Physician Shift Scheduling: Who Suffers with Extended Shifts?

In November 2007, the Joint Commission published a paper highlighting the negative effects that repeated 24-hour physician shift scheduling stints have on resident physicians. The report noted that these residents make more serious errors, suffer more injuries, and exhibit impairments comparable to being legally drunk. Nurses who work extended shifts also face these risks.

The uptick in errors, accidents, and attention deficits can be traced largely to sleep disruption. Humans are hardwired to be alert during the day and drowsy at night. When physician shift scheduling rapidly switches from days to nights and back again, a resident’s circadian rhythm becomes misaligned. According to the report, this drives residents into “a permanent state of ‘jet lag’ as they attempt to remain awake and work, and subsequently sleep, at the incorrect internal circadian phase.”

Physician Shift Scheduling & Sleep Deprivation

Moreover, physicians and nurses who are on extended shifts suffer from both acute sleep deprivation and chronic partial sleep deprivation. The latter can result in a disconnect, where the doctor or nurse believes their performance on the job is consistent, when in fact it is deteriorating. Think 40 winks is the answer? The Joint Commission pushes back on the notion that on-duty naps can compensate for sleep deprivation, noting that “sleep inertia” can impact alertness and judgment for up to 30 minutes after a nap. This window of time is typically when crucial decisions must be made.

While the organization called for a public policy solution that would limit work hours for residents and nurses, there was no political will to do so. In fact, in 2017 the Accreditation Council for Graduate Medical Education (ACGME) actually extended the number of hours – from 16 to 28 – a first-year resident could work. According to the ACGME program requirements, “Clinical and educational work hours must be limited to no more than 80 hours per week, averaged over a four-week period, inclusive of all in-house clinical and educational activities, clinical work done from home, and all moonlighting.”

Unintended Consequences

Despite the reaction of many that work limits should be enforced, research published in the British Medical Journal found that cutting hours had unintended consequences. A UK mandate to improve working conditions limited a resident’s hours to a maximum of 48 per week. This change to resident physician shift scheduling resulted in an increased number of night shifts that impaired both sleep and learning. After reviewing existing literature on the negative health effects of shift work, the authors argued that physician shift scheduling should be based on scientific evidence rather than an arbitrary number of hours. Their research suggested that physician shift scheduling should minimize consecutive night shifts and should limit individual shifts to 10 to 12 hours. They also suggested that physicians should have a say in their schedules and that the rapid rotation of shiftwork – called phase delay – is tolerated better than other shift patterns.

Optimizing physician shift scheduling is all too often like trying to hold a dozen ping pong balls under the water. When facilities use manual scheduling processes, such as spreadsheets, physician preferences and last-minute changes can be unmanageable and leave the door open for work hour imbalances. MDsyncNET’s cloud-based physician shift scheduling software enables staff to create schedules that can be updated, disseminated, and accessed in real time, as well as reports that track hours and shifts worked. The result? Schedules that align with organizational policy and happier – and better-rested – physicians.