#DoctorLife #LongShifts #MedicalTraining #Healthcare #WorkLifeBalance
Have you ever wondered why many doctors work in crazy 24-36 hour shifts? 🏥 It’s a question that has sparked debate and curiosity among both patients and healthcare professionals. In this article, we’ll delve into the reasons behind these long shifts and explore the impact they have on doctors and their patients.
The Reality of Long Shifts
When we hear about doctors working 24-36 hour shifts, it often prompts the question, “Why do they subject themselves to such grueling hours?” 🕒 The truth is that these long shifts are deeply ingrained in the medical profession and are a result of various factors, including:
1. Medical Training and Residency Programs
2. Staffing Shortages and Overwhelming Patient Loads
3. Patient Care Continuity and Handoffs
4. Impact on Doctor’s Health and Patient Safety
5. Reforms and Advocacy Efforts
Medical Training and Residency Programs
The demanding nature of medical training and residency programs plays a significant role in why many doctors endure long shifts. Medical residents are required to complete rigorous training that often includes working extended hours to gain valuable hands-on experience and exposure to different medical cases. While the Accreditation Council for Graduate Medical Education (ACGME) has implemented guidelines to limit resident work hours, the reality is that many medical trainees still work long shifts due to the demands of their programs.
Staffing Shortages and Overwhelming Patient Loads
In many healthcare settings, staffing shortages and overwhelming patient loads contribute to the necessity of doctors working extended shifts. Due to insufficient staffing levels or high patient demand, doctors may opt to work longer hours to ensure that all patients receive the care they need. This is particularly common in emergency departments, where the influx of patients can be unpredictable and constant, leading to doctors working extended shifts to meet the demand.
Patient Care Continuity and Handoffs
The importance of patient care continuity also plays a role in why many doctors work long shifts. Continuity of care refers to the consistency of care provided to patients over time, which can be compromised when doctors work shorter shifts and hand off patients to different providers. By working longer shifts, doctors can maintain continuity of care for their patients, ensuring that they are closely involved in their treatment and progress.
Impact on Doctor’s Health and Patient Safety
The impact of long shifts on doctors’ health and patient safety is a valid concern. Working extended hours can lead to fatigue, burnout, and increased stress levels, all of which can affect doctors’ ability to provide quality care. Additionally, research has shown that prolonged work hours can lead to errors in patient care, putting patient safety at risk. So, the question “They re more prone to do mistakes right?” is a valid consideration when examining the impact of long shifts on doctors and their patients.
Reforms and Advocacy Efforts
In recent years, there has been a growing push for reforms and advocacy efforts to address the issue of long shifts for doctors. Many healthcare organizations and medical professionals have advocated for improved work hour regulations, increased staffing levels, and greater support for physician well-being. These efforts aim to create a healthier work environment for doctors and improve patient safety by addressing the challenges posed by long shifts.
In conclusion, the decision for many doctors to work in crazy 24-36 hour shifts is influenced by various factors, including medical training, staffing shortages, patient care continuity, and the impact on doctors’ health and patient safety. While there are valid reasons for these long shifts, it is important to acknowledge the potential risks and challenges they pose. Through ongoing reforms and advocacy efforts, the medical community is working towards creating a balance that prioritizes both the well-being of doctors and the quality of care provided to patients.
They have beds at the hospital so doctors can go nigh nigh, but still be close if someone gets a booboo.
>They re more prone to do mistakes right?
Yes, its a problem. However, transitions from crews at the hospital is also where a lot of problems happen for patients as well.
The weird truth of it is some cocaine addicted doctor who invented residency and a lot of the modern medical education route did this, stayed up and lived at the hospital. And now thats the norm in tandem with wanting to minimize risk in transferring care.
I’m an attorney and I had a doctor as a plaintiff once on the other side. During a deposition, he said that in certain areas, such as ICU or long term care areas of the hospital, the biggest reason was because it’s less hands on each patient. If you do 8 hour shifts, that’s three different sets of hands on one patient in 24 hours. But if you do 24 hour shifts, it’s one set of hands on each patient, and that leaves a lot less room for mistakes, oversight, communication issues, etc.
From other posts on the subject I’ve seen many times. It’s statistically more likely there will be some sort of catastrophic accident from transferring a patient from one crew to another than if the one crew just works long hours
It is a big problem and the causes can be disastrous.
[https://en.wikipedia.org/wiki/Libby_Zion_Law](https://en.wikipedia.org/wiki/Libby_Zion_Law)
The industry is gradually migrating away from this. Residency work hour restrictions went into effect in 2003 and were revised again in 2011. Interestingly, many studies have shown little benefit in patient outcomes.
In practice post residency the surgeons and interventional cardiologists still get slammed pretty hard on long call shifts. Many groups are moving towards more humane shift patterns though.
Most hospitals have Hospitalists that work 12 hour shifts, and they often make the burden of call for other specialists much more tolerable by doing all the patient care except for the opinion or procedure of the specialist. So if you’re on call for GI for the whole weekend and a GI bleed comes in at 2am, the Hospitalist will admit and stabilize the patient and you can do the endoscopy procedure in the cool light of day (usually).
This is a real problem in the medical world and there is a lot of evidence to support the notion that tired and overworked doctors do indeed make more mistakes.
Unfortunately, a lot of it is cultural. There is this pervasive notion in medicine that we should accept working these crazy hours because ‘that’s how it’s always been.’ Some people also believe that there are safety risks involved in handing things over / having more professionals involved in a patient’s care, but I don’t really buy into these arguments because those issues frankly pale in comparison to the likelihood of error made by a doctor who is overworked and fatigued.
