We're killing people, say over-worked doctors

Courrier Mail ^ | 9/6/09 | Matthew Fynes-Clinton and Michael Crutch

[Nachum]

EXHAUSTED doctors have confessed to killing and harming patients, falling asleep during surgery and crashing their cars because of marathon shifts.

The public hospital medicos claim to be so tired on the job that they are working "like drunks".

More than 100 doctors vented guilt and anger in a confidential Queensland survey. Almost 60 per cent admitted to fatigue-induced errors while performing procedures.

[AzaleaCity5691]

They’re overworked because there are not enough of them. They need to just accept a pay cut (as do medical schools) and allow the number of slots in medical schools to increase so that there can be more doctors and stronger competition.

[Forgiven_Sinner]

Here’s the problem: “The Queensland Government wants to push through a new pay and conditions deal for doctors that offers only limited respite. “

The government has no business setting wages or working conditions. This should be all private sector.

What you’re seeing is rationing—reducing the cost of health care, which reduces the wages for doctors, which reduces the number of doctors, leading to shortages, longer working hours, and lower quality.

[Forgiven_Sinner]

Here’s the problem: “The Queensland Government wants to push through a new pay and conditions deal for doctors that offers only limited respite. “

The government has no business setting wages or working conditions. This should be all private sector.

What you’re seeing is rationing—reducing the cost of health care, which reduces the wages for doctors, which reduces the number of doctors, leading to shortages, longer working hours, and lower quality.

[jimtorr]

Overpay obviously is not the problem. Lack of incentive to practice medicine is the real problem behind a doctor shortage in the modern world.

Greater incentive, ie, higher pay, is the way to increase the number of doctors.

The USA is actually paying medical schools to hold down the number of slots in their schools. Is Australia doing the same?

[Nachum]

They need to just accept a pay cut (as do medical schools) and allow the number of slots in medical schools to increase so that there can be more doctors and stronger competition.

Excuse me? Are you joking?

[Blood of Tyrants]

But, but, but, it’s FREEEEEEE!

[GnuHere]

You forgot the sarcasm alert. If the pancake house waitress could be a doctor, she probably has already checked that out.

[ransomnote]

This is Australia’s ‘public option’ workforce. Note the article refers to their public status “The public hospital medicos ...”
In 1978, I attended a lecture given by a speaker from Australia. He said things rather gently, fearing he would offend us, about how the US medical and housing system compared unfavorably to that of the Australian. He said very cautiously, “I have toured the US and I hate to say it but...there...are...some places I would not not want to live.” I almost laughed, I could think of places I would not want to live in the US. As his talk wore on - here was his point. In Australia (circa 1978) the government sees to it that if you are willing to work (e.g. street sweeper, dog groomer, bar tender - any fully employed person) then the government guarantees you housing and medical insurance. He pondered the idea of Americans without medical insurance saying “It’s as if some people don’t admit they are human...” He was baffled by housing and medical access inequity and said Australia guarantees nice housing (He agreed there was still disparity among the rich and poor but said none of it was at all objectionable) and full medical care. 30 years later, it looks like Australia’s ‘public option’ medical system in in collapse. Too few want to become a heavily monitored, underpaid physician so they have a doctor shortage. I recall horrible stories coming out of AU about a year ago listing extreme shortages of basics (one of which was aspirin) among the public option facilities - with one medical person lamenting conditions they likened to 3rd world countries. You can’t force someone to go to medical school to partake in this kind of system.

[AzaleaCity5691]

It’s not sarcasm. It’s basic economics. The medical school system in our country is not operating in sync with economic demand. They have limited the number of medical school slots far below what our country’s physician needs are. This limits the supply of doctors in the market thereby increasing the per unit demand for each one and therefore their price (salary). The green doctor right out of medical school, once their residency is done is guaranteed a pretty standard salary from the time they finish to the time they retire.

Because this salary is high enough it also puts them in a position to pay back exorbitant loans and so medical schools charge more than is economically necessary because they can get away with it and because it also serves as a barrier to entry.

Compare the medical school process to the process for getting an JD or an MBA and you’ll understand what I am talking about. We need to increase the number of medical school slots, increase the number of doctors and force them to actually compete with patients on the basis of service price and service quality rather than just opening an office and being guaranteed a full waiting room because there are so few doctors on the market.

[AzaleaCity5691]

But the thing is current U.S. physician pay is due to a market that is dealing with an artifical labor ceiling. If we were to quadruple the number of doctors medical costs would come down but so would the salary of the average physician and you would find that medical service providers would have to compete through price competition, something that they don’t have to do right now.

[Nachum]

I want to be sure what your point of view was before commenting.

It’s basic economics.

Yes. it is indeed basic economics.

Wage and price controls fail 100% of the time. One cannot "create" more medical schools to "create" more doctors. The only reason why there is a shortage of doctors in Australia is because there is absolutely no incentive to be a doctor. The state dictates an unattractive wage. There is no incentive to build medical schools because the state dictates the cost of tuition and the kind of payments to the school. You are experiencing what every single socialized system of medicine in the world experiences. If you want more doctors, establish a privatized market. Let the schools charge as much as they think they can get. Let the marketplace provide the incentive and let individuals have the freedom to choose. Then, even if your own schools do not create enough doctors, you will attract people from outside your country to practice medicine to fill the need.

[krb]

How hard is it to see that we don’t allow enough doctors to train?

