Andy9o8 2 #51 July 27, 2009 QuoteInterestingly, I've talked to several physicians who think that the (fairly) recent imposition of a mandatory maximum of 80 hour work week in residency has reduced the quality of care, because they don't get as intensive of training, and also because there are less provider-hours available. On that tangent, I've always wondered about the quality of delicate health care decisions made by or procedures done by hospital residents while in a state of sleep-deprived, over-worked exhaustion. Lots of other professions (pilots, truck drivers, etc.) have mandatory rest requirements for safety's sake, obviously for good reason. I'd love to hear some physicians' input on this. Quote Share this post Link to post Share on other sites
kelpdiver 2 #52 July 27, 2009 QuoteQuoteMoney traders tend to even worse hours than doctors, and they don't last nearly as long before they shift to something slightly different. What kind of educational loans and personal time investment do those folks make to become traders? 12 years and a couple hundred thousand dollars? More? Less? Also, if you think the stresses of trading rival the stress of having someone's life literally depend on your actions, you probably shouldn't be a doctor. Most doctors take that very, very seriously, and it contributes a lot to their stress. Personally, I think it also contributes to making them good doctors. But there's a price they pay, and we're the one's who collect the benefits. Are you a doctor or a trader, or just bullshitting along? Many traders are finished in less time than doctors go to school. Doctors practice for decades. Doctors smoke like crazy, despite obvious knowledge of the problems. Traders do lots of coke and speed. What's the point? The reason for 80hour maximums is that it's pretty fucking stupid to have people working even just double work weeks and making decisions that can kill or save patients. Errors kill tens of thousands per year, more than guns or cars. This comes back to the supply problem - the medical profession keeps the supply low for self interested reasons. Not for the benefit of society. that said, I'll venture those surveyed claiming skill has decreased were ones that went through the 100+ hour residencies and are miffed that the hazing experience is over. The usual 'when I was your age, I walked 10 miles to school in the snow.' Quote Share this post Link to post Share on other sites
Andy9o8 2 #53 July 27, 2009 Quotethat said, I'll venture those surveyed claiming skill has decreased were ones that went through the 100+ hour residencies and are miffed that the hazing experience is over. The usual 'when I was your age, I walked 10 miles to school in the snow.' That's what I'd suspect, too. Quote Share this post Link to post Share on other sites
TomAiello 26 #54 July 27, 2009 QuoteAre you a doctor or a trader, or just bullshitting along? None of the above, I guess. I'm not a doctor, but I've got a pretty good window into their lives, since when the phone rings at 3am it wakes me up, too. The 18 hour shifts sandwiching a wedding was my wedding, with the doctor in question being one of the bridesmaids. The financial calculations? I guess those are mine, now, too, since it's pretty much community property. The stress? Well, I'd like to think that I'm in pretty good touch with that, since it has a pretty direct impact on my life, and our kids' lives. I'm not a trader (you were the one with the knowledge about them, I thought, since you brought it up), although I did spend several months road tripping around with a guy who was just getting out of that. That's why I was asking you questions about them--I assumed you'd know. That leaves bullshitting...I dunno, I guess that depends on your perspective. QuoteDoctors smoke like crazy, despite obvious knowledge of the problems. Traders do lots of coke and speed. What's the point? The point is that those people are under a lot of stress. And that we depend on them to provide quality healthcare. And that it doesn't make a whole lot of sense to increase their stress by adding a bunch of new rules, while at the same time trying to cut their pay. Especially not if we still want them to provide healthcare of the quality they are now. QuoteI'll venture those surveyed claiming skill has decreased were ones that went through the 100+ hour residencies and are miffed that the hazing experience is over. Mostly, it's people who are having to clean up after the residents, actually, since the mentality now is "hey, when my shift is over, I go home" rather than "this patient is my responsibility." Which of those attitudes do we want to see in our doctors? Do we really want them doing shiftwork, and being incentivized to see as many patients in as short a time as possible? Is it really a good idea to put them on fixed salaries and then push them to see a higher volume of patients? Won't that tend to encourage an assembly line mentality? Is that really how we want our doctors thinking?-- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com Quote Share this post Link to post Share on other sites
