[trianglesphere]

It's looking grim for plenty of reasons, but nurses and doctors working 50+ hours is not new. Some docs do that their entire career.

Also, if you've ever been treated by a resident, they were almost certainly over worked, they move to cap their hours at 80 per week received pushback from docs saying that residents needed 80-100hrs/wk for training.

[oh_sigh]

Can humans even effectively learn/train @ 80-100 hrs/week? 90 hrs/week + 8 hours sleeping(all-in) leaves 3 hours/day for "personal" non-(work|sleep). Or, alternatively, it leaves 1 full day free per week, with 6 days where there is only 1 hour/day for personal activities.

[s1artibartfast]

It depends on what you mean by effectively. Slaves routinely worked sun up to sun down 6 days a week. Long work weeks are common in some developing countries now.

[slg]

To further build off this point, shift changes are incredibly dangerous at hospitals because there is usually specific patient knowledge that isn't sufficiently passed from the outgoing workers to the incoming workers. So if we are optimizing for patient health, it isn't as simple as just having them work less hours.

[julianlam]

I feel like this is an excuse more than anything. If there are higher complication or medical error rates as a result of patient handoffs, the solution isn't to make the medical team work longer hours, it's to fix miscommunications wrt the handoff process.

[slg]

I completely agree, but this isn't a new problem in medicine. If we couldn't fix it during normal times, I doubt we are going to fix it during a pandemic when staff are already overworked.

[nradov]

How specifically would you propose to fix miscommunications? Communication itself takes time, whether it's entering data in an EHR or talking 1:1 with your shift replacement. Time spent on communication is time not spent on delivering direct patient care.

[watwut]

That actually is, because the doctors and nurses make more mistakes when they are tired.

[slg]

It that were the case, you would expect the danger to come towards the end of shifts and not from the changeover itself or beginning of new shifts. The problem is the passing of information. Some places operate on a 12 hour schedule and some on an 8 hour schedule. It isn't clear that the 8 hour schedule is actually safer because while workers are less tired, you increasing the number of daily handovers by 50%.

[watwut]

And meanwhile both 12 ams 8 hour schedule places involve people who were at work more then 24 hours or had massive overtimes last weeks.

[Ericson2314]

Yes I'm so sick of the "need to work long hours" bullshit. It's an incoherent argument.

Higher more people, overlap shifts, problem solved.

[slg]

>Higher more people, overlap shifts, problem solved.

Sure, sometimes the solution is to just throw more money at the problem. However that doesn't mean the money is available to dedicate to that solution.

[Ericson2314]

If the problem is money, they should just say so. The "but the outcomes" talk is still a lie.

Also US healthcare is so grossly inefficient it doesn't make sense to look at one cost center in isolation from a policy perspective, only from a the perspective of private sector actors I think shouldn't exist.

[nradov]

Hiring clinicians is expensive. Healthcare is already 18% of GDP. Where would you propose to get the additional funding?

[watwut]

Are you claiming the work hours of doctors are the expensive thing in all that?