Research demonstrates resident doctors are among the most sleep-deprived people in North America, and they often have lower quality sleep. During on-call shifts residents average around two hours of sleep, though one-sixth get no sleep at all. Night float systems are unlikely to make a major difference, as studies found that residents had even lower sleep efficiency on those shifts.
To put it in perspective, at a recent medical education conference, a presenter explained that pilots actually get more sleep than residents, with more rest time between long-haul flights compared to call shifts.
Why is sleep and appropriate rest time for residents between 26-hour shifts (on-calls) important? And why does the “controversy” on duty hours make little sense?
It’s simple: sleep deprivation has a domino effect on everything else. One can’t learn and consolidate information without sufficient sleep. It affects motivation, our food choices (remember that high-carb/-salt/sugar snack you craved after too little sleep), and emotional regulation. These impact patient care and our ability to have civil and professional interactions with them.
The research is quickly expanding in the field. Studies are demonstrating sleep deprivation is a major factor in depression in residents. Further, residents working on-call shifts are less alert compared to those working regular shifts.
Sleep deprivation is not only affecting the person; it’s impacting outcomes. Lack of sleep is associated with an increase in medical errors among residents. This is seen especially if they work over 70 hours a week and get less than 6 hours of sleep a night. They’re also over eight times more likely to omit a crucial patient-care issue. These extended shifts are even putting people at risk outside of the hospital. They triple the risk of a hazardous driving event, with 40% of attendings reporting they’ve fallen asleep while driving.
It’s fair to say the decline in cognitive output, emotional well-being, and performance drop-off is becoming more well-defined weekly.
What’s being done for the wellness of us all?
New rules have been placed to prevent some extreme measures of sleep deprivation. But, there is still no “pilot safety” rule. So far, the 16-hour duty limit per day doesn’t seem to impact clinical learning. It’s unclear if it improves resident wellness and patient safety. This is a promising step in the right direction, and heavily under study.
Block scheduling where residents are on call for 2-3 weeks but have 1-2 weeks of ambulatory regular hours has also been shown to help restore sleep schedules while correcting circadian misalignment and sleep debt.
Other research is focusing less on hours, and more on chronotyping to determine optimal productivity. The theory is maximizing each resident’s most alert and responsive times will lead to more efficient hours, better care, and improved happiness. It looks great on paper, but humans are engrained with the same circadian rhythm. So, we’ll see what the data finds.
Treating people like people and prioritizing sleep seems like common sense. But with tight budgets, and high needs, residents still find themselves in a tough place. That said, physician burn out and mental well-being is finally becoming a focus within healthcare. Check back soon as we track efforts by administrators to keep us fresh and contributing.
For more insight into physician wellness, follow @DrAmithaMD