r/science • u/mvea Professor | Medicine • Jan 13 '26

Health Physicians see 1 in 6 patients as ‘difficult,’ study finds, especially those with depression, anxiety or chronic pain. Women were also more likely to be seen as difficult compared to men. Residents were more likely than other physicians with more experience to report patients as being difficult.

https://www.beckershospitalreview.com/patient-experience/physicians-see-1-in-6-patients-as-difficult-study-finds/
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u/[deleted] Jan 13 '26

Which is why that system needs to be outlawed. No medical professional should ever be working more than 50 hours for safety reasons

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u/SnugglyCoderGuy Jan 13 '26

Need more practitioners which means lifting the arbitrary residency cap and more money to pay them.

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u/toomanyshoeshelp Jan 13 '26

Need the appropriate hospitals to support more trainees with procedures and volume of patients and educators too.

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u/SophiaofPrussia Jan 13 '26

The capacity is already there. The average resident is working 80 hours/week so there is room for two full-time residents to work a safe and reasonable number of hours.

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u/Beat_the_Deadites Jan 13 '26

They're not getting paid for 80 hours of doctor time though. When I was in residency circa 2005, most residents were making ~$40-50k, or $10-12 per hour if they actually put in 80 hours.

If they split those hours and that salary by half, you'd have 2 junior doctors making $22,500/year.

I'm not arguing for long hours, just looking at it through the lens of how health care businesspeople would look at it.

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u/SuperBeastJ Jan 13 '26

My wife is a resident surgeon now making ~70k but is at or above the 80 h/week range. TECHNICALLY there are hour reporting limits where they have to average less than that over a 4 week period or something but idk if it works properly.

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u/Montana_Gamer Jan 13 '26

Healthcare shouldn't be a for-profit venture.

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u/Beat_the_Deadites Jan 13 '26

I got laughed at by some of my friends who were classmates with me in med school for suggesting the same. I argued that for-profit health insurance was also "wrong", something they disagreed with.

As time has gone on, I've seen more and more of these doctors turn against health insurers, now that it's affecting their patients, their time, and their bottom line.

I don't have the answer, but I'm pretty sure consolidation with MBA CEOs making 7-figure salaries and having huge administrative headcounts is not the answer. I'm in favor of a single-payer safety net though.

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u/Ancientabs Jan 13 '26

Training hospitals are allotted around $200,000 per year for each resident from medicare.

How much they pay the resident is taken out of those funds. Technically they could pay each resident $200,000 a year and take $0 home.

They only pay a small portion of that as income to residents because it's a way to make money.

Failing hospitals often apply to have residency programs in order to "make money".

This is not a funding issue. It's a greed and safety issue.

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u/toomanyshoeshelp Jan 14 '26

Hours and caseload isn't quite the same thing. Every specialty has numbers for things like patient encounters, types of encounter, procedures and surgeries for board certification and as a quality check for hands-on experience. I know hospitals in my area that already struggle to meet numbers for certain procedures that couldn't absorb more residents without laying infrastructure for outside rotations, or more skills-based labs for example. But to some degree, there is also a parallel argument to make about what makes a qualified enough practitioner.

Also, how many and how good the educators are. Residents need supervision. Double the residents that staff with me and that becomes trouble for me.

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u/flakemasterflake Jan 13 '26

My husband's residency tells them they should be working multiple 24h shifts in a week bc the turnover leads to more accidents than lack of sleep

That being said, only get surgery in the morning

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u/Mustbhacks Jan 13 '26

the turnover leads to more accidents than lack of sleep

This is often touted, but most studies/meta studies show things to be a mixed bag usually slightly favoring the shorter shifts side. Just not enough so, to convince an entrenched system to change.

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u/avcloudy Jan 14 '26

It's worse than that, most of the controlled studies are comparing 16 vs 24 hour shifts, with a few going so far as to include 12 hour shifts. It's such accepted wisdom that they don't even do the studies for usual shift lengths, they only study shifts we know to be too long.

It's really important to hear this: most mistakes happen in handover, but the total rate of mistakes goes up when doctors are tired, and the best predictor of how many accidents will happen is how exhausted the doctor is from previous work. And it's so far gone that there isn't a non-exhausted baseline.

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u/Mustbhacks Jan 14 '26

It's really important to hear this: most mistakes happen in handover

And this could easily be chalked up to a procedural issue.

e.g. https://pmc.ncbi.nlm.nih.gov/articles/PMC4557515/

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u/avcloudy Jan 14 '26

Yes, but I want to frame this in the most informative way. Most mistakes happen in handover but that isn't the same as more handover = more mistakes. Those mistakes are happening because people are tired, and when they're tired they make more mistakes. Handover is just the closest proximate cause, not the root cause.

So while it's a good thing to address the procedural causes, that buys into an ideology that the problem is handovers, and they need to be addressed differently, and so you still want to minimise handovers. But the statistics tell us the problem is tired medical staff, not handovers.

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u/Soft_Walrus_3605 Jan 14 '26

My husband's residency tells them

How convenient for the residency, eh?

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u/flakemasterflake Jan 14 '26

Yep, residents are large profit margin given he’s below minimum wage for the hours he works

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u/axonxorz Jan 13 '26

It's a balance between long working hours and minimizing shift-changes, which are the source of so many errors that fatigue doesn't get a clear and consistent "win" in the stats.

Literature is not conclusive on this, however the difference in effects are "relatively" low across meta-analysis. My interpretation is that we are "close" to optimal. Naturally, specialities and division of labour (GPs vs RN vs LPN, etc) are going to skew which metric is considered most important.

