Burnout in Physicians vs Pilots: Who’s Flying the Plane?

Safety in aviation has been compared with safety in healthcare. As the only physician in a family of career pilots, I think about this often.

While the aviation industry has been used as a safety model at the systems level for healthcare, I have not seen any data comparing burnout between the two industries. I wondered whether it could be a useful model.

As a thought experiment, I considered situations that have become commonplace for physicians to deal with in the workplace and what analogous situations might look like for pilots if they were to happen.

For example, what if passengers second-guessed the pilot’s every action because they spent 5 minutes googling “how to fly a plane”?

Or what if pilots had to obtain “prior authorization” to execute emergency measures to save their passengers’ (patients’) lives?

While physicians must document every medical decision and often use hours of their own time at home to keep up with the charting burden, pilots have automatic flight recording software.

There are other areas more similar than not between the lives of pilots and physicians — and the effects on their families. Like physicians, pilots also work odd hours, including nights and holidays, and spend significant time away from home and their families.

But families of pilots often get flight discounts or free flights. Why don’t families of physicians (or physicians themselves) get discounted or free healthcare?

I started thinking that perhaps we should look to the airline industry not only for a systems safety model but for a model of burnout prevention.

I was curious to compare the duty-hour restrictions of pilots to physicians’.

Since 2011, FAA rules limit pilots’ work hours to:

• A maximum of 60 hours of flight duty per week (per every consecutive 7-day period).
• The maximum flight time is 9 hours if there is only one pilot on the flight. (If there are three pilots on the flight, the limit can be extended to 13 hours, and four pilots increase the limit to 17 hours.)
• The minimum rest period for pilots consists of 10 hours with no allowable reduction, and pilots must have the opportunity to have 8 hours of sleep during the rest break.
• Pilots must be free from duty for a minimum of 30 consecutive hours each week.
• In any consecutive 28-day period, a pilot cannot exceed 290 hours, of which no more than 100 can be flight time.
• During 365 consecutive days, pilots cannot exceed 1000 flight time hours.

In contrast, medical residency duty-hour restrictions, per the ACGME, provide for:

• An 80-hour weekly limit averaged over 4 weeks.
• An adequate rest period, which should consist of 10 hours of rest between duty periods.
• A 24-hour limit on continuous duty and up to 6 added hours for continuity of care and education.
• One day in 7 free from patient care and educational obligations averaged over 4 weeks.
• In-house call no more than once every 3 nights averaged over 4 weeks.

I put together this table to be able to more readily compare and contrast the differences:

*guaranteed

**not guaranteed because of averaging clause

And, of course, once a physician finishes residency and enters practice, there are no work-hour restrictions in place any longer.

I expected to find lower burnout rates for pilots than physicians, but upon further research, I discovered that not to be the case. One recent study found a 40% burnout rate among pilots, almost identical to the 42% rate seen in physicians.

Resident physicians work more hours per week and have longer times on continuous duty than pilots. But pilots, despite more protected hours and rest time per week, do not necessarily have lower burnout rates than physicians.

Both pilots and physicians work under high-stress, high-stakes conditions. It is interesting to me that much attention has been paid to using the airline industry as a safety model for healthcare when it would seem that both industries fall far short in protecting their most skilled and essential members from burnout — the ones flying the plane.

Originally published on Medscape Blogs July 8, 2021