Long Shifts, Longer Risks: Do Extended Hours Help or Harm Doctors' Performance?

The Endurance Test of Medicine
Few images capture the popular imagination like that of the exhausted doctor:
Sleeves rolled up, eyes red, still making life-or-death decisions at 3 AM.
This image isn’t fiction—it’s the daily reality for many physicians and residents worldwide.

Long shifts—sometimes lasting 24 to 36 hours—have been a traditional part of medical training and practice for decades.
They're seen as a rite of passage. A test of commitment. Even a badge of honor.

But in an era increasingly focused on patient safety, physician well-being, and evidence-based practices, a critical question looms:

Do long shifts really help doctors become better? Or do they ultimately harm both doctors and patients?

In this deep dive, we’ll explore:

• The historical reasons behind long shifts
  
  
• The physical, mental, and emotional toll on doctors
  
  
• Research on how extended hours impact clinical performance
  
  
• The effects on patient safety and healthcare outcomes
  
  
• Efforts to reform working hours—and the backlash against them
  
  
• Real-life stories from doctors on the front lines
  
  
• Solutions for balancing endurance with effectiveness
  

Because the goal isn’t just surviving medicine—it’s practicing it at the highest, safest level possible.

1. The Origins: Why Long Shifts Became the Norm
The tradition of grueling medical hours dates back over a century, rooted in:

• The Apprenticeship Model:
  Physicians trained under experienced doctors by staying at the hospital full-time, learning by total immersion.
  
  
• The "Flexner Report" Era (1910s):
  Reforms emphasized rigorous, hospital-based education, reinforcing the norm of full dedication.
  
  
• Military Influence:
  Wartime medicine demanded resilience and adaptability under exhaustion—traits that bled into civilian medical training.
  
  
• The Hidden Curriculum:
  Unspoken values in medical culture glorified self-sacrifice, toughness, and "putting patients above self."
  

In many places, particularly the U.S., medical training came to idolize suffering as proof of devotion.

"If you can’t handle the hours, you can’t handle the responsibility."
"Patients don't stop needing care because you're tired."

And thus, extended shifts became not just routine—but expected.

2. The Toll of Long Shifts on Doctors
A. Physical Health

• Sleep Deprivation:
  Chronic lack of sleep leads to:
  
  • Impaired immune function
    
    
  • Increased risk of hypertension, diabetes, and cardiovascular disease
    
    
  • Weight gain and metabolic disorders
    
• Fatigue-Related Accidents:
  Doctors after 24-hour shifts are comparable to drunk drivers in reaction time and judgment.
  
  
• Decreased Physical Endurance:
  Sleep deprivation reduces muscle strength, coordination, and even fine motor skills—critical for surgeons and proceduralists.
  

B. Mental and Emotional Health

• Cognitive Impairment:
  
  • Memory lapses
    
    
  • Reduced concentration
    
    
  • Slower problem-solving speed
    
    
  • Poorer critical thinking
    
• Mood Disorders:
  
  • Increased rates of depression, anxiety, and burnout
    
    
  • Emotional blunting and detachment from patients
    
• Substance Use:
  
  • Some doctors turn to stimulants, caffeine overloads, or alcohol to cope.
    

C. Decision-Making and Clinical Judgment

• More Medical Errors:
  Fatigued doctors are more likely to:
  
  • Misdiagnose
    
    
  • Prescribe incorrect medications
    
    
  • Miss subtle warning signs
    
• Poorer Patient Communication:
  Tired physicians may appear rushed, irritable, or less empathetic, eroding trust.
  

Summary:
Fatigue doesn’t just make doctors suffer—it endangers patient care.

3. The Evidence: What Studies Say About Extended Hours
✅ Landmark Studies:

• Landrigan et al., 2004 (NEJM):
  Residents working traditional 24-hour shifts made 36% more serious medical errors and 5.6 times more diagnostic errors compared to those on shorter shifts.
  
  
• Barger et al., 2006 (PLoS Medicine):
  Extended shifts correlated with a 2.3-fold increase in motor vehicle crashes post-shift.
  
  
• Lockley et al., 2004 (Sleep):
  Sleep deprivation significantly decreased residents’ alertness and cognitive performance.
  

