Sleep is a medical necessity


We have all heard the grumblings regarding the 80-hour resident workweek.  This is due to the opinion that jobs after residency typically require hours that surpass 80 hours a week.

But, why?  Why does medicine have to be this way?

I have worked 100 plus hour weeks for over 20 years, and I am exhausted.  I am burned out and I can not catch up because of the sleep deprivation.

This is where the culture of medicine needs to change.

Everyone has solutions for burnout: wellness initiatives, mindfulness training, counseling, exercise, work-life balance, and lowering stress. What if the solution for sleep deprivation is what could cure burnout?

Is this from residency where the one who stayed up the longest and did the most admissions would inevitably get the gold star and silent nod of approval?  This is the culture where we, as residents felt rewarded for working the longest, getting up the earliest, sleeping the least, essentially being superhuman, which is just impossible.

Yet this culture is still what makes us feel proud when, somehow, you run on adrenaline at work (you can admit 3 patients at 2 different hospitals and do a delivery at noon, then see 15 patients in the day right after a night call) and then you crash at home due to exhaustion, leaving nothing for your kids. You are exhausted and guilty and yet the proud feelings are also still there.

We are all aware of the damaging effects of sleep deprivation. Sleep deprivation has widespread consequences, causing cognitive dysfunction, weakened immune system, impaired healing, increased blood pressure, increased insulin resistance, increased cortisol levels, increased risk of mental illness, and even increased mortality, by Drew Cotler in an article, “Sleep isn’t a luxury. It is a medical necessity.”

So why is chronic sleep deprivation OK for physicians?

In 2014, there were 893,851 physicians in the United States.  Let us subtract 170,000 for the physicians who are part-time, close to retiring, no longer taking call, no longer working, to leave 700,000 working physicians.  If everyone was lucky and took 1 in 7 call, there would still be 100,000 physicians taking overnight call at any given moment.  I understand that medicine is not a 9 to 5 job and that we need doctors in the most grueling time of the night: 12 a.m. to 6 a.m. However, we have the resources to start change.

1. We need more students in each medical school. There is a prediction of a shortage of physicians in 2025.  That is only nine years away.

2. We need to retain female physicians. Studies show that female physicians who have improved work-life balance were happier.  They had higher career satisfaction and lower intention to leave employment.

3. We need to decrease the number of hours in shift work.  Why does the typical shift have to be 12 hours?  What about job sharing?

4. We need to create a new resource: a nurse on-call service that will take phone calls. Why do all 100,000 physicians need to answer the middle of the night phone calls, most of which are non-emergent? In Australia, there is a government funded nurse help line that will answer all phone calls.

5. We have to feel that it is acceptable to work less. The culture of medicine imposes these rules that we are slackers if we work less.

Not only does change need to start, but we, the physicians ourselves have to be comfortable with this change.  Physicians are not superhuman individuals that can do everything, and this concept is the first change that needs to take place in the culture of medicine. No one can function without adequate sleep.  Sleep is a medical necessity.

Sophy Feng is an obstetrician-gynecologist.

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