Comments on: Long hours and the doctor shortage http://www.medrants.com/archives/2296 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Craig Hayek M.D. http://www.medrants.com/archives/2296/comment-page-1#comment-544691 Craig Hayek M.D. Mon, 08 Aug 2011 17:18:51 +0000 http://medrants.com/archives/2005/03/08/long-hours-and-the-doctor-shortage/#comment-544691 Most certainly the medical communitiy is an unattractive field and as such supply decreases even though demand increases.  It seems to be simple macro economics, primary care does not pay enough money , therefore highly educated people who also need to send there children to college, buy a vehicle and a home as well as foot the bill for med school will not take on a job that does not foot the bill.  I don't think it has anything to do with hours or shifts etc.  While the word "cowardly" may seem daunting to the casual observer physicians have done nothing as a whole to fight back the businessmen (and women) who pervade the field, their cut comes first make no mistake, and so cowardly would be the accurate descriptive here.  Personally I hate bullies, I fight back in the true sense, but I am a minority and for it am usually punished in some way for not having a square head instread of a round one. Most certainly the medical communitiy is an unattractive field and as such supply decreases even though demand increases.  It seems to be simple macro economics, primary care does not pay enough money , therefore highly educated people who also need to send there children to college, buy a vehicle and a home as well as foot the bill for med school will not take on a job that does not foot the bill.  I don't think it has anything to do with hours or shifts etc.  While the word "cowardly" may seem daunting to the casual observer physicians have done nothing as a whole to fight back the businessmen (and women) who pervade the field, their cut comes first make no mistake, and so cowardly would be the accurate descriptive here.  Personally I hate bullies, I fight back in the true sense, but I am a minority and for it am usually punished in some way for not having a square head instread of a round one.

]]> By: Pat Conrad, MD http://www.medrants.com/archives/2296/comment-page-1#comment-18096 Pat Conrad, MD Thu, 07 Apr 2005 13:57:49 +0000 http://medrants.com/archives/2005/03/08/long-hours-and-the-doctor-shortage/#comment-18096 Could it be that the growing doctor shortage is due to medicine becoming an unattractive occupation? Our cowardly profession will not declare its own value and educate patients on the evil heart of the belief that there is a "right" to health care. We view the slide of this nation's health care system into full-blown socialism as tragic, and...kinda funny. Come share your comments with us at www.doctorsforfreedom.com Pat Conrad, MD www.doctorsforfreedom.com Could it be that the growing doctor shortage is due to medicine becoming an unattractive occupation? Our cowardly profession will not declare its own value and educate patients on the evil heart of the belief that there is a “right” to health care.

We view the slide of this nation’s health care system into full-blown socialism as tragic, and…kinda funny. Come share your comments with us at
http://www.doctorsforfreedom.com

Pat Conrad, MD
http://www.doctorsforfreedom.com

]]> By: Jonathan http://www.medrants.com/archives/2296/comment-page-1#comment-14062 Jonathan Wed, 09 Mar 2005 12:38:51 +0000 http://medrants.com/archives/2005/03/08/long-hours-and-the-doctor-shortage/#comment-14062 I'm an internal medicine resident, from the last class to have done my internship before the Work Hours Rules went into effect. I will give the debate the attention it deserves later, but I'd like to address a few points: --We say that long hours lead to "continuity of care", but we still don't stretch that to true CofC. It is still the norm in many areas of the country for a physician to take call for his own patients 24/7, and if we truly believed that continuity of care was sacrosanct, we'd all do the same thing. Most of us, however, share call with others, and that means that we eventually have to trust our colleagues to take over, continue what we've started, and put out any new fires. We can do that after 30 hours or 40 hours or 12 hours, but we eventually do it. --You're right that adrenaline is a great motivator; I can run a code just fine after 20 straight hours of working. However, the more common situation of admitting that eighth COPD exacerbation of the day just doesn't stimulate much adrenaline, and that's where the error is more likely to be made. That error might not be as immediately critical in a code situation, but it might end up causing just as much bad outcome. You're also right that being on call is not always horrible--but sometimes it is. I have had call days in which I started working at 7:00 AM and didn't stop until sometime the next afternoon, with barely a chance to choke down a sandwich at some point in there. It isn't common, but it's something we all have even in the "new era". I am barely in any shape to drive home after an experience like that, much less to provide patient care. Honestly, I think of anyone who says they can provide quality patient care in that setting the same way I think of the guy who says he can drive just fine after a 6-pack. --I would love it if the rules could be applied via "common sense" rather than fiat from above, but that's what we had before July 1, 2003, and the upshot was that the rules were ignored entirely. Even if you gave a resident the right to sign out and go home if he feels he is too sleep-deprived to work effectively, no approval-seeking intern is going to risk a bad evaluation for that. Making it required is the only way for it to work. I’m an internal medicine resident, from the last class to have done my internship before the Work Hours Rules went into effect. I will give the debate the attention it deserves later, but I’d like to address a few points:

–We say that long hours lead to “continuity of care”, but we still don’t stretch that to true CofC. It is still the norm in many areas of the country for a physician to take call for his own patients 24/7, and if we truly believed that continuity of care was sacrosanct, we’d all do the same thing.

Most of us, however, share call with others, and that means that we eventually have to trust our colleagues to take over, continue what we’ve started, and put out any new fires. We can do that after 30 hours or 40 hours or 12 hours, but we eventually do it.

–You’re right that adrenaline is a great motivator; I can run a code just fine after 20 straight hours of working. However, the more common situation of admitting that eighth COPD exacerbation of the day just doesn’t stimulate much adrenaline, and that’s where the error is more likely to be made. That error might not be as immediately critical in a code situation, but it might end up causing just as much bad outcome.

You’re also right that being on call is not always horrible–but sometimes it is. I have had call days in which I started working at 7:00 AM and didn’t stop until sometime the next afternoon, with barely a chance to choke down a sandwich at some point in there. It isn’t common, but it’s something we all have even in the “new era”.

I am barely in any shape to drive home after an experience like that, much less to provide patient care. Honestly, I think of anyone who says they can provide quality patient care in that setting the same way I think of the guy who says he can drive just fine after a 6-pack.

–I would love it if the rules could be applied via “common sense” rather than fiat from above, but that’s what we had before July 1, 2003, and the upshot was that the rules were ignored entirely. Even if you gave a resident the right to sign out and go home if he feels he is too sleep-deprived to work effectively, no approval-seeking intern is going to risk a bad evaluation for that. Making it required is the only way for it to work.

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