kbordson 8 #55 July 27, 2009 QuoteQuoteInterestingly, I've talked to several physicians who think that the (fairly) recent imposition of a mandatory maximum of 80 hour work week in residency has reduced the quality of care, because they don't get as intensive of training, and also because there are less provider-hours available. On that tangent, I've always wondered about the quality of delicate health care decisions made by or procedures done by hospital residents while in a state of sleep-deprived, over-worked exhaustion. Lots of other professions (pilots, truck drivers, etc.) have mandatory rest requirements for safety's sake, obviously for good reason. I'd love to hear some physicians' input on this. I feel that I have a VERY fair right to comment on this. My intern year was prior to the federal work hour restriction. The remaining 3 years were with the 80 hour (averaged) work week restriction. And NOW... they are even moving it to a 60hour limit. LOTS OF DEBATE in the medical field about experience and exposure v. abuse. Personally... on some of those 36+ hour days... I felt dangerous even driving home. But I got "credit" for observing additional surgeries or procedures (as an intern, I really didn't DO all that much... especially during day time hours... the senior residents actually DID most of the procedure, I just did the paperwork and the "scut monkey" stuffs) But... even though I could document that I was present, I really don't know how much I was truly learning or retaining when my main focus was on the HORRID headache and the racing heart (caffeine). I think that there should be some limitation in hours... but let me also add that once out of residency, there are NO FEDERAL RESTRICTION ON WORK LOAD. And... to mandate it would drive even more physicians out of practice. If someone is a solo practioner, he/she is on call 24/7. And depending on the patient load, that can be full clinic in the day, interrupted by procedures/ER calls/ deliveries (if OB or Family Practice), phone calls all night and start over again in the morning. Even in a group practice (like I currently am in), you don't walk out at 5pm. You still have some patients in the hospital that you feel responsible for, so although you could "turn them over" to the on call doc, you feel like you know what's going on better so you tell the nurses - "page me." And the patients appreciate that too. They want one familiar face... and they tend to forget that you have 30 other patients in clinic and how many other calls from the ER REAL LIFE practice is hard. Residency was hard too... don't get me wrong. But at least then you had a senior resident or an attending watching over your shoulder.... But in REAL LIFE.... it does take LOTS of hours (and yes... I understand that here I type on dz.com at 4pm - but currently Mondays are my "day off", really more of an administration day, charting, signing off labs and doing hospital things... and since I was on call this past weekend... dz.com is a nice way to relax) Quote Share this post Link to post Share on other sites
kelpdiver 2 #56 July 27, 2009 Quote Mostly, it's people who are having to clean up after the residents, actually, since the mentality now is "hey, when my shift is over, I go home" rather than "this patient is my responsibility." That's the complaint of any team lead watching over newbies. I have 8 guys in Singapore I have to clean up after. But again, it sounds like the grumpy old timers whining about the youngsters whenever they make a mistake. Working them 80 or 100 (or even 60) hours certainly encourages mistakes and a desire to go home after "their shift." If I had one of those, I'd want to go home right on time too. Instead I work 5 days and the occasional weekend on call, and I am ok with it going long when there's something important going on. Quote Share this post Link to post Share on other sites
turtlespeed 226 #57 July 27, 2009 Is there a law or restriction that keeps Doctors and Nurses from striking? I know it may be a horrendous thought - but I see it happening if too much "Change" and "Hope" is forced upon you guys - whether or not it is legal or not. It would suck for a LOT of people out there - but it MAY just get Barry's attention.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
