I have a lot to say about this.
Regarding general inaccessibility:
Medicine is not friendly to disability, period. Signed, a disabled doctor.
Because medicine is hostile toward disabled doctors/students, we haven't placed much focus on finding ways to arrange accommodations for doctors, normalizing asking for accommodations, or viewing disability as anything other than a red flag that gets your application side-eyed. Medical training, as I will discuss below, is a really inhumane process sometimes. The things that are physically and emotionally expected of people are simply not survivable for people with various types of illnesses or disabilities. The people making decisions about who gets accepted to school and who doesn't take this into account. Anyone who says "no they don't!" or "that's not legal!" can message me directly. Again, signed, a disabled doctor who was questioned at length about it when applying to school and residency.
The end result is that many disabled would-be doctors get pushed out of the field early, already skewing practitioners toward people who are generally healthier and able bodied, and therefore less empathetic toward the disabled and chronically ill.
Quick side note before I go on: Even though the structure of training and practice is not disability-friendly, that doesn't mean disabled doctors don't make it through or that doctors who start off healthy/able-bodied cannot become ill or disabled later. There is an odd view that we are inhuman robots who do not understand or experience poor health ever, which worsens ableist expectations of medical practitioners and trainees & the overall problem here.
Due to inaccessibility and discouragement during the selection process, we are already starting with a sample of healthier-than-average people. Then the training and practice itself just kind of squeezes the remaining empathy out of people. Some of that is necessary. If I felt the full force of empathy for every patient who hurt, who cried, who died, I would not be able to walk out of the room and deal with the next patient. But even then, it isn't that I don't FEEL the emotions - I just compartmentalize them, deal with them later, when people don't immediately need me. The problem comes when the superhuman expectations on trainees and practitioners makes you so jaded that your ability to feel these emotions at all gets damaged.
It is...hard to feel sympathetic toward a patient with a chief complaint of "tiredness" when you are on day 14 of a stretch of 12 hour shifts, but also had to cover a 24 last night in which you were up all night running code blues, and now have morning clinic office hours. It's hard to be sympathetic towards another's depression when you haven't slept normally in weeks, haven't spent any time with your family in as long, have lost all your friends, missed most weddings/birthdays/funerals in the family for years, and have sacrificed most if not all hobbies (all of these things are common especially in residency). I have seen residents and doctors go through some really inhumane things, especially during residency training, and it absolutely changes you when the people around you care so little for your needs. Cries for help are often met with professional concerns for your ability to continue. Medicine teaches us that our suffering does not matter, needing help is weakness, & stoicism is necessary, so when we see our patients come to us for help for things that we also experience, it is really, really easy to feel bitter toward them. It is WRONG, of course, but easy. People are just people.
I can say both anecdotally and from personal experience: the lifestyle balance can improve, if you seek it out, after residency, but the years of being treated like a robot and the "tough it out" mindset that was hammered into our heads during that time doesn't just go away, and it impacts the way we communicate with and think about patients forever.
Side note 2: Obviously not every doctor has had experiences like the above, but it is really common, and was much worse in the older generations of doctors. Obviously not every doctor has been so deeply affected to the point of bitterness. I am just discussing in broad strokes some common things I have heard, seen, and personally experienced among myself and my colleagues.
Regarding the shift & work hours, specifically:
People who support long shifts can generally be divided into 2 camps: the "this is how I trained so you will too/it builds character/if you can't handle this you can't handle medicine" camp, which can be immediately disregarded as an appeal to authority and tradition, and the "frequent care transitions are dangerous to patients" camp, which deserves discussion.
When a doctor goes off shift and a new one comes on to take their place, a transition of care occurs. All the important information about a patient has to be quickly communicated between providers. Information gets lost because human communication is never perfect. Due to this, deceasing the number of transitions between doctors per day is best for patient care.
Doing the more standard 8 hour shifts (in hospitals, anyway) would mean having 3 doctors working that day and require 2 trade offs. This means employing (and therefore paying) more people, and increases risk of information loss or miscommunication during the day.
In the inpatient setting, I really think 12 hour shifts are fine. You can have a day and night shift doc, 1 transition. This issue I have is not with 12 hour shifts themselves, but that people are sometimes expected to work way too many in a row. I have had to do 14+ days of 12s without any breaks, and that wears you down fast when you consider how mentally exhausting this type of work is. You have to always be at your best or you could kill someone.
I think 24+ hour shifts should never happen. There is no good justification for it outside of true emergencies. The risk of hand offs is not greater than the risk of a sleep deprived doctor caring for you. We know way too much about how sleep deprivation works for any good doctor to feel this is ethical for their patients, who often have no idea just how little sleep we have got when they agree to be under our care. Our patients deserve so much better than this dishonesty and it should be considered equivalent in unprofessionalism to coming into work drunk or high. I once was in a trauma surgery where one of the residents actually dozed off while standing over the patient. Explain to me how that was safer than calling in another resident.
People like to say the long hours or multiple days/weeks without relief is a necessary part of medicine. It isn't. The problem could be improved by creating more doctors to meet demand. This would mean entirely revamping the medical school + residency process and creating more positions. Physician salaries would end up lower, but who cares if by increasing med school accessibility we lower its cost, so we don't all have 3-400K in student loan debt that necessitates high salaries to manage, and are not so bitter and sleep deprived that our divorce rate is like 70-80% and suicide rate is ridiculously high? We need a greater push in the culture of medicine to prioritize physical and mental well being of trainees and doctors so we aren't churning out people whose empathy has been burned out of them. We need a greater culture change to find ways to accommodate doctors with disabilities, to get more perspectives in the field and to force the issue of improving work-life balance in medicine.
That is really over simplified in terms of a solution, of course.
A genuine health care worker strike would probably be very effective. One time all the doctors at my hospital started mass transferring our post-cardiac arrest patients (big hospital money makers) out to other hospitals until our administration got a hypothermia protocol in place. The protocol was instituted within 24 hours. I don't think a traditional strike will happen, though, at least not among American doctors. Partly because you are talking about a bunch of beaten down rule-followers. Mostly because a doctor truly leaving their post means innocent people are irreparably damaged or die. It complicates matters.
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