JAMA Study: Work Hours Limits Don't Improve Rate of Readmissions and Mortality

[PL198]

The question is this: because residents are working shorter shifts but handing off more, are hand-offs balancing fatigue in patient outcome? This has not been addressed yet.

Residency is not about length or "being hard." The term "Resident" came from the fact that you used to be a resident in the hospital. That was your life. I think it is silly to bring up "lifestyle" when talking about medicine - stop that. If you wanted a lifestyle you should have gone to dental school or some other profession where your skills are not immediately needed if someone gets sick. That's a crappy reason to go into medicine.

I can tell you from a "lifestyle" specialty of EM - I sure as hell put in plenty of extra time staying late, calling patients, doing charts etc, because sometimes it's the right thing to do.

As a medical student, and a resident, your job is to see AS MANY PATIENT PRESENTATIONS AS POSSIBLE. I say keep the long hours. Sorry if you can't go to the beach, but you may miss important cases.

Know why the surgical specialties laugh at duty-hour restrictions? They can't afford to miss cases. They absolutely cannot afford to miss repetitions of routine cases, follow up complications, see unusual cases, see unusual presentations. They get it. I'd let the surgeons lead the way on this.

You will be glad you worked your ass off MS3/4 and in residency when you are an attending and you get a difficult presentation. The more repetitions you do, the more experience you gain over a broader presentation matrix. What sucks is coming up against something you have no idea how to treat. Not only is insufficient training a medicolegal liability, it is bad patient care.

Get your reps.

Why should medicine be this unusual profession where a concept like lifestyle should be completely disregarded? That's a superiority complex, you're saying physicians should be so much better than the general public that they don't have to worry about normal human things like lifestyle. It's not normal for someone to want to work for 120 hours every week of their life. The whole " medicine is a calling " BS was the crap that screwed everything up in the first place. It's a complete joke to expect a completely different set of behavior from physicians as every other occupation. Show me another one where " I think it's silly to bring up lifestyle" is used. There aren't any. The avg person would freak out if you make them work a 60 hour week, yet physicians sit here and look down on students who say working 80 for 45k is enough. Blows my mind. If you want to expect residents to devote their whole life to their training, maybe you'd compensate them a little differently during that training. Making less per hour than a teacher, while I have an MD isn't too appealing.

Insufficient training is only a liability because the mindset that every doctor has to be 100 % right all the time, exists. It's not reasonable to expect someone to abandon their life so they can improve their percentages from 99 to 100%. Everyone makes mistakes, its *****ic to make policy saying that doctors are somehow different.

---

Members don't see this ad.

 

[PL198]

Seriously. what is the rational explanation behind " medicine is a calling," ? Why isn't law a calling, people's legal status is just as important as their health status in terms of their overall well-being. What about their accountants or financial managers? Obviously your financial status is very important towards well-being.

Also it's pretty clear to me there is a significant difference between the actual work done by a resident in a 100 hour week in 1990 than in 2014. The whole " I did it, you can too" crap doesn't make any sense.

Seriously. when were physicians brainwashed into this thinking that they owed it to their patients ?

 

[KnuxNole]

It's NOT a calling. that attending I think just wanted to vent. I like lifestyle. On services that I work 40-50 hours, it is hard work when in the trenches, then you go home, rest/relax, and focus on what really matters: life. So yes, I would happily take the beach day, sorry. Of course, it wouldn't be during work hours, it's for after work silly!

Don't worry, not everyone is like that. I know I am DEFINITELY not like that. Medicine is a job, a job I truly like. I do my job, and go home when work is done. I'm not someone who thinks I need to work 24/7...or wish I can take call every other day. Honestly, maybe it's bias because I'm NOT in a surgical specialty, but the duty hours rules have little effect on me. I'm thankful that I get plenty of days off, and not forced to work crazy amount of hours, since the learning value would literally be small. Hell, when I'm on call, I dont feel like I learn anything, especially when I'm too tired to even think or know what I'm doing....

At least call is slightly educational vs. useless as a med student

 

[PL198]

It's NOT a calling. that attending I think just wanted to vent. I like lifestyle. On services that I work 40-50 hours, it is hard work when in the trenches, then you go home, rest/relax, and focus on what really matters: life.

