Doctors’ Extended Shifts as Risk to Practitioner and Patient: South Africa as a Case Study

Koot Kotze, Helene-Mari van der Westhuizen, Eldi van Loggerenberg, Farah Jawitz and Rodney Ehrlich
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Koot Kotze: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, UK
Helene-Mari van der Westhuizen: Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford OX2 6GG, UK
Eldi van Loggerenberg: Helen Joseph Hospital, Rossmore, Johannesburg 2092, South Africa
Farah Jawitz: Saïd Business School, University of Oxford, Oxford OX1 1HP, UK
Rodney Ehrlich: Division of Occupational Medicine, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town 8001, South Africa

IJERPH, 2020, vol. 17, issue 16, 1-10

Abstract: Extended shifts are common in medical practice. This is when doctors are required to work continuously for more than 16 h, with little or no rest, often without a maximum limit. These shifts have been a part of medical practice for more than a century. Research on the impact of fatigue presents compelling evidence that extended shifts increase the risk of harm to patients and practitioners. However, where the number of doctors is limited and their workloads are not easily reduced, there are numerous barriers to reform. Some of these include a perceived lack of safer alternatives, concerns about continuity of care, trainee education, and doctors’ preferences. As such, working hour reorganisation has been contentious globally. South Africa, a middle-income country where extended shifts are unregulated for most doctors, offers a useful case study of reform efforts. The South African Safe Working Hours campaign has promoted working hour reorganization through multi-level advocacy efforts, although extended shifts remain common. We propose that extended shifts should be regarded as an occupational hazard under health and safety legislation. We suggest options for managing the risks of extended shifts by adapting the hierarchy of controls for occupational hazards. Despite the challenges reform pose, the practice of unregulated extended shifts should not continue.

Keywords: shift work; extended shifts; on-call; working hour organization; duty hours; fatigue; occupational hazards; sleep deprivation (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
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