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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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