Don't worry, not everyone is like that. I know I am DEFINITELY not like that. Medicine is a job, a job I truly like. I do my job, and go home when work is done. I'm not someone who thinks I need to work 24/7...or wish I can take call every other day. Honestly, maybe it's bias because I'm NOT in a surgical specialty, but the duty hours rules have little effect on me. I'm thankful that I get plenty of days off, and not forced to work crazy amount of hours, since the learning value would literally be small. Hell, when I'm on call, I dont feel like I learn anything, especially when I'm too tired to even think or know what I'm doing....

Nope you're evil, a terrible doctor and clearly not committed enough. GTFO you're fired

 

[KnuxNole]

Mwahaha

 

[DermViser]

Seriously. what is the rational explanation behind " medicine is a calling," ? Why isn't law a calling, people's legal status is just as important as their health status in terms of their overall well-being. What about their accountants or financial managers? Obviously your financial status is very important towards well-being.

Also it's pretty clear to me there is a significant difference between the actual work done by a resident in a 100 hour week in 1990 than in 2014. The whole " I did it, you can too" crap doesn't make any sense.

Seriously. when were physicians brainwashed into this thinking that they owed it to their patients ?

It's a calling bc medicine makes you sacrifice so many areas/aspects of your life for it. This isn't dentistry.

 

[PL198]

It's a calling bc medicine makes you sacrifice so many areas/aspects of your life for it. This isn't dentistry.

that's done for the rewards at the end of the road. If you cut those rewards and say residents should do it anyway, then it's a superiority complex and you're expecting supernatural things from certain subsets of people.

 

[DermViser]

Why should medicine be this unusual profession where a concept like lifestyle should be completely disregarded? That's a superiority complex, you're saying physicians should be so much better than the general public that they don't have to worry about normal human things like lifestyle. It's not normal for someone to want to work for 120 hours every week of their life. The whole " medicine is a calling " BS was the crap that screwed everything up in the first place. It's a complete joke to expect a completely different set of behavior from physicians as every other occupation. Show me another one where " I think it's silly to bring up lifestyle" is used. There aren't any. The avg person would freak out if you make them work a 60 hour week, yet physicians sit here and look down on students who say working 80 for 45k is enough. Blows my mind. If you want to expect residents to devote their whole life to their training, maybe you'd compensate them a little differently during that training. Making less per hour than a teacher, while I have an MD isn't too appealing.

Insufficient training is only a liability because the mindset that every doctor has to be 100 % right all the time, exists. It's not reasonable to expect someone to abandon their life so they can improve their percentages from 99 to 100%. Everyone makes mistakes, its *****ic to make policy saying that doctors are somehow different.

Medicine has a special contract with society - one that is changing esp. with Obamacare. The bar is set higher for how society expects doctors to behave --- hence all the professionalism lectures you get from the school. It's a calling bc you sacrifice in so many aspects for it, w/nearly no thanks at all - from patients. Salary, job security, prestige, etc. don't make up for that. The primary driver to change in the healthcare system is the patient and their outcomes, not resident/attending well-being.

 

[jeffk805dent]

Medicine has a special contract with society - one that is changing esp. with Obamacare. The bar is set higher for how society expects doctors to behave --- hence all the professionalism lectures you get from the school. It's a calling bc you sacrifice in so many aspects for it, w/nearly no thanks at all - from patients. Salary, job security, prestige, etc. don't make up for that. The primary driver to change in the healthcare system is the patient and their outcomes, not resident/attending well-being.

with all the new medical schools opening up, this still exists?

 

[DermViser]

that's done for the rewards at the end of the road. If you cut those rewards and say residents should do it anyway, then it's a superiority complex and you're expecting supernatural things from certain subsets of people.

Those sacrifices would be there regardless of the end of the road - that's just how medicine is. As far as the govt. is concerned, they would replace all of us with PAs and NPs to cut costs, if the public didn't wasn't so adamant about wanting to keep their doctors. Look at the HUGE outcry about "If you like your doctor, you can keep your doctor", when it was found to be false. It's bc patients, esp. those who are elderly, like their personal doctor. People view physicians as being better than your average person and hold them to a higher standard.

 

[DermViser]

with all the new medical schools opening up, this still exists?

