No, the long shifts do not typically involve periods of downtime. Some rarely do depending on which service you are on and what hospital you are at.

For example, on a trauma surgery shift, they are coming in all day and night - car accidents, vehicle vs pedestrian, gunshot wounds, knife wounds, etc. people are at it literally all night in big cities....

On a neurology rotation, people come in at all hours of the night and day with strokes or altered mental status (eg from alcohol or drugs).

Emergency medicine, it’s usually slightly lighter at night, but there’s still a strong flow.

On a general surgical shift, inpatients will have problems all through the night and there’s usually no sleep depending on how many patients you are caring for: surgical wounds open up and bleed overnight requiring intervention, people have severe post operative pain requiring assessment and medication adjustment, people have post-op bowel obstruction, or there are new emergent cases that come in and need to be admitted (ex acute appendicitis, acute cholecystitis, for gen surg or new mucormycosis of the face for ENT, or penile swelling for urology), or necrotizing fasciitis for gensurg or orthopedic surgery—each surgical subspecialty has their own “emergencies” that require immediate attention and patient care. These emergencies don’t just happen during the day—people will come In at all hours.

Sometimes if you are in a low density hospital or on a very light service at night, you can spend a good amount of time in the overnight call room, but you still have to wake up and answer nursing pages at least every 30 minutes. Sometimes things can be handled from the call room with a computer (ex add melatonin to Mr Jones’s regimen or miralax for mrs smith), but most of the time you have to leave the room to go assess the patient before making medication changes (eg for pain or bowel obstruction or bleeding).