[KennyBlanken]

Nope. Alarm fatigue is a well documented problem in the medical field.

Like residents who are getting a few hours of sleep over days worth of high-stress / high-stakes work, poor hand-washing between patients, and not clearly printing one's handwriting on prescription forms - all things that kill patients - doctors and hospital administrators just don't care enough.

For a profession that is supposedly so pure morality-wise - do no harm, patient privacy, etc - doctors are remarkably careless.

[hiAndrewQuinn]

"They just didn't care enough" is an argument which can explain everything about how 1 person operates, half of a 10 person group, and roughly 0% of an entire profession. It's a question of the economic incentives at play far more than doctors universally deciding not to give a shit.

The economic recommendation is to deregulate the medical personnel industry and allow supply to increase. A great many smart and good people would love to become doctors but aren't in love with 5 years of residency and taking a quarter million dollars in debt to make less than their dropout cousin does at Netflix.

[nabusman]

Pure deregulation can lead to a bit of anarchy, but a more measured approach that ensures that the regulation doesn't act as a way to decrease supply and increase profits for the industry would make sense. Probably something for Lina Khan to look into.

[nradov]

The easiest way to increase the supply of physicians would be to increase Medicare funding for residency programs. We already have a surplus of smart and good people who would love to become doctors. Every year some of them graduate from medical school with an MD/DO degree but are unable to practice medicine because they don't get matched to a residency slot (some of them do get matched the following year).

https://savegme.org/

There has already been deregulation to an extent. The scope of practice for lower licenses such as Nurse Practitioners and Physician Assistants has been increased in many states such that they are now allowed to perform most primary care services. This is a great option for other smart and good people who don't want to spend 3 - 7+ years in residency and take on enormous student loans.

[matheusmoreira]

> deregulate the medical personnel industry and allow supply to increase

And salaries to plummet.

Who's gonna be the first to volunteer to spend about 14 hours of their day in some shithole hospital nearly every day sacrificing their own health and sanity for the sake of others, all while making a fraction of what people here make? Deny people their prosperity and suddenly going to medical school turns into a stupid and irrational decision and something only rich people will put up with for the status.

[hiAndrewQuinn]

Plummeting salaries for doctors means better average healthcare at all price points for the rest of us.

Plus, play the tape forward. You're working 14 hour days and your pay has been halved in the last 5 years. What can you negotiate on? More pay probably isn't an option. How about working only 12 hour days for 6/7s the (already reduced) pay? That might be doable. In a decade, you might even be working a normal 9 to 5 again. The horror!

[matheusmoreira]

Negotiate? Just quit. At some point you're better off doing literally anything else with your limited time on this earth. Way too much time and effort for too little reward. Who's looking forward to doing a decade of hard training only to end up with some 9-5 job and salary? That's just absolute nonsense.

Becoming a doctor is quite simply a stupid decision if you're not gonna get rich off it. You're replying to a citizen of a country which implemented your idea and then some. Believe it when I say the "get into medical school and you're set for life" meme has worn off.

You haven't seen the damage that stupid indebted underpaid doctors are capable of causing. I'm actually afraid of getting sick. Killing patients? I've seen worse.

[hiAndrewQuinn]

Your profile indicates this is Brasil... Let me do a quick Google search.

"[T]he Brazilian healthcare system has achieved significant success in improving population coverage, reducing infant mortality rates [a 4-fold drop!], and controlling infectious diseases." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10231901/

It sounds like doctors are actually doing a much better job there nowadays than they were 35 years ago. The facts I see simply don't match your outrage.

[matheusmoreira]

Even the article you cited contains allusions to the truths I will write about in this comment. "Unequal access to healthcare services and resources", "significant disparities in healthcare outcomes between different regions" and the most hilarious point of all... "Low quality of care". Just lovely.

Let's rid ourselves of all these polite euphemisms though. Here's a likely incomplete list of all the things that you don't see.

What you don't see is the communist president of the worker's party who is literally quoted saying "we need to create a new generation of leftist doctors who accept working for less". Population needs doctors, and they vote, so give them what they want: more doctors. And when you want quantity, then obviously you also want cheap. Flood the market with doctors, open hundreds of new schools with ever more lax filters and bring in doctors from neighboring countries too even though they seem to be in even worse shape than us. Problem solved, look at all those happy voters.

The government's latest move was to remove doctors from the decision making positions that control residencies in an obvious preparation to flood the market with "specialists" by dumbing down the requirements and opening new residency programs, no doubt without any concern for quality. You might be skeptical about this claim but these are people who are stupid enough to believe a nurse with 10 years of job experience is equivalent in knowledge and skill to a doctor. At least one such "illustrious" politician can be directly quoted on that.