We haven't reached the point of more U.S. graduates than residency positions yet.

 

[KnuxNole]

The reality is, their perception is wrong. Doctors ARE in reality the same as your average person. For me, I always see docs as just regular people, that I hold in the same standard. But, for the average citizen, I can see where they get this idea, from media and from certain expectations...

 

[jeffk805dent]

The reality is, their perception is wrong. Doctors ARE in reality the same as your average person. For me, I always see docs as just regular people, that I hold in the same standard. But, for the average citizen, I can see where they get this idea, from media and from certain expectations...

if the average citizen cant see that, this country is even in more trouble than ever

A doctor would be like a normal person in the US - one that breathes air, has a social security number, and loves Chipotle.

 

[GUH]

Medicine has a special contract with society - one that is changing esp. with Obamacare. The bar is set higher for how society expects doctors to behave --- hence all the professionalism lectures you get from the school. It's a calling bc you sacrifice in so many aspects for it, w/nearly no thanks at all - from patients. Salary, job security, prestige, etc. don't make up for that. The primary driver to change in the healthcare system is the patient and their outcomes, not resident/attending well-being.

I didn't sign any such contract. If my workload is causing significant harm to my health or family life or if my pay is not at least equal to the market value of the services I provide, I'm not going to keep working under those conditions if I can help it.

 

[KnuxNole]

if the average citizen cant see that, this country is even in more trouble than ever

A doctor would be like a normal person in the US - one that breathes air, has a social security number, and loves Chipotle.

Chipotle...drools...

 

[DermViser]

I didn't sign any such contract. If my workload is causing significant harm to my health or family life or if my pay is not at least equal to the market value of the services I provide, I'm not going to keep working under those conditions if I can help it.

It's a societal contract the profession has made: https://www.google.com/?gws_rd=ssl#q=medicine+social+contract

http://virtualmentor.ama-assn.org/2004/04/msoc1-0404.html

 

[PL198]

It's a societal contract the profession has made: https://www.google.com/?gws_rd=ssl#q=medicine social contract

http://virtualmentor.ama-assn.org/2004/04/msoc1-0404.html

wait 90 percent of physicians say the AMA doesn't represent their views, yet they get to make social contracts for the profession? no, I don't think so

 

[Cytarabine]

No, that is not part of the RCTs. Not sure how you would standardize that at ~150 different residency programs

Eh, not sure it would require any additional randomization or anything. Wouldn't be able to gain a ton of additional information from doing this, but just doing a subgroup analysis based upon whether or not the program has instituted a standardized hand off procedure or not would provide some data on how modifiable the risk of increased hand offs is in practice

 

[Cytarabine]

Yes but I think that would be as meaningless as the Canadian checklist study showing no benefit to instituting surgical timeouts.

Implementation science requires a consistent, high quality implementation process. Just relying on whether programs self-report that they have a standardized signout process pretty much guarantees a negative outcome.

Fair point

 

[alpinism]

Why should medicine be this unusual profession where a concept like lifestyle should be completely disregarded? That's a superiority complex, you're saying physicians should be so much better than the general public that they don't have to worry about normal human things like lifestyle. It's not normal for someone to want to work for 120 hours every week of their life. The whole " medicine is a calling " BS was the crap that screwed everything up in the first place. It's a complete joke to expect a completely different set of behavior from physicians as every other occupation. Show me another one where " I think it's silly to bring up lifestyle" is used. There aren't any. The avg person would freak out if you make them work a 60 hour week, yet physicians sit here and look down on students who say working 80 for 45k is enough. Blows my mind. If you want to expect residents to devote their whole life to their training, maybe you'd compensate them a little differently during that training. Making less per hour than a teacher, while I have an MD isn't too appealing.

Insufficient training is only a liability because the mindset that every doctor has to be 100 % right all the time, exists. It's not reasonable to expect someone to abandon their life so they can improve their percentages from 99 to 100%. Everyone makes mistakes, its *****ic to make policy saying that doctors are somehow different.

Exactly.

