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If you were working 24 hour shifts, weekends, and holidays - and then someone decided to cut your pay in half. Would you keep working period? Probably not. Would you entertain those hours? Zero chance.
Nurses typically work 3 12s or 4 10s and in some cases make six figures and we already have a nursing shortage problem because they don't like the schedule (because clinical work can suck and nights, weekends, and holidays also suck).
I wouldnt work 24 hour shifts in the first place, and I'd be pissed if I found out that a doctor who was seeing me and potentially making huge decisions or recommendations about my health was 23 hours into a shift.
Anyways, average seems to be somewhere in the 50s of hours per week. Increasing the amount of doctors such that they no longer have to work stupid hours seems like a no brainer, I would easily take a ~30% pay cut to go from 55 hours to 40 and not have 24 hour shifts. No idea why doctors wouldnt either.
https://www.statista.com/statistics/1385440/physicians-work-hours-united-states/
Attending physician work life definitely lands more in the 40-60 range "on average." Surgical specalities can still end up in the 60-80 hour range as an adult.
As a resident 60-80 is more common with 80 being the "max" allowed but many places go over that. Neurosurgeons may end up working 100-120 hour weeks more often than not for like seven fucking years.
The devil is in the details though. Most medical jobs require someone to cover weekends, nights, and holidays. How that shakes out is pretty variable but you can be an attending with a relatively normal 60 hour work week.....but a few times a month you work 24s. Maybe you do trauma at a midsized trauma center. If it's Tuesday you actually sleep through the night. If it's Friday you are working 24 hours in a row. That is ass at age 27. At age 55 it is catastrophic.
Um.....about that.
If you go to a university hospital (you should if you have the choice) you WILL be cared for by a resident who hasn't slept in a day. If you get a surgery done the person operating on you might be on hour 28 and gotten 4 hours of sleep the night before that long ass shift.
Edit: these days theres a good number of women in medicine who decide to work part time for a pay cut. It is a thing but given how time consuming and expensive it is to train someone it's usually unwise.
I'm from the UK, where a typical long shift for a doctor is 13 hours, so I cant really tell if this is an exaggeration.
But if this is true, holy shit. That is absolutely outrageous. how can you with a straight face protest that doctors are so desperately committed patient wellbeing, while accepting a 28 hour long surgery shift? There's no other way to describe it - that's dangerous. You, above all, should know what the science tells us about decreasing performance with fatigue. Any airline pilot that accepted a shift even close to that would lose their license.
The 36 hour shifts are an exaggeration (well, more specifically in some specialties it happens in others it doesn't).
24s are the standard.
To briefly summarize residents are called residents because they lived in the hospital, back in the day when that made sense - the social technology existed to support it (everyone had supportive wives who would still be there after and bring them food) and the medical technology was limited (yeah you lived in the hospital but most overnight work was "shit hope he is still alive in the morning), also the inventor of residency was a massive coke head and we didn't figure that out until later.
Now it is a bit more complicated. Bad outcomes happen, see https://en.wikipedia.org/wiki/Libby_Zion_Law
But 24s are often more popular than the alternative. Often the alternative is something like working 16 hours a day 7 days a week. No or less days off. After a 24 you get home between 6am-12pm and get to sleep until the next day. Or run errands while fucked on sleep deprivation.
The problem is that you need 24/7 365 coverage and that's complicated to do and expensive, residents take the burden.
Importantly our regulatory entities have a bunch of research showing that working 24+ hours is better for patients than handing off to a new team. Things get missed. Your drunk (on lack of sleep) doctor is more reliable than a new doctor that doesn't know you.
I work at a hotel which is open 24/7 365. That means we need someone in the front desk at all times. We have three 8-hour shifts, from 7 AM to 3 PM (morning), from 3 PM to 11 PM (afternoon), and from 11 PM to 7 AM (night). That's 3 x 7 = 21 shifts per week. We have a full-time worker for each shift doing 5 shifts a week, for a total of 3 x 5 = 15 shifts. The other 6 shifts get covered by other people as needed (I cover two afternoon shifts and two night shifts, and somebody else covers the remaining two morning shifts; it helps that our company owns two hotels, so the person with only two shifts at my hotel can work more shifts at the other hotel if they want a full workweek, but in principle you could cover this schedule by having four people working 5 shifts each and rotating the extra day among them unless somebody wants to volunteer for the overtime).
