EM and health

[zero0]

Current MS3 looking into emergency medicine.

One of my main concerns is the long-term health repercussions of swing shifts and having a constantly out of whack Circadian rhythm. I've heard all kinds of unsubstantiated claims that living that way can cause HTN, dyslipidemia, lower life expectancy, etc. and can't help being a little worried.

I'm curious as to what practicing attendings' experiences may be, personal or anecdotal. Thanks in advance.

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[miacomet]

It's crappy for your health. Not sure what else there is to say.

 

[Hercules]

Agreed. I think all of the studies and data have concluded it’s bad for your health. Every doctor who has worked it can tell you it’s bad for your health. How bad is it for your health? I would say that varies exponentially with your work load.

As far as anecdotes, I know several EM docs with rotating schedules who are in phenomenal shape. I think this happens despite our schedule, and they would be even better off with a normal sleep schedule.


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[gamerEMdoc]

Its very important to live a healthy lifestyle in EM. Eating healthy, exercising daily, and prioritizing sleep make a huge difference in how you feel and how you’ll adapt to the stress of the job.

 

[Birdstrike]

Current MS3 looking into emergency medicine.

One of my main concerns is the long-term health repercussions of swing shifts and having a constantly out of whack Circadian rhythm. I've heard all kinds of unsubstantiated claims that living that way can cause HTN, dyslipidemia, lower life expectancy, etc. and can't help being a little worried.

I'm curious as to what practicing attendings' experiences may be, personal or anecdotal. Thanks in advance.

EM is bad for your emotional, physical and social health. The stress, the pace, the circadian rhythm disruption and soul-crushing administration overreach amount to the equivalent of smoking a pack of cigarettes per day on life expectancy. EM can be really fun at times, it's noble work and it pays well. But there's no question, that it's bad for you. I lasted 11 years and I got out.

Who ever told you that the negative health effects of shift work was "unsubstantiated" is either a liar, uneducated or naive. The evidence for this is well established in occupational medicine research across many fields, not only EM. Do a EMB lit search on the topic.

Start here, as an appetizer: Is Shift Work Killing You? - Emergency Physicians Monthly

 

[Groove]

It's all relative. I'll be the first to agree that the circadian shift disruption and stress along with the regular weekend/holiday work can take it's toll on your mind, body and relationships but then again...it's not like other people don't have to worry about the same things. I was charting during a 5p-3a shift and a housekeeping lady stopped by to change out the trash can around 1am. I just starred at her then decided to strike up a conversation and she went on to tell me how she only worked nights though sometimes she worked days and had just gotten used to it. Although she hoped to get another job as a hospital sitter, she was still really grateful to have this one and felt that although she was in her 60s, was still in good health and able to bend down and lift the bags. I just sat there thinking that this lady must make pennies compared to what I make on an average shift and had such a better attitude than I do most of the time. Sure, the work sucks sometimes but c'mon... it's not all that bad when you think about the salary we can command. I think the key is working in moderation and allowing plenty of time for exercise and your health. I feel the worst when I'm greedy and working too much. I've certainly entertained the idea of other fields from time to time during periods of my greatest exhaustion but when I get rested and come back to reality, it never seems worth it and I usually regain my enthusiasm for the field.

 

[deleted859535]

Current MS3 looking into emergency medicine.

One of my main concerns is the long-term health repercussions of swing shifts and having a constantly out of whack Circadian rhythm. I've heard all kinds of unsubstantiated claims that living that way can cause HTN, dyslipidemia, lower life expectancy, etc. and can't help being a little worried.

I'm curious as to what practicing attendings' experiences may be, personal or anecdotal. Thanks in advance.

I’ll give you both.

Personal: it’s hard. I’m an early partner in an SDG. I work in busy EDs. You never totally get used to nights. Just somewhat. Pace is tough.

Part of why you should be careful with choosing jobs in that efficient departments with good help and a good group makes all the difference (the royal you — final-year residents reading this, pay attention).

Anecdotal: I’ve watched several people leave for greener (slower) pastures with more routine hours. Some were my partners even before I was a partner. Some cut back hours. A handful are still nose to grindstone.

We have a good thing, we do well, and our hospital system, while far from perfect, is way better than some of the horror stories you’ll see here. But it does affect you. Big +1 to the above comments about prioritizing your well-being when not at work.

