Many of us have the experience of boarding a plane with a prayer that the pilot has had enough sleep. With your surgeon, it’s a similar problem. Few people get to choose who will do their surgery. Even if you’ve gone to the trouble of arranging a referral to the best, how can you know the doctor hasn’t hit a rough patch? Maybe a crumbling marriage? Or a punishing work and travel schedule that simply has your surgeon fatigued? What can you do?
As individual patients, not much. In fact, wait lines are often so long there’s a disincentive to jeopardize that precious surgery date, but as for airline pilots, healthcare systems have safeguards to ensure surgeons are in good working order. Unfortunately, they are looser and more opaque.
Working hours for pilots are strictly regulated by law. Residents in training often work 24-hour shifts despite known fatigue risks. Fully trained surgeons often have no legally mandated work-hour limits. Schedules are set by hospitals and departments. Is there a culture of bravado among doctors, that they tolerate this?
When there’s a near miss in an airplane, the pilot faces the same consequences as passengers. When a surgeon makes an error, there is no co-surgeon to prevent, or correct it, and reporting of incidents is rare for fear of lawsuits.
Physicians are trained to diagnose and to treat. They are not trained to admit vulnerability. Yet, the profession is showing serious strain. More than half of Canadian doctors report feeling burned out, with many contemplating early retirement. In the United States, the numbers are similar. Across Europe, countries have begun to notice alarming levels of depression, addiction, and even suicide among doctors.
Why then does the public know so little about existing programs that support doctors and their families? Even healers need help when the going gets rough. We should be broadcasting programs that care for doctors, and they do exist.
The Ontario Medical Association offers a confidential Physician Health Program for: doctors, residents, and medical students dealing with mental health challenges, addictions, or professional stress. Other provinces in Canada have comparable services. The U.S. has the Federation of State Physician Health Programs. In Europe, the NHS Practitioner Health service in England, the Practitioner Health Matters Programme in Ireland, and programs in the: Netherlands, Norway, and France provide support.
Spain offers a particularly sobering example. In the 1990s, several high-profile physician suicides shocked the medical community there. The profession realized that denial and silence were killing their own, and that patients, too, were at risk. In response, the medical colleges created the Programa de Atención Integral al Médico Enfermo, or “Comprehensive Care Program for the Sick Doctor.” It has become a model across Europe, combining confidentiality with structured monitoring to ensure doctors get well and return to practice.
The model is strikingly consistent across jurisdictions, offering confidential support, separate from licensing bodies, to encourage doctors to step forward. Where risk to patients is clear, reporting obligations to regulators remain. The central aim is prevention: address problems before they spiral into impairment, mistakes, or withdrawal from practice.
Should the public know more about these programs? My answer is yes. Not to fuel distrust, but to build confidence. A doctor who seeks help is not a doctor to be feared; quite the opposite.
Still, it is easy to see why some bristle. Shouldn’t the system be stricter, not gentler, with impaired physicians? Isn’t there a danger these programs “protect their own”? Such suspicion misreads the design. These programs are protective, for doctors and patients.
Alas, medicine clings to its culture of invincibility, and that’s why flying is safer than surgery.
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