Creating sustainable working environments: working hours of Junior Doctors during the COVID-19 pandemic

Authors: Dr Alvaro Cerame del Campo, Dr Francisco Ribeiro Mourao, Dr Mathias Korner, Dr Antanas Montvila, Mr Dimitri Eerens, Dr Ellen McCourt

Context
Junior doctors’ (JDs) working conditions have been linked to have an effect on physician’s wellbeing, training outcomes and patient safety. Reducing working hours where there is excess has proven to improve patient’s safety while not impacting postgraduate training (PGT) negatively.
Methods
We present a summary of the compliance with the European Working Time Directive (EWTD) gathered by the European Junior Doctors (EJD) member countries during the COVID-19 pandemic, alongside with a review of the relevant literature regarding working hours and workforce sustainability.
Results
Our results show that during the COVID-19 pandemic (2020-2022) working conditions have deteriorated, particularly regarding excessive working hours. Moreover, a trend was observed in the exacerbation of pre- existing violