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PaperclipPerfector  3mo ago (text post)   29424 thread views

Culture War Roundup for the week of August 19, 2024

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Thanks for dropping Halsted’s name, it led me to these papers explaining how it spread across America:

  • Necessity is the mother of invention: William Stewart Halsted’s addiction and its influence on the development of residency training in North America
  • The Education of American Surgeons and the Rise of Surgical Residencies, 1930-1960

How or when did this model become unsustainable?

I mean, is it unsustainable? It sucks but one of the reasons we let it go is because residency is temporary and when you are done with residency it's great. Not sure THIS PORTION of US healthcare is gonna collapse.

Ah ok, when you said “initially somewhat sustainable,” I interpreted that to mean that it’s no longer sustainable

I supposed tolerable would have been a better word choice in my initial post, as I'm not sure if it's truly unsustainable or not (you'd think it'd collapse, but you'd also think it would have collapsed a while ago at this point). Certainly it made more sense when it was first a thing, less so now.

The "everyone bitches about residency" while in residency (and it truly is profoundly awful) is well counterbalanced by "almost everyone shuts up when they are free of it."

The U.S. healthcare system as a whole? Fuck that's gonna need some changes or it will die. It's also doing very well in some ways (like quality of care) and everyone is going to be fucked when demographic crisis creates severe rationing on caregivers for the elderly.

Do you think there's any value in weeding out the people who can't cut it? Or do you lose valuable people who'd actually make decent doctors?

I think it's somewhat difficult to tell, we lose the most people in preclinical years of Medical School (typically year 1 or 2, which is the drinking from a firehose traditional coursework) and in the transition to Residency. Both of those seem appropriate times for people to realize they can't hack it or don't want to.

Residency creates a trickle drain of people too burnt out to continue with some definitely being people who need to go. The former might be generated by the process as much as assessed by it however, which is tricky.

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