Literature Review: Impact of Shift Work on Junior Doctors

Introduction

Shift work is defined as work performed outside of normal daytime hours.¹ In the UK, full-shift schedules for junior doctors usually consist of a fixed normal working day, rotating long day shifts, and regular weeks of night shifts.² Although total working hours have declined due to regulations such as the European Working Time Directive (EWTD), the proportion of time worked outside standard hours has increased.² This trend raises concerns about its implications for junior doctors’ physical and mental health, clinical performance, and work-life balance.

Night work affects training because people’s capacity to learn during the night is significantly impaired, and sleep is required for consolidating new information.² Recommendations from professional bodies suggest limiting night shifts to a maximum of four consecutive nights and reducing shift length to enhance safety.² However, implementing such changes often requires increased staffing and financial resources, which may not be feasible under current constraints.²

Night shifts disturb the natural sleep-wake cycle and circadian rhythms, which are essential for physical, mental, and cognitive health.¹ The EWTD restricts junior doctors to a maximum of 13 working hours per shift, leading to widespread use of rotating shift patterns.³ However, daytime sleep after night shifts is usually shorter and of lower quality due to circadian misalignment.³ The focus of this literature review is on four critical areas: physical health, mental health, clinical performance, and work-life balance. It excludes broader societal implications and the experiences of other healthcare professionals to maintain a focused analysis. It aims to synthesize current evidence, identify research gaps, and propose recommendations to improve working conditions and the well-being of junior doctors.

Search Strategy

This literature review used a structured search strategy to identify relevant studies on the impact of shift work on junior doctors. The databases searched included PubMed, MEDLINE, and Google Scholar. Keywords and MeSH terms used in combination with Boolean operators included: “shift work,” “junior doctors,” “night shifts,” “fatigue,” “mental health,” “clinical performance,” and “work-life balance.” The search was limited to articles published in English between 2000 and 2024, focusing on peer-reviewed studies, systematic reviews, meta-analyses, and official reports from professional bodies such as the Parliamentary Office of Science and Technology (POST) and the British Medical Journal (BMJ). Reference lists of key articles were also handsearched to identify additional relevant studies. Studies were included if they specifically focused on junior doctors or medical trainees and addressed at least one of the four review domains: physical health, mental health, clinical performance, or work-life balance. Studies involving other healthcare workers or lacking a focus on shift work were excluded to maintain specificity and relevance.

Impact on Physical Health

Several studies have documented the negative effects of shift work on junior doctors’ physical health. For example, neonatal registrars on 12-hour rotating shifts report significant fatigue and disrupted sleep patterns, particularly after night shifts.⁴ Irregular schedules cause excessive fatigue and poor sleep, affecting patient safety and personal well-being.³ Evidence suggests avoiding seven consecutive night shifts, except in rare cases with minimal fatigue risk.³

Physical effects extend beyond tiredness. Sleep deprivation delays response times, reduces manual dexterity, and impairs overall clinical performance.⁵ Non-pharmacological strategies, like improving scheduling and good sleep hygiene, help address sleep challenges.1 Circadian rhythm disruptions-caused by inconsistency between internal biological clocks and external light-dark cues-pose both short-term and longterm health risks.¹

Short-term effects include fatigue, impaired attention and decision-making, and increased risk of driving and workplace accidents.¹A UK survey revealed that 57% of junior doctors reported an accident or near-miss while driving back home after a night shift.⁶ Long term consequences include obesity, type 2 diabetes, cardiovascular disease, depression, anxiety, and potentially cancer.¹ The Institution of Occupational Safety and Health (IOSH) has emphasized the need for more research to confirm the association between cancer and shift work.¹

Recommended interventions include optimizing shift length and rotation, incorporating forward-rotating schedules, providing rest breaks, and offering facilities for short naps during shifts.¹ Additional measures such as sleep disorder screening and safe commuting policies could mitigate health risks.⁷

Impact on Mental Health

The psychological impact of shift work is profound. Doctors working over 55 hours per week are more likely to develop common mental health conditions than those working 40-44 hours per week.⁷ Long hours, high workloads, insufficient support systems, and lack of rest contribute to mental health conditions such as anxiety, depression, and burnout.^8,9 The irregular nature of shift schedules disrupts circadian rhythms, eating patterns, social and family life, and contributes to anxiety.¹⁰ These psychological stressors do not significantly differ across genders.⁹ Long, demanding shifts lead to exhaustion, limited recovery, and persistent emotional stress.⁸ Feelings of inadequacy are common due to high performance expectations and limited tolerance for error.⁸ These challenges are worsened by limited control over workloads, understaffing, and poor access to mental health resources.