TomAiello 26 #58 July 27, 2009 QuoteIs there a law or restriction that keeps Doctors and Nurses from striking? No. It's not necessary, because doctors (not necessarily nurses) will never strike in any large numbers. Believe it or not, they actually do take their duty to heal very seriously. You could have guys out there shooting at them as they drove to the hospital, and most of these people would still head in at 3am, because they feel a real responsibility (or perhaps a calling) to do so.-- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com Quote Share this post Link to post Share on other sites
turtlespeed 226 #59 July 27, 2009 QuoteQuoteIs there a law or restriction that keeps Doctors and Nurses from striking? No. It's not necessary, because doctors (not necessarily nurses) will never strike in any large numbers. Believe it or not, they actually do take their duty to heal very seriously. You could have guys out there shooting at them as they drove to the hospital, and most of these people would still head in at 3am, because they feel a real responsibility (or perhaps a calling) to do so. Hmmm - I guess you never heard of the camel with the T5-T6 impaction then - One too many straws . . .I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
headoverheels 334 #60 July 27, 2009 Hearing doctors complain about work conditions and hours reminds me of hearing the same line from actors on the Tonight show. Neither of these groups is going to do as well in any other endeavor, and both are making hourly rates several times that of other well educated groups. "leave the office at 5"? Who does that? I have it fairly cushy, but still am usually at work until 8, often until 11, and working many holidays and weekend days (42 extra days in a 7 month period last year), and no, I don't get paid for those days or hours. The government is already subsidizing health insurance for all of us who get it as an employment benefit, by not taxing us on the value. Quote Share this post Link to post Share on other sites
TomAiello 26 #61 July 27, 2009 QuoteQuoteQuoteIs there a law or restriction that keeps Doctors and Nurses from striking? No. It's not necessary, because doctors (not necessarily nurses) will never strike in any large numbers. Believe it or not, they actually do take their duty to heal very seriously. You could have guys out there shooting at them as they drove to the hospital, and most of these people would still head in at 3am, because they feel a real responsibility (or perhaps a calling) to do so. Hmmm - I guess you never heard of the camel with the T5-T6 impaction then - One too many straws . . . Sure. But recognize that doctors, under our current system, are people who have already been through a tremendous selection process (involving more than a decade of constant striving and 6 figure debts) for exactly the same characteristics (work ethic, responsibility, desire to help others, ability to take insane stresses) that keep them from striking.-- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com Quote Share this post Link to post Share on other sites
turtlespeed 226 #62 July 27, 2009 QuoteQuoteQuoteQuoteIs there a law or restriction that keeps Doctors and Nurses from striking? No. It's not necessary, because doctors (not necessarily nurses) will never strike in any large numbers. Believe it or not, they actually do take their duty to heal very seriously. You could have guys out there shooting at them as they drove to the hospital, and most of these people would still head in at 3am, because they feel a real responsibility (or perhaps a calling) to do so. Hmmm - I guess you never heard of the camel with the T5-T6 impaction then - One too many straws . . . Sure. But recognize that doctors, under our current system, are people who have already been through a tremendous selection process (involving more than a decade of constant striving and 6 figure debts) for exactly the same characteristics (work ethic, responsibility, desire to help others, ability to take insane stresses) that keep them from striking. I still think that if pushed into what they DO NOT WANT they will.I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
TomAiello 26 #63 July 27, 2009 QuoteNeither of these groups is going to do as well in any other endeavor... I totally disagree. Our system tends to select the best, brightest, hardest working and most motivated to be doctors. You really think those people aren't going to succeed in some other line of work?-- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com Quote Share this post Link to post Share on other sites
