Are these really the people that should be required to work so much? Isn’t their job about handling life and death daily? Wouldn’t we want exactly these people to come fully rested to work every single day and be fully staffed?
I don’t know if there are jobs with similar stakes that are so carelessly staffed and disgustingly paid.
Because health care is a service and not profitable except when selling Drugs. Thats the unethical incentive behind addiction and the opioid crisis.
There’s a number of factors at play and rest is only one of them. Other factors are cost cutting in hiring and risk of information loss or error during patient transfers.
No we’re not. But generally governments everywhere want to starve the medical industry to make it generate profit for the wealthy. The US is their role model.
Glares at Doug Ford
Honestly, I don’t think it’s even about profit everywhere.
I obviously don’t know what it’s like in Canada, but in my country, we also have socialized healthcare (like Canada), we have a shortage of some specialty doctors because they’re expensive to train and expensive to hire, and many go to other, richer countries instead (Finland in particular, as it’s close by). But nobody works huge amounts of overtime usually. Nurses work double or triple shifts, but mostly overtime is voluntary, and the only reason they work 16 or 24 hours in a row is because of stupid traditions and the slight risk of information going missing with the shift change.
The one upside is that they get a bunch of days off after each shift since you only need 2 shifts a week, and actually get to skip one shift every now and then if you don’t want to do overtime.
they kinda are doing that, by UNDERSTAFFING everywhere, replacing expensive MDs for NP/ or even nurses, and PAs. PAs are useful if they can spend time with your medical history like 30min+, anything less than that they are only slighty better than NP/nurses.
Glares at Tim Houston
ಠ_ಠ
Tries to glare at Tim Hortons but it is not available in my region
I mean they deserve it too…
Right in the Tim bits.
Because the alternative is the rich paying more in taxes, and we can’t have that obviously.
Not really.
Universal healthcare could be more than paid for just with what we pay in insurance.
It’s still money, but in this case it’s that profit healthcare is tied to employment causing employers across all industries to want less employees, which means a lot of overtime.
The real solution was shortening the work week to spread the labor around while keeping salaries high.
That seems very US specific. In Europe, we have universal healthcare, but it’s chronically underfunded.
sounds like a billionaire problem
It damn well is, no doubt about it.
always is. Universal healthcare is a reality. We just have a billionaire problem
Mods, jail.
I don’t understand why people aren’t voting for the uber-rich to pay their fair share. Billionaires pay less tax percentage-wise than any worker out there and it’s all because we focus so much on income tax. The uberrich don’t have income - the have wealth, which isn’t taxed.
the rich hospital admins, they skimp out on hiring more mds to rotate the burnouts.
Because the results of malpractice only kill, maim, or injure one person at a time.
In aviation, however, the consequences are much more visible; so commercial pilots have regulated limits to flight duty.
Funnily enough, those duty cycle limits played a significant role in history’s worst aviation accident: The collision of 747s at Tenerife.
The short version of the story: There was some bomb threat at a European airport, so traffic bound there had to divert to wherever else they could. A lot of them ended up landing on the Spanish island of Tenerife, at an airport not used to handling that much large aircraft traffic. This included two 747s full of passengers.
When it was time for them to go, a thick bank of fog had rolled in. The taxiway was apparently not suitable for 747s so they had to taxi down the runway. The first of the two 747s had taxied to the end of the runway and was in position and ready for takeoff. Extremely ready for takeoff; the captain was pre-occupied with a recently tightened air crew duty cycle policy and was anxious to get home before going over his hours.
The second was taxiing up the runway straight toward the first, and had missed a turn off the runway, so they were kind of jackknifed across the runway trying to figure out where they were.
The captain of the first jet decided to take off without clearance from the tower. One 747 under full takeoff power T-boned another 747. Nearly 600 people died.
I’m all for crew duty cycle rules, we shouldn’t have exhausted pilots at the controls. Something that has kind of shut my life down is the notion that even our good laws turn poisonous when interpreted with absolute strictness. A pilot afraid of breaking the “You’re not allowed to over-work pilots because flying tired is unsafe” law killed 583 people including himself.
