Blog | Wednesday, December 19, 2012

Call me a commie, I dare you


I've been following a discussion on Twitter about the work environment of post-docs and other scientists. There are a lot of parallels with medical training.

Medical training and science training both continue to follow a guild system, with apprentices, journeymen, and masters. Medical residents and post-docs are expected to work ridiculous hours for a pittance. One of the games we used to play as interns was to figure out our hourly wage (It came out to somewhere between $4 to $5).

The first argument against this system is quality of work. At least in medicine, multiple studies have shown fatigue to degrade quality of care. Similar data are seen in other industries. I don't know if it's ever been studied in academia, especially STEM academia, but I would be willing to bet that quality and quantity of work do not necessarily line up with hours worked.

There are certain tasks in medicine and in science that simply take time. One of the most frustrating ideas in medicine is that of the "hand-off," where a team on call hands over their patients to the new team. In the past we have always tried to minimize this since it can have a negative impact on quality of care. But so can fatigue.

Academics should look at the trends in medical training, where we are trying to bring hours more in line with what data shows works, and what reduces harm to the workers.

And that's really the other argument: Overworking post-docs and medical residents harms them, both physically and economically. Let's set aside for a moment such things as the data regarding medical residents and traffic accidents.

The system itself devalues labor, and thereby the people who perform the labor. We perpetuate the idea that medical schools and grad schools must be cut-throat-competitive. This may or may not be true, but this creates a system where laborers (medical and science trainees) are told they are "lucky to be here," that "there's a dozen others ready to take your place should you fall."

Once again, this may or may not be true, but it helps perpetuate a feeling among laborers that their position is always at risk, that they should be thankful for their abusively long hours and any other mistreatment they receive. And they should thank the boss that they get paid anything at all.

In many ways, this system has served us well; put a small percentage of us through the grinder, and a smaller percentage will survive to become the best of the best. But is that even true?

We need to question our most basic assumptions about medical and scientific training. How do we value the work that is done? How do we express that value? In medicine, we pay the survivors a living wage, one which is offset by crushing debt, and that discourages doctors from specialties that are most in need.

In science, it creates an academic underclass, where unless you manage to invent something very lucrative and get a nice cut from the university, you can only survive by perpetuating the system of undervaluing labor.

It's easy to imagine this system only affects those who are foolish enough to choose to enter it, but think about this. The shortage of primary care doctors, in fact our entire medical system that fails to care for those most in need is perpetuated by the system that underlies it.

And entire classes of people are discouraged from choosing these professions, limiting opportunity for people who are not already financially set.

Recognizing these facts does not make one a Republican or a Democrat or a Socialist.

Remember that inconvenient facts do not determine political ideology. Political ideology is created by facts.

Peter A. Lipson, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. After graduating from Rush Medical College in Chicago, he completed his internal medicine residency at Northwestern Memorial Hospital. This post first appeared at his blog, White Coat Underground. The blog, which has been around in various forms since 2007, offers "musings on the intersection of science, medicine, and culture." His writing focuses on the difference between science-based medicine and "everything else," but also speaks to the day-to-day practice of medicine, fatherhood, and whatever else migrates from his head to his keyboard.