TomAiello 26 #64 July 27, 2009 QuoteI still think that if pushed into what they DO NOT WANT they will. My personal experience with doctors, and their willingness to accede to even the most unreasonable demands on their time and energy, lead me to conclude that they're more likely to commit mass suicide (check the suicide rates on physicians, by the way) than go on strike.-- Tom Aiello Tom@SnakeRiverBASE.com SnakeRiverBASE.com Quote Share this post Link to post Share on other sites
kbordson 8 #65 July 27, 2009 Quote Hearing doctors complain about work conditions and hours reminds me of hearing the same line from actors on the Tonight show. Neither of these groups is going to do as well in any other endeavor, and both are making hourly rates several times that of other well educated groups. "leave the office at 5"? Who does that? I have it fairly cushy, but still am usually at work until 8, often until 11, and working many holidays and weekend days (42 extra days in a 7 month period last year), and no, I don't get paid for those days or hours. The government is already subsidizing health insurance for all of us who get it as an employment benefit, by not taxing us on the value. Just to point out - residents don't make "cushy" pay. 30k for 80 hour work weeks (that would be two separate minimum wage jobs) Yes, once residency is over and then making physician pay, the amount is more. But, honestly, my husband makes QUITE A BIT more than I do... and he doesn't even have a college degree. Quote Share this post Link to post Share on other sites
Andy9o8 2 #66 July 27, 2009 QuoteJust to point out - residents don't make "cushy" pay. 30k for 80 hour work weeks (that would be two separate minimum wage jobs) Yes, once residency is over and then making physician pay, the amount is more. But, honestly, my husband makes QUITE A BIT more than I do... and he doesn't even have a college degree. And, of course, many just-out-of-residency docs have huge student loan payments to make. Plus, there's hefty malpractice insurance - either off the top if you're a solo or compensated on a percentage of profits, or reflected (one way or another, even if indirectly) in your salary if you're salaried. Aren't you an OB/GYN? I know they have about the highest malpractice premiums of all the specialties. Quote Share this post Link to post Share on other sites
kbordson 8 #67 July 27, 2009 Depending on state, the malpractice can vary from 16k/yr to 277k/yr source And HOW you're compensated varies - it can be by direct salary or by a percentage of billing or collections (where you are penalized for lesser paying insurances - read MEDICAID) or by RVU (which are the most fair... but not too many pay by that standard) Quote Share this post Link to post Share on other sites
turtlespeed 226 #68 July 27, 2009 QuoteDepending on state, the malpractice can vary from 16k/yr to 277k/yr source And HOW you're compensated varies - it can be by direct salary or by a percentage of billing or collections (where you are penalized for lesser paying insurances - read MEDICAID) or by RVU (which are the most fair... but not too many pay by that standard) Would you advocate a "Strike" if the government was demanding you work as they want you to?I'm not usually into the whole 3-way thing, but you got me a little excited with that. - Skymama BTR #1 / OTB^5 Official #2 / Hellfish #408 / VSCR #108/Tortuga/Orfun Quote Share this post Link to post Share on other sites
kbordson 8 #69 July 27, 2009 QuoteQuoteDepending on state, the malpractice can vary from 16k/yr to 277k/yr source And HOW you're compensated varies - it can be by direct salary or by a percentage of billing or collections (where you are penalized for lesser paying insurances - read MEDICAID) or by RVU (which are the most fair... but not too many pay by that standard) Would you advocate a "Strike" if the government was demanding you work as they want you to? I don't know that "strike" is the right term... cuz I would still try to take care of the ladies that I felt responsible for, but I would adjust my practice (and am even currently making plans to adjust the level of government control) Quote Share this post Link to post Share on other sites
headoverheels 334 #70 July 28, 2009 Quote Just to point out - residents don't make "cushy" pay. 30k for 80 hour work weeks (that would be two separate minimum wage jobs) Yes, once residency is over and then making physician pay, the amount is more. But, honestly, my husband makes QUITE A BIT more than I do... and he doesn't even have a college degree. I meant that my work conditions are relatively cushy, not pay. I'm aware that residents make very little for their hours and point of education. Along with the med school, it is the price of entry for a very high career income -- stopping short or failure would be very bad financially. MD pay varies, but the guy who removed a small BCC from my forehead nets well over a million a year from his practice, partly by "upgrading" -- on mine, he measured the secondary defect size then, for no plausible reason than boosting the charges, cut another 3mm to get into the next size bracket. It took maybe 30 seconds and increased the charges by over $900. Quote Share this post Link to post Share on other sites