Physician, heal thyself.

 

[cyanide12345678]

Does anyone think that having a consistent night schedule is better for health than a constantly changing schedule with swing shifts? At least it's a circadian rhythym that is consistent, even if off compared to "normal people". I'm 30, already diagnosed with HTN, crap family hx of early onset heart disease. Considering working all nights to avoid changes in schedule. Wife and family thinks I'll be slowly killing myself lol.

 

[Birdstrike]

Does anyone think that having a consistent night schedule is better for health than a constantly changing schedule with swing shifts? At least it's a circadian rhythym that is consistent, even if off compared to "normal people". I'm 30, already diagnosed with HTN, crap family hx of early onset heart disease. Considering working all nights to avoid changes in schedule. Wife and family thinks I'll be slowly killing myself lol.

Staying on one shift, even the least desirable shift, is definitely better from a circadian rhythm and health standpoint, than the disordered switching back and forth among all of the shifts. But for it to work, you have to continue to stay up all night and sleep during the day, on your off days. If you do, then you're most likely completely out of synch with your family and the rest of the world, which most people don't like. If you try to be a "day person" on your off days and a night person when you work, then you're still doing the circadian switching, and then it's no better, possibly even worse. You can also try sleeping in shifts while on nights and carry that sleep schedule through to your off days, unchanged. For example, sleeping from 8 am to 12 pm, then 5 pm to 9 pm, every day, whether you work a night shift or you're off. But for me, that never felt normal and always felt dysphoric compared to a classic 11 pm to 7 am type of sleep schedule.

You have to decide if any of any of this works for you. Most people decide they just can't make permanent nights work for them, long term. The few that can, are like jewels, to be kept, treated with care and never let go. That's why there's often a pay differential to pull as many people onto the night shift, as possible. And that's why for most people, EM will never fit the definition of "lifestyle specialty" that a specialty like Derm does.

 

[bikERdoc]

I think this group is becoming more doom and gloom all the time. And you guys are all feeding each other.

Some of the healthiest people I know are ER docs. I've met competitive tri athletes, sponsored mountaineers, semi pro skiers, ex college athletes, etc who all sling shifts in the ED. And they all still crush. And I highly doubt they come on some internet forum to whine all day about how crappy their health has become.

Very few specialties will give you the free time to pursue your interests like EM. What you do with that time is up to you.

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[bikERdoc]

And I'll add on one more piece. In most groups there are those who like the 6a shift, those who like the 3p shift, and those who like the 11p shift. If you hate certain shifts, talk to your scheduler. In my group, people tend to work the shifts that make their lifestyles more reasonable. And those who want to make more money, especially younger docs, can choose to work more nights. As we age, the nights get harder. Most older partners in my group work zero nights, and that's by choice. Gotta make it work for you. And be thankful you're not sitting at a desk the ENTIRE day or pulling regular 24 hour calls, cuz that is truly terrible for your health. I still like this job and I don't feel unhealthy.

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[Birdstrike]

Some of the healthiest people I know are ER docs. I've met competitive tri athletes, sponsored mountaineers, semi pro skiers, ex college athletes, etc who all sling shifts in the ED.

Does their shift work expose them to no risk or are they a group of educated, motivated health professionals that know shift work takes a certain toll and they're serious about risk factor modification and managing that risk?

British Medical Journal. Pretty big review. 34 studies. 2 million people. Shift work associated with a greater risk of vascular event, including a 41% greater risk of coronary events specifically among the night shift workers.

"Shift work and vascular events: systematic review and meta-analysis. BMJ 2012;345:e4800

Abstract
Objective To synthesize the association of shift work with major vascular events as reported in the literature.

Data sources Systematic searches of major bibliographic databases, contact with experts in the field, and review of reference lists of primary articles, review papers, and guidelines.

Study selection Observational studies that reported risk ratios for vascular morbidity, vascular mortality, or all cause mortality in relation to shift work were included; control groups could be non-shift (“day”) workers or the general population.

Data extraction Study quality was assessed with the Downs and Black scale for observational studies. The three primary outcomes were myocardial infarction, ischaemic stroke, and any coronary event. Heterogeneity was measured with the I2 statistic and computed random effects models.

