Heavy overnight shifting takes a toll on emergency rads, although some prefer its payoffs

Emergency radiologists who work lots of overnight shifts and/or shifts longer than nine hours tend to feel less healthy, closer to burnout and more dissatisfied with their work than emergency rads who have more humane schedules, according to a study published online Dec. 4 in the Journal of the American College of Radiology.

What’s more, the researchers found, randomly rotating radiology shift work seems to have a pronounced, albeit subjective, impact on memory.

Tarek Hanna, MD, of Emory University, and colleagues arrived at their findings after surveying by email 1,106 emergency radiologists around the U.S. over a four-week period earlier this year.

The form drew responses from 327 survey recipients (29.6 percent), 284 of whom (87 percent) were fulltime practitioners.  

Of the 327, more than a third (118, or 36 percent) did no annual overnight shifts at all, while 81 (24.9 percent) worked 182 or more overnights and 51 (15.6 percent) worked 119.

Analyzing the response data with hypothesis testing and logistic regression modeling, Hanna and team found a significant association between average overnight shifts worked per year and both perceived negative health effects (P < .01) and negative impact on memory (P < .01).

They also found an inverse association between overall job enjoyment and number of annual overnight shifts (P < .05).

Meanwhile, they found, when shift length is held constant, the odds of agreeing to the statement “I enjoy my job” for radiologists who work no overnights is 2.21 times greater than for radiologists who work at least 119 overnight shifts.

In their discussion, the authors observe that some practice actions reflected in the responses “appear unsustainable,” while some others are not supported by the literature.

They peel off three findings in these categories for closer consideration.

56 percent of respondents who work more than one type of shift indicated that they rotate shifts in random fashion, rather than the clockwise rotation shown to improve sleep patterns. In designing a rotating shift-work schedule, direction of rotation and speed of rotation are the most important variables, Hanna et al. write. “Many radiologists in our survey work rotating shifts, and there is nonradiology data suggesting that this carries higher safety risks than fixed after-hours shifts. Indeed, we show that among radiologists who answered ‘agree’ or ‘strongly agree’ to job impact on memory, the highest percentage was from the group working one to 100 overnight shifts annually.”

6 percent of surveyed radiologists work 11- to 12-hour shifts and 3 percent work 12+-hour shifts. The authors cite prior research showing that, after long clinical shifts, radiologists have reduced ability to focus, symptoms of eye fatigue and oculomotor strain, and reduced ability to detect fractures. “Based on those results, it is not surprising that radiology residents working 12-hour shifts show increased error rates in the final 2 hours of their shifts,” they write, “although to our knowledge this study has never been conducted in board-certified radiologists.”

8 percent of respondents who work overnight shifts reported working more than 26 weeks of nights annually. However, the authors point out, there is no specific literature placing a cap on the reasonable amount of annual night work.

“Some practices engage in potentially unsustainable schedules, including random shift rotation, shifts that are 11 hours or longer, and annual night shift burden exceeding 26 weeks,” the authors underscore in their concluding takeaways. “Fifty percent of emergency radiologists occasionally feel overwhelmed at work, and efforts should be made to optimize the reading room environment to lessen this number, which may decrease the frequency of radiologist burnout.”

The authors include in their report free-text comments from the respondents, and these include positive as well as negative tilts. Some examples of the former:

• “Switching to nights was a huge improvement in regards to personal lifestyle. I now have time to see my three kids. My job is now much less stressful and physically demanding.”
• “For whatever reason, my physiology is well suited to night work.”
• “A big reason why I do overnight radiology is that I enjoy the often very interesting emergency radiology cases that typically come during my overnight shifts.”

Among the limitations the authors acknowledge in their study design are the relatively low response rate and the possibility for distortions due to the researchers’ reliance on e-mail lists from large enterprises. These included the American Society of Emergency Radiology, the 500-rad teleradiology firm vRad and emergency/overnight radiologists at six private practice groups with more than 50 total physicians.