While there is evidence that night shifts increase the risk of depression, this does not warrant excluding individuals with mental health histories from shift work altogether.¹¹ However, physicians should remain alert to psychosocial factors and ensure robust support to shift workers.¹¹

Mental health challenges have significant implications, including impaired cognition, reduced focus, and poor decision-making-all of which directly affect patient safety.¹ Broader implications include increased absenteeism, higher staff turnover, and reduced trust in healthcare services.¹¹

To reduce these effects, healthcare systems must adopt interventions, including adequate rest, reduced workloads, and better mental health support. Further research is required to understand how specific shift patterns affect mental health.⁹

Impact on Clinical Performance

Clinical performance is closely tied to cognitive functioning, which is adversely affected by shift work. Fatigue and sleep deprivation impair critical functions such as memory, concentration, and decision-making, increasing the risk of diagnostic or procedural errors.^3,10 Shortened sleep periods following on-call duties lead to greater fatigue the next day, impairing critical clinical functions.¹⁰ Loss of sleep negatively affects motor skills and balance, essential for physically demanding tasks.⁵

Sleep-deprived medical residents exhibited impaired balance, indicating that shift work affects motor coordination as well.⁵ These impairments can compromise the clinical tasks requiring precision and steadiness.⁵ Shift work also contributes to sleep disturbances and psychological distress among doctors.¹² These factors impair concentration, reaction time, and complex decision-making, all vital for safe and effective patient care.¹² Extended work hours and inadequate rest reduce doctors’ ability to perform diagnostic tasks, such as interpreting electrocardiograms or recognizing subtle clinical signs during simulations.¹³

Poorly designed shift patterns exacerbate fatigue among junior doctors, negatively impacting their well-being and the quality of patient care.³ Disruption of circadian rhythms and prolonged sleep deprivation reduce cognitive and clinical performance.³ Aligning shift patterns with doctors’ natural sleep preferences may reduce burnout and enhance clinical performance and job satisfaction.¹

While the correlations between shift work and diminished clinical performance are well-established, the neurocognitive mechanisms remain poorly understood. The evidence underscores the need for reforming shift scheduling in healthcare. Evidence-based shift designs that promote cognitive resilience and rest are vital to minimizing risk and improving patient outcomes.

Impact on Work-Life Balance

Shift work presents considerable challenges to maintaining a healthy work-life balance. An observational study explored the challenges doctors face in balancing their aspirations for a successful medical career with homelife commitments.³ Personal needs are often overlooked in favor of professional obligations.²

The duration and frequency of on-call shifts significantly limit doctors’ ability to engage in non-work activities, especially for those with family responsibilities or studying for exams.¹⁰ Working more than 48 hours per week has been strongly associated with greater work-life conflict.¹⁰ Time typically reserved for social or family interaction-such as evenings and weekends-is often lost, leading to emotional strain, isolation, and relationship difficulties.^3,8 Workplace support and flexible scheduling can play a vital role in helping doctors manage these competing demands.⁸

A literature review linked nonstandard working hours to reduced marital satisfaction and strained family dynamics.¹⁴ Additionally, parents working irregular shifts reported adverse child development outcomes, including behavioral issues, mental health concerns, and obesity.¹⁵ However, these associations may be influenced by confounding factors such as parental mental health, low quality parenting, and the overall home environment.¹⁵

These findings highlight the need for healthcare organizations to address work-life balance challenges among junior doctors. Recommended strategies include implementing better-structured shift patterns, promoting sleep hygiene, ensuring adequate rest, and enhancing social support systems. Aligning professional responsibilities with personal needs can significantly improve well-being and job satisfaction.³ 

Conclusion

This review has examined the multifaceted effects of shift work on junior doctors in the UK, highlighting its negative impact on physical health, mental well-being, clinical performance, and work-life balance. Irregular and extended working hours and limited rest contribute to fatigue, stress, and reduced personal time, with broader implications for both patient care and doctor well-being.

Addressing these issues requires a comprehensive approach that includes supportive workplace policies, mental health resources, and evidence-based scheduling practices. By prioritizing these strategies, healthcare organizations can help junior doctors manage the demands of shift work while maintaining their health, job satisfaction, and clinical performance.

Conflict of Interest

Nil