1.
Elaine Schattner, MD, MA
Lifelong patient, Advocate, Journalist
Clinical Associate Professor of Medicine
Weill Cornell Medicine, New York, NY
A System Without Slack:
How Delivering Care Harms the
Health of Physicians

2.
Having healthy
and experienced
doctors is good for
patients.
Elaine Schattner, MD, MA

3.
The Personal Toll of Practicing Medicine
Schattner, E. Health Affairs. 2017 Feb 1;36(2):371-375.

4.
“Older” Physicians Work Long Hours
History:
1988 – New York State began regulating schedules of intern
and resident doctors;
2003 – ACGME implemented work-hour limits for all
physicians-in training (interns, residents, fellows);
Yet no rules restrict hours of “senior” physicians. Many
specialists routinely work:
• 36 hour shifts; typical weekends (~64 hours) on-call;
• weeks at a stretch, on-service supervising younger doctors
Why this matters to the public:
Unregulated doctors’ hours may endanger patient care.
Grueling workloads harm physicians’ long-term health and
diminish the medical workforce.
Elaine Schattner, MD, MA

5.
Elaine Schattner, MD, MA

6.
Doctors Do Get Sick.
Like other people:
Cancer, heart and vascular disease,
arthritis, diabetes, Parkinson’s…
Depression and mental illness
Substance abuse
(Pregnancy)
High risk:
Infectious diseases:
hepatitis, flu & other viruses, Tb…
Suicide
Stress-related conditions?Portrait of Dr. Alfred Newman, 1896
National Library of New Zealand
Elaine Schattner, MD, MA

7.
Physicians’ Health is a Delicate Subject
• Privacy issues:
• treatment at place of work
• colleagues as providers
• Stigma of mental illness
• Need to inform patients?
• Responsibility to tell
coworkers, supervisors and
employers?
• Insurance and malpractice
concerns
House (Fox, 2004 - 2012), fan club image
Elaine Schattner, MD, MA

8.
Depression ≠ Burnout
Depression is a clinical diagnosis with symptoms
(mood impairment) manifest at home and at work.
Burnout usually refers to a constellation of symptoms
relating to behavior at the workplace.
Signs of burnout include:
• emotional fatigue
• depersonalization
• lost enthusiasm for goal(s)
→ Providers stop caring.
Burnt out? Depressed? Simply tired?
(Tait D. Shanafelt, et al. Arch Intern Med. 2012;172(18):1377–1385.) Elaine Schattner, MD, MA

9.
A System without Slack: How to Fix it?
Suggestions:
1. Set a slower pace for practicing:
Be realistic about expectations in clinical care;
Allow time for communicating, reading and reflecting.
2. Provide more support staff to all doctors:
Nurse practitioners and physician assistants;
Secretaries, phlebotomists, clerks, etc.
3. Take advantage of telemedicine and other technology;
4. Train more doctors, including specialists.
$$$ compassion
Elaine Schattner, MD, MA

10.
Thank you!