There's already a huge number of medics, they just happen to be concentrated in the major cities and capitals. The simple fact is nobody wants to live in some undeveloped shithole. Living in Brazil to begin with is punishment enough, there just aren't many maniacs around here who are willing to work and live in the literal amazon jungle. Even comically high salaries fail to attract doctors to areas like that. Partly because quality of life is abysmal and partly because those little villages are so poor they're actually likely to default on those payments anyway so there's no point. Those are the places where the government wants to ship doctors off to though. You'd think they'd develop the country instead so that people in general would want to move there but that's too difficult. Better to just destroy the profession of the "mercenary" doctors instead until they're so squeezed they have little choice.

You don't see the hundreds of brazilian medical schools soaking up billions in government student loans while providing mediocre education. Student loans are very efficient at making school administrators very wealthy. They were devastating for academic integrity everywhere in the world including the US but this country always manages to make it worse by not even pretending to give a shit about quality. In the US medicine apparently escaped that fate due to stronger regulation. In Brazil? So many of these medical schools do not even have an actual hospital for medical students to practice on. How do you become a doctor without seeing patients? You don't.

You don't see the palpable pessimism in health care workers, as a class. What was once a profession that guaranteed prosperity turned into essentially a joke. Doctors generally do not recommend that their children follow in their footsteps. Why would they want their children to bust ass in medical school just to make six dollars a patient? That's just stupid. And those are the lucky ones. The family medicine workers of the study you cited usually make even less than that. This new generation of doctors is feeling the pressure, meanwhile older generations of doctors are taking the wealth they built up and bootstrapping actual businesses instead.

You don't see the 40 thousand newly minted doctors of dubious quality entering the job market every single year. That obviously brings about difficulties with job and residency availability, not to mention the massive and constant downward pressure on salaries. So how does the typical newly minted doctor react to this adversity? Charlatanism.

You don't see the rampant charlatanism on social media. Social media platforms are absolutely filled with them. "Professionals" promising miracle cures, promising results, just basically doing everything that medical ethics says they can't do. That includes passing themselves off as specialists while having a fraction of the education, or just straight up advertising "specialties" they just made up on the spot.

Hilariously, these charlatans are actually the ones who are making it in this distorted reality. They do things like charge people thousands for aminoacid injections that literally do nothing. Brazilian medicine regressed to literal "blow smoke up people's ass" charlatanism and these people are getting rich off it. Do you know what coffee enemas are good for? I haven't the slightest clue but you bet there are doctors doing that to patients literally right now. Things are so screwed up even non-doctors, people who have never stepped foot in a medical school let alone an operating room, have grown bold enough to do "simple procedures" on their customers.

Ever seen an unemployed doctor? Ever seen doctors become Uber drivers? Cashiers? I have. It used to be a meme. Then it actually started happening. Salary only ever decreases. We have emergency services paying the lowest and ever decreasing salaries. What kind of doctor do you think that's going to attract? The simple fact is there aren't enough hospitals in this country for all of them. Most of the ones we do have are in such disrepair that nobody sane would actually want to work there.

The decentralized public health care system familiy medicine situation is even more precarious. There are workplaces in this country that do not have a working sink for doctors to wash their hands with. You simply cannot exercise your profession with dignity under such conditions. The smarter, better doctors have better options and don't subject themselves to that. The ones manning the public health system are generally the desperate and indebted ones. The ones who weren't good enough to match into a good residency.

You don't see the criminally stupid doctors who fuck up so bad they end up on national television. Doctors working an ER who are so stupid they don't run a simple EKG on a patient with textbook myocardial infarction symptoms. Imagine being this fuckup's lawyer. And it's not an isolated case either, their numbers are increasing. The fact is in Brazil any moron can become a doctor these days and you better believe it shows. The problem with that is people's loved ones die in the process and there's no amount of damages that will bring them back. A few years ago I nearly died of appendicitis myself because they initially blamed my symptoms on COVID19. The doctors who saved my life were all older than the public health system the paper you googled talks about. They're becoming rare now, and knowing that makes me afraid of getting sick again.

I seriously hope you reconsider this "just increase supply" nonsense. I know HN hates doctors and it's kind of a tall order but I sincerely hope what I wrote here makes some impact. Simple solutions like that will not accomplish what you want. To put it mildly.

[LorenPechtel]

Alarm fatigue is very real. And the lack of sleep is very real.

Where you go off the rails is with saying "don't care enough". This is a market problem, not a problem with individuals. "We don't overwork our people" isn't a selling point with insurance. The budget is pretty much fixed, a company that doesn't overwork their people ends up in the red.