As for the work hours, as Panda Bear said it best:

"welcome to the dysfunctional residency training system which was designed, literally, by a cocaine-addicted physician and which has changed very little since its insane beginnings. Sure, some of the hours have been limited but the system still depends on depriving you of sleep and making you work the kind of hours that are considered war crimes in most other countries. Heaven forbid you point this out. Apparently when it comes to an abusive medical training system, everybody is a hoary old conservative protecting their peculiar institution from reform."

http://www.studentdoctor.net/pandabearmd/2007/07/04/welcome-to-intern-year/

 

[Perrotfish]

It's not like the AMA made this up. The concept of a social contract dates back to at least as far as the hippocratic oath...

Have you read the Hippocratic oath? All it makes you promise, from a patient care/societal perspective, is not to use your medical knowledge to actively harm people and not to repeat things that your patients tell you. The rest is about not performing cholecystectomies and letting your old attendings crash at your place whenever they want. Its not what I would call a social contract.

 

[KnuxNole]

I know I sure as **** don't agree with that social contract....

 

[PL198]

Not to mention the hippocratic oath really isn't a social contract to begin with. You aren't pledging to citizens of your nation, you're pledging to your profession. If it was a social contract, it would be required of all medical students and physicians, when it isn't. Not to mention, that reciting it would be significant and not just some "alright your turn" type deal like it was at most schools. If it actually had meaning, we'd spend time studying it, deliberating over it's meaning, deciding if we want to take it up or not , since it would be a significant commitment.

The way it's done now in the schools that still do it, is it's basically an afterthought and tradition of ceremony. If it had actual binding societal obligations, the way it is performed today would be both coercive and negligent.

 

[Psai]

I don't know why you guys are talking about the ama but there's definitely a social contract between doctors and the rest of society. They get sick and we take care of them no matter who they are without any extra consideration for social standing or ability, etc. But it's being broken as people come in demanding things from doctors, putting extra outside pressures on us from non medical people and suing us for adverse outcomes even when they are not our fault

 

[Perrotfish]

I don't know why you guys are talking about the ama but there's definitely a social contract between doctors and the rest of society. They get sick and we take care of them no matter who they are without any extra consideration for social standing or ability, etc.

We have never, not once in American history, taken care of the sick no matter who they are. We have always had separate, understaffed hospitals for the poor. We have frequently given them cheaper, less effective medications, most recently exemplified by the Walmart $5 medication list. We have in many cases denied patients care entirely if they couldn't pay our rates (go look up how many physicians take Medicaid at all). And if they are unfortunate enough not to have insurance, we almost universally send them a nonsensical bill that's larger than their lifetime earnings (and 100 times what an insurance company would pay us), and then send our debt collectors to take their house away.

 

[DermViser]

Exactly.

As for the work hours, as Panda Bear said it best:

"welcome to the dysfunctional residency training system which was designed, literally, by a cocaine-addicted physician and which has changed very little since its insane beginnings. Sure, some of the hours have been limited but the system still depends on depriving you of sleep and making you work the kind of hours that are considered war crimes in most other countries. Heaven forbid you point this out. Apparently when it comes to an abusive medical training system, everybody is a hoary old conservative protecting their peculiar institution from reform."

http://www.studentdoctor.net/pandabearmd/2007/07/04/welcome-to-intern-year/

I love Panda Bear MD!!

 

[DermViser]

We have never, not once in American history, taken care of the sick no matter who they are. We have always had separate, understaffed hospitals for the poor. We have frequently given them cheaper, less effective medications, most recently exemplified by the Walmart $5 medication list. We have in many cases denied patients care entirely if they couldn't pay our rates (go look up how many physicians take Medicaid at all). And if they are unfortunate enough not to have insurance, we almost universally send them a nonsensical bill that's larger than their lifetime earnings (and 100 times what an insurance company would pay us), and then send our debt collectors to take their house away.

 

[DermViser]

Not to mention the hippocratic oath really isn't a social contract to begin with. You aren't pledging to citizens of your nation, you're pledging to your profession. If it was a social contract, it would be required of all medical students and physicians, when it isn't. Not to mention, that reciting it would be significant and not just some "alright your turn" type deal like it was at most schools. If it actually had meaning, we'd spend time studying it, deliberating over it's meaning, deciding if we want to take it up or not , since it would be a significant commitment.

The way it's done now in the schools that still do it, is it's basically an afterthought and tradition of ceremony. If it had actual binding societal obligations, the way it is performed today would be both coercive and negligent.