✅ Meta-Analyses and Reviews:

• Reducing work hours leads to fewer medical errors, improved mental health, and slightly increased patient safety—but does not necessarily improve educational outcomes unless accompanied by better training structures.
  

✅ Patient Safety Organizations Agree:

• The Institute of Medicine (IOM) recommends capping shifts at 16 hours for residents to minimize fatigue-related errors.
  

Conclusion:
Long shifts harm doctors’ health, degrade decision-making, and increase the risk of patient harm.

4. The Counterarguments: Why Some Defend Long Shifts
Despite overwhelming evidence, resistance remains:

A. Continuity of Care

• Shorter shifts = more handoffs between doctors = risk of communication errors.
  

B. Preparing for Real-World Practice

• In some fields (emergency medicine, surgery, critical care), doctors may need to function during extended crises without rest.
  

C. Tradition and Culture

• Older physicians often argue, "We did it, and it made us better doctors."
  

D. Economic Pressures

• More shift changes require more staffing—which hospitals resist due to cost.
  

Reality Check:
While some arguments have merit (continuity of care is important!), most are rooted in tradition and resource challenges—not scientific evidence.

5. Real Stories: Doctors on the Front Lines
Dr. M, Internal Medicine Resident
"After a 30-hour shift, I once prescribed the wrong dose of insulin.
Luckily, the nurse caught it.
I barely remember writing the order.
It scared me to realize how fragile I was."

Dr. S, Emergency Medicine Attending
"You do get tougher with experience. But there's a difference between resilience and stupidity.
Fatigue will humble you—and harm your patients if you're not careful."

Dr. L, Pediatrician
"In training, I thought working endless shifts made me a superhero.
In reality, it just made me cynical, sick, and sloppy.
Shorter shifts saved my career—and my empathy."

6. Current Reforms: Shifting Toward Sanity
✅ Duty Hour Restrictions (ACGME Guidelines, U.S.):

• Residents limited to 80 hours per week, averaged over 4 weeks.
  
  
• One day off every 7 days.
  
  
• No more than 24+4 hours continuously on duty.
  

✅ Pilot Programs:

• Some hospitals implementing 16-hour shift maximums.
  
  
• Encouraging napping strategies during night shifts.
  

✅ International Efforts:

• In Europe, the European Working Time Directive caps medical work at 48 hours/week.
  

✅ Mental Health Initiatives:

• More hospitals offering counseling, fatigue management training, and "wellness days."
  

7. Where We Still Fall Short

• Cultural Change Lags Behind:
  Endurance is still celebrated; admitting fatigue is often stigmatized.
  
  
• Inconsistent Enforcement:
  Some programs find ways to "fudge" reported hours.
  
  
• Financial Disincentives:
  Hospitals resist hiring additional staff to offset shift reductions.
  

8. Solutions for the Future: Thriving, Not Just Surviving
✅ Structured Handoffs:

• Standardized protocols minimize information loss during shift changes.
  

✅ Fatigue Education:

• Train doctors to recognize and mitigate cognitive impairment signs.
  

✅ Protected Nap Periods:

• Scheduled naps during night shifts shown to improve alertness.
  

✅ Flexible Scheduling Models:

• Tailor shift lengths based on specialty demands, not tradition.
  

✅ Normalize Seeking Help:

• Encourage mental health support without stigma.
  

✅ Empower Residents to Speak Up:

• Create anonymous reporting systems for dangerous fatigue levels.
  

Conclusion: Long Hours, Long Shadows
The dream of medicine demands sacrifice.
But sacrificing the health of doctors and the safety of patients is not noble.
It’s dangerous.

The evidence is overwhelming:

• Long shifts impair doctors' minds and bodies.
  
  
• Fatigue leads to mistakes, suffering, and burnout.
  
  
• Better-rested doctors are safer, more compassionate, and more effective healers.
  

Tradition alone cannot justify practices that harm.
The true badge of honor for a doctor isn't surviving exhaustion—
It’s protecting patients and themselves with wisdom, courage, and change.

Because medicine deserves better.
Doctors deserve better.
And so do the patients who trust them with their lives.