The video I linked above calls it “The Worst Air Disaster In History.” It’s one episode of a long-running series, and they always feel the need to come up with some similar line, so some of them are “The worst single-aircraft disaster involving a non-American made plane operated by an American airline to take place during daytime.” I think my favorite quote from the show was during the Cross Air CFIT episode, “On board was Passion Fruit, Germany’s answer to the Spice Girls.”
We aren’t. But it’s generally better for patient care. It’s the same nurse/doctor seeing through more of the care of a patient with less handovers.
Handovers are where minor details or context can be forgotten, dropped or misunderstood - especially after a really tough shift.
Patients also get to see the same faces more often, which makes them feel like they are being taken care of - as opposed to a part being made in a machine.But it’s wrong. It would be better to have 8 hour shifts with 2-4 hour overlaps between shifts. So it’s not a handover, it’s an actual rounds, it’s actually servicing patients and so on.
But that is likely very intrusive for patients, and 4-8 hours of the shift is with someone else (who you might not like or agree with) and communicating (which can be tiring).So yeh, it’s not great. Understaffing doesn’t help, especially since these are people that genuinely care about their work. It’s pure exploitation, because it is cheaper and hospital administration can justify it and get away with it (or whatever is higher that hospital admin in the case of free healthcare).
In some cases, it’s budget and exploitation. And it’s bullshit.
But there is a genuine argument that a doctor who is fully informed and tired is better than a doctor who is fresh and oblivious.I’m always slightly skeptical of this answer just because residency pretty much intentionally gaslights doctors into thinking that exhausted decision making is normal and unavoidable… All because the guy who started medical residencies has a massive cocaine addiction and it was 1900.
I’d be curious to see a study with data on patient outcome, wait time, use of resources etc, that measures exhausted double shifted doctors, vs fresh doctors with more context switching, vs fresh doctors + appropriate overlap to avoid context switching.
They’ve done those studies and context switching has historically been where the most problems occur. Whether they’ve repeated them with modern electronic medical records and systems, I don’t know. I think most people agree there’s probably a better middle ground between 8 hr shifts (3 handoffs a day) and the standards set by a dude who liked to experiment with coke and meth.
One of the big issues that I feel like doesn’t get touched on as much is longer shifts allow less doctors, which reinforces the artificially low doctor graduation rates. The national board in the US pegs the graduation at X thousand new doctors every year and that number is mostly tradition / vibes. No we don’t want to compromise on the ability of new doctors, but “gestures vaguely to US healthcare” good lord do we need more of them. Much the same could be said for nurses.
And all of that circles back around to not wanting to dilute traditionally higher paying job markets with more practitioners because the for-profit system will try to wring out every cent they can.
There are probably many more minds that could hack being a good doctor, but are smart enough to go into a field where the work-life balance hasn’t been a terrible trope since 1900. I think I could have been a good doctor but from a very young age I remember it seeming like the time wasn’t worth it.
That being said, I did end up becoming an RN, and I’ll say that my program is probably not unlike others in the US where sacrifice and fucking martyrdom reign supreme. Like wouldn’t you do anything to help your patient? Lose sleep, skip breaks, skip meals? If you don’t, whooo wiiiiilll???
There are probably many more minds that could hack being a good doctor, but are smart enough to go into a field where the work-life balance hasn’t been a terrible trope since 1900.
This was me. Studied for and did well on the required exams, interviewed at a couple of schools, and in between my interviews and acceptance letter I talked to a couple of people in residency at my university. The descriptions of their work-life balance was so atrocious, and the altruism of the profession so stomped out of their mentality that I decided I could probably help people in other ways.
As I watched a couple of my close friends battle depression all through medical school and residency with very little institutional or mentor support, I decided I absolutely made the right choice. I really respect you for staying within the system and becoming an RN, because you guys also have it just as rough, along with the added disrespect of “But you’re not a DOCTOR.”