headoverheels 334 #71 July 28, 2009 QuoteQuoteNeither of these groups is going to do as well in any other endeavor... I totally disagree. Our system tends to select the best, brightest, hardest working and most motivated to be doctors. You really think those people aren't going to succeed in some other line of work? If they are already experienced, and are earning the income that most MDs do, most of them will not make as much doing something else, even if they are rather successful at it. For similar reasons I stick with specific engineering jobs, where I have valuable skills, rather than changing to other business where I could do okay, but would have only my intellect, and not the experience and/or education that might be needed to be competitive. Quote Share this post Link to post Share on other sites
justinb138 0 #72 July 28, 2009 Quote The government is already subsidizing health insurance for all of us who get it as an employment benefit, by not taxing us on the value. So by that same logic is the state subsidizing my prescription drug purchases by not taking sales tax on them? Is the federal government subsidizing my ass because they don't tax me when I take a shit? Quote Share this post Link to post Share on other sites
headoverheels 334 #73 July 28, 2009 QuoteQuote The government is already subsidizing health insurance for all of us who get it as an employment benefit, by not taxing us on the value. So by that same logic is the state subsidizing my prescription drug purchases by not taking sales tax on them? Is the federal government subsidizing my ass because they don't tax me when I take a shit? Sort of. It's been a few years since I worked as a sole proprietor (schedule C, etc), but at that time I couldn't deduct cost of medical insurance, but my friends doing similar work as employees had part of their income (medical coverage) that wasn't taxed. Maybe we should all just be paid more, and pay for our own medical plans if we care to. Actually, my current employer will let me opt out of group coverage, and take some amount of income instead (about $6500/yr, IIRC) My county taxes me when I take a shit -- part of my property taxes. Quote Share this post Link to post Share on other sites
mnealtx 0 #74 July 28, 2009 QuoteQuoteLet's say that fed.gov has decreed that healthcare is now a human right. Now, let's say that every doctor in the country decided they didn't WANT to be doctors anymore, and quit. What happened to your "right" to healthcare? How are you going to claim it when there's nobody to provide it? Healthcare is a COMMODITY, not a right. QuoteIt's a pretty stupid argument, and just as likely to happen as all doctors quitting. One of our problems is that we currently have too few doctors, not too many. Med schools effectively act as limiters on the supply of new doctors, protecting the guild of existing ones. Then prove me wrong. Since it's such a stupid argument, it should be very simple for you - tell me where your healthcare is going to come from when the doctors quit and the hospitals shut down. QuoteAs for the usual tangents, the BoR does not grant us gun rights. It protects the rights we already had as people. I think one can argue that health is another right we have. Free healthcare, otoh, is a different matter. Gold star for you - of course, I mentioned that upthread, as well. The gov't doesn't PROVIDE rights...it protects them.Mike I love you, Shannon and Jim. POPS 9708 , SCR 14706 Quote Share this post Link to post Share on other sites mnealtx 0 #75 July 28, 2009 Quotepromote the general Welfare Promote != provideMike I love you, Shannon and Jim. POPS 9708 , SCR 14706 Quote Share this post Link to post Share on other sites Prev 1 2 3 4 5 Next Page 3 of 5 Join the conversation You can post now and register later. If you have an account, sign in now to post with your account. Note: Your post will require moderator approval before it will be visible. Reply to this topic... × Pasted as rich text. Paste as plain text instead Only 75 emoji are allowed. × Your link has been automatically embedded. Display as a link instead × Your previous content has been restored. Clear editor × You cannot paste images directly. Upload or insert images from URL. Insert image from URL × Desktop Tablet Phone Submit Reply 0
mnealtx 0 #75 July 28, 2009 Quotepromote the general Welfare Promote != provideMike I love you, Shannon and Jim. POPS 9708 , SCR 14706 Quote Share this post Link to post Share on other sites
