Written by: Sophie Egan and Cristin Weekley
In 1984, the posthumously famous 18-year-old, Libby Zion, died in an emergency room in part because she had been left in the care of two sleep-deprived, under-supervised residents. At the time, doctors regularly worked 36-hour shifts. Over decades of crusading by Libby’s father Sidney Zion, among others, reform measures have reduced the maximum hours a resident can work in a given shift. However, life as a doctor is still defined in large part by chronic stress, sleep debt, and scarce socializing. All three are correlated with shorter lifespan.
During the first year of our MPH program here at Berkeley, we noticed that we don’t hear much about the health of those who provide health care. More humane work hours for our health care workforce are important not only for their sake, but for the general population as well. As Libby Zion’s case reminds us, doctors’ well-being affects their ability to ensure our well-being. We in public health should work with doctors to engage hospital administrators and policymakers to further reduce maximum shift lengths and weekly hours.
We are a nation of workaholics, and this culture in medicine has been around for so long that no one questions it. But doctors have lives in their hands. At UCSF, the maximum shift a second-year resident is allowed to work is 24 hours of “continuous in-house duty.” To address the obvious issue of fatigue, the official policy suggests “strategic napping.” In contrast, the maximum shift length allowed under federal law for drivers of passenger-carrying vehicles (like MUNI) – yet another profession to which we entrust public safety – is 10 hours.
Shorter shifts and lower weekly maximums could improve the quality of care, boosting efficiency and reducing fatigue-induced errors. Better-rested doctors might also translate into better interactions with patients. In fact, patient satisfaction is the top consideration for choosing and maintaining a doctor or hospital. It even beats out price, which is the primary factor when customers select other types of businesses.
Additionally, giving medicine a reputation for work-life balance could lead more young people into the field. This is especially important given the impending physician crisis many predict will result from Affordable Care Act (ACA) implementation early next year.
Beyond policy change, we need cultural change. The San Francisco Chronicle reported in September, “Today’s doctors want a real life,” meaning everything from snowboarding to parenthood. As a society, we can’t keep expecting doctors to be superhuman, somehow outside the prescription for well-being that applies to the rest of us. It’s time we recognize that doctors are also part of the public in “public health.”
A recent Gallup poll found that doctors are less likely to smoke, be obese, or have high blood pressure or diabetes than other working adults. While this might make it seem like doctors don’t need our help, the poll reported that doctors are equally likely to have high cholesterol or a heart attack, and more likely to have cancer. These are not trivial findings: heart disease and cancer are the top two causes of death in the United States. We have no way of knowing whether these rates are because of environmental/lifestyle factors or higher screening/diagnosis rates, but given everything doctors know about etiology and preventive care, we would expect their numbers to be significantly lower than those among the general population.
As we work to enhance our health care system with ACA implementation, we can also invest in how we care for our providers. To change social norms, public health professionals could harness the power of popular media, spreading a message along the lines of, “Doctors are people too.” We could start with social marketing to healthcare providers, and changing hospital and clinic culture to ensure that internal stigma doesn’t prevent new policies from being followed. Screenwriters could work with residents and doctors to embed story lines in TV shows and movies that illustrate the realities of life as a doctor. We could encourage authors to write accessible nonfiction books like Brian Eule’s “Match Day,” about the impact of residency on medical students’ personal relationships. We could partner with filmmakers like Participant Media – responsible for “Waiting for Superman” and “Food, Inc.” – to produce a documentary on physicians’ daily lives.
This handful of big-picture ideas is meant as food for thought, but we want to hear from you! How would you address this issue? What can we all do today? Tomorrow? This year?
However we go about it, as both public health professionals and society at large, we must keep doctors under our purview. Improving doctors’ well-being has benefits beyond their own health. It has the potential to improve the quality of care and attract more young people into primary care. Perhaps most important, taking care of them is crucial for ensuring they can continue taking care of us.
 Ackermann, K., Revell, V. L., Lao, O., Rombouts, E. J., Skene, D. J., & Kayser, M. (2012). Diurnal rhythms in blood cell populations and the effect of acute sleep deprivation in healthy young men. Sleep, 35(7), 933-940. doi: 10.5665/sleep.1954
Vanitallie, T. B. (2002). Stress: a risk factor for serious illness. Metabolism, 51(6 Suppl 1), 40-45.