls space) much more often than many people would be comfortable with.

A better healthcare example may have been, would you be comfortable with people changing the building automation software that controls operating room air exchange rates or oxygen delivery systems?

But again, this isn’t really about software devs so it should extend beyond just SWE roles. It’s about positional duties, regardless if you write code or deliver meds to patients.

All of these systems run into schedule and cost pressures that often causes people to feel overburdened. I don't actually think they are fundamentally different.

There might be difference between healthcare systems in different parts of world.

> Not only in general do hospital staff work 12 hour shifts including being on-call and having to work abrupt hours

Not in EU countries that do not allow the medical profession to opt out of the Working Time Directive.

See"Are the opt-outs related to long hours?" in https://www.europarl.europa.eu/meetdocs/2014_2019/documents/...

Having personally worked in both healthcare and construction (sometimes even healthcare construction), I disagree.

Roles are not nearly as defined as you suggest. Take construction: there will always be conflicts between sub-domains. If there’s a clash between disciplines there’s nothing more frustrating than two sub-contractors who point to each other as the one who must “own” the problem to fix it. Same thing in healthcare. A surgeon who won’t do a task because they believe it’s beneath them is not benefiting the patient.

I don’t think most missions are capable of having clearly defined roles like you suggest. There will always be jobs that fall in the gray area and that’s why almost every job I’ve had included a “and other duties as assigned.”

I agree that perspective is important, but that’s talking about prioritization not shirking duties. I also understand burn out is a real risk, but I don’t think the right mitigation is taking a "that's not my job" perspective; I'd much rather see someone work with their supervisor to say, "here's where that falls in my current priorities". "It's not my job" tends to results in un-productive finger pointing or venting as opposed to actually aligning one's work with what's important to the shared mission.

I want to work with problem solvers not people who identify with strictly defined roles.

I don’t want overworked medical professionals. I want the hospitals to hire more people to work healthy 8 hour shifts.

There is a viable different approach, but the employers do not like it. Let’s stop pretending.

Ultimately, it's payers -- taxpayers and insurance payers -- that aren't down the the "hire more people" solution. Another stakeholder group that's not down with it? Doctors. The AMA, who doctors control corporately, don't certify enough medical schools to train sufficient doctors to make the reality you want possible.

Does the AMA certify the colleges of nurses? No. And yet here we are:

https://www.theguardian.com/society/2019/feb/12/nurses-hospi...

I didn't say doctors were responsible for all understaffed roles in the country. But they are partly responsible for understaffed physician roles. :) The payer aspect I mentioned is relevant for the nurses.

In America we pay on average ~$3000 per day of stay in the hospital. How much extra do we have to pay to have enough nurses so that we don't work them to death?

Why British hospitals have a fraction of that cost (1/10th)? Oh yes, it is because they decided that it is not a moneymaking business.

Overworked employees should not blame themselves for not being able to keep up with unreasonable hours. They should blame the real responsible for their misery. Their employer.

It feels good to have a villain to blame, but in a complicated problem, there are often complicated reasons.

https://www.investopedia.com/articles/personal-finance/08061...

Hospital profits are part of the costs, but doctors and nurses here are also paid more than elsewhere. Doctors in the US are paid multiple times as much as doctors in the UK, and supply restriction is a big part of why that is possible.

There are also administrative costs, drug costs, and insurance overheads to deal with.

It's not that complicated. When we setup competition for infrastructure, we needlessly duplicate management, marketing, accounting, and everything else that does not directly result in the service being provided. The US is doubly idiotic by creating huge financial barriers for anyone who wants to enter healthcare. We make the problem even worse with a system that encourages people to delay treatment for problems that get more expensive to treat over time. The less money you have the more you delay, so the entire system eventually ends up overpaying for a worse outcome.

