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shift work and life expectancy

Discussion in 'Emergency Medicine' started by Sun Down, Mar 17, 2009.

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  1. Sun Down

    Sun Down

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    So I know there are already plenty of burn-out threads, but I hope this will be a little different. What are your opinions on the scientific evidence that shift work may decrease life expectancy and increase the risk for MI and obesity? There have been several studies on this (a fewing saying no and perhaps a few more saying yes), but I don't think that any of the studies is particularly strong. Among other things, people who work shift work tend to be a bit worse off socioeconomically than day workers (confirmed by the data in these studies). Most of the studies attempt to account for education level, smoking, etc, but significant confounders may remain.

    There is considerable evidence that sleep is important and that diseases like sleep apnea have serious health consequences. At the same time, narcolepsy (a disease that profoundly affects sleep) does not appear to alter life expectancy.

    1) What are your observations of you and your colleages? Is shift work rough on your health?
    2) Do you think other fields of medicine with call/long hours are vulnerable to similar sleep deprivation issues?

    Anyway, what are all of your thoughts?

    Here are some studies
    1) http://www.circ.ahajournals.org/cgi/content/full/92/11/3178
    Prospective study in female nurses

    2) http://www.ncbi.nlm.nih.gov/pubmed/10341746
    Case-control study from Sweden

    3) http://www.nature.com/ijo/journal/v27/n11/full/0802419a.html
    Obesity and shift work study

    4) http://www.springerlink.com/content/gxc2ahyhx2kqj3cn/
    Shift work and HDL, glucose, etc
  2. EC3

    EC3 Member

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    Even at a conservative relative risk of 2, if shiftwork allows you to better enjoy your life, it's worth it. Besides, there are so many confounding variables to any of these studies that it's silly to base decisions off of them.
  3. trieditallerdoc

    trieditallerdoc

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    HI, I'm an ER doc with 25 years experience. I am in my 50's and feel as young as my 30's. I have just finished working 23/28days for the past 2 years to "catch up" on my savings and get out of debt. I have worked days/nights/and flipped back and forth and I can definitely tell you, that once you hit your 30's you start to feel it. Some of us want our nights 1 at a time, and some have asked to do them all in one month and then not again for another 3 or 4 months...either way...it drains you to be flipping back and forth. And if you want to know if working nights promotes obesity, just look at your night staff...food keeps them awake and many struggle with their weight or their social lifestyles if they are 30 or older...
    good luck!
  4. pseudoknot

    pseudoknot

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    I wouldn't get too excited about those studies as they are all observational. I do think shift work makes it easier to have an unhealthy lifestyle, but you can still choose to resist those forces (maybe).
  5. jbar

    jbar Senior Member

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    I'd note that most of the studies I've seen on shift work are overnights v regular day shifts.

    I think a better question for people going into EM is shift work overnights v call.

    I can't imagine that being up for 30 hours taking call on IM is better for you than just working an overnight.
  6. bartleby

    bartleby Senior Member

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    Medicine in general is all about circadian disruption. Whether you get it through taking call and working 13 days straight (when you have to round over the weekend and maintain your usual weekly schedule) or you do shiftwork, only a miniscule portion of physicians will be able to score bankers' hours over the long term.

    I think that, for me, the downsides of shiftwork are miniscule compared to the benefits. If I only worked days, I'd only see my 2 & 4 year old kids an hour a day during the week, if that. But by working a predominance of evenings by choice, I get to spend most of the day with them.
  7. AmoryBlaine

    AmoryBlaine the last tycoon

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    The studies are kind of interesting but they don't do much (or shouldn't do much) from a decision making process. Really they just confirm that medicine is hard, something we probably already knew.

    I wouldn't allow a few observations about the MI rates among Swedish nurses to dissuade you in any way from EM. The future of medicine is probably going to include alot more shift work for other fields -- you already see this happening in IM/Peds (hopitalists), Ob/Gyn, etc.
  8. Sun Down

    Sun Down

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    thanks for the responses. I agree that this is not a good reason to choose a career (or not choose a career). I'm about 90% certain that I am going to do EM (and won't base it on this info), but I just find this stuff interesting. Among other things I think it is very interesting how the media tends to write firm and alarmist articles based on studies that are rather small and obscure and have significant methodological problems (not to mention ignoring the contradictory studies).

    A few more interesting articles I have found:

    1) http://74.125.47.132/search?q=cache...e life expectancy la&cd=8&hl=en&ct=clnk&gl=us
    It appears that police officers (who work stressful shifts) have a longer life expectancy than the general public and other non-police government workers.

    2) http://www.ncbi.nlm.nih.gov/pubmed/...nkpos=4&log$=relatedarticles&logdbfrom=pubmed
    Physicians as a whole have a longer life expectancy than the general public and lawyers. While there are plenty of reasons for this not related to sleep, physicians as a whole dont get much sleep and still do okay. This data is based on doctors who practiced in the 1960s and 1970s etc - a time when many probably took a lot of long call. I also found it intersesting that anesthesiologists and internists live approximately the same lifespan.

    3) There is considerable evidence that career satisfaction is important to overall health. Something like 400 physicians commit suicide every year (thats more than two of my medical school classes committing suicide every year). http://emedicine.medscape.com/article/806779-overview
    Some studies suggest EPs have somewhat higher career satisfaction than some other specialities and that the burnout and attrition rates do not appear higher than family practice and other specialities.



    I guess my take home message from all this is that the data suggesting that that shift work decreases life expectancy is rather weak. While it is possible and even very likely that working nights is not the healthiest thing in the world, it is certainly only one aspect of health. I think many of the studies suggesting shift work decreases life span are confounded by the fact that usually the people working nights are a bit more down on their luck and are of a lower socioeconomic status than day workers (after all, who in their right mind would choose to work nights:)). I think that having a job that you like and working nights is probably healthier than having a job you really dont like and working days.

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