How Work Changes

As I wrote my last post a number of thoughts came to me that weren’t completely relevant to the post but which I wanted to include somewhere. I’m going to try and bring them together in this post.

I think it’s a tremendous irony that in just 60 years the typewriter could go from a symbol of women’s liberation to one of oppression. From the nineteen teens through the 20s, the Underwood Typewriter was probably as great a force for liberating women as has ever been devised. It enabled women with ordinary educations and just a little training to hold jobs that enabled them to support themselves. Previous to that the only honorable jobs a woman could hold outside the home were teacher, nun, and nurse. By 1980 being clerk-typist had come to be considered demeaning. I think that exemplifies the differences between the First Wave feminists, interested in making the lives of ordinary women better, and the Third Wave feminists. I’m not sure what their interest has been but it’s pretty clear that they’re not particularly interested in ordinary working class women whose lives have frequently become much worse over the last 30 years, either trying to raise a family as single mothers or being expected to hold fulltime jobs while also being expected to be fulltime wives, mothers, and homemakers.

A “teamster” used to be someone who handled a team of horses or mules to haul loads. By 1920 the same men who had handled teams of horses were driving motorized trucks, represented by the same union. The skills required were very different but, since loading and unloading was generally the responsibility of the drivers, it still required big, burly men. Hauling the first load by motorized truck across the United States took place in 1912 and took 90 days. In the same period hauling a load across the country by railroad took four days.

Right now there’s a lot of hype about fully automated trucks. We already have them. They’re called “railroads”. IMO hauling loads on the regular public roads with fully automated trucks is far in the future if ever.

IMO American physicians’ greatest accomplishment has not been in the area of public health but organizational and political. They’ve managed to convince people that physicians educated in 1920 still had the skills to do their jobs in 1950, physicians educated in 1950 still had the skills to do their jobs in 1980, and physicians educated in 1980 still had the skills to do their jobs in 2010. When you reflect on it, what physicians did in 1920 resembles what they do today only superficially. Physicians of a century ago simply do not have the skills to practice medicine today and, in all likelihood, vice versa. Most of what they have in common is what they call themselves. Continuing education probably helped but it has its limits. I think that’s an issue that will only accelerate.

12 comments… add one
  • steve Link

    So does this apply to other professions? An engineer, banker, architect, computer designer, software writer who turns 55 is no longer useful? In medicine most of us track outcomes and process. If someone has bad outcomes and/or is not following process they are usually gone, at least from quality organizations. As I have seen over and over when we take over failing hospitals there is a whole subculture or marginal physicians (nurses, pharmacists, technicians, etc) with poor outcomes . Many of these are older providers who are still practicing they way they did 20 years ago, though most are younger people who are just not very good.

    The drugs I use now, the equipment I use now are almost entirely different than what I used when I trained. Plus, I guess would be remiss if I didnt point out that it is often those people in the 20-30 year experience range who are leading the research efforts to create new therapies and procedures.


  • So does this apply to other professions?

    To different degrees, yes. Attorneys are probably in the best shape. With engineers it varies by specialty. Bob Sykes can probably give us an informed opinion about civil engineers. Guarneri might be able to comment intelligently about the situation for metallurgical engineers and/or bankers.

    Very, very few software developers continue to develop software for their entire working lives. They either, essentially, age out or they’re stuck maintaining the stuff they wrote when they were 20 when they’re 55. A very small number keep their skills current enough to be productive.

    I think there are fundamental flaws in our educational system and that hits physicians the hardest. In most of the world becoming a physician is not a matter of graduate education as it is here. IMO our system is not serving either physicians or patients but medical educators.

  • steve Link

    I guess you can believe that but there isn’t much evidence to support it. I know inpatient stuff best so maybe its more of a problem with PCPs, but anyone who doesn’t keep up in the ICU or in the OR gets noticed pretty fast.


  • There actually is some evidence of my claims. For example, this

    A group of University of Michigan doctors documented the results of more than 460,000 complex surgical procedures between 1998 and 1999 to determine whether patients with older surgeons were more likely to die during or shortly after surgery. In five of the eight surgical procedures examined, the older surgeons did not perform significantly worse than their younger colleagues. However, in the three categories in which there was a statistically significant difference—coronary artery bypass, pancreatectomy, and carotid endarterectomy—surgeons between the ages of 41 and 60 were more likely to keep their patients alive than were surgeons older than 60. Several other studies have reached a similar conclusion: As surgeons age, there is a small but detectable diminishment in the quality of their work.

    is not dispositive but it is suggestive. I’m not sure how you disaggregate aging from the time elapsed since training.

  • steve Link

    The study didnt look at years of experience, just age. It showed that for most procedures age didnt make much difference. So, I would hesitate to suggest that years out from training was the cause of the difference they saw. (Their speculation about bypass surgery needing better motor skills is kind of funny.)

