Abstract Introduction Sleep deprivation impairs attention, memory, and executive function, creating serious risks for physicians making rapid, high-stakes decisions. Chronic sleep loss contributes to clinical errors, dysregulated stress pathways, inflammation, and burnout. Because long hours, overnight shifts, and unpredictable schedules are common in U.S. healthcare, insufficient sleep has become normalized, undermining both physician well-being and patient safety. We hypothesize that chronic sleep deficiency in U.S. physicians leads to measurable declines in cognitive performance and safety, influenced by institutional factors such as staffing and workplace culture. Methods A PubMed search using “sleep deprivation, physicians or doctors, U.S.” identified 284,453 articles. Restricting results to full clinical research–excluding abstracts, reviews, conference summaries, and non–peer-reviewed content–in English from 2020–2025 yielded 6,461 studies. Titles, abstracts, and full texts were screened using standardized criteria, excluding studies that did not explicitly measure sleep. Thirteen studies met inclusion criteria, and handsearching identified two additional full-text articles, for a total of 15. Results Across these studies, 34,049 U.S. physicians (~19,500 trainees and ~14,500 attendings) across internal medicine, pediatrics, surgery, anesthesiology, emergency medicine, neurology, and primary care from ≥96 institutions were represented. Study designs included 8 randomized or cluster-randomized trials, 1 national cohort, 1 pre–post intervention, and 5 cross-sectional studies. Sleep deprivation was measured using 24–28-hour shifts, the monthly frequency of such shifts (reduced from 3.9 to 0.2), 4 hours of sleep on call, and validated sleep-impairment scales capturing acute and chronic fatigue. All five studies studying cognition reported measurable impairment, including 51-point declines in vigilance and 100% increases in attentional lapses. Burnout worsened in all 10 studies assessing the outcome, while interventions such as coaching, mindfulness, and physiological feedback produced improvements (e.g., 30.1% reduction in interpersonal disengagement). Safety outcomes showed 40% fewer percutaneous injuries after duty-hour reforms and significantly fewer serious PICU medical errors under ≤16-hour shifts. Conclusion Chronic sleep deprivation consistently reduces physician cognitive performance, increases burnout, and elevates medical errors. Risks peak during extended shifts, whereas system-level scheduling reforms offer the strongest protective effects. Support (if any) None
Lew et al. (2026) studied this question.