Limiting resident shifts to 16 hours is evidence informed, ethically sound

In the article, “Do no harm, even to residents. Rethinking extended-hour call shifts”¹ published in the September 2025 issue of Canadian Family Physician, author Dr Nicholas Preobrazenski highlights the growing concern regarding extended-hour call shifts and their impact on resident wellness and patient safety. Across Canada, resident duty hours vary by province, specialty, and program culture. Any scheduling model must remain pedagogical, reflect attending practice realities, and align with the resident’s level of training.

Evidence links prolonged duty hours with cognitive impairment, decision fatigue, increased medical errors, and burnout.^2,3 Provincial case law has recognized that 24-hour shifts can infringe fundamental rights¹ under the Canadian Charter of Rights and Freedoms. Yet extended shifts remain common outside Quebec.

Cultural and hierarchical barriers persist. Residents often hesitate to voice concerns about unsafe workloads for fear of being perceived as less dedicated or jeopardizing future career opportunities. Addressing this requires broader cultural change in medicine. We must value wellness, psychological safety, and open dialogue alongside competence and dedication.

Limiting shifts to 16 hours is evidence informed, ethically sound, and aligns resident schedules with those of other health care professionals, supporting safer and more sustainable care delivery.^4,5 Reform must balance resident wellness with sufficient clinical exposure and the steep learning curve inherent in physicianship, ensuring educational objectives are preserved. Achieving this requires more than scheduling adjustments; it demands strategic workforce investment to expand physician capacity, strengthen coverage, and provide reliable backup systems.

Safer and sustainable training environments will only be possible with more boots on the ground, addressing physician shortages and creating opportunities to recruit and spark interest in the versatile and essential specialty of family medicine.

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