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A Gender-Based Analysis of Work Patterns, Fatigue, and Work/Life Balance Among Physicians in Postgraduate Training

Gander, Philippa PhD; Briar, Celia PhD; Garden, Alexander MB, ChB, PhD; Purnell, Heather MSc (Hons); Woodward, Alistair MBBS, PhD

doi: 10.1097/ACM.0b013e3181eabd06
Gender Issues

Purpose To document fatigue in New Zealand junior doctors in hospital-based clinical training positions and identify work patterns associated with work/life balance difficulties. This workforce has had a duty limitation of 72 hours/week since 1985. The authors chose a gender-based analytical approach because of the increasing proportion of female medical graduates.

Method The authors mailed a confidential questionnaire to all 2,154 eligible junior doctors in 2003. The 1,412 respondents were working ≥40 hours/week (complete questionnaires from 1,366: response rate: 63%; 49% women). For each participant, the authors calculated a multidimensional fatigue risk score based on sleep and work patterns.

Results Women were more likely to report never/rarely getting enough sleep (P < .05), never/rarely waking refreshed (P < .001), and excessive sleepiness (P < .05) and were less likely to live with children up to 12 years old (P < .001). Fatigue risk scores differed by specialty but not by gender.

Fatigue risk scores in the highest tertile were an independent risk factor for reporting problems in social life (odds ratio: 3.83; 95% CI: 2.79–5.28), home life (3.37; 2.43–4.67), personal relationships (2.12; 1.57–2.86), and other commitments (3.06; 2.23–4.19).

Qualitative analyses indicated a common desire among men and women for better work/life balance and for part-time work, particularly in relation to parenthood.

Conclusions Limitation of duty hours alone is insufficient to manage fatigue risk and difficulties in maintaining work/life balance. These findings have implications for schedule design, professional training, and workforce planning.

Dr. Gander is director, Sleep/Wake Research Centre, Massey University, Wellington, New Zealand.

Dr. Briar was, at the time of this study, senior lecturer, Department of Sociology, Social Policy, and Social Work, Massey University, Palmerston North, New Zealand, and is a freelance writer and researcher in New Zealand and the United Kingdom.

Dr. Garden was, at the time of this study, clinical associate director, Sleep/Wake Research Centre, Massey University, Wellington, New Zealand, and is currently clinical scientific leader, Simulation and Skills Centre, Capital and Coast District Health Board, Wellington, New Zealand.

Ms. Purnell was, at the time of this study, junior research officer, Sleep/Wake Research Centre, Massey University, Wellington, New Zealand, and is currently clinical research associate comonitor, Biogen Idec Ltd., London, United Kingdom.

Dr. Woodward is head, School of Population Health, University of Auckland, Auckland, New Zealand.

Correspondence should be addressed to Dr. Gander, Sleep/Wake Research Centre, Massey University, Private Box 756, Wellington, New Zealand; telephone: (644) 380-0633; fax: (644) 380-0629; e-mail:

© 2010 Association of American Medical Colleges