Sleepless in Scrubs: The myth of the invincible doctor

“How little did you sleep last night?”

That’s a conversation often overheard wherever medical students and residents gather, sometimes turning into a competition of who slept the least and still managed to function. It’s spoken half-jokingly, half-proudly, as if sleep deprivation were a badge of honour, a rite of passage into the profession.

While trainees may joke about exhaustion, its impact is anything but humorous. Chronic fatigue in medical education is not just normalized but is also institutionalized. It’s a symptom of a system that has failed to evolve with what we now understand about human performance, cognition and safety. Unlike other high-stakes industries such as aviation or freight transport, where fatigue is seen as a liability and managed accordingly, medicine continues to romanticize suffering in silence.

This is the hidden curriculum of medical education: an unspoken lesson that being a “good doctor” means pushing yourself past your limits. This myth of invincibility isn’t just toxic but also dangerous.

In contrast, the aviation industry takes fatigue seriously. Federal regulations limit pilots to a specific number of flight hours, and predictive models are used to prevent fatigue-related impairment. If a pilot shows up to work tired, they’re considered a liability not a hero. Airlines don’t expect pilots to land planes after 24 hours without rest, yet many hospitals expect the equivalent of their resident physicians.

In Canada, the policies surrounding shift lengths vary dramatically. Quebec has taken a progressive step in 2012 by limiting continuous duty for residents to 16 hours. This was before recently introducing its controversial Bill 2, which threatens to increase pressure on health professionals, according to the Canadian Medical Association. However, in most other provinces, shifts can extend up to 24-26 hours, often with little sleep in between. These extended hours are justified by arguments for continuity of care and maximizing learning. But these justifications increasingly fall flat when weighed against research on burnout, error rates and mental health.

A 2024 study in BMC Medical Education found that the culture of endurance embedded in medical training leads to higher rates of emotional exhaustion and reduced empathy in trainees, key components of physician burnout. Another study out of the University of Toronto demonstrated that extended shift lengths are associated with more frequent medical errors, raising concerns about both physician and patient safety.

Yet, despite this evidence, many trainees feel pressure to remain silent. To speak out against these conditions is to risk being perceived as weak, ungrateful or unfit for the profession. After all, didn’t generations before us endure the same? Tradition alone, however, is not a justification. Just because something has always been done a certain way does not mean it should continue.

The glorification of physicians, through pop culture and now social media, further complicates the issue. TV shows like The Good Doctor, Grey’s Anatomy and House MD portray doctors as simultaneously brilliant, tireless and often superhuman. Social media has introduced a new character: the “medfluencer,” a polished and curated image of medical perfection. These portrayals obscure the daily reality of the profession and discourage honest conversations about vulnerability, limits and burnout.

It is essential that we dismantle this myth of the invincible doctor.

Being a doctor is a job. An important, often meaningful job, but not one that should require the sacrifice of personal well-being or basic human needs. Just as we advise our patients to sleep, eat and rest to preserve health and function, we must extend that same care to ourselves.

Institutions have a critical role to play. Fatigue risk management systems, akin to those in aviation, should be implemented across all training environments. These systems use predictive modeling, rest requirements and scheduling algorithms to mitigate risk. There must also be alignment across provinces in regulating shift lengths, with limits informed by evidence, not tradition or convenience. The current patchwork of rules creates unnecessary inequities in training and safety standards.

In parallel, medical education must more explicitly challenge the hidden curriculum. This involves encouraging conversations about wellness, providing protected time for rest and fostering a culture in which asking for help is seen as a strength rather than a flaw. Mentorship models should reward not just clinical excellence, but also healthy boundary-setting and teamwork.

As individuals, we can also take steps. Trainees can speak up, support one another and push back against toxic norms. Senior physicians can model healthier behaviours, check in with learners and advocate for safer scheduling.

Medical students, residents and staff alike must remember: Working while exhausted is not noble; it is a risk to us and to our patients.