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  cmiles8
  The challenge in the US is that the best and brightest increasingly have no interest in entering the medical profession. The debt, crazy years of minimum income, all to let an insurance company admin dictate your every move and while more and more physicians become a labor pool for PE healthcare tracked with metrics fit for warehouse workers (edit: and that’s not OK in a warehouse either). All to earn a decent income but no longer the top of the market. A decent mid-level developer or tech executive makes more than nearly all physicians. No sane top performing talent would dive head first into that mess.There are exceptions of course but when my brother was considering medical school he visited about 10 different top physicians to seek input and advice and nearly all said if given a Time Machine they wouldn’t do it all over again. That was a real wake up call.If you go into medicine as a business entrepreneur and build a successful medical business then there’s opportunities for one to still taste some of the glory of the medical profession that once was. Outside that it’s basically a reasonably well paid life of indentured servitude. Yes you’re “helping people” but that only carries you so far which is why so many just burn out and leave.Massive reform is needed but the powers that be between the AMA and insurance companies seem unlikely to let that change happen unless it’s forced on them by Congress, and that too seems unlikely for now. Something more alike to an apprenticeship model where one grows up from EMT, to nurse, to physician fits the current business model much better than trying to preserve the old world “Officer vs enlisted” model where folks enter the profession directly as officers (physicians).
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  lll-o-lll
  > Doctors are caught in a web of business, no longer a noble vocation. The altruism of young doctors have been replaced by the shackles of efficiency, productivity and key performance indicators.And later> To some hospitals and their business, I’m not a Surgeon. I’m just an employee. Overworked, burned out, replaceable. The noble call to Medicine has been suffocated by the bureaucratic force exerting itself as the medical industry.How much of the world has gone this way? Feels like there is something sick deep down in society that is manifesting itself as “you are not a human, you’re a set of metrics”.Seems like this aspect could have been written by an Academic, a designer, certainly a software developer. The debasement of human dignity.
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  estearum
  (speaking from US): The reality is we need more doctors. A lot more.There's no solution other than training a lot, lot, lot, lot more doctors.Their salaries need to be lower, training needs to be cheaper and faster, and we need a lot more of them.
• matheusmoreira
  > Everyday, there’s a new form, a new guideline, a new protocol, a new health software, a new policy all dictating, restricting and modifying clinician activities.I felt this one... Takes all the running you can do, to keep in the same place.The entire loss of support section is way too real. I'd almost forgotten what that sort of institutional chaos felt like. So glad I don't work in a hospital anymore. It kills you inside.Loss of meaning was different for me. The author seems to long for patient contact... Just as easy to lose meaning there, I'm afraid. It's just as tiresome but in a different way. The repetitiveness can easily lead to a sort of depersonalization.> What I am realising is that today in modern medicine, a doctor is just one of the many commodities in this complex industry.This could be a fourth chapter all of its own: loss of autonomy.