You're right. It's just expected. It's an ethical contract, not a legal one. Looks like someone was studying for a Pharmacology exam during the Professionalism lectures.

 

[Psai]

We have never, not once in American history, taken care of the sick no matter who they are. We have always had separate, understaffed hospitals for the poor. We have frequently given them cheaper, less effective medications, most recently exemplified by the Walmart $5 medication list. We have in many cases denied patients care entirely if they couldn't pay our rates (go look up how many physicians take Medicaid at all). And if they are unfortunate enough not to have insurance, we almost universally send them a nonsensical bill that's larger than their lifetime earnings (and 100 times what an insurance company would pay us), and then send our debt collectors to take their house away.

Who is we? Are you seriously trying to blame doctors for things that hospitals and the government are doing? If a third party decides to reimburse less than is required to sustain a practice after mandating large unnecessary expenses like emrs I don't see how you can be surprised when they don't accept your poorly managed, underfunded system

 

[deleted480308]

We have never, not once in American history, taken care of the sick no matter who they are. We have always had separate, understaffed hospitals for the poor. We have frequently given them cheaper, less effective medications, most recently exemplified by the Walmart $5 medication list. We have in many cases denied patients care entirely if they couldn't pay our rates (go look up how many physicians take Medicaid at all). And if they are unfortunate enough not to have insurance, we almost universally send them a nonsensical bill that's larger than their lifetime earnings (and 100 times what an insurance company would pay us), and then send our debt collectors to take their house away.

My plumber expects to get paid or he doesn't show, my restaurant gets paid or they don't make me food, my electric bill gets paid or my house goes dark

I will not apologize for expecting payment

 

[LabMonster]

Ironically enough, the reason Emergency Medicine is now popular with medical students is actually because of lifestyle in terms of controlled work hours, shift-work, once you're done and off-shift - no pager afterwards, etc. Hence the mnemonic E-ROAD: http://yalemedicine.yale.edu/autumn2007/features/feature/51534/ (the initial story is in Emergency Medicine actually).

I just think Surgery and all of its subspecialties should be treated differently than the rest of the specialties. The learning that takes place on Surgery is different than the learning that takes in Internal Medicine or any another specialty. Surgeons know best how surgical education should be conducted. That being said, the reason it is probably not done that way, is bc it would be completely abused by programs.

Residency is a set amount of time, that is correct, but depending on specialty, it can be one of the worst experiences of your life. Do you really think a human being can completely abuse his body in terms of sleep deprivation, etc. and have it not manifest itself in terms of physical and mental health?

Shift work seems cute and cuddly, but if you work in a fairly rural hospital - the ER is the primary care office, and so you do follow patients and you do worry about certain patients because they my be, hmm - generally more unhealthy than others. So I do not think EROAD is applicable to all facets of EM.

I completed my residency and passed my boards, so I have perspective and you do not. Residency is hell, I get it, but embrace what you are doing - learning on the job when you are primarily responsible for making decisions is much harder. Prepare for it.

 

[PL198]

Who is we? Are you seriously trying to blame doctors for things that hospitals and the government are doing? If a third party decides to reimburse less than is required to sustain a practice after mandating large unnecessary expenses like emrs I don't see how you can be surprised when they don't accept your poorly managed, underfunded system

Government doing? Huh. How do you expect to take no money for services? Yeah if someone is dying in front of me I'll help them out, but if they're not going to die, I'm not going to give up free value to help them. It's a slippery slope and eventually you can extend it to where no one should pay. I don't work to help others, I work to provide a service and get paid for it. There's a huge difference. Kinda strange you default to hospitals and government, who are the two common bad guys in health care arguments. Just because someone is a doctor, doesn't mean they have to give everyone access regardless of ability to pay. You guys act like these things are assumed when they aren't. You can't just arbitrarily make social constructs for a whole profession without ever actually creating those constructs. That's like saying all the stupid idealistic med students make up the social constructs for being a medical student. Uh no they don't because they're stupid and idealistic, so why would they represent anyone? Why would physicians have that same comparison?

