Amid the coronavirus disease 2019 (COVID-19) pandemic, the American Academy of Sleep Medicine has issued a position statement noting the significance of sufficient sleep among physicians. An insufficient amount of sleep has been linked to physician burnout.
In recent years, there have been modest declines in physician burnout, with the overall burnout rates decreasing from 2011 to 2017 (39.8% vs 28.1%). Although promising, physicians remain at heightened risk for burnout compared with other fields, and this may intensify due to COVID-19. In a previous study, physician burnout was associated with an increased risk of patient safety incidents, poorer quality of care, and reduced patient satisfaction.
In the statement, which was recently published in Journal of Clinical Sleep Medicine, senior author Indira Gurubhagavatula, MD, associate professor of medicine at the Veteran's Administration Medical Center at the University of Pennsylvania and chair of the AASM Public Safety Committee, noted potential reasons behind physician burnout. "Physicians tend to reside in a culture of working hard at the expense of self-care, including adequate sleep. We need a major culture shift to allow physicians to get the sleep they need," she said.
The authors noted that recent estimates of physician burnout have exhibited higher rates, which contradict prior reductions, amounting to 50% or more with midcareer physicians at highest risk. The researchers highlight that the prevalence of shift-work schedules, high workload, long hours, sleep interruptions, and insufficient recovery sleep have been linked to widespread burnout.
In the statement, the authors called for more research to explore sleep disruption, deprivation, and circadian misalignment in physicians, with potential interventions such as rest breaks, designated nap areas, counseling, and education on sleep health and hygiene warranting further investigation. "Some coping habits, such as the use of alcohol or excessive caffeine, can worsen sleep quality and quantity, which may in turn impact the ability to function at high levels. Healthy sleep is one of the major restorative activities that will help health care workers cope and perform well," said Gurubhagavatula.
As the study authors note, the high prevalence of physician burnout in those at the peak of their careers can lead to early retirement, which can negatively impact the total physician workforce. With increased dependence and worsening conditions for physicians being reported amid the COVID-19 pandemic, Gurubhagavatula stresses that sufficient sleep is needed now more than ever. "Insomnia related to stress and anxiety about the pandemic may compound the physical, emotional, and cognitive demands of working in high-stress environments."
Kancherla BS, Upender R, Collen JF, et al. Sleep, fatigue and burnout among physicians: an American Academy of Sleep Medicine position statement [published online February 28, 2020]. J Clin Sleep Med. doi: 10.5664/jcsm.8408.