The FAA enforces work limitations on pilots, but we schedule our health care workers like this? How are there not even civil cases against errors caused by this kind of administrative foolishness? Overworking doctors like this is insane.
ER doctors work on a shift schedule, which has many documented advantages and disadvantages. Health issues are among the disadvantages. In my opinion, they can be pretty serious.
Many medical specialities have concerns with depression and suicide. ER and ICU are among the two with which I have personal experience that face these issues quite acutely. If you have a loved one in one of those departments, the last thing you want to hear is that your physician may be dealing with depression and suicidal thoughts.
Personally, I don't think the advantages outweigh the disadvantages. I suspect removing the shift schedule nature of emergency medicine may have a remarkable improvement. Many ER nurses and clinics have already moved away from a rotating shift schedule, and I haven't heard of any serious repercussions. I really hope emergency physicians follow suit someday. Or, find an alternative model that doesn't incur such health issues.
Can you go into more detail about this? I'm currently a medical student in the US near the end of my training, and I'm weighing multiple specialties (including ED). From my personal experience in the ED, it's actually the best schedule I've worked. Yes, it's irregular, but you're always working a fixed amount of time per shift and a fixed amount of hours per week (seems to be around 40). You know when you're on, and you know when you're off. Working three 12 hour shifts per week felt very doable. Most other specialties have call at least once a week, and there are days where you end up staying several hours longer than you expected. True weekends (Friday evening through Sunday evening off) seemed uncommon in other specialties as well. Not doubting what you're saying—I'd just like to hear more about your side of things.
I guess it depends on the person and your situation.
Before we had kids, my wife's shift schedule wasn't too bad. I owned my own business and could take time off when she was free during weekdays.
Now that we have kids, the shift schedule is tougher on her. Kids don't work on a shift schedule, and when they make demands of her time and I'm unable to help, she ends up sacrificing her sleep. That happens often enough that it makes any jokes about startup founders being sleep deprived, well, a joke.
Somehow, she's able to rally herself and get enough energy to work through a string of night shifts, even after having to take the toddler to the pediatrician during the day if I wasn't able to.
My wife also moonlights at another hospital (something she did back when I was getting my startup going and we needed the extra income). She continues to do this because she enjoys the work there (it's higher acuity).
That's just our personal experience. Colleagues of hers have solved this by hiring help (au pairs, nannies, etc), which we intend to do soon.
She's told me stories about some of her colleagues that don't have kids and have their own share of difficulties. One of them recently dealt with a particular tough case where a 3yo died. There's a culture in the ED where you don't take time off unless you're truly dying. Got the sniffles? Suck it up and come to work. Dealing with a traumatic experience and can't sleep because you've been crying all night? Suck it up and come to work. Hopefully that colleague finds a way to cope, because it's kind of frightening to me, as an outsider, to think of my ED doctor being that person.
I can only speak to the ED specialty. I'm clueless about other medical specialities and any potential health issues around them.
Thanks for the response. I'll definitely keep that in mind as I pick a specialty.
I'm only a med student right now, but I have spent a year rotating through all of the most common specialties. I have to say that the culture you describe isn't unique to the ED. I've seen it throughout the hospital. Taking time off isn't easy in any specialty. I've found this to be especially true in the niche subspecialties (especially surgical subspecialties). I work with a colorectal surgeon who is the only colorectal surgeon at her particular hospital. She's responsible for all of the patients she's ever treated and any emergencies that may need a colorectal surgeon. It's nearly impossible for her to ever take time off or even leave the city for more than a few days. An advantage that I see for ED physicians is that they're not directly tied to patients. Any ED physician can fill in for another when the need arises. I can't speak to whether that actually happens, but theoretically it's possible in the ED.
From what little I know, I would guess any kind of surgical subspecialty experiences what ED physicians experience, times two.
I heard the story of a good neurosurgeon who, one day, made a serious mistake during a surgery and paralyzed his patient. It haunted him so much that he eventually took his own life, after he dealt with the malpractice lawsuit.
There is a tradeoff that is used to justify the long hours. On the one hand, having a well rested doctor is obviously good for them to be making good decisions. But on the other hand, patient handoffs are dangerous. The more times you change the person responsible for a patient, the longer the game of telephone you are playing with their care. This has been measured as being bad for patient outcomes.
Now, that doesn't seem to justify the fact that long hour shifts are placed so close together. It seems like you could give doctors a longer break in between shifts than they have. Residents have the worst of it. The attending actually do get a fair amount of time on/off. Residents already work a lot less than they did 50 years ago, some think that their training should be extended to cover the loss of density.
Maybe OT, but pilots have a lot of time off between shifts and it's starting to come to light that their depression rates are much higher than anyone is comfortable admitting. This may from a different source though, since flying is very much about precise repetition and less about complex decision making (ADM is hard, but not the same level of mental stress that doctors endure), you eventually realize that you're a very highly trained bus driver.
It's way more complex than that though. The regulations exist because companies were pushing pilots to do more than they could handle, leading to a number of high profile crashes. Yes, the pilots are incentivized to manage fatigue but it's like any other profession, it's easy to get complacent.
I hate when this gets brought up, because it inherently implies that we can't improve them. Everyone talks about increases in handoffs causing increases in medical errors. I think handoffs have a long way to go, and we need to better utilize technology to help in this (ie make better EMRs).
The overworked doctor is just as bad IMO. I've been there on solo 28 hour calls going on my 11th admission. In the morning I'm next to useless and my handoff to that team was less than stellar.
I had a friend who was a QA process engineer at a regional hospital. He identified a significant source of errors - every morning there was a 'double-handoff' as the doctors handed off to nurses, who ended their shift and handed off to the next shift. The problem would be solved by moving hand-off time by a mere 15 minutes, but neither the doctors' group nor the nurses' group would budge on the matter.
I've heard a few other similar stories from him as well. Doctors have immense political power; if hospitals are grinding them to dust, it's because doctors as a group are letting them (the good old 'seniors don't care that juniors are getting crushed' problem). From my own limited experience working with them as a neuro tech, doctors will close ranks quickly against outside forces, but plenty will sell each other out within the profession. For every haggard ED doctor, there's a specialist somewhere making cushy deals with the administration.
Depends on what you call training. 250 hours under a private (no payment allowed) licence, then you get your CPL. All of this is on your dime (average about $200/hr with instructor and such). The CPL phase work afterward (banner flying, flight instruction, etc) pays like garbage since the GA community is struggling significantly. To do airline work, you need minimum 1500 hours (ATP), then pilots have a sort of residency beyond that where they need to spend a month in airline training, then years as a first officer before becoming a captain (PIC). On top of this, you have the regionals where you get payed like crap before you can typically get a seat at a major airline.
To fly for the airlines you'll need a college degree, probably with a >3.0 GPA. I agree it's not as academically rigorous though (unless you count the USAF route). Also, most people I've seen do the 250 in as short a time as possible or go part 141 which is a sort of direct-to-CPL training program. Right now there's a shortage of airline pilots but traditionally, those 7-8 years you mention would be spent at a regional before you have a chance at making enough money to start to really service all the debt you undoubtedly have at that point.
Obviously they're pretty different career paths, but they're both effectively 'trades', in a more traditional sense, that require obscene amounts of training.