I don’t know why medicine is so gatekeepy in it’s processes. Being strict in education and procedures I understand. But the heirarchy, egoism, and political games to grind down all these young trainees is quite archaic.
Yeh, same. Which is why I said ideally there would be 100% overlap with shifts. Always 2 doctors, offset by half a shift.
Like, that is the fix. Peer review of decisions, easy conference/council/whatever-the-word-is, context can be handed over better (outgoings doc/nurse briefs incoming doc/nurse while remaining doc/nurse listens & supplements)But I have also been on gigs (I work in events) where there is a rig crew, a show crew and a derig crew.
When everything is meticulously planned out and everything goes according to plan with all the communications in advance, it works. It does. (As a tech, I’d rather set up the kit I’m using). If I know it has been set up according to pre-communicated spec then I can work it. If it deviates and I have been in the loop, I can work with it. But if it turn up and it doesn’t make immediate sense then it is many times harder. If I am rigging kit without a clear concrete plan, then I am guessing what the tech wants.
And I also know 2 lampies can’t co-light a gig unless they take turns.
Someone has to be incharge, someone has to take responsibility.But I don’t think (and from what I have read, and I’m sure I have been somewhat misinformed) that applies directly to healthcare. Meticulous plans don’t exist. Every patient is different. Something minor reported and expected to go away on the last visit of the leaving doc that is then reported as slightly-more on the new docs visit… That could be significant. And a few extra hours on a shift could save a life, because of that easily dismissed/forgotten context/knowledge during a handover.
2 doctors at all times is the fix. Or, actually, a voice-to-text and an LLM… Likely a decent usage of an LLM.
It doesn’t need to know who/what the patient is. It doesn’t need to know co-morbidities, existing conditions, medications, treatmens etc. Just that the doctor is interacting with patient A, and here is a summary.
Patent A is the same patient that a nurse interacts with.
Helps with hangovers and context.
Patient A is still in the hospital? Patient A still has a transcribed record that can be quickly summarised by a local (or onsite) LLM.
Using onsite LLMs is no different than using a database. And it doesn’t have to be massive. 30m before a shift change, there can be a “notes after this time will not be summarised during handover so previous context can be summarised”. So doctors only have to remember the last 30m during a handover, and the rest of the context (even transcripts) are provided to prompt their memory for a better handover. It’s an information tool for doctors, not a crutch.
And now I sound like an AI shill.Sorry for the wall of text. I’ve been drinking. I hate the “just use LLMs bro”, but think they have genuine utility when applied safely and locally.
And I want doctors and nurses and janitors/cleaners/sterilisers/techs of hospitals to be treated like the fucking heros they are.
I’m going to disagree with you on the “better for patient care”, as the study I saw was not good. I remember the study being put forward by a party that had a significant interest in having people work longer shifts, which amused me when that’s exactly what they found was better. Your study might be a different one that has actual methodology done after the one we liked to make fun of because it was a shit study with a conflict of interest (even if it may have shown something that may be true that I disagree with, I haven’t gotten around to granting that I’m wrong yet I still have two full paragraphs of bullshit in me).
Aside from becoming a valuable piece of medical evidence I’ve done a fair amount of MD education and worked in the office side. I know my own icd 9, 10, and 11. To give my credentials without doxxing myself (I could just show my famous anatomical abnormalities, the ones that got photos sent around to every medical schools in the world, but like then EVERYONE would know who I am. I might have just doxxed myself just saying that I haven’t had privacy for a while)
This is what I feel is the
gold[ew that feels wrong now.] prime bean standard of hospital care: the lead doctor needs to be able to explain to the patient and the nurses what is going on in their care such that they understaffed it. You have handoff happen in front of the patient and have the patient explain (as concisely as possible. Under 30 seconds if you can, you have all day to practice) their upcoming routine medications/appointments/therapies/allergies/dreams/hopes/eyeshadow/steam engine kebab designs and then the nurse/aide explains any additional procedures/steam engine kebab design competitions that have been scheduled during the shift. If there’s anything else that you need to cover during handoff, like the location of the nearest Turkish or Afghan restaurant and a handy menu, that’s easy enough to cover.I wonder if less workdays alongside higher staffing would be a better way of reducing burnout while preventing handovers
Your downvotes are all nurse administrators and bed control. Bullies. Because who else would argue that hospital staff is not exploited, honestly.
