Increase in shift-work among junior doctors could have a detrimental effect on the NHS

Apr 15 2007

The increase in shift-work among junior doctors could have a detrimental effect on the NHS of the future warns a junior doctor in this week's British Medical Journal.

Dr Yasmin Ahmed-Little says if the health problems associated with shift working are not taken into consideration now, there may not be enough trained junior doctors to adequately staff wards when the European Working Time Directive (EWTD) comes into force fully in 2009.

Changes in working practice and the introduction of the EWTD have led to a much needed reduction in the number of hours junior doctors work. However it has also meant an increase in shift-working. Most full shift rotas require junior doctors to work seven consecutive, 13 hour night shifts, a practice the Royal College of Physicians recently recommended should be avoided.

This increase has caused great dissatisfaction among junior doctors. Many have reported fatigue and poor performance while working nights. Dr Ahmed-Little says this has led to concerns about future recruitment and retention, especially in the acute 24 hour specialties.

Furthermore she says evidence suggests shift-working increases the risks of peptic ulcers, diabetes and coronary heart disease. The situation may also be worse for women. One study from Denmark found a 50% increase in the risk of breast cancer in women who worked regular night shifts. Rates of miscarriages, low birth weight and premature births are also more prevalent amongst shift-workers, and one study has suggested people working night shifts for over six years are more likely to suffer from cardiovascular disease.

These findings, she says, have repercussions for future workforce planning given the rapidly increasing number of women in medicine, many of whom, at some point, will want to work part-time. This means they will do shift-work for many more years than their male colleagues. She warns the societal costs of treating the adverse outcomes of shift work, especially among women, may outweigh the benefits gained.

Dr Ahmed-Little says doctors could be put off agreeing to shift work if they know the potential health risks. In addition it may not be possible to ask senior doctors to work shifts without compromising their health, as tolerance to shift working appears to reduce with age.

Dr Ahmed-Little goes on to suggest ways that hospitals could improve staffs' tolerance to shift working by improving their rostering, for example, by increasing the pool of doctors providing overnight cover. However she stresses the design of rotas must be evidence based to minimise the potential detrimental health effects on employees' health and performance.

She concludes that the NHS has a responsibility to improve rostering to reduce adverse effects and to provide education about the dangers of and the ways to cope with night-shifts.