Results 34 studies in 2 011 935 people were identified. Shift work was associated with myocardial infarction (risk ratio 1.23, 95% confidence interval 1.15 to 1.31; I2=0) and ischaemic stroke (1.05, 1.01 to 1.09; I2=0). Coronary events were also increased (risk ratio 1.24, 1.10 to 1.39), albeit with significant heterogeneity across studies (I2=85%). Pooled risk ratios were significant for both unadjusted analyses and analyses adjusted for risk factors. All shift work schedules with the exception of evening shifts were associated with a statistically higher risk of coronary events. Shift work was not associated with increased rates of mortality (whether vascular cause specific or overall). Presence or absence of adjustment for smoking and socioeconomic status was not a source of heterogeneity in the primary studies. 6598 myocardial infarctions, 17 359 coronary events, and 1854 ischaemic strokes occurred. On the basis of the Canadian prevalence of shift work of 32.8%, the population attributable risks related to shift work were 7.0% for myocardial infarction, 7.3% for all coronary events, and 1.6% for ischaemic stroke.

Conclusions Shift work is associated with vascular events, which may have implications for public policy and occupational medicine.


Study implications
Our findings have several implications. The increased risk of vascular disease apparent in shift workers, regardless of its explanation, suggests that people who do shift work should be vigilant about risk factor modification. Screening programmes for modifiable risk factors in shift workers have yielded substantial burdens of treatable risk factors, including dyslipidaemia, smoking, glucose intolerance, and hypertension.59 60 61 62 63 Shift workers should be educated about cardiovascular symptoms in an effort to forestall or avert the earliest clinical manifestations of disease. Evidence also exists in the literature to suggest that modification and rationalisation of shift schedules may yield dividends in terms of healthier, more productive workers; however, the long term effects of these alterations on vascular outcomes remain unknown.64 65 66 More work is needed to identify the most vulnerable subsets of shift workers and the effects of shift modifying strategies on overall vascular health."



Assess risk. Manage it. That's all.

And enjoy life.

 

[miacomet]

Does anyone think that having a consistent night schedule is better for health than a constantly changing schedule with swing shifts? At least it's a circadian rhythym that is consistent, even if off compared to "normal people". I'm 30, already diagnosed with HTN, crap family hx of early onset heart disease. Considering working all nights to avoid changes in schedule. Wife and family thinks I'll be slowly killing myself lol.

I would try and do straight days or swings (swings are often super unpopular) or start transitioning to UC, Pain, or whatever gives you a regular schedule.

And exercise, exercise, exercise. Not that I take my own advice.

 

[Apollyon]

I think this group is becoming more doom and gloom all the time. And you guys are all feeding each other.

There are exactly 3 posters that exclusively post the doom and gloom. Since that is all they post, it seems excessive.

However, we are not ALL "feeding each other".

 

[alpinism]

Does anyone think that having a consistent night schedule is better for health than a constantly changing schedule with swing shifts? At least it's a circadian rhythym that is consistent, even if off compared to "normal people". I'm 30, already diagnosed with HTN, crap family hx of early onset heart disease. Considering working all nights to avoid changes in schedule. Wife and family thinks I'll be slowly killing myself lol.

Its definitely better than constantly switching from days to nights.

What I've found is that having a modified day schedule when you're off helps to avoid being out of synch with everyone else and also prevents circadian disruptions.

For example when I work 11p-7a I'll sleep from 8a-3p which isn't horrible since most people are doing school/work till 3p anyhow and you still have all evening to spend time with family and friends. Then when I'm off I just shift the schedule back 4 hours and sleep from 4a-11a which is almost like you're sleeping in on the weekends. This way you wake up in time for lunch and basically have the rest of the day free to do whatever you like with normal people on day schedules. At least in my experience the circadian disruption is minimal and you don't have to sacrifice your days off as a result.

 

[zero0]

Pretty sobering stuff.

Special thanks to @Groove for helping put things in perspective. At the end of the day we are lucky to be doing something that makes a difference and I'm sure we'd all agree the pay is at least fair.

Still there's no ignoring the toll it takes on your health. I considered doing all nights as a possible solution. I'm still not sure what the heck I'm gonna do...

 

[Angry Birds]

Main thing is not to eat unhealthy at work. Don’t stress eat. I blew up like a balloon because of that during residency. I just finally lost the weight doing intermittent fasting. Can’t recommend it enough.