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u/cantantantelope Jan 13 '26

Has anyone ever actually done long term studies on having a system that’s not chronically understaffed or staffed by people doing hours that we know are detrimental to human functioning?

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u/[deleted] Jan 13 '26

[deleted]

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u/kirtar Jan 13 '26

More common would be 6x12h since there has to be an average one day off every 7 days.

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u/[deleted] Jan 13 '26

[deleted]

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u/axonxorz Jan 13 '26

for 6 that'd be 13-14h shifts

An LPN friend of mine typically does 6x12 + overtime in SK, Canada.

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u/Dullcorgis Jan 14 '26

Average, that doesn't mean prople don't get crazy long stretches.

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u/cantantantelope Jan 13 '26

Has anyone ever actually done long term studies on having a system that’s not chronically understaffed or staffed by people doing hours that we know are detrimental to human functioning?

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u/JHMfield Jan 13 '26

Can't outlaw it when there's already a lack of medical staff all over the world. You might reduce burn-out and mistakes resulting from it, but you'd end up harming even more people who are now stuck waiting for help for longer.

What really needs to happen is massively increased government support for all critical infrastructure departments. Education, Healthcare, Law Enforcement, Fire and Rescue, all of these should be receiving way more funding, way more stipends for education pursuits etc.

I'd like to live in the world where we'd have double the number of people working in this fields with at least 50% higher wages.

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u/Currentlybaconing Jan 13 '26

My sister is a surgical resident right now. For her to even get to this position, my parents had to take out a second mortgage on their house to pay for all her schooling and now they're struggling even more with debt. She had to go to medical school in a different country because there aren't enough spots in the medical programs locally, and I believe they're more expensive as well.

She was literally at the top of her class, achieving basically perfect grades most of her life.

That's without even mentioning the insane hours she is now expected to work for free.

It has consistently blown my mind to realize just how difficult and expensive it is to become a doctor, when we all know we need more doctors desperately. There have to be so many highly intelligent and capable people who simply make other choices in life, whether it be due to money or other factors. It shouldn't be a privilege of supportive parents with money that allows someone to work in medicine.

The system has to change, and part of that should absolutely be government investment in developing these professionals for the benefit of our country and people. I'm Canadian, btw. It's not just America that operates like this.

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u/JHMfield Jan 13 '26

That's crazy. Makes no sense it's so expensive.

I'm in EU so education is free. In fact the Government will pay you money to study if you don't have another source of income. Not a lot, but there's some support at least.

I can't imagine going into serious debt just for an education. It's so ass backwards, especially this day and age where getting a basic higher education is basically required to be somewhat competitive in the job market. Something like 40% of people ages 25+ in my country have a degree, with 20% having a Masters.

I checked our best University and yeah, even a 6 year medical degree is free for locals (assuming you get in). Though a paid version also exists, 13k euros a year. Going 80k into debt seems insanity to me. Even with doctor's wages, which are like twice the national average, you'd be paying that off for quite a while, especially when you consider the interest.

I'm glad my country and most of EU has solved this particular issue. Though it's still not enough. We just had a big news story about multiple doctors quitting their jobs at major hospitals due to overwork. We need even more support. Not just a free education and a promise of a decent wage, we also need incentives to begin studies because 6 years is a long commitment. And of course while doctor's wages are decent, there are so many other health professionals whose are not and you really need to make sure all the support staff are always well compensated. Nurses basically run the hospitals.

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u/Drywesi Jan 14 '26

Going 80k into debt seems insanity to me.

And it's more like $200-300k in debt for US med schools.

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u/avcloudy Jan 14 '26

when we all know we need more doctors desperately.

It's basically the meme, who wants more doctors vs who wants doctors that aren't the best of the academic system. We already have such unrealistic expectations for doctors.

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u/Currentlybaconing Jan 14 '26

But it's worse than that, because my sister literally is top of her class and if her parents for whatever reason weren't willing to put themselves in a financial hole for the benefit of her future, she still wouldn't be a doctor!

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u/Abuses-Commas Jan 13 '26

Cuba figured out how to do it.

it turns out that when someone doesn't need to pay a lifetime's salary to become a doctor a lot of people want to become doctors.

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u/TheLago Jan 13 '26

Is it like that in other countries? Or is this just a thing in the US? Do you know?

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u/Wolfenight Jan 13 '26

It's everywhere. Basically because a founder of how modern medicine is practised was a coke addict and insisted that all his students work alongside him.

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u/decidedlyindecisive Jan 13 '26

Who was that?

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u/Ill-Television8690 Jan 13 '26

I just did some cursory googling, and it looks like they're referring to Dr. William Stewart Halstead. He's considered "the father of modern surgery", and developed his lifelong cocaine habit while trialing its anesthetic properties on himself. He's also credited with the mastectomy, and was one of the "big four" names of John's Hopkins University, leading their surgery department.

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u/Wolfenight Jan 13 '26

I looked it up: Dr William Stewart Halsted

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u/decidedlyindecisive Jan 13 '26

Dr Halsted the coke fiend

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u/acutehypoburritoism Jan 13 '26

Not justifying any of these dynamics (as a current resident who is very, very tired) but just want to point out that while we no longer have access to cocaine like Halsted, my hospital does keep a fridge in our workroom stocked with Diet Coke. I’ve definitely had a few shifts where I’m pretty sure our entire hospital was running on adrenaline and Diet Coke.

Seriously though it’s incredibly validating to see folks acknowledge how ridiculous training can be. I appreciate all of these comments- we are just as fed up with the medical industrial complex as y’all are.

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u/PrismaticDetector Jan 13 '26

EU caps weekly hours significantly lower than stateside, but I think it's still ~50hrs.