Bipolar physicians & others.
BPAD is prevalent in up to 2-10% of the population depending on what study and how you define the spectrum.
I could speculate prevalence in physicians, and my reasons for thinking it's similar or even higher than gen pop. My argument: we're not talking about an insignificant # of physicians. I could argue that these physicians represent special diversity in medicine that's worth trying to include.
"But 2nd yr there's overnights...." the rationale of not allowing interns vs seniors to do overnight shifts was for experience level affecting ability to cope and practice safely. Overnights can be hard on anyone with BPAD, but I would argue that all else equal it's likely harder on them as an intern owing to stress levels.
Yes, many docs with BPAD suck it up for years and manage. Doesn't mean I think that more years of such a sleep schedule is better overall and means they all can. I could get into some of the science about cumulative effects of stressors and how it affects BPAD long term. 3 years vs 2 years call I think can be significant. When's the breaking point?
Yes, many suck it up & manage, but some lose it, it's hard to predict, & no, I don't think that supports this change.
That "normal" people are arguing for weekends of all things, over the sanity of a not insubstantial # of physicians, I don't find compelling.
Anyone going into medicine is embracing a lot of work. A fair number of people go into medicine fairly healthy, and it's training itself in school or beyond that pushes them to the physiological limits where they even attain diagnoses of BPAD, narcolepsy, seizures disorders, migraines, etc. So it's also not enough to me that we just demand that people with such dx just don't apply to med school, or that when they get diagnosed we don't think of better ways to treat and include them. Sometimes that means the healthier among us take a hit. That's training. Just as when someone has a baby, etc.
Stress is a reality we embrace as well. I don't argue that if the stress exacerbates conditions and then people can't practice with reasonable accommodations, that we change essential functions of the job.
For most specialties, being able to work longer than 24 hours at a time is not an essential job function. In residency it's a convenience to employers and scheduling and typically not an essential element of education, which is why specialty boards and courts have allowed for shorter shifts in many fields.
Also, the frequency of such call makes a difference. Someone with BPAD might be OK with the frequency of 24 hr call out in practice, at once a week, with few actual calls, vs q3. At my program, nightfloat was 1 month, and 1 month of such a schedule is less disrupting to circadian rhythms
Seniors taking call only had one overnight per week.
We've proven that 16 hour intern shifts can be done. "Stress level" intrinsic to performance of the job while you're at work is a bit different than how long a shift is. One we might be able to change to positively increase the the diversity and inclusiveness of our workforce, another we might argue we have less control over.
As far as "reasonable" accommodations BPAD and other physicians who have conditions that are affected by overnights, there's a thread in psych forum now. I have seen discrimination for more than one doc dealing with a psych or med dx. Don't kid yourselves justice is done by our affected colleagues.
Yes. I appreciate it's hard to qualify the positive impact on health of more weekends vs what we KNOW is physiologically a strain, one that can even be deadly to a not insignificant number of us, 24 hr shifts.
In general, if I have to work 6x16s and enable, say, 10% of physicians with certain conditions to be included in the workforce, and sacrifice my weekends for it for a few years, I would rather that sacrifice than them.
16 vs 24 hr shifts is more stressing physiologically, and that's just fact. As someone said, continuing to insist that we must physically abuse physicians to provide quality care, sounds ridiculous to me.
The fact a study finds most residents can suck it up either way to protect patients, as has been pointed out, doesn't do much to look at how residents cope.
If you can show this is the ONLY way to make patients safer (I doubt it), that there's no way to structure residencies to better respect physiological needs, I'll find the "but my weekends!" " but hospitals hiring more people, $!" "Patient handoff!" arguments more compelling.
Tldr
Not convinced there's no better way
These hours are bad for HUMANS
There must be a way to protect pts
The tradeoff shouldn't be inhumane hrs vs inhumane lack of weekends
This is not essential for educational experience, per courts, other countries, specialty boards, stop pretending Osler meant this sort of thing
Don't pretend the ADA & employers will protect docs that have a hard time with this, or that even attempting to exclude such docs is possible, reasonable, and won't cost us
