c.f.
"...everything is rushed, and mistakes are bound to occur."
"I am realising more and more that what brings me greatest distress is the relentless administrative pressure which take away the meaningful clinical engagement I have with my patients."
"I was burned out and I couldn’t control my emotions at work and at home. I’m not inherently an offensive or rude person, I’m just a person pushed to the limits and set to fail because of the circumstances around my work."
> In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those service
This is Australia, which does not have artificial restrictions on the supply of doctors to the same extent. On the other hand, they don't have a surplus of surgeons nor can nurse practitioners do the work
> (note the comment about denying other physicians income).
Yah, he's saying that if he doesn't come in, the backlog gets worse, and other people don't get paid.
> He's proud he's never sought help or tried to change anything.
He says he would like to seek support, but highlights the structural problems that prevent it:
"I know where I can get support, but practically, when and how am I going to get that support?"
"In addition, doctors who scream for help may be formally reported, therefore having restrictions placed on their practice and then incurring higher medical indemnity fees in some situations. Trainees who ask for help may be labelled as underperforming and have to be commenced on probation or remediation. We may not have practical access to the support that are often advertised."
I absolutely am in agreement with you that the things done to artificially lower the supply of residency training in the US are terrible. But those criticisms don't seem to apply to this essay.
Yes it does. One of the really interesting questions is actually why the same problems have been created in so many otherwise-different systems.
Edit: a post giving details on the Australian medical training constraints https://www.aph.gov.au/About_Parliament/Parliamentary_depart...
Your source says that the government sets (indirectly) a limit on the number of places at most public universities, but there are private, full-fee universities that are not so limited.
Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough.
Compare to the US, where congress basically directly controls the number of residency slots and has failed to increase them really at all to keep up with increasing population and increasing need for medical services.
I feel like you don't understand the distinction about positions at universities for initial medical training vs. internship and residencies, which I believe I discussed fairly above.
see
> > Internship slots, in turn, are set by disparate government agencies. They've climbed, but probably not climbed enough.
"Disparate agencies" isn't great phrasing, though, as what I really mostly meant was "each province".
More generally, Australia does have states and territories, but the federation model is far more centralized than the US: for instance, public hospital funding is a shared pool coordinated by federal agreement. https://www.publichospitalfunding.gov.au/victoria-basis-nati... While the vast majority of internships are at public hospitals, the federal government also pays directly to create a relatively small number of internships at private hospitals.
But of course this is all largely irrelevant because about one third of doctors in Australia completed all of their training in another country, and were then awarded a visa based largely on their profession being listed as a national priority under the system managed by the federal government.
But the question is why does the rest of society insist that pilots be properly rested but not doctors? I'm sure a lot of pilots would also work crazy amounts of overtime if allowed.
A truck driver! But doctors? No… they are Uberhuman and can make life or death decisions after 24 hours on call and awake. Ridiculous. It is a topic that angers me a lot.
This happens in Portugal as well as Poland, it indeed feel universal. I think the reason is that doctors are kind of like gods: in the hour of your biggest need it is them that can help, therefore they are highly respected and have huge influence over a wide cross section of society. Everybody will eventually need a doctor in their life.
Another pet outrage topic related to doctors is the amount of time they need for training. They train almost 12 years after high school before they are qualified. What a wasteful training. They learn lots of generalities to the specialize in the end. With a 10 or 12 year higher education you are speaking about phd or post docs for a profession that requires 1 for every 1000 citizens. Imagine that ratio of phds and post docs. Is being a GP really requiring such training? I don’t think so and agree with above posts that their duties should be broken down, opened and delegated.
Far more people die from car crashes than airplane crashes too: It's not even close. And yet, people who have no business behind a wheel drive, and the penalties for being a poor driver are typically minimal. Same difference.
With other professions, the people are awake, their brain just isn’t functioning properly, so it’s easier for people to ignore the true cause, since well rested people can make mistakes too.
He sounds like the kind of person that brags about being mentally sound but is secretly addicted to benzos. Always advocate for yourself!
At least in the US, there's a kind of masochistic pride in the physician community, that everything he described in his essay is laudable, noble, to be emulated. Nowhere does he acknowledge the risks to his patients or whether the costs are worth it in the end, or if a different system might be better. And he's holding up the lack of mental illness diagnosis as if it's something to be proud of, as opposed to never being diagnosed with say, cardiovascular disease or cancer. He's proud he's never sought help or tried to change anything. Sure he mentions problems with patient care in passing, but what he's really upset about is "just being another employee".
In the end in his mindset whatever he's complaining about is better than the alternatives, which is ceding over some of the care responsibilities to others or opening up healthcare to a more competitive market so he's not the only provider who could provide those services (note the comment about denying other physicians income). The AMA and physicians union (yes it's a union) basically guarantees this in lieu of having real competition, decreased income, and so forth.
Why is it different in something like aviation? My guess is because the failures are more visible, they're on the nightly news, people are there posting pictures on social media? For whatever reason, I don't think pilot organizations ever managed to remove themselves from scrutiny in the same way as physicians did. We see pilots as highly skilled professionals, but part of a system, with alternatives, and the subject of fair scrutiny from outsiders who are not pilots: engineers, safety experts, investigators and so forth. In my experience when these kinds of issues come up in healthcare though, everyone defers to physician groups themselves, as if no one else has expertise enough to scrutinize them.
I imagine too at some level, part of the issue is that the pilots themselves are subject to their own mistakes: if a pilot crashes a plane, they take themselves out at the same time. If a surgeon makes a mistake and kills a patient, they still walk home and can rationalize whatever they want, all they want.
I'm growing unsympathetic to these types of essays (the one linked). If physicians want me to empathize with them more, maybe they should stop stigmatizing mental unwellness and recognize it in themselves. Maybe they as a professional group should admit that others could take on some of the load, maybe even better in some situations. It feels a bit like they create a mess out of selfish greed or ego and then expect me to feel bad for them.