I live in NZ so our health system is different from the US one. They say that there 'aren't enough doctors' and I do think that the main problems I've had with my healthcare have been due to clinician's having too many people on their books and being overworked / burned out. I don't know whether the problem is that there aren't enough suitably qualified doctors to fill advertised positions or whether the problem is that there isn't the money for another position / another doctor to join the team to take up some of that caseload. I suspect it is mostly the later.

The best health care I've ever had has come from people who worked part time. 3 days per week. I finally felt heard. I finally felt cared for. I finally felt like they had the cognitive resources to see me and accept me as an individual rather than rushing me quickly into some preconceived box / schema.

I think that medicine is very 'old school' in some ways. Slow to change. Part of it is about public acceptability. Sometimes... People really do want Superman. I don't want to know that I have the trainee surgeon who has never done that particular operation before and who has trouble suturing a pigs foot... I want to believe that I have the very best surgeon that there is. Calm assuring confidence is important in some settings, for sure. But I do think that medicine has been slow to... Look out for it's own (in truly psychologically health ways, I mean, clearly it is good at closing ranks). Perhaps because of the huge numbers of people queuing to do it there is this idea that people in training are really expendable. For every medical student who burns out there are 4 or 5 more (who would all go on to be competent, likely enough) queuing to take their place...

I think things are starting to change. But slowly, yeah.

I am finding a lot of inspiration from some of the stuff that is coming out about flexible workplaces. In particular, the idea of job share. I am fairly sure that studies show you get about 3/4 of the full time work equivalency out of a person who is employed for 1/2 of a position. I know from my own experience that studying part time is about 3/4 of the workload. And so very (very very) much more enjoyable and interesting and so on for only being part time. Manageable. Competence. Etc. Great for my own psychological health. Great for the psychological health of the people I'm working for / with.

Something has happened here with GP's where they seem to have the power to work part time. And a lot of them are doing it. And I think that quality of care has improved because of it. I'd like to see this transition more broadly through to other areas of medicine. Especially something like psychiatry. Halve the caseloads.

I suspect the problem is that it is the student doctors (years 5 and 6) who are doing the bulk of the (unpaid or grad stipend equivalent) work. Since they are unpaid already we can't really pay them 1/2 for doing a part time workload (thereby achieving 1.5 labor output equivalence). Anyway... This is the kind of thing I am thinking...

I suspect... The real resistance comes from senior clinicans / consultants. Who feel they have worked freaking hard to get into positions they are currently in - of part time workloads at 2 or 3 or 4 or 5x the salary that anybody needs to be paid for a decent quality of life...

I don't know... I need to learn more.