Why can't you do something like this? Sounds to me like the fundamental problem is simply that you need more doctors. Double the number of residents and see if anybody still needs to work 24 hours straight.
Nursing still needs 24 hour coverage and uses formal hourly shift work. It works okay but gets expensive because nursing salaries are high (deserved!) and lots of people do not want to work nights/holidays/weekends. The people who do will try and hoover up endless amounts of overtime but it is still over time. Expensive to staff especially given the fact that you need a shit ton of people.
Doctors typically work a salary/until it's done style approach. This is a for a number of reasons. It's cheaper and more flexible for one. The work is not evenly distributed. Sure the ED is roughly equally busy 24/7 (and does shift work) but hospitalist shifts are massively more day time focused (but someone needs to be available for nights for obvious reasons and outcomes can be catastrophic if the person is a lazy do nothing type or if you say cover more than one hospital and more than one problem happens at once).
Do formal shift work and then suddenly you are handing off anesthesia mid surgery, leaving work undone which is impossible to effectively knowledge transfer to the next shift. In fact handoffs in general are time consuming, hard, and massively unsafe (thus the research claiming being effectively drunk is just as safe).
That said I'm sure if you doubled to tripled the number of doctors you could get wider coverage without causing too many problems. But that's nearly impossible to do. Yes blah blah supply restrictions but you run into things like "you need to perform X of a certain procedure" if you triple the number of residents and the procedure is rare its going to take three times as long to train. Quality in your doctor is important and theres no way to ramp up supply that much without tanking quality.
You also get weirder stuff like - there are three hospitals just outside of a major metro area. You need one ENT actuarially to cover that area. 6/10 nothing happens. 3/10 it gets busy but it's fine. 1/10 its a total shitshow and the ENT works 36 hours in a row.
Paying extremely highly skilled labor for the 6/10 to prepare for the 1/10 is a hard pill to swallow, especially since everyone is trying to save money right now.
Look, I think that the larger point everyone is trying to make is that whatever scheduling issues you are running into (24 hour shifts, 80 hours weeks), they will get much better if there are more doctors. There may be some good reasons, such as handoffs during surgery, to avoid a straight up 8 hour clock in / clock out, but that can be worked around. Somewhat trivially: if you are mid surgery and your shift is done then just finish the surgery. Keep doctors on salary, but keep them on 8 hour shifts with the expectation that they are to leave when the patient is stable or a hand off is feasible and negligibly bad.
The point is that there are not two (insane) options. There is a third option, hire more doctors and spread out the hours. Doctors might make less pay, but now they don't have to work 24 hour shifts. I think almost all doctors would take that trade off, and that seems like a great trade off for the patients as they don't have sleep impaired doctors attending to them.
From the outside - it looks like you are defending this system that you and no one else wants. Why? Why do you want to work 24 hour shifts? Why do you defend this system where you have impaired doctors attending to patients, as if there are no other options? Even without more doctors - why not do whatever the NHS apparently does, which is 13 hour shifts?
I am willing to get paid less to work less but that is somewhat orthogonal to my original post given that it is unlikely to reduce total costs to the taxpayer/economy.
I did want to point out that the insane shift schedule happens for a reason however (benefits are present, it is not just costs).
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Sometimes there's just no other option. An airline can simply delay the flight until a new pilot is available, but you can't always delay a surgery like that, and there might not be any other surgeons available. We have a massive shortage of doctors because of the dumb med school/residency system.
Of course there is another option - you don't put yourself in that position in the first place. you don't bite off more than you can chew, as an institution. and if you fuck up and end up overbooked, then you take the hard choice and start cancelling surgeries. There might not be another airline pilot available, you think that excuse would fly when a pilot crashes an airliner into a mountain because he was exhausted? of course not. So why should it fly when an exhausted surgeon perforates a bowel or misreads a chart?
GP's point is that air travel is not analogous to surgery because nobody ever dies from not being able to catch a certain flight (Saigon and Kabul aside).
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