This doesn't factor in all the time spent dealing with inscrutable billing practices for fully insured people having routine medical procedures, or the tens of thousands who are bankrupted every year by the same practices. We recently took our daughter to the ER, which is supposed to be a $400 copay. We now have three separate bills from that visit totaling $1100, and I have no idea how many hours it will take to sort out. The same billing department sent us a $380 invoice six months after her birth because (in their description) they forgot she was there.

>It's not that complicated

Just out of curiosity, what’s your proposed solution?

There's been decades of very smart people working on this problem and its still a problem largely because of its complexity. If there was a simple solution, I have a feeling it would have been implemented already.

The irony of your post that starts with "its not that complicated" ends with an anecdote about just how complicated the system is.

It was an anecdote about how complicated the US system is. Other countries figured out decades ago that adding competition to healthcare does not bring down the price or lead to better life expectancy.

It is not complicated.

https://data.oecd.org/healthres/health-spending.htm

https://data.oecd.org/healthstat/life-expectancy-at-birth.ht...

But you’re missing a crucial point: The US is not starting from a blank slate.

President Obama acknowledged this much when he proposed the Affordable Care Act. He said that he’d prefer a single payer system like other countries use, but that it’s not feasible in the US because we can’t just completely uproot the current system without a ton of unintended consequences.

“Just do it like other countries” isn’t a real plan.

So given the current state of the healthcare system, how do you propose it gets modified to mirror those other countries? Do you have a good handle on how those proposed steps (like drastic reductions in R&D spending) will affect the overall system?

When people naively think there are simple solutions to extremely complex systems, it reminds me of the quote “For every problem there is a solution that is simple, straightforward, and wrong.”

Obama has also been endorsing Medicare For All since 2018. From an article about that subject:

"The facts are undeniable. Citizens of developed countries with variations of single-payer systems — Britain, Germany, France, etc. — pay roughly half what Americans pay for health coverage and have better results to show for it (longer life spans, lower infant mortality).

They accomplish this not through some exotic, foreign magic but by exploiting the economic benefits of large insurance pools that represent the entire population. This allows comprehensive coverage to be offered at affordable rates because everyone shares in the risks and rewards of the system.

Let’s be real clear: This isn’t socialism. This isn’t communism. It’s simple risk management — the same economic principle that underlies all forms of insurance."[1]

The bottom line is that nearly a third of America (over 100 million people) are already on Medicare or Medicaid. That is enough data to forecast any outcome there is. Billing, coding, everything is already at a federal standard. Hospitals, doctors, and clinics love Medicare/Medicaid because they know what they are going to be paid and they are paid. Anyone who claims that it can't work here is either unaware of these facts, or purposefully pretending they don't exist.

[1] https://www.latimes.com/business/lazarus/la-fi-lazarus-obama...

I think you are misunderstanding what I'm saying.

I'm not arguing whether single payer is a good idea. I'm not arguing that it's tantamount to communism. I'm not arguing that there are many politicians (Obama, included) who are in favor of it. I'm arguing about the feasibility of it in light of naive statements.

It's easy for a politician to endorse a policy, particularly a populist one like Medicare for All. It's entirely different to craft a policy, within the current system, that pragmatically implements it.

My claim is that Obama endorsed the idea because he both thought it was good policy and populist idea that worked in the favor of his politics. But that's entirely different from crafting a pragmatic policy that actually can get passed into law.

I think he's been on the record stating that he didn't like the ACA, but the goal was to pass something, even if it's broken, to try to force it into policy so that it would eventually be fixed into something better. So with so much support, why can't the U.S. implement it? That's central to my point.

"President Obama was clear that – while he would have preferred single payer if we were starting from a clean slate – it would be too disruptive given our current system."[1]

Point being, in many ways it is against the current system. So while you haven't directly addressed my questions, I get the impression you think "Just expand Medicare" is the answer. My point is that it's a bit naive because it really doesn't address the systemic effects that have kept single payer policy from already being implemented.

