Should Doctors Work Longer Shifts? Experts Debate Whether Trainees Should Work 24-Hour Shifts

This week, The BMJ looks at the issue of working hours and burnout among doctors.


An editorial warns burnout rates among doctors have reached an "epidemic level" And one doctor argues that willingness to work extra hours is affecting doctors' health

In the first article, experts debate whether doctors should work 24 hour shifts, following a recent decision to allow trainee doctors (residents) in the US to increase their maximum limit of hours on duty from 16 to 24 hours.

Steven Stain, a surgeon at Albany Medical College in the US argues that longer shifts are not harmful to patients but encourage professionalism. There is no conclusive evidence indicates that working 24 hour shifts negatively impacts patient care, he writes, and it is important for residents to train in a supervised environment to prepare them for independent practice.

But Michael Farquhar, a consultant in sleep medicine at Evelina London Children's Hospital, emphasises the debilitating impact of sleep deprivation on patient care and safety. "Our systems must support us as functioning human beings," he writes. "We must acknowledge sleep deprivation and fatigue have profound effects, on us, and the care we deliver to our patients, and encourage better strategies to address it."

An editorial argues that burnout rates among doctors have reached an "epidemic level." Jane Lemaire and Jean Wallace at the University of Calgary say the medical profession "must change its culture to tackle the toxic aspects of medicine that cause and sustain burnout."

They propose several changes to help drive this transformation, including viewing doctors' wellbeing as central to patient care, and research to identify evidence based strategies to reverse the rising tide of burnout globally.

"Human resources are the most important asset of any organisation," they write. "As doctors continue to grapple with staying well, it is imperative that they have the support of their profession and their healthcare organisations to maximise their ability to care for themselves and their patients safely and effectively."

Finally, Jan Wise, medicolegal committee chair at the British Medical Association, warns that doctors' willingness to work beyond their contracted hours is affecting their own health and causing wider problems for the health service.

"People are burning out," he says. And by "going the extra mile" doctors are helping to obscure gaps in service provision from those responsible for managing workforce numbers, he argues.

Wise believes that there needs to a shift in the medical profession's attitude to taking on unpaid additional work - and that doctors need to reassert their rights to work the hours stated in their NHS contracts.

Without a shift in attitudes, the failure to tackle staffing shortages could have a major impact "which may quite possibly precipitate a failure or a downsizing of the NHS," he says.

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