    They cite the Harvard study which is one I know pretty well. That study showed that as you got older outcomes got worse. However, when they controlled for number of cases, the difference went away. Everyone who saw at least 200 patients a year, these were hospitalists, had equivalent outcomes. Being 30 years out made no difference, as long as you were working full time and carrying a full case load. (200 patients a year for a hospitalist is not a very large case load.)

    So, my best guess absent confirming studies, is that older docs sometimes go part time. These docs are probably the ones having worse outcomes. I am also convinced that there is a drop off that we see starting in the early to mid 60s , but with a lot of people not showing anything until late 60s early 70s. This is all with the proviso that the doc is working full time at a quality institution. The ones that would worry me would be an older doc at a marginal small hospital.


  • James P Kirby Link

    “I’m going to try and bring them together in this post.”

    In English, we say, “I’m going to try to bring them together in this post.”

  • Guarneri Link

    “Guarneri might be able to comment intelligently about the situation for metallurgical engineers and/or bankers.”

    The answer is yes, you must keep current or else. But I’m surprised this is even controversial. A little meat on the bones:

    Thermodynamics, physical chemistry don’t change. But refining and physical metallurgy techniques move quickly. But any engineer worth his salt keeps current. Or perishes.

    The principals of credit have been in place for hundreds of years, but the capital markets and associated technology have forced change at rapid rates. In by nine, at the golf course by 3 is a bygone day.

    Private equity has moved the most. For obvious reasons. Its not about the financing, its about running the companies. And that moves at the speed of business in general. Perhaps faster than any other pursuit I’ve been involved in.

  • steve Link

    In my specialties just keeping up is not good enough. You need to maintain the physical skills, integrate the knowledge and work at speed. You sometimes just have a few minutes to do something and if you cant do it then the pt is dead. I think that is why we see some people start to have issues in the 60s. They can have a perfectly good fund of knowledge and know exactly what to do, they just cant do it fast enough. I also think they dont recover as fast if they make a wrong guess and need to change what they are doing. I dont think that has anything to do with being 30 years out from there initial training, just aging.


  • Guarneri Link

    I’ve known surgeons who have flat out said that they should be retired at 55. Speed.

  • CuriousOnlooker Link

    On software, it is hard to say.

    There are not many programmers over the age of 55, but is that because of the large increase in computer programming graduates starting from 1995, or because older programmers became obsoleted?

    If you look at the some of the most influential people in computer science — the inventors of C++, Unix, and Java were still contributing into their mid 60’s and 70’s.

    What is true is software engineers need to learn the trends in the field, and the trends change fast. There is little demand for specialists in mainframes (but it can still be lucrative). Similarly, demand for programmers in Windows client applications is a lot lower now then IOS or Android app developers. But this can usually be picked up “on the job”.

  • Grey Shambler Link

    “sometimes just have a few minutes to do something and if you cant do it then the pt is dead. ”
    Spent too much time in the ER with my wife, I think not 60 but 40, like an athlete. Eyesight, hearing, hand eye co-ordination, endurance, speed. Plus an exceptional medical knowledge. Older you may be wiser, but we all slow down, it’s no shame at all to admit it. I’ve even noticed I’ve lost sensory feeling in my fingertips, not good for a doctor.

  • TarsTarkas Link

    First Wave Feminism was about getting equality under the law.
    Second Wave Feminism was about getting equal opportunities.
    Third Wave Feminism is about getting preferential rights and opportunities.
    Fourth Wave Feminism is about eliminating male rights and opportunities.
    Fifth Wave Feminism will be about eliminating men.

    Third, Fourth, and Fifth Wave feminism of course only applies to Western Civilization. Women from other cultures need not apply, because those cultures are so obviously superior to our white supremacist patriarchal oppressive culture/sarc

    Railroads versus Trucks: Automobile manufacturers, Oil companies, and the desire to be able to move about freely and live without being forced to live by RR’s clock all bear responsibility (along with others) for the reduction of transport by rails. Considering the NIMBY attitude towards any new construction in suburbia, there’s no going back.

    Salesmanship hasn’t changed much, at least for specialty truck equipment where the goods aren’t virtual. The tools have changed radically – no more mass mailings, handing out slick brochures, going to trade convention after convention drumming up business (some shows still survive) in favor of websites, online brochures and video, and social media. Thanks to the internet the competition is now the world rather than traditional local rivals. but the techniques haven’t changed. Salesman still have to go belly-to-belly with the customer, build personal relationships, demonstrate equipment, and have nuts and bolts knowledge about the equipment they are trying to sell. Customers still walk in the door to kick the tires. I don’t see that changing anytime soon.

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