 

[PL198]

You're right. It's just expected. It's an ethical contract, not a legal one. Looks like someone was studying for a Pharmacology exam during the Professionalism lectures.

some disillusioned hack who sees 5 patients a year doesn't get to decide what is and isn't my responsibility

 

[LabMonster]

Why should medicine be this unusual profession where a concept like lifestyle should be completely disregarded? That's a superiority complex, you're saying physicians should be so much better than the general public that they don't have to worry about normal human things like lifestyle. It's not normal for someone to want to work for 120 hours every week of their life. The whole " medicine is a calling " BS was the crap that screwed everything up in the first place. It's a complete joke to expect a completely different set of behavior from physicians as every other occupation. Show me another one where " I think it's silly to bring up lifestyle" is used. There aren't any. The avg person would freak out if you make them work a 60 hour week, yet physicians sit here and look down on students who say working 80 for 45k is enough. Blows my mind. If you want to expect residents to devote their whole life to their training, maybe you'd compensate them a little differently during that training. Making less per hour than a teacher, while I have an MD isn't too appealing.

Insufficient training is only a liability because the mindset that every doctor has to be 100 % right all the time, exists. It's not reasonable to expect someone to abandon their life so they can improve their percentages from 99 to 100%. Everyone makes mistakes, its *****ic to make policy saying that doctors are somehow different.

No, we don't have to be right all of the time, the public expects that, but the science and economics doesn't back it. But don't be a wuss. Yes, you are being called a sissy. Resident hours are not "forever" - they are limited, limited to a period of time in which you need to experience X number of cases to facilitate good patient care. It's not about YOU. Did you not get that in medical school? Medicine has little to do with YOU when you are practicing. When you are dealing with patients, everything is about THEM.

It's a "joke" to expect physicians have a different level of expectations from someone who works an unskilled job? Really? I've worked many "unskilled" - read, non-professional jobs on my development to medical professional and I can tell you that there are certainly different expectations of the medical profession versus "average" jobs. Doctors HAVE to be different because this profession is not about YOU, it's about caring for another person, a human being. You are also caring for their family.

This job is a big deal. It's not ego-maniacal if you keep perspective and you need to understand that patients and families will hang your every word, patients will depend on you, patients place their entire trust in your judgement. This "job" is not average. It is a calling. We get beat up, and it's not easy. Your psyche will suffer if you actually care about the people you take care of.

As a medical student, you will need to realize the difference between occupation and profession. They are different. They are distinctly different entities - and YOU are not the center of the universe when you enter medicine.

 

[LabMonster]

Exactly.

As for the work hours, as Panda Bear said it best:

"welcome to the dysfunctional residency training system which was designed, literally, by a cocaine-addicted physician and which has changed very little since its insane beginnings. Sure, some of the hours have been limited but the system still depends on depriving you of sleep and making you work the kind of hours that are considered war crimes in most other countries. Heaven forbid you point this out. Apparently when it comes to an abusive medical training system, everybody is a hoary old conservative protecting their peculiar institution from reform."

http://www.studentdoctor.net/pandabearmd/2007/07/04/welcome-to-intern-year/

I love Pandas posts. I disagree on this one. I will add that different residencies add different amounts of "crime and punishment." You need to pay your dues folks. Some of residency is bull**** - get over it. You will be responsible for peoples lives, so you are held to a notably higher standard. It's not a big stretch.

 

[DermViser]

some disillusioned hack who sees 5 patients a year doesn't get to decide what is and isn't my responsibility

Whether right or wrong, academic physicians at medical schools speak for medicine as a whole esp. to the govt. the AAMC speaks for them. The AMA "speaks" for America's doctors. Or at least they would if they didn't have a 72 million dollar slush fund from the federal govt. that exceeds the amount of money they get from member dues.

 

[DermViser]

Shift work seems cute and cuddly, but if you work in a fairly rural hospital - the ER is the primary care office, and so you do follow patients and you do worry about certain patients because they my be, hmm - generally more unhealthy than others. So I do not think EROAD is applicable to all facets of EM.

I completed my residency and passed my boards, so I have perspective and you do not. Residency is hell, I get it, but embrace what you are doing - learning on the job when you are primarily responsible for making decisions is much harder. Prepare for it.

Except most EM residencies are in academic medical centers in urban areas, not rural areas.

