Surgical residency works on a pyramid system--8 will start as interns -- 2 graduate as surgeons. Resident training is where you are the apprentice, you learn the techniques which a textbook or You Tube cannot teach. Technique is volume driven--the more you do--the better.
Residency restriction hours have diminished this training. Newer techniques have changed operations. The majority of surgical specialties will not graduate with enough procedures performed during residency. These surgeons will either go on to more training=fellowship or practice a narrow scope of practice( limit to couple of procedures).
The General/Vascular surgeon of the 90's is gone. Replaced by Breast surgeon, Foregut surgeon, Hindgut surgeon.....

quote:

Originally posted by Rey HRH:
I protest that the article makes the impression that the suicide trend is endemic to the medical profession.

I believe it cuts across society. Here's my reasoning: I've recently learned there's a spate of suicides in the military, specifically in the Navy...

Yes, and the legal profession. The suicide trend is high in many high-stress jobs.

The U of Iowa medical center in Iowa City has grown immensely in 20 years, it's huge now.

And is experiencing difficulty in finding and keeping all sort of employees in the medical profession.

Getting appointments now is out five months.
Only ten years ago, it was three weeks.

A lot of the old farts are retiring.

quote:

Originally posted by bendable:
A lot of the old farts are retiring.

That's the trend across the board, as the last of the huge Baby Boomer generation enters retirement.

The result is a net decline in the overall workforce, compounded by the fact that many of the younger folks entering into the workforce are going into new types of jobs rather than backfilling vacated existing jobs.

For some professions, that's not necessarily a bad thing. (For example, there's a glut of attorneys, IMO. So that industry can afford to have overall fewer of those overall without too much of a detrimental impact. See also the overbloated tech giants shedding excess nonproductive positions.)

And in some industries, part of that worker shortage will be made up via automation or AI.

But for industries like medicine and the skilled trades, it's a major problem if all the old guys retire, since demand isn't going to decrease, there's not enough young guys to take their place, and we're generations/centuries away from having robotic doctors/carpenters/plumbers/etc.

Why is the medical system still this way?
^^^^^^^^^^^^^^^^^
IMHO because you, the patient, would not want to pay for checks and balances. A huge portion of the health care system is administration and insurance which contributes nothing to patient wellness.

^ it's not so much a Healthcare system as it is a Sickcare system. It's a losing battle. Pre- med requirements in undergrad steered me away from the medical profession. I probably would have become depressed by my inability to help people given the medical training I would receive. I see a future of Direct Primary Care where doctors aren't "treating" every chronic disease under the sun and can be true partners in health. If patients aren't doing their part how can we expect doctors to make up for that.

quote:

Originally posted by bryan11:
For software development, there are frequently multiple levels of testing, peer review, and load testing at scale before things are released to production. Engineering in general tries to use similar approaches.

With things that involve life and death, it's normal to push doctors, nurses, and others so they work while exhausted, stressed, and likely to make mistakes.

Why is the medical system still this way?

I've often thought about this myself. I did two residencies in the 90's, before there were work time limits, and spent alot of that time tired and stressed out. Not in surgery, but very demanding fields, nonetheless. I think part of the answer was:
1. this is the way it has always been, why change it now?
2. From the attendings in charge; "we went through it, so you have to also".
3.Perhaps the only justification that was valid was that it taught one how much they could endure/tolerate and still perform the duties of the job appropriately and correctly. Sort of like "that which does not kill you makes you stronger".

Medicine isn't a 'group' occupation; there's no meetings or discussions or teleconferences with other employees or colleagues at 3 am when the nurse calls you with a crumping patient. It's just YOU and you have to wake up (if sleeping), be alert and at 100% cognitive function; all cylinders firing, and address the situation immediately and correctly with no delay. This is an absolute requirement, not an option, of the profession.

Residency is not only a time of massive information and skill acquisition, but also a "socialization" process to the huge responsibilities and lifestyle demands of being a physician. I used to tell the med students rotating through my department that being in medicine was like being married to a very jealous spouse; it will take up every waking and sleeping moment of one's life if one lets it. One needs to make sure there is some counter-balance; some time set aside for them alone and away from medicine, or they will be swallowed up and burn out sooner than later.