Medicare/Medicaid is on track to be the largest proportion of the entitlement budget, before expanding it and it doesn't count the Dept. of Veterans Affairs budget (I don't think healthcare is a bad way to spend the budget btw). I know many people will say the Defense budget can be cut to pay for it. But how do you plan on getting that passed when nearly every senator wants to protect the DoD jobs in their state? I'm not even against that idea, I'm just not seeing you advocate a real strategy to implement it. The U.S. is perpetually running against the debt ceiling and your proposal will exacerbate that. This is just the beginning; how do you address the medical insurance industry, particularly when they are heavily lobbying Congress?

If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy. So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system?

[1]https://washingtonmonthly.com/2015/09/13/obama-the-negotiato...

> I'm arguing about the feasibility of it in light of naive statements.

I have directly addressed your question with the fact that already a third of Americans are in a single payer system, and most of the world has a single payer or hybrid system.[1] It's naive to think we don't know how to do it, and that we can't learn something from other nations when we expand it.

If you don't think we're capable of achieving the same results as a bloc of nations that has twice our population and many more cultural differences between them, why? Low confidence in America as a whole? Math and science fundamentally change in different time zones? Nobody in America knows how to read German, Spanish, French, Japanese, Korean, Italian, Swedish, Norwegian, Dutch, Belgian, or English?

> If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy.

There's an even simpler explanation: S.1129 was not passed.[2]

> So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system?

No, your question is, "How can I keep the conversation going pretending that I'll accept an answer?" So let's nip that, and you can answer the following question: what evidence would convince you it is feasible?

[1] https://en.wikipedia.org/wiki/List_of_countries_with_univers...

[2] https://www.congress.gov/bill/116th-congress/senate-bill/112...

Yes, the bill was not passed. Neither were any of the proposals for the last 3 decades. Why do you think that is??

I mean, it’s “obviously” just so easy. Do you have better answers than President Obama? Or President Clinton before him? Or Bob Dole? Or John McCain? Yet with all their knowledge and connections, they couldn’t get it accomplished. Note that in nearly 20 years, Medicare for All bills only made it out of committee once. Why do you think that is?

Perhaps because it’s an enormously complex problem with lots of stakeholders and lots of competing interests. One that doesn’t get fixed by just copying a different model that operates outside of the U.S. constraints.

You still never addressed why those bills don’t pass. It’s like your answer is the trivial (and useless) one that “it’s because not enough people voted for it.”

Saying “we already cover 100MM” doesn’t explain how it can be more than tripled. I didn’t claim it can’t be done, I’m asking why none of the proposals have worked out so far. I’ve never claimed the US “doesn’t know how”, I’m saying they haven’t shown political will to implement it. I’m asking for a pragmatic answer that shows why it hasn’t worked despite previous efforts.

I’m asking for your opinion why that’s the case that nothings has been passed in the last 30 years despite the desire among many, many people to do so. I’ve already outlined a few examples that you just blow past for the naively simple answer. That’s not helpful nor does it demonstrate anything beyond a simplistic understanding of the problem.

I have no problem accepting an answer that actually shows an understanding of the complexity of the problem, even if I don’t agree. I’ll help you: I think the very first problem needs to campaign finance reform. Because without that, any proposed bill that goes against the monied interest is dead in the water. But that’s just the first of many things that has to happen before the bills you’re talking about have any chance.

>what evidence would convince you it is feasible?

Short answer: a bill that passes.

Again, I’m not arguing whether it’s technically feasible. I’m saying the US has not yet shown its politically feasible. I think you’re conflating my position on these.

That latter part is a much tougher and complex problem but every bit a necessary part of the solution. So take just a very small subset of that problem: how do you plan on mitigating the insurance industry’s influence in preventing the passage of a bill that goes against their interests?

Once you figure that out, you’ll have dozens of other political concerns to solve before you ever get to consider implementing the technical solution.

There’s a saying that your can choose between access, quality, and low cost but you can only choose two. The US system has chosen quality and access at the expense of cost.