 

[DermViser]

No, we don't have to be right all of the time, the public expects that, but the science and economics doesn't back it. But don't be a wuss. Yes, you are being called a sissy. Resident hours are not "forever" - they are limited, limited to a period of time in which you need to experience X number of cases to facilitate good patient care. It's not about YOU. Did you not get that in medical school? Medicine has little to do with YOU when you are practicing. When you are dealing with patients, everything is about THEM.

It's a "joke" to expect physicians have a different level of expectations from someone who works an unskilled job? Really? I've worked many "unskilled" - read, non-professional jobs on my development to medical professional and I can tell you that there are certainly different expectations of the medical profession versus "average" jobs. Doctors HAVE to be different because this profession is not about YOU, it's about caring for another person, a human being. You are also caring for their family.

This job is a big deal. It's not ego-maniacal if you keep perspective and you need to understand that patients and families will hang your every word, patients will depend on you, patients place their entire trust in your judgement. This "job" is not average. It is a calling. We get beat up, and it's not easy. Your psyche will suffer if you actually care about the people you take care of.

As a medical student, you will need to realize the difference between occupation and profession. They are different. They are distinctly different entities - and YOU are not the center of the universe when you enter medicine.

It's any wonder we are losing the battle when it comes to reimbursement.

 

[DermViser]

i must have missed something...when did anyone say physicians don't deserve to be paid?

I think the issue above is regarding, reimbursing less than what it costs for those specific hospital services.

 

[W19]

We have never, not once in American history, taken care of the sick no matter who they are. We have always had separate, understaffed hospitals for the poor. We have frequently given them cheaper, less effective medications, most recently exemplified by the Walmart $5 medication list. We have in many cases denied patients care entirely if they couldn't pay our rates (go look up how many physicians take Medicaid at all). And if they are unfortunate enough not to have insurance, we almost universally send them a nonsensical bill that's larger than their lifetime earnings (and 100 times what an insurance company would pay us), and then send our debt collectors to take their house away.

You can't be serious!

 

[DermViser]

Government doing? Huh. How do you expect to take no money for services? Yeah if someone is dying in front of me I'll help them out, but if they're not going to die, I'm not going to give up free value to help them. It's a slippery slope and eventually you can extend it to where no one should pay. I don't work to help others, I work to provide a service and get paid for it. There's a huge difference. Kinda strange you default to hospitals and government, who are the two common bad guys in health care arguments. Just because someone is a doctor, doesn't mean they have to give everyone access regardless of ability to pay. You guys act like these things are assumed when they aren't. You can't just arbitrarily make social constructs for a whole profession without ever actually creating those constructs. That's like saying all the stupid idealistic med students make up the social constructs for being a medical student. Uh no they don't because they're stupid and idealistic, so why would they represent anyone? Why would physicians have that same comparison?

The social contract medicine has with society existed LONG before third party payers ever came into play.

 

[DermViser]

You can't be serious! That 250k+ student loan gotta be paid bro.

According to Perrotfish, everyone should have equal access to Memorial Sloan Kettering when they get cancer.

 

[DermViser]

No, it's conflating the idea that physicians have an ethical role in society with a whole bunch of other crap that no one has said in an attempt to torpedo the original idea.

Well one of the ethical roles is we give medical services to people regardless of their ability to pay. That's the issue, above.

 

[W19]

The social contract medicine has with society existed LONG before third party payers ever came into play.

I guess it's a one-way social contract since my COA is not free.

 

[W19]

According to Perrotfish, everyone should have equal access to Memorial Sloan Kettering when they get cancer.

It's very disturbing to see med students or residents making these kind of statements... Physicians are being f... everyday and you have other physicians saying 'well it's ok'.

 

[PL198]

No, we don't have to be right all of the time, the public expects that, but the science and economics doesn't back it. But don't be a wuss. Yes, you are being called a sissy. Resident hours are not "forever" - they are limited, limited to a period of time in which you need to experience X number of cases to facilitate good patient care. It's not about YOU. Did you not get that in medical school? Medicine has little to do with YOU when you are practicing. When you are dealing with patients, everything is about THEM.

It's a "joke" to expect physicians have a different level of expectations from someone who works an unskilled job? Really? I've worked many "unskilled" - read, non-professional jobs on my development to medical professional and I can tell you that there are certainly different expectations of the medical profession versus "average" jobs. Doctors HAVE to be different because this profession is not about YOU, it's about caring for another person, a human being. You are also caring for their family.

