The Consequences of Shift Work by Richard Bukata, MD
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KEY POINTS AND RECOMMENDATIONS
1. Although night shift work can have multiple negative effects on everyone, some clinicians are more prone to problems than others and physicians over 50 are particularly at risk.
2. A litany of diseases has been associated with night shift work – however, it would be very difficult to determine causality.
3. Clinical studies have measured a large number of physiologic derangements during night shift work.
4. A link between night shift work and all-cause mortality is particularly distressing.
5. Shift work sleep disorder
6. Falling asleep while driving after a night shift may be interpreted as culpable behavior in the event of an MVA that injures others.
7. Modafinil improves cognitive performance and alertness in sleep-deprived physicians – perhaps even physicians who are not sleep deprived might consider taking it.
8. Melatonin does not promote daytime sleep.
9. Physicians clearly prefer shorter shifts during the night (8-10 hours), but even shorter shifts are reasonable.
10. In general, doing a block of night shifts is a painful way to deal with the night shift burden. Most recommend intermittent night shifts.
11. Casino shift scheduling allows anchor sleep to be achieved by all clinicians – but appears to be a radical departure from current staffing patterns.
12. There are a large number of steps that clinicians can take to mitigate the effects of night shift work in their own lives.
13. To optimize EM clinical careers it is prudent for ED groups to thoughtfully and actively address the negative effects of night shift work in order to optimize the careers of its members.
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