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No, that’s because a lack of labour laws in the US allows them to do that.
If they weren’t allowed to force their CPAs to do that, they would have to hire more CPAs, which would increase the overall salary for CPAs and attract more people into the field.
Can I introduce you to EMS and firefighters 24 and 48 hour shifts?
Yeah, but that’s not constant work over that span. Most of it (and frequently all of it) is just sitting around the firehouse waiting for a call. In the meantime they can eat, sleep, watch TV, etc.
Edit: Ok, ok, there are duties that need to be done around the station so it’s not all sitting around. But it’s also not fighting fires 24 hours straight.
In an ideal world those 48 hour shifts involve zero work
On a good shift, yes, we have down time. My current job I am usually lucky and get time to sit around, but it’s not generally as relaxing as you’d think because at any time I need to be up and out the door within 90 seconds, so I’m always mentally in go mode.
My last job I didn’t do 24s, but I did do 16s, and I had to work a lot of OT to pay rent, so it was not uncommon for me to work 6 days/80 hours a week and I definitely did not spend time sitting around the station. I was almost always out running calls. I’d come home, sleep for 3/4 hours and be out the door again to work.
Not trying to do the suffering one-upsmanship. I’ve had to do clinical shifts in the ER for my schooling and I hated every moment of it. I don’t think you could pay me enough to work in a hospital, it’s not my thing. I have deep respect for my nursing homies, I love them and always have had a great working relationship with them. OP commented that they don’t know any other jobs with such ridiculous working requirements so I added two.
HA! Maybe firefighters, but EMS gets to sit around the firehouse once in a bloody blue moon. The 24 hour shifts suck, because the chances of you actually getting to sleep during the night hours are incredibly low.
Sure, there are going to be differences based on where you are working, but generally EMS is nearly call-to-call.
I can assure you part time, seven days isn’t better.
Why do people constantly fall into “suffering one-upmanship” when discussing making things better? Who does that benefit? Why not simply agree that it’s wrong and work together to solve both problems?
Your question is based on a false premise and therefore invalid.
Your answer is based on bad faith and therefore blocked.
You say bad faith, but most other answers here seem to say they’re not ok with it, so it appears I’m right.
At least they’re getting paid. Air traffic controllers are working similar hours and not getting paid every time they have issues with government shutdowns.
As another user here put it, “at least” is not an argument; both situations are bad and should be rectified…
I think basically everyone, if you ask them directly, would agree with you. The issue is cost disease. In order to continue attracting workers to the medical profession, institutions must raise wages. Raised wages means more cost for the institution. But no medical institution gets a blank check to run its operations. So institutions are constantly looking for ways to save money, which often means hiring fewer people and making their existing workers work longer hours.
Medical institutions make billions, the CEO rates are insane. They don’t have to be
According to some random googling I did, the largest health care provider in the USA is HCA Healthcare. In 2025, their CEO made $26,456,606. Meanwhile, they had 316,000 employees in 2024. If the CEO were fired, that would mean each employee could be paid an extra $866 per year. The company’s total salaries and benefits came to $32.2 billion in 2024, averaging $107,333 per employee. Firing the CEO could result in hiring an additional 260 full time employees, increasing the number of employees in the company by 0.08%.
So based on this napkin math, you can be opposed to CEO pay on an ideological basis - but not on the basis that it would have a non-negligible impact on this specific issue.
