Hey Doc, night shifts are slowly killing you

I recently met up with my friend, an anesthesiologist, who said: “Ever since I turned 40, an overnight call is getting tougher and tougher to recover from”. Speaking with other colleagues and friends, I have found the 40-year-old mark to be a common age when people begin to notice the toll on their bodies from overnight work.

Bottom line: Call/overnight work is harmful to your health! But somebody has to do it.

Humans are not nocturnal creatures. Overnight work is unnatural for humans, but the work is a necessity in our modern 24/7 world, especially in the hospital setting.

There is increasing evidence that overnight work has harmful effects on “virtually every system in the body”. The long-term health toll can be devasting including obesity, Type 2 diabetes, cardiac disease, increased risk of cancer, depression, burn-out….and the list goes on.

Every night shift you work, your body is taking an internal beating. Your life energy is being depleted faster than normally. At the age of 40, you only have about 16,425 remaining days on Earth (assuming life expectancy to age 85). Night shift is a thief silently robbing a disproportionate amount of your remaining days.

Don’t fall into the trap of thinking sleep loss is a badge of honour, which is prevalent in the medical training environment. It is not a sign of weakness when your body is telling you it needs to sleep.

One of the world’s least valuable clichés is that you can sleep when you die. Much truer is: If you don’t sleep, you will die — sooner.

NY Times

Can anything be done? Should you resign to living a shorter life-span due to overnight shifts?

Here are my tips for preventing overnight shifts from slowly killing you:

  1. As a medical student, find out about the call/overnight shift requirements for different specialties. If you are equally interested in 2 specialties, then choose the one with the least amount of call/overnight shifts. Better yet, choose a specialty or family medicine with no overnight shifts, assuming you are interested.
  2. If you are in a specialty with onerous call/night shifts, then obtaining financial independence as quickly as possible is key. My anesthesiologist friend told me he does night shifts because it is so lucrative and he needs the money. Once you are financially independent, you have options. Do less call by going down to part-time work. Sell off your shifts to colleagues (usually the younger docs) who are hungrier for money. Take on a more administrative role rather than a clinical role. Take on an academic position and have residents work overnights for you.
  3. Work overnight shifts in a batch. Studies show it can be healthier for your body, rather than rotating from day to night work frequently
  4. Don’t work the day following a night shift. Financial independence makes this possible.
  5. Drink lots of fluids during your shift. Eat protein-rich foods. Avoid heavy-carbohydrates until after the shift which will help you fall asleep
  6. Sleep is the magic pill to recover. I used to enjoy the post-call high as a younger doc when I would work-out and do a bunch of errands the following day. This is doable in your 20’s and 30’s because your body can recover faster. As you age, recovery is slower. Take care of your body by sleeping following night shifts to allow your cells and immune system to recover from the onslaught of damage done by overnight work

In summary, avoid and minimize overnight shifts, if possible, as they are harmful to your health especially as you get older. Obtain financial independence so you do not feel indebted to work nights because of money. Sleep is the magic pill to recover.

What do you do to prevent overnight work from harming your health?

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1 year ago

do as little overnight work as possible
take the day off after call or minimize post call work
pay others to do some or all of on call work

Loonie Doctor
1 year ago

This is definitely true and I have to agree that 40 isn’t just a number when it comes to night call. However, night call does tend to pay well. Front-loading it while young and best able to bounce back can help. The two cautions that I would give with that are: 1) Don’t totally miss the time with your kids if you also have them while young. Of course, when they are pre-school, you can work nights when they are sleeping and be around during the day -but it can be painful. 2) Use the money wisely towards enough building… Read more »

Big Family Small World

Hey, DN – important topic, because, as you rightly point out, the physiologic stress of that fatigue and circadian disruption is incredibly harmful over time. Sure, the money is nice, but it’s a little like day-trading in a bull market; we are wired to focus on short-term gains when it’s the long term consequences that matter more – and the reckoning will come! It’s not just cardiovascular disease, cancer, and mental health either; we shouldn’t forget that medical errors, college complaints, and lawsuits are also more prevalent when we’re not functioning at our best. I’ve been happy to give away… Read more »

Dr. MB
Dr. MB
1 year ago

Hey DN!

I could barely recover from night call when I was in my twenties and thirties. There would be times post call that I could not sleep for a few days in a row. Holy palpitations galore man!

Anesthesia call was the worst since the cases did not stop coming!!! Yuck.

Dr. FIREfly
1 year ago

Ahaha, I couldn’t help but chuckle at “Take on an academic position and have residents work overnights for you.” As a resident, I am definitely doing that these days! And to echo Dr. MB, I’m so impressed you had the functionality you did when post-call in your 20s and 30s. I’m heading into my 30s and have not had a functionality post-call …possibly ever.

Thanks for another great post!

P.S. Is that adorable cat in the photo a member of your household?

10 months ago

Our emerg group started splitting night shifts (aka casino shifts) several years ago (>5) and most docs are sold on the benefits of a few hours of anchor sleep and a quick recovery. A few still do the whole night but the majority would never go back to full nights. It’s also easier to string a number of nights together. Shift 1 -10 pm -0400 for the night hawks who are good at cleaning up and getting out of the emerg on time Shift 2 0400-9:00 for the early birds – Downside is more night shifts but the recovery is… Read more »


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