This job is a big deal. It's not ego-maniacal if you keep perspective and you need to understand that patients and families will hang your every word, patients will depend on you, patients place their entire trust in your judgement. This "job" is not average. It is a calling. We get beat up, and it's not easy. Your psyche will suffer if you actually care about the people you take care of.

As a medical student, you will need to realize the difference between occupation and profession. They are different. They are distinctly different entities - and YOU are not the center of the universe when you enter medicine.

alright so tell me one more profession. you throw around buzzwords aimed at eliciting this sort of mystical ambiguity about medicine, so I'd like to hear about a similar profession. just because a job isn't average, doesn't mean you have to give a poor amount of effort. I don't get what you're saying, you're speaking from both sides of the aisle. We shouldn't care what people think about us, yet we're supposed to be mother theresa and have some superior representation of commitment towards our customers? It's one or the other.

 

[PL198]

Whether right or wrong, academic physicians at medical schools speak for medicine as a whole esp. to the govt. the AAMC speaks for them. The AMA "speaks" for America's doctors. Or at least they would if they didn't have a 72 million dollar slush fund from the federal govt. that exceeds the amount of money they get from member dues.

they "speak" only as long as they are allowed to. academics exist and circle jerk because the avg person in their field thinks their own time is better spent being left to their devices. as soon as those academics go bat crazy and start overreaching, thinking they are the champ, that's when people step in and say " no, you really don't represent me" and knock them down a peg( see current AMA). not to mention academia is extremely idealistic and they can say all they want, but it doesn't mean what they're saying gets carried out at the actual person to person level. all fields are like this, where the academic representation of them are this idealistic impossibility. the one problem here, is that medicine actually tries to make those impossibilities into reality, instead of just saying " yeah ok whatever" and letting the circle jerkers circle jerk with each other. that's what every other field does and the only reason medicine is any different is because the avg doctor doesn't have the common sense to see it, since their entire training pathway beats the common sense right out of them

 

[W19]

Whether right or wrong, academic physicians at medical schools speak for medicine as a whole esp. to the govt. the AAMC speaks for them. The AMA "speaks" for America's doctors. Or at least they would if they didn't have a 72 million dollar slush fund from the federal govt. that exceeds the amount of money they get from member dues.

The government gives AMA $72 million every year!

 

[Old_Mil]

By now you should know that anyone can put together a study that comes up with the desired results...

Let's put the shoe on the other foot for a minute and consider this hypothetical:

"United Airlines To Revamp Pilot Training System To More Closely Reflect That Of Medical Residents

United Airlines will shut down it's Denver based training center in an effort to make its pilot training syllabus more closely reflect that of medical residents. After a series of written tests, newly hired pilots will report to Denver International Airport and ride around with United crews for three years. To increase their chances of seeing an in flight emergency, these newly hired pilots will not have the contractual duty hour limits that regulate previously trained United crews. After this three year period, newly hired pilots will take another written test and be integrated into the airline's schedule to fly passengers on revenue generating trips. After this, they will take annual written tests to demonstrate competency."

Ready to buy a ticket yet? Or does this fall under the category of "headlines I never hope to read"?

In reality, medical training is a bit of a joke. A lot of the time you spend at the hospital is time wasted searching for a needle in a haystack. The process would be dramatically improved by reducing the amount of time wasted in a hospital and spending more time reading and running simulations.

There is a confounding factor though...no airline expects to make money while training its pilots. Residents absolutely function as physician extenders - particularly in their PGY 2+ years - at half the pay of a PA/NP.

 

[Promethean]

I guess it's a one-way social contract since my COA is not free.

Not free, but more subsidized than you may be aware.

I am not entering the argument about whether physicians are getting enough in return for upholding their end... just saying that there is more to the social contract than you are admitting.

EDIT:

The government gives AMA $72 million every year!

Oh, look! My point!

This is just one of many ways that the profession is supported which may not be entirely obvious to someone who only considers their own COA and time investment. Not to say that what we put into upholding our end of the social contract is in any way trivial. It is enormous sacrifice, but it is not made in a void.