[AzaleaCity5691]

See. I don’t know about Australia, I was referring to America. However, one actual can create medical school slots. It is called, one day, the medical school makes a decision and says “we are doubling the number of slots in our medical school. Send your applications in now”

The problem in the U.S. is that there are so few slots and many people who would make very doctors are never given the opportunity because of one bad grade or because they miffed a test and it doesn’t work that way for most professional schools. Business school, law school, most graduate programs all do admissions on a sliding scale between GPA, scores and other factors.

Not so for med school. If you don’t dot every I and cross every T you don’t get in and while there are alternatives with domestic schools overseas which are cheaper and which do admit Americans the med schools in this country have basically tried to shut them out of residency and out of the market to keep their wages artifically high.

Maybe I can explain this another way. If tommorow all the law schools got together and cut the number of law school slots by two thirds within a decade average attorney salary would be higher than average doctor salary and there would be no more “starving lawyers”. The same can be said for MBAs, MPAs, and hell, for undergraduate degrees itself. One reason that undergraduate degree has become worthless is because of how many people now have them. Apply the same reverse principle to med school enrollment and you would increase health care quality while lowering the cost.

This is nothing the government can do though, at least not directly, because there are no federal universities. However, a state government would be empowered to double the slots at their state run medical schools and that could have a positive impact on the situation.

[Jim Noble]

The medical school system in our country is not operating in sync with economic demand. They have limited the number of medical school slots far below what our country’s physician needs are

I've taught medical students for 34 years. About 1/3 of them shouldn't be allowed to graduate.

We went from 8800 in 1967 to 17 000 in 1977, and we relaxed standards so much to get to the higher figure that we've had problems with the output ever since.

If we can't get 17 000/year that have the stuff to become doctors (and, BTW, this has gotten much worse in the past ten years), where are you going to find all these extra doctors?

[AzaleaCity5691]

The problem is med schools do admission based on UGPA and the MCAT scores, neither of which have anything to do with being a doctor. A UGPA is only a reflection of how responsible you were as a 21 year old and the MCAT score is only a reflection of how well you test. Neither has anything to do with medicine and yet that’s how you determine admission and so many intelligent people who would be great doctors never get a chance because of their GPA or MCAT.

The other problem with med school admissions is that there are no second chances for applicants if they’re white or Asian. If they don’t have the numbers the day they finish undergrad, unless God smiles upon them they are almost always shut out of even having the chance to go, even if they would make far better doctors than those who do have the numbers but who, in your words, “shouldn’t be allowed to graduate”

[ArmstedFragg]

Let’s remember that in recent years, a sizable portion of the third world has moved to Australia.

[ransomnote]

Yes - I worked with someone from Monterey, California who also moved to Australia in the early 1990’s. One of the reasons he went was government subsidized medical and housing.

[Polybius]

It’s not sarcasm. It’s basic economics. The medical school system in our country is not operating in sync with economic demand. They have limited the number of medical school slots far below what our country’s physician needs are ....

You can always increase quantity by lowering quality. That is what Cuba does. Cuba cranks out "doctors" like Keebler cranks out cookies.

Guyana’s Cuban trained doctors – the tragedy of mediocrity – Walter Ramsahoye ...... There are no individuals who would qualify for recognition at the centres named above so we have a situation where the unqualified are training the unqualified. We will at the end of the day have numbers without quality and the majority of Guyanese are being put at risk. Another troublesome aspect is that these unaccomplished individuals behave as if a piece of paper makes them the reincarnation of Hippocrates. Their arrogance knows no bounds. They know not what they do not know. It is the tragedy of mediocrity. ....... Not a single Guyanese has achieved that qualification and this explains why Cuban “specialists” do not measure up to specialists trained in North America or the United Kingdom. [worth reading again!] Our unsuspecting public believes the holders are specialists when all they have is an entrance qualification for further training.

The green doctor right out of medical school, once their residency is done is guaranteed a pretty standard salary from the time they finish to the time they retire.

Ummmm .... "Once their residency is done" usually means 6 years AFTER they graduated from medical school. What other profession requires you to have 6 years of intensive experience BEFORE you are even hired?

The doctor "just out of residency" is often the doctor in the group with the latest training in the latest advances in medicine.

Then again, you can always cut that experience down and take your chances.

Maybe we can save money by having Physician's Assistants do your your total prostatectomy.

Because this salary is high enough it also puts them in a position to pay back exorbitant loans and so medical schools charge more than is economically necessary

Harvard Medical School charges about $42,000 in tuition. That's right in the ballpark with my daughter's private undergraduate college tuition.

Harvard Medical School Tuition

Compare the medical school process to the process for getting an JD or an MBA and you’ll understand what I am talking about.

What's the very worst that a JD or an MBA can do?

With a mistake, the JD can lose a case (in which his client gets a Mulligan in the form of an appeal). With a mistake the MBA can blow a business deal.

With a mistake, the MD can kill you or cripple you for life. (Sorry. No Mulligans. Mother Nature is a nasty mother.)

When what you do really does not matter all that much, you can roll the dice and take your chances three years after undergraduate graduation, like a JD, or two years after undergraduate education, like an MBA.

You know what you call a future surgeon three years after undergraduate graduation?

You call him a medical student.

We need to increase the number of medical school slots, increase the number of doctors and force them to actually compete with patients on the basis of service price and service quality rather than just opening an office and being guaranteed a full waiting room because there are so few doctors on the market.

"I graduated as a surgeon from a residency program where every surgery professor trained 5 residents at a time during each case. I never got very much "hands on" experience but I will do your surgery for HALF PRICE!"

[SaraJohnson]

Maybe they are killing people but the major question is whether they are killing the right people and are they reducing health care costs! /s/