A rational approach to shift work in emergency medicine.

As the only medical specialists who routinely provide continuous 24-hour daily coverage, emergency physicians are all too familiar with the demands of shift work. Although shift work has a pervasive effect on the practice of emergency medicine and is regarded as a major stressor, it has received little attention per se in our literature and in our residency training programs. We review the principles of circadian rhythms and their effects on sleep and alertness, and recommend ways by which emergency physicians can better schedule themselves to mitigate the negative consequences of working shifts.