The Impact of Long Shifts on Medical Professionals and Patient Care

Noah Silverbrook

Updated Wednesday, June 5, 2024 at 7:25 PM CDT

The Impact of Long Shifts on Medical Professionals and Patient Care

Historical Background of Medical Residency

The American approach to medical residency was pioneered by Dr. William Stewart Halsted at Johns Hopkins. Halsted's philosophy was rooted in the belief that young medical professionals did not require as much sleep as they claimed, seeing sleep deprivation as a test of endurance and commitment. This perspective was likely influenced by Halsted's own heavy use of cocaine, which skewed his views on sleep and work hours.

Halsted's model has had a long-lasting impact on medical training programs across the United States. Despite advancements in medical science and a better understanding of human physiology, the grueling hours set by Halsted continue to shape the residency experience for many young doctors.

Current Practices in Medevac Nursing

Medevac nurses often work 24-hour shifts, a practice that is both physically and mentally demanding. These nurses are required to watch annual training videos that highlight the dangers of fatigue, comparing the effects of prolonged wakefulness to being drunk. Despite the inherent risks, many medevac nurses prefer 24-hour shifts over 12-hour shifts due to the unpredictable nature of emergency calls and the extended time off they receive afterward.

The preference for longer shifts is also supported by the argument that mistakes in medical care tend to increase during shift handoffs. Fewer shift changes theoretically mean fewer opportunities for errors, making longer shifts seem like a safer option despite the associated fatigue.

Controversy Over Shift Lengths

There is ongoing debate about the optimal length of shifts for medical professionals. Some argue that 12-hour shifts are better than 8-hour shifts for reducing mistakes, but 24-hour shifts remain problematic. The issue is particularly pronounced in specialties like Family Medicine (FM), where residents often experience much crazier hours compared to other fields like pathology, which typically has more manageable hours.

The root cause of these long shifts and residency issues can be traced back to systemic greed within the healthcare system. A shortage of residents exacerbates the problem, making it difficult to distribute workloads evenly.

Systemic Issues in Healthcare

The healthcare system's problems are multifaceted and deeply rooted. Midlevel creep, where administrators attempt to replace physicians with less expensive alternatives, is a growing concern. This trend is often driven by administrative culture, where MBAs and other non-medical professionals make critical care decisions, affecting residency conditions and overall patient care.

Insurance companies also play a significant role in perpetuating the flawed residency system. The profit motive in healthcare artificially limits the number of healthcare providers and resources, resulting in fewer doctors, hospitals, and clinics than there should be. Existing healthcare resources are being overworked to maximize profit for upper administrators, owners, boards of directors, and the C-suite.

The Path Forward

Addressing these issues requires a comprehensive approach and significant effort to reverse the current trends. Reforms in residency training, better work-life balance for medical professionals, and a shift away from profit-driven motives are essential steps toward a more sustainable and effective healthcare system. Only by tackling these systemic problems can we hope to improve both the working conditions for medical professionals and the quality of care for patients.

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