Re: Physician health

With up to 75% of physicians reporting burnout,[1] it is now more important than ever to understand the evidence on physician wellness. The Canadian Association of Interns and Residents (CAIR) supports efforts like those of Ms Tyzuk [Physician health: A review of lifestyle behaviors and preventive health care among physicians, BCMJ 2012;54:419-423] to highlight the importance of physician wellness interventions.

However, her conclusion that “…  cutbacks to resident hours means that health care facilities will have to find ways to cover the extra hours traditionally worked by residents, either by hiring additional staff or by increasing the workload of more senior physicians” is an over-generalization of the article by Fletcher and colleagues.[2] In this article, the majority of the new schedules were simply rearrangements of existing schedules; in fact, only 8 of the 54 studies reported hiring any additional staff.

Such misinterpretations necessitate clarification because there are already too many myths impeding improvement of physician fatigue management. For example, the idea that residents are advocating for “cutbacks” to work fewer hours is also a myth. Rather, Canadian residents are calling for a reduction in the number of consecutive duty hours.[3] This distinction is important because models exist (such as in Quebec[4]) where residents no longer work over 16 consecutive hours, yet still work virtually the same total number of hours. With such models, coverage for “extra hours” is not required.

CAIR wholeheartedly joins Ms Tyzuk in calling for physicians to “embrace changes that promote optimal physician wellness as an avenue to improved patient care.” We owe it to our colleagues and our patients to adequately understand the evidence, and to eliminate the myths that impede such positive changes.

—Simon Moore, MD, CCFP
President, Canadian Association of Internes and Residents
—Mathieu Dufour, MD, FRCPC
Vice-President, Canadian Association of Internes and Residents


1.    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: A missing quality indicator. Lancet 2009;374(9702):1714-1721.
2.    Fletcher KE, Davis SQ, Underwood W, et al. Systematic review: Effects of resident work hours on patient safety. Ann Intern Med 2004;141:851-857.
3.    Canadian Association of Internes and Residents. Canadian Patient and Physician Safety and Wellbeing: Resident Duty Hours. Accessed 5 December 2012.
4.    Fédération des médicins residents du Quebec. Maximum 16-hour call duty in an establishment… A reorganization backed by convincing scientific data. Accessed 5 December 2012.

Simon Moore, MD, CCFP, Mathieu Dufour, MD, FRCPC,. Re: Physician health. BCMJ, Vol. 55, No. 1, January, February, 2013, Page(s) 9 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply