Intended for healthcare professionals


Implications of shift work for junior doctors

BMJ 2007; 334 doi: (Published 12 April 2007) Cite this as: BMJ 2007;334:777
  1. Yasmin Ahmed-Little, medical workforce manager
  1. North Western Deanery/NHS Northwest, Manchester M1 3DZ
  1. y.ahmed-little{at}
  • Accepted 2 March 2007

Yasmin Ahmed-Little provides evidence that junior doctors' dislike of shift working is more than a stubborn reaction and discusses how to make shifts more tolerable

Junior doctors in the UK have seen their working hours cut through implementation of the European Working Time Directive and the Department of Health's new deal to improve working conditions.w1 w2 However, the resulting increase in shift working has caused great dissatisfaction. Juniors report fatigue and poor performance on the night shift,1 and evidence from outside medicine suggests there may be long term health effects. Concerns have been raised about future recruitment and retention, particularly in the acute 24 hour specialties. Shift working is likely to increase further as junior doctors' working hours are reduced to a maximum of 48 hours per week by 2009. Without an evidence based approach to the implementation of such large scale changes, there is a real danger of adding new, unknown risks and perhaps even worsening the status quo.2

Shift working patterns in the UK

Traditionally junior doctors worked long hours in a resident, on-call capacity with continuous shifts of up to 56 hours, and an average working week of up to 72 hours of duty.w2 The performance implications of these working patterns are now widely recognised, and increases in the UK medical workforce have allowed sensible reductions to working hours and the introduction of full shift working.

Full shift working for UK junior doctors usually means a fixed normal working day plus rotating long day shifts and regular weeks of night shifts. Although overall working hours have reduced, the proportion of out of hours working has increased. This affects training because established international evidence shows that people's capacity to learn overnight is significantly impaired and sleep is required to consolidate new learning.3 Most full shift rotas currently require junior …

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