New Delhi: The ongoing discourse around long working hours, reignited by Larsen & Toubro, Chairman, SN Subrahmanyan’s advocacy for a 90-hour workweek, has brought renewed focus to the sustainability of gruelling schedules. While much of the debate revolves around corporate environments, the medical profession has long endured such intense demands. For doctors in training, a 90-hour week is not a theoretical challenge—it is an entrenched reality. This raises critical questions about the toll on healthcare professionals and, by extension, patient care.
In India, junior doctors frequently work 80–100 hours a week, with shifts often extending to 24–36 hours. This is particularly common during residency or in government hospitals that handle high patient volumes.
Several factors contribute to these extended hours: frequent night shifts, on-call duties that demand availability even after long hours, working on weekends and holidays with minimal time off, and a high patient-to-doctor ratio with limited support staff—all of which amplify workloads.
In contrast, Western countries enforce stricter regulations to protect doctors’ well-being and patient safety. India, however, lacks consistent enforcement of such standards, leaving junior doctors to face overwhelming workloads due to resource constraints and patient overload.
A Grueling Reality for Doctors
“For a doctor in training, working more than 90 hours a week is common,” says Dr. Satish Koul, Senior Director, Internal Medicine, Fortis Hospital. “Resident doctors, junior doctors, and even fresh MBBS graduates often endure long hours and sleepless nights. Most training institutes don’t provide night offs, and the disruption of sleep leads to significant long-term repercussions.”
Dr. Koul highlights the dual impact of such schedules, “Physically, exhaustion compromises muscle reflexes and overall stamina, affecting professional outcomes. Mentally, emotional instability is a major concern, with high rates of suicide observed among doctors. Chronic sleep deprivation also disrupts circadian rhythms, leading to metabolic diseases such as early-onset diabetes and hypertension. These stresses contribute to doctors often living shorter lives compared to the general population.”
The Sleep Factor
Sleep deprivation is a critical concern in discussions about long work hours. “Sleep is not just about duration but also quality,” emphasises Dr. Sandeep Nayar, Principal Director & HOD of Chest & Respiratory Diseases at BLK-Max Super Speciality Hospital. “Insufficient sleep is linked to mental and cognitive health issues, chronic diseases, and even work-related injuries. For medical professionals, this can manifest as impaired concentration and reaction time, which are critical for performing procedures or managing patients.”
Dr. Nayar adds, “Chronic sleep deprivation affects every system in the body. It increases the risk of cardiovascular diseases, diabetes, anxiety, and depression. It weakens the immune system, making individuals more susceptible to infections. Sleep-deprived doctors not only compromise their own health but also the quality of care they provide.”
Impact on Cognitive and Physical Performance
Explaining the importance of sleep as a crucial biomarker for both physical and mental health, Dr. Preet Singh, Sr. Consultant Clinical Psychology and Chief Medical Officer, Lissun, states, “Studies have shown that prolonged or repeated episodes of partial sleep deprivation—getting less than seven hours of sleep—deteriorate physical and mental health outcomes. Factors like sleep quantity, timing, and recovery time after long duty shifts are critical determinants of performance and safety. Sleep-deprived doctors face a significantly higher risk of errors, taking longer to complete surgeries and sometimes compromising outcomes.”
Fatigue due to long working hours is one of the most common contributors to medical errors. Exhaustion impairs judgement, concentration, and decision-making, leading to mistakes in medication administration, surgical procedures, and diagnostic decisions.
Dr. Girish Soni, Neurologist, Lilavati Hospital in Mumbai, explains, “Sustained sleep deprivation impacts memory, focus, and decision-making, causing brain fog and confusion. Physically, it leads to fatigue, stress, and an increased risk of cardiovascular diseases. Over time, it can also contribute to obesity, diabetes, and musculoskeletal discomfort.”
Dr. Vishwanathan Iyer, Brain and Spine surgeon, Zynova Shalby Hospital in Mumbai, adds, “Chronic sleep deprivation accelerates brain decline, disrupts hormonal balance, and weakens the immune system. For surgeons like myself, a lack of sleep directly affects stamina and concentration, both critical for successful outcomes in complex surgeries.”
The Larger Implications
Doctors, by the very nature of their work, are constantly exposed to infectious diseases and high-stress environments. “The incidence of tuberculosis and other infections is notably higher among doctors,” observes Dr. Koul.
“Despite high emotional resilience, the mental and physical toll of their profession is significant. Suicide rates among doctors are alarmingly high, and prolonged working hours disrupt circadian rhythms, leading to hormonal imbalances and metabolic changes. Doctors face a higher prevalence of diabetes, hypertension, and heart disease at an earlier age, which reduces their life expectancy,” Dr Koul added.
A Call for Systemic Change
While the debate around a 90-hour workweek unfolds in corporate sectors, it is crucial to highlight its long-standing implications in the medical profession. The health of healthcare professionals directly impacts the quality of care they provide.
As Dr. Nayar aptly puts it, “Inadequate sleep and long working hours don’t just affect the individual; they ripple through to those who depend on them.”
It is high time for systemic reforms in the healthcare sector. Enforcing work-hour limits, ensuring adequate rest periods, and providing mental health support for doctors are not just ethical imperatives but practical necessities for ensuring patient safety and sustaining the well-being of those who dedicate their lives to healing others.
Investing in the health of doctors is not an expense—it is a safeguard for the entire healthcare system.
