24-Hour Call

Is 24-hour call for resident physicians truly in with current times, or is it an archaic tradition with no purpose except to submit today’s trainees to a taste of the misery older physicians had to endure? As a resident who has experienced intern year twice, once in a program with the standard 24 hour plus 4 hour every 4 days and the second in another program that had a scheduled night float team, I would like to share my opinion in this matter. When I read the editorial in Annals by Bernstein and Gold (1) on Fang and colleagues’ study (2), the finding that caught my eye was that increased sleep and decreased work hours (among other things) were associated with decreased depression in interns.

As a fourth-year medical student, I was confident that my workload and call schedule would not affect my mood. I was wrong. Within the first month, I had learned what true exhaustion was and lived with constant stress because my schedule was call day, post–call day, normal workday, and then another call day. I was never truly rested. The 80-hour work weeks with 24 hour plus 4 hour call every 4 days took its toll. I did not realize it then, but I was burned out throughout most of my intern year. I adapted to the stress and limited sleep as I became more efficient with my work. However, exhaustion contributed to mistakes in patient care and made me increasingly bitter. More than once, I fell asleep while driving and found that my decreased patience affected me outside of work. I was not happy and, after experiencing the night float call schedule in my new residency program, I realized that 24-hour calls were the source of my unhappiness. Looking back, there were times when I should have sought help from a mental health professional, especially during the first weeks and months during the transition from medical student to resident physician. Yet, I did not even consider looking for help. I did not want to seem weak and did not want to burden my coresidents if mental health appointments kept me away from work.

Thanks to ongoing efforts to prevent depression, burnout, and suicide among physicians, there have been positive changes in residency training that are being developed. I am glad more colleagues are inclined to seek out help (1, 2). We must remember that to help others, we must first help ourselves. Many of us know of a colleague who is struggling with depression, and some of us unfortunately have lost colleagues to suicide. I agree with Bernstein and Gold: There is more to be done.

References 

1. Bernstein SA, Gold JA. Interns are increasingly using mental health services, but more can still be done [Editorial]. Ann Intern Med. 2022;175:131-132. [PMID: 34781712] doi:10.7326/M21-4077
2. Fang Y, Bohnert ASB, Pereira-Lima K, et al. Trends in depressive symptoms and associated factors during residency, 2007 to 2019. A repeated annual cohort study. Ann Intern Med. 2022;175:56-64. [PMID: 34781718] doi:10.7326/M21-1594