Intended for healthcare professionals

Feature Christmas 2023: Workforce Crisis

Workload and the mysterious law of karma

BMJ 2023; 383 doi: (Published 18 December 2023) Cite this as: BMJ 2023;383:p2686
  1. Jakob Mejdahl Bentin, resident1,
  2. Frida Run Jonsdottir, resident 2
  1. 1Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Denmark
  2. 2Department of Vascular Surgery, Heart Centre, Copenhagen University Hospital-Rigshospitalet, Denmark
  1. Correspondence to: J M Bentin Jakob.Mejdahl.Bentin{at}

If good deeds beget good consequences, why do you always get the toughest shifts, ask Jakob Mejdahl Bentin and Frida Run Jonsdottir

Why do some colleagues seem to always have easy shifts, while others face a consistently high workload? Could something more than mere chance be at play? Ancient Indian and Chinese philosophies posit a law of karma—that is, your previous actions, thoughts, and behaviour decide your future.12

Cycles of rebirth (samsara) occur, determined by the accumulation and resolution of karma from past lives, finally culminating in liberation (moksha), according to many schools of Indian religions. Despite no scientific basis, healthcare professionals often speculate about “work karma”—that is, doctors who have done good deeds experience relatively easier shifts. The less than virtuous, those with karmic debt, face more arduous tasks, paperwork, and sleep deprivation.

What goes around comes around

We considered doctors’ working patterns to decide whether karma was at play in a European hospital surgical department. Our retrospective observational study followed STROBE guidelines and continued throughout 2022, not just in the festive season, when workloads can be even more onerous. We had no loss to follow-up and used reliable data with few missing; but it was only one department in one hospital.

A shift was 3 pm to 8 am on weekdays and entire days on weekends (8 am to 8 am. Each shift was staffed by a surgeon, an attending surgeon, and a consultant on standby. Doctors who worked fewer than four shifts in the year were excluded from the dataset, leaving a …

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