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  pedrosuave
  I see a lot of comments that we need more doctors to be able to pay doctors less. There are of course exceptions but I really don't think 300k a year is unreasonable when coming out with nearly 600k in debt in a field with such high burn out and liability risk.Unlike salary position that 300k, at least in my field, is all via private equity and we are all independent contractors--meaning does not include any vacation, any paid time off, any sick days, any retirement or medical care or insurance of any kind.I have not seen a raise since I started which was prior to covid. I'm not saying I need a raise I am well paid but again to be 500k in debt with zero benefits and I see on Reddit buckees managers or UPS /fed ex drivers making 150 to 200k with benefits and the ability to call out sick and the ability to not lose everything because of a single case where you follow standard practices or guidelines followed around the country but something bad still happens.I go to work everyday with the understanding that the majority of my colleagues have been sued and even if not career ending the stress is enormous. At work I wear a tracker so that every fart and cough and patent interaction can be tracked. A VIP club of patients that donates to the hospital can ruin me with some bad reviews. A stray comment about poor care by an ems crew can end my career (as they bring the hospitals patients).I don't believe doctors are overpaid and we need more to bring their pay down. A patient will get billed 2000 dollars if they ask for a burrito out front in triage, walk in, are told by me that Taco Bell is across the street, and they promptly walk out without a single test done.On the other hand I may see sixty people in a busy night which require procedures such as being intubated and put on a ventilator, fractures being reduced , etc.A major problem is private equity in medicine. Everyone should be focused on removing these groups which skim money off everyone both doctors and patients included. Even if the argument that somehow their efficiency increases result in extra money to the system they can feed on there is no reason why hospitals can't group up and also be efficient and cut them out and pass down savings to the customer or not overwork us docs or treat us like expendable McDonald's employees. The lack of working directly for the hospital there is no metric for skill or seniority or anything like that you are an expendible piece of meat/fall guy that they load down with as many mid level providers as they can get away with
• Schlagbohrer
  I still cannot understand why a profession like medical doctor does not have better working conditions + a guild or union to enforce that, like actuaries have. Doctor is a profession that few can do, few want to do, it's very hard, many barriers to entry etc. so all that would seem like it should result in doctors getting great pay and benefits like good working hours, even moreso because no one wants a surgeon who is severely sleep deprived and possibly suicidally depressed!I just don't get it. Do doctors collectively do something wrong here that allows hospital admins to mistreat them so much, including the mistreatment of interns/residents during med school? And this is international too, I have heard these awful working conditions from doctors in Australia, USA, and the Netherlands. In the Netherlands example the resident intern I spoke to was even in a Dutch union but apparently the union was pretty worthless because he got paid extremely little and had the same 20-30 hour shifts that doctors in the USA have.
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  khalic
  I remember some friends working in intensive care during the pandemic, I'll never forget their facial expressions after these 24hr shifts... I really wish someone would come up with a better way to do this
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  simonw
  Important context that's not obvious from the article - this is about the Australian healthcare system. I'd assumed it was the USA.
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  osmukka
  Healthcare is the last industry that should be privatized. It should be for the public good rather than for the profit of few.
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  willtemperley
  I thought the point of this article is that unsuitable technology and the associated loss of personal agency is seriously affecting the mental health of doctors, yet none of the comments here seem to reflect that.
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  hutattedonmyarm
  In the same vein: there’s the fantastic bookThis is Going to Hurt: Secret Diaries of a Junior Doctor by Adam Kay
• 1970-01-01
  This very much points to the administrative side causing the damage. The overall toolset is broken and nobody is fixing.
• Grimeton
  >Interestingly, the above physical and emotional stressors are reasonably manageable to me. I’m understanding my own physical and emotional limits. These stressors induce exhaustion, but the excitement of the work and the intellectual challenge of the job bring a lot of personal satisfaction.This is the poisonous pill. In any job.This AI is set to fail and if it was a real person i'd be concerned.>This is Episode 1 of a Trilogy. >Episode 2: The Dark Side Awakens >Episode 3: Restoring Hope and Humanity to Health Care. Here I write about the 3 corresponding antidotes to the 3 issues above. >Episode 2 will be published next Thursday >Would you agree or disagree with my thoughts? What other “Dark Side of Doctoring” issues can you think of?https://deemagclinic.com/2017/08/27/dark-side/
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  ang_cire
  > You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. I accept the fact that I have a duty of care to be on call.Ultimately, this is a situation in which doctors doing this is worse in the long run.Burning yourself out to cover for understaffing means both worse life balance for you BUT ALSO worse patient care.No one quantifies how many people die, or how many diagnoses are missed, or how many patients feel unheard and become disillusioned with going to doctors, because doctors are dead tired and mentally burnt out, because they're trying to do right by patients.You have to force hospital admin and owners do THEIR JOB, which is (in part) to provide needed staff to run properly, by not letting them exploit or impart a hero complex onto a job.
• anon
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• hermitcrab
  What country is this Doctor in?Here in the UK, it seems that every time there is a problem they just add more managers.
