In other fields like trucking or air traffic control, they have maximum time limits so that tired workers don’t cause dangerous accidents. It’s surprising that there isn’t something similar for doctors since medical accidents could also kill people. So, why do I keep hearing about medical workers working super long 12-48 hour shifts? Is there a benefit that outweighs the risk of accidents?
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Doctors are expensive. High pay, good benefits, all that stuff. It’s cheaper to hire 5 doctors than 10, especially if they’re on salary and don’t get OT pay.
Residents do this (as it makes hospitals a lot of money), but this practice has changed recently. Established doctors may work this much for more money but they don’t have to. Except ER docs, who may work 12 hour shifts because of continuity of care: less shift changes in staff means less miscommunication. But these docs only usually work 3 days a week.
Continuity of care is the primary reason. When a new doctor comes on shift they need to essentially catch up on the current status of all patients, review the charts, etc. In all fields there’s down time during shift changes. Reducing this down time improves patient care.
Studies have found that harm caused by errors as a result of shift changes (e.g. miscommunication from the previous shift to the next) exceeds harm caused by errors due to tiredness.
I read a theory once that physicians historically did not work that many hours per day. At some point in the last 1/2 century 2 things changes among medical students / residents / physicians:
1. a large percentage of people in that industry are what we would describe as “type a” personalities. Their competitive nature drove them study longer, prepare longer, and subsequently work longer
2. that competitive nature led to the use of additional “stimulants” to stay awake longer, work harder, and do more during those hours.
The highly driven nature of those in the medical field actually masked reality. The “stimulated” outcomes were deemed productive and acceptable. It shifted the level of expectations for physicians from working an 8-10 hour day to working +12 hours on back to back days.
In short…”type A personalities” + drug use = false expectations that have never relented
Fewer and fewer people want to do it so fewer are being trained and what’s left has to cover the whole 24 hours. Depending on where they work some also are paid per patient so the longer days can equal more cash for them
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So we can make $$$ for the hospital admin. Physician Residents work 80-100 hours a week and make like 50-75k (depending on state), while generating probably at minimum 1m a year for the hospital –Senior Surgical Residents probably generate a lot more revenue.
I remember one time in medical school on my surgical rotation, I slept about 1 hour then started a 19-20 hour surgery day. Obviously I wasn’t operating — just functioning as a surgical first assist, but it was terrible to close/suture patients on 1 hour of sleep. Residency was a **lot tougher** esp on-call days.
In the 90’s my gp said he worked around 65 hours a week. 30 was patients, the rest was office admin and dealing with insurance com.
There are rules in place they’re just not followed out of necessity. For one a shift change with medical professionals is difficult because those starting their shift have to catch up with any changes or new patients and those whose shift is ending may be in the middle of something, or there are simply emergencies and patients can’t be left without doctors and nurses for even a few moments. But really the main reason is staff shortage. There’s not enough doctors and nurses to go around and this is compounded by the fact that public healthcare in more or less all countries keeps trying to cut costs so even if there are enough available doctors that doesn’t necessarily mean that they’re hired or that they’re paid well. The fact of the matter is that a lot of doctors refuse to work these hours for low pay after a point and look for work in private clinics if they can or work in their personal practice. I know the common conception of medical professionals is that they’re paid well and they’re all rich but that’s not actually the fact for many doctors in public health, especially young doctors.
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