We need more regulation of doctors’ hours, in the same way that pilots’ hours are restricted in the aviation industry. But equally I’m not holding my breath – cultural change in medicine is painfully slow.
There are a lot of half truths here in the comments. I’m a surgery resident currently recovering for several 24hr shifts due to the holidays. Yes, there are historical reasons and questions of errors secondary to handoff but the real reason is there aren’t enough of us.
Hospitals are open 24hrs a day and emergencies can happen at literally anytime. If you have a group of 4-6 surgeons covering a hospital then in order for a few to have a weekend off then 1-2 of them have to work a 24hr+ shift. Simple as that.
A solution would be to train more doctors but that’s a whole other can of worms.
I just had a kidney transplant and everyone was on 12 hour shifts. It was a specialty hospital so maybe that makes a difference but it seems like most places are adapting.
There aren’t enough of them, and schools don’t let enough in to make up the short supply in most developed countries
Doctor here. Reasons are:
1. Not enough doctors for too many patients
2. Blind allegiance to tradition: “we worked 36 hour shifts in 1968 so you have to work 36 hour shift”
3. Continuity of care: transferring patients from one team to another is complex and prone to errors so the shifts are made longer to reduce them
It is actually not crazy and actually are very good for patient care because it lessens hand offs and helps with patient continuity.
Answer: the modern system of residency and hospital scheduling was largely invented by one man. And that man was a raging cocaine addict who was part of the small % of the population that functions well with little sleep. So he designed a system that maximizes your time and abilities, as long as you’re a coke head that doesn’t need much sleep.
The argument I see made here is that in transitioning to new doctors and nurses there can be errors made in reporting / understanding the patient’s needs.
Fair enough, but I don’t think that is outweighed by the utterly devastating impact that sleep deprivation has on cognitive function.
It’s far worse than being drunk.
Show me a faster way to pay off 250k USD student loans with interest that grows faster than you can pay it off.
Which country are you asking about?
In Ontario the standard billing is $80 every 40 min visit. Hard to do that and run an office with a secretary and office space. Often stack visits 4x in 10 min appointments and over bill.
Veterinarian here – at least on the emergency/specialty side we’ve got the same issues at play. Others have discussed it at length in this thread already but I’ll add my 2 cents:
The main rationale for long shifts is that many medical errors result from bad handoffs. One clinician is looking after a patient, their shift ends, they pass the case off to the next clinician, and some critical piece of information is missed in the process of catching the second clinician up on the case and that results in an error. Generally, the data supports that having more handoffs is more dangerous than having tired doctors, so in net it is supposedly safer to have clinicians working longer shifts with the same patients (even if they’re tired to the point of potentially making mistakes) than it is to increase the number of handoffs in order to ensure doctors are less tired.
My 2c: It’s an ass backwards solution. The answer to dangerous handoffs is to develop better protocols to directly mitigate that issue. There’s plenty of ways to ensure that handoffs go more consistently smoothly including mandatory checklists for patient transfer rounds, frequent medical record audits by attendings to make sure that recordkeeping is accurate and comprehensive, staggering staff switches (nurses don’t turn over at the same time as doctors, so there’s always some continuity between shifts), and more can make patient handoffs go more smoothly. Notably, none of those solutions involve being so tired after a shift that you fall asleep at the wheel at the end of a shift and end up in a ditch (happened to a colleague) or deliriously tired while tending to patients (happened to me by the end of a shift that turned into 36 hours thanks to an overnight full of emergency surgeries).
It’s a misnomer to think that all doctors work shifts. Most specialty consultants are not shift workers for example. When we’re consulted on a hospital patient, we’re responsible for our consult area 24/7. For example I’m a consultant and I saw 40 patients last Friday. Of these 40, 18 were during my clinic day from 8-5 pm. The other 22 I saw were hospitalized patients that I rounded on from 6 am until clinic start at 8 am and then again from 5 pm until 8 pm. As the consulting doc I remain responsible for my consult area on those 22 at all times, even when I’m home. For most specialists this job is 24/7. During this entire day I’m dealing with an incredible amount of documentation too and the pages, texts and calls never stop.
No more than anyone else who hasn’t practiced the routine.
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>The weird truth of it is some cocaine addicted doctor…
This is because he used it, but did not abuse it. Cocaine in itself is super helpful when used with control. The problem is, cocaine is a powerful substance, which requires a lot of discipline to control. If had he abused it, he wouldn’t have been able to produce enough coherent work that he did.
Physician here. Reasons for this
1) We have been indoctrinated in a system dreamed up by a coked up physician (Halsted) who could work those hours unassisted
2) Physician shortage in the US, due to lack of Medicare funding for residency spots, and low compensation for frontline specialties (primary care, internal medicine, pediatrics etc)
3) Our for profit system that puts doing the most with the least resources possible
4) Thoughtless allegiance to tradition, aka the abused becoming the abuser
5) Some say “less handoffs” although I think this is some bullshit. Physicians are human. We can only function effectively for a certain amount of hours, without being literally on drugs (see above). Those who say otherwise conveniently forget that many physicians have died due to falling asleep behind the wheel due to fatigue, or have made errors due to fatigue.
why do so many doctors work crazy 24-36 hour shifts 🙁 literally. they sign out of their human rights. FOR US.
If truck drivers are no longer allowed to work not than 15 hours in a shift, maximum 7 hours driving consecutively, with a required 8 hour break before the next shift–all of this is for SAFETY, then it’s insane that doctors and nurses don’t get better working limits.