Night on-call duties among senior surgeons disrupt sleep, drive fatigue, and may affect clinician health and patient safety. New data from Australia quantify this burden in a group underrepresented in earlier research.

Medical fatigue is a recognized risk factor for reduced performance, impaired well-being, and burnout. Contributing factors include night duties, whether on site or on call, including operational responsibilities or telephone-based duties. In several specialties, calls at night and potential travel to evaluate patients are integral to practice, including obstetrics, anesthesia, critical care, and surgery. Prior research has focused mainly on medical students and junior doctors, examining the consequences of daytime and nighttime work.

On-call shifts among junior doctors are restricted to no more than five per month in hospitals, except in exceptional circumstances under supervision by the Medical Staff Committee. Each shift is limited to 24 consecutive hours, followed by a mandatory 11-hour rest period after any work at night.

No equivalent provisions apply to senior doctors beyond the labor code, which does not cover public hospital employees. Senior clinicians can therefore accumulate three or more consecutive on-call shifts without compensatory rest, particularly during holiday periods when duties may extend across entire weeks. These night shifts are added to daytime clinical responsibilities.

This sustained physical and mental burden has clear consequences, with many clinicians reporting greater strain with age. Evidence has been limited. Australian researchers addressed this gap through an analysis of surgeons’ night workload.

Night Interruptions

This mixed cross-sectional study was conducted in four public hospitals in New South Wales, Australia, including one level 3 hospital and three level 2 hospitals. Over 14 consecutive days, surgeons were contacted the morning after on-call duty to complete a brief questionnaire on work-related night interruptions, defined as any phone call or text message received between 8 PM and 8 AM. Among 238 surgeons, the response rate was 70%. A total of 277 on call interruptions were recorded, corresponding to a mean of 1.65 interruptions per surgeon per night.

Interruptions were frequent and often occurred during typical sleep periods. Of all interruptions, 45.5% occurred between 8 PM and 10 PM, and 46.2% occurred between 10 PM and 5:59 AM. One third of surgeons reported sleep disturbances related to work, with some individuals waking up to five times per night. Specialties most affected during sleep hours included neurosurgery, gastrointestinal surgery, and pediatric surgery. Most contacts were brief, lasting 2-5 minutes, although 26% exceeded 5 minutes.

Most interruptions involved information exchange (71.5%), whereas 20.2% required remote access to review laboratories or imaging results on computers. Some interruptions required travel, including 2% for examining a patient and 6.5% for intervention in the operating room. After a nighttime interruption, 35.5% of surgeons returned to sleep within 30 minutes, whereas 16.1% were unable to resume sleep. Nonwork-related disturbances, particularly those involving children, were also reported.

The senior surgeons interviewed highlighted a clear psychological burden, including mental fatigue, fragmented sleep, and perceived disruption of rest patterns associated with the on-call schedule. The median self-reported rest score on the day after on-call duty was 7 on a 10-point scale.

Health Impact

This study provides original data showing that senior surgeons on call experience frequent and repeated sleep interruptions that may adversely affect both physical and mental health. These effects occur even when they are not called in because the need to remain available alone disrupts sleep.

Although sleep disruption does not appear to impair the technical performance of surgical residents, objective data are lacking for technical procedures performed by senior surgeons. Disruption of circadian rhythms is associated with increased risk for road accidents, along with higher risk for fatigue-related medical errors and burnout.

Fatigue in senior surgeons warrants closer consideration in team scheduling to reduce these risks, which may affect patient safety. While the analysis focused on surgery, similar patterns are likely across other specialties that involve on-call duties, including radiology and cardiology.

This story was translated from JIM, part of the Medscape Professional Network.