Other countries benefit largely from the US healthcare R&D machine. The US funds over 40% of the world medical R&D. While other countries put price controls on their medicine, this arrangement won’t work with the current system if the US does the same. To a certain extent, US high prices partly subsidized the rest of the world.

Hiring may be a part of it, but not the whole answer. It actually needs a more process-oriented solution. Adding people to a broken process makes things worse.

When people complain of being over burdened, more often than not it means the process they worked within had a lot of waste. Invariably, the proposed solution was always “we need more people”. You can sometimes hide process waste problems with inventory. The number of times hiring people made for a long term solution is exactly zero in my experience, and this includes process improvement work within healthcare.

“Just hire more people” tends to be a myopic view that underscores a misunderstanding of the systemic effects at work.

Are 8 hour shifts healthy for patients? More handovers is strongly correlated with poorer patient outcomes. We need to strike a balance between the falloff in ability that comes with consecutive hours awake past a certain point, and minimizing handover.

Refineries have blown up because of messed handovers, is the solution to have the console operators on 24h/7 days-a-week shifts?

Like the sibling comment said, if you are overworking then the process is broken.

The thing that I added, is that maybe the process remains broken because the employer finds it profitable.

NHS doctors will typically have a significant part of their rota made up of 'long days'. The 'solution' is never 24/7, or less hyperbolic but still overly long hours, because there is a median decrease in cognitive function that renders additional benefit from fewer handovers moot.

But as regards 'overworking', while that is certainly true for many US residents in particular, I think the majority of people would be overworked on a surgeon's schedule. Yet reducing it significantly would probably be much worse for patients and decried by surgeons. My viewpoint is mostly informed by the British neurosurgeon Henry Marsh's opinion on working hours.

You’re not wrong, but when doctors work longer shifts, they work fewer days of the week. The total weekly hours are the same, they are just distributed differently.

There's room to have pride in your job and still erect those boundaries. Maybe not doing the literal "bare minimum," but recognizing where your duties end. If you're constantly going beyond your duties, there are likely structural issues that are not being addressed.

I wouldn't appeal to a person's better nature to counteract this attitude. If their nature were to be a team player, they would be a team player. Instead, employers need to recognize that there will be mercenary employees, and they need to set up their systems to reward the behavior they actually want to encourage. If mercenary behavior is rewarded, that's what you'll get at the margin.

At least at my employer, it doesn't seem like shirkers and work-to-rule folks are rewarded. Maybe there are some people who do work like this and are still getting rewarded by giving off the appearance of being team players, but I guess you'd have to be a pretty careful actor to accomplish that. You'd also need to be able to manipulate your colleagues into doing the work you aren't, but still liking you enough to review you well during 360 reviews.

That being said, there is a grain of truth in what the op was saying as well. It's not healthy to care too much about your employer's goals, because they are necessarily in tension with yours to a certain degree. Work should be compartmentalized to the degree appropriate to how much you enjoy it and the material rewards you're getting from it, and this balance is going to be specific to each individual person.

I couldn’t agree with this more. I think it also speaks to the importance of leadership in creating a culture that incentivizes the right behavior

Have you ever thought how and why the “it’s not my job” attitude fostered? Most people at least myself on their first day working would never thought they would end up at some point as people they despised so much.

I have had a similar career experience. In time, I’ve decided to accept that I’m much more like those people than I wanted to accept when I felt I was a young and hungry “disruptor”

I am much more a product of the systems than I wanted to accept. That’s the most mature perspective I have had to date - and has led to more empathy than I thought I was capable of.

The reason you didn’t like those people is that somewhere deep inside you knew it could be you in ten years. I had the same thoughts, and came to the same insight.

It’s a lot like how you dislike the people who remind you of your bad qualities.

Like most problems I think there’s the actual issue at hand and also the feelings that fosters. Feeling under appreciated is the #1 complaint amongst employees, I believe, and even out-ranks salary. There’s probably a balance. Sometimes the employer isn’t appreciative and sometimes the employee overly inflates their contribution.