Many Factors -- Not Just Long Hours -- Can Topple Residents' Work-Life Balance

Study Results Could Have Impact on Physician Workforce Policy

October 19, 2010 04:50 pm News Staff

Limiting resident physicians' duty hours alone won't necessarily lower their risk for fatigue or ease their difficulties in maintaining work-life balance. Women residents, especially, say they don't get enough sleep and rarely wake up feeling refreshed. Both men and women want a better work-life balance, especially if they are parents.

These findings from a study published in the September Academic Medicine may sound familiar to the ears of U.S. residency directors and resident physicians. But the conclusions actually are drawn from a survey of "junior doctors" conducted in New Zealand. Since 1985, these health care professionals -- the equivalent of U.S. residents -- have had a contractual duty limit of 72 hours per week.

According to the study(, simply limiting work hours has not kept New Zealand's junior doctors from experiencing fatigue and having problems balancing work with other daily activities.

"Multiple aspects of work patterns, not just long working hours, are associated with problems of work-life balance," said researchers from the Sleep/Wake Research Centre of Massey University in Wellington, New Zealand(

More than 1,400 junior doctors in hospital-based clinical training positions completed questionnaires on work patterns, sleep habits, fatigue-related errors in clinical practice and social support. Each received a fatigue risk score based on his or her answers, with "fatigue" defined as an impairment that occurs when a person continues working before recovering from previous work and other activities.

The researchers found that the higher the fatigue risk score a junior doctor received, the greater the work-life imbalance that individual reported. And although the fatigue risk scores of men and women did not differ significantly, women were more likely than men to report inadequate sleep and excessive sleepiness.

Both genders reported feeling socially isolated from friends, family and community outside the hospital; both complained that they frequently were too tired to exercise or prepare healthy meals. Both also said their personal relationships suffered because of work demands.

Mothers of young children said balancing full-time work and parenting was difficult. Fathers said their jobs put pressure on their spouses because the fathers often were unavailable to help out at home.

According to the researchers, typical comments on the survey were "(I have a) failed marriage, social isolation, depression" and "I don't have my own personal life; I live for the institution I work for."

The study's main takeaway, said the researchers, is that "limiting work to 72 hours per week has not prevented many junior doctors in hospital-based clinical training positions from experiencing fatigue and problems with work-life balance."

They said that multiple aspects of work patterns aside from longer total duty hours are independently associated with these difficulties, including increased amounts of night duty and schedule changes. Other variables that upset the balance are commuting times, even modest ones; living with children; studying more than 20 hours a week; and inadequate supervision at work.

Solutions are elusive. Only a small proportion -- about 15 percent -- of the junior doctors reported ever having received training or guidance on personal strategies for coping with shift work and extended duty hours, the study said.

Moreover, although online journals offer advice on getting enough catch-up sleep and exercising or meditating to reduce stress, physicians in the study commented that their work demands precluded such activities.

The researchers said the study's findings -- particularly the finding of a disproportionate impact of the demands of medical training on women -- could have significant policy fallout, in light of a growing number of women physicians worldwide, the current competitive global market for medical graduates, and the projected increases in demand for medical practitioners in industrialized countries due to aging populations and efforts to reduce working hours.

"The feminization of the medical workforce has important implications for workforce planning and postgraduate training," the researchers said. Among both genders, "expectations concerning work-life balance are changing among physicians in postgraduate training."

For the moment, however, solving the sleep dilemma should take center stage, the study authors concluded. "To maintain productivity, safety and workforce health, there must be a shift in focus from limiting work hours to providing adequate opportunities for recovery sleep," they said.

"The importance of sleep is illustrated in the present study by the finding that commuting, night work and schedule changes (all of which affect the amount of time available for sleep) are independent risk factors for reporting difficulties with work-life balance, as are long duty hours.

"Night work and schedule changes also are independent risk factors for reporting excessive sleepiness and fatigue-related clinical errors among the participating doctors."

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