• ratmice
  Feels like a hundred years later we're still cursed by the cocaine addiction of Dr. William Stewart Halsted
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  simonw
  Wow.> I had worked in a hospital network that covered 4 campuses and drove 500kms a week when covering these sites. I had worked in a hospital where I didn’t get home for days at a time, sleeping overnight in hospital quarters, outpatient clinic benches and in my car.As a patient, I'd like the person performing surgery on me to be well-rested!It gets worse:> I used to be able to arrange the operating list because I know that some operations take longer than others. But now, the bookings office determine that that all my tonsillectomies take 14 minutes because that’s the average time recorded on the computer. The moment I scrub in, the timer starts. The moment I unscrub timer stops. Click. Click. Click. Because the theatre bookings does not take into account the interpreter time, pre-med period or transfer to ICU, the list is running late. The nurse in charge is breathing down my neck to finish on time.And yet somehow that 14 minute tonsillectomy gets billed at ~$10,000.This seems to me like a system that has been hyperoptimized in a way that grinds down the participants.
• jcft2
  Are these problems consistent all over the world, or are they particularly severe in certain countries? I assume there are many studies of this already so it would be good to understand whether this is a problem that has a solution.
• ferrule
  Friends in medicine often mention the constant emotional drain from dealing with suffering and death. Takes a serious toll.
• carver2941
  Makes you wonder if they face similar on-call burnout but with actual life-or-death stakes. Way more intense than a buggy deploy.
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  heronbank
  Yeah, the burnout is insane. Knew a resident who basically lived at the hospital for years, completely lost their social life.
• underdeserver
  It's ridiculous. We need more doctors.
• anon
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  asdefghyk
  It seems there needs to be more doctors to help reduce the insane workload. Must be lots burn out suffered ? by Drs?
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  exdoctormachina
  I had a patient who tried and failed to use the legal system to extort me. Extremely frivolous.I'm in the process of leaving the profession.I don't feel guilty for the patients who will be left behind, they voted for this.
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  robertcope
  I feel like a very similar article could be written by a teacher.
• kiln_ash
  Friends in residency describe it as a grind that breaks people, not just physically but emotionally too. The toll is immense.
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  panick21_
  How the US does scheduling is kind of insane. Doctors like pilots (and truck drivers in Europe) should have clear rules about how long they work with rest periods and so on. Giving people 24h shifts is nonsensical and insane.
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  lotsofpulp
  >You might ask, why can’t you work less? It’s not as easy as that. If I decide to work less, who is going to cover the hospital? If the hospital aren’t employing other doctors, we can’t allow patients to go uncovered. I accept the fact that I have a duty of care to be on call.Yes, you can allow patients to go uncovered. This hero mentality is what leads the bosses to not properly staff and the politicians to not properly fund in the first place.It is not an individual’s responsibility to correct a societal failure by hurting themselves.
• RickJWagner
  A few years back a great doctor working at a local children’s hospital took his own life. News said he’d become despondent over children dying when he couldn’t save them. The whole thing is heartbreaking.
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  ransom1538
  "I have lost control of my days. I had worked in a hospital where I was oncall 24/7, 12 days out of 14. I had fortnightly weekends off."Medicine is ran by a bunch of creepy boards. "ACGME Review Committee for Dermatology." For example gets together and votes on how many Dermatologist we get, fun fact it doesn't go up much.$They were so kind to add 400 more Dermatologist$ in the past decade to the student pipeline.$ What could the rea$son be?What I would do if you are a doctor and don't hate humans - ask these boards to let more people in (hopefully Americans, but Americans have an uphill climb getting accepted with the flood of fraud applications from around the world).
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  logicallee
  I'm not suicidal and have never been suicidal or thought about suicide. I'm happy and in a good mood every day. If someone is thinking about suicide please reach out to me: rviragh@gmail.com I'll listen to your issues and concerns and we will find a better solution for you.
• kunley
  Same corporate-greedy shit as everywhere but harder, because it's dealing with suffering and death.
• farceSpherule
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• iluvcommunism
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• throw39304938
  [flagged]