Long hours are not what tires junior docs most

NEW YORK (Reuters Health) - Working nights and frequent schedule changes are stronger predictors of fatigue by junior doctors than are endless shifts at the hospital, a new study finds.

The finding could have important implications for recent initiatives introduced in the U.S. and Europe that seek to reduce physician fatigue primarily by limiting work hours.

Extraordinarily long working hours are a given for residents and interns. Patient safety is a concern, and so is the well-being of the young doctors themselves.

To curb fatigue-related risk among junior doctors, it's important to consider factors in addition to total hours of work and duration of rest breaks, Dr. Philippa Gander, from Massey University in Wellington, New Zealand, and colleagues note in the journal Occupational and Environmental Medicine.

Gander and colleagues surveyed 1,366 junior doctors in New Zealand about work patterns, sleepiness, and fatigue-related errors.

Based on their responses, 30 percent were deemed excessively sleepy.

Forty-two percent of these doctors-in-training reported making a fatigue-related error in the last 6 months.

Sixty-six percent of subjects said they felt close to falling asleep while driving home in the past year and 24 percent said they had actually fallen asleep behind the wheel.

The survey also revealed that night work and schedule instability were stronger predictors of fatigue than was total hours worked.

"Interestingly," the authors say, junior doctors who had regular access to a supervisor seemed to fare better and this "may therefore represent a useful fatigue countermeasure."

The findings of this survey support the view that a more comprehensive risk management approach -- one that takes into account more than just total work hours -- is needed to reduce doctors' sleepiness and improve patient safety, the team concludes.

SOURCE: Occupational and Environmental Medicine, March 22, 2007.