Head To Head

Should doctors work 24 hour shifts?

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3522 (Published 26 July 2017) Cite this as: BMJ 2017;358:j3522
  1. Steven C Stain, chair1,
  2. Michael Farquhar, consultant in sleep medicine
  1. 1Department of Surgery Albany Medical College Albany, NY, USA
  2. 2Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust London, UK
  1. Correspondence to S C Stain stains{at}mail.amc.edu, M Farquhar Michael.Farquhar{at}gstt.nhs.uk

Longer shifts are not harmful to patients and encourage professionalism, argues Steven Stain. But Michael Farquhar emphasises the debilitating effect of sleep deprivation

Yes— Steven C Stain

The question of whether doctors should work 24 hour shifts has several aspects: are they harmful to patients, are they harmful to trainees, and are there benefits to trainees if they are going to be required to care for patients for 24 hours after completion of training?

In the United States, the question of 24 hour shifts resurfaced with the recent decision of the Accreditation Council for Graduate Medical Education (ACGME) to revise the requirements for all residency and clinical fellowship programmes they accredit.1 Although many changes were to improve the clinical learning environment related to patient safety and physician wellbeing, the modest change of allowing first year residents to increase their maximum limit of hours on duty from 16 hours to 24 hours received the most attention.

Since 2003, the council’s standards for residents’ hours of duty have been based on an 80 hour weekly limit. They have allowed 24 hour shifts (with additional time to transfer patient responsibility) except for interns, who had a 16 hour limit applied in 2011.2 The council’s comprehensive literature review on residents’ work hours and learning environment found that evidence on the effect on patient safety was inconclusive and that resident learning and the shortened work periods under the 2011 standards resulted in workload compression and increased resident stress and potential risk of burnout.3456

In response to these uncertainties, the American College of Surgeons, the ACGME, and the American Board of Surgery funded the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial, a prospective “non-inferiority” study comparing …

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