It’s not so much the CEO’s direct pay. It’s what they are paid to do. CEOs generally get paid to maximise shareholder dividends and stock value, which leads to them doing anything they can to minimise the staff’s wages, and minimising the staff in general, to keep down costs, especially in something where inputs and outputs are not strictly correlated, like medicine, where you can’t hire 10% more nurses and expect to get 10% more patients paying bills. The CEO’s work probably hurts everyone involved except for the shareholders, but it increases profit margin so they do it.
This is a fair enough critique of the US system.
But to the topic of “why are medical staff overworked?” we see this in countries other than the US as well. Typically because even if institutions arent trying to maximize shareholder value, they are still having to make due with limited funds allocated to them by the government in the face of rising (or potentially rising) healthcare worker wages.
The rising wages of NHS healthcare workers are only a problem if the taxes are not being levied to cover it from the profits the care enables. Without medical care, companies would have more lost productivity, which is the non-moral/economic motivation for an NHS. If the extra productivity were reclaimed in the form of corporate taxes, there would be no budgeting shortfall.
Sure, but there are a few problems here.
First is that the total cost of a health intervention is not fixed, and there is always a give and take between providers, who want to provide better care/make more money, and whoever is paying, who wants good care without overpaying. Writing a bureaucracy a blank check is never going to happen.
So you would need to quantify how much reclaimed productivity you are gaining, which seems like a rather fraught endeavor.
And most medical care provided to people in developed nations is care provided to the elderly, who are not in the work force. So your productivity reclaimation tax would still have a shortfall, which you would need to make up somehow. And voters tend to not like higher taxes, so governments tend to not want to raise them, even for reasonable things like adequate funding of medical care for seniors.
averaging $107,333 per employee
That is far, far, far greater than the average of their CNAs, nurses, custodial staff, basically the bulk of their workforce is either at or near minimum, or making around half that if they’re the higher paid chunk of the vast majority of the workforce. I’m willing to bet the top 10% makes close to 90% of the wages
I mean, it also seemed high to me. My guess is
- Employee benefits (like, ironically, medical) are more expensive for the company than we would assume, but aren’t included in nominal worker pay.
- The company subcontracts out its lower wage work, like custodial staff or CNAs. So it ends up paying a bunch of doctors $200k per year, and twice as many nurses $50k per year. Assuming this custodial staff don’t count in the metric I found, since they aren’t on payroll. And we could argue that CEO pay could be directed to them as well… but then we are just splitting the pie more ways.
Of course, if you have some proof that 90% of those wages are going to 10% of earners in the company, I’m all ears. But I kind of doubt it.
Hospitals shouldn’t be “making money” directly. They are there to heal people. A healed worker is an indirect gain to the economy. Good care and good prevention mean a stronger, fitter, and more productive society.
I bet that the better the care a hospital provides, the less recurring patients it will have and the quicker it will be able to release patients.
I mean, I didn’t say anything about making money. Public institutions will face the same pressures in the face of rising wages outside the healthcare sector. Hospitals are filled with old people, who are sometimes racist assholes, who need their bedpans cleaned. And whoever needs to do that cleaning needs to get paid a competitive wage. And so if a public institution isn’t allocated additional funds to compensate for increased wages (and bureaucracies and legislatures hate increasing funds) they will need to find a way to save money.
Also, a very large portion of people in hospitals will never work again, as they are the elderly. Of course, we should care for these people - but just saying that if you try to take an economic prodictivity tack with your argument, you will run into this problem
I have heard the excuse is that the chance of a miscommunication during shift change could result in more issues than the longer shifts, so it’s better to keep the same doctor on a patient if possible. Don’t know if that’s true or not.
The greatest fear of capitalist administrators is that there might be a slow night in the hospital and a few employees have some down time to take a breath where no “production” is taking place. The shareholders would not be amused. That’s why they staff hospitals with the bare minimum, paying them as little as possible and using them as much as possible.
I agree. Same thing with truckers driving to long. Part of it is the culture. The worst is when they get out of medical with residency and such. Its that frat type of. I had to do it so so should they.
We’re not.
We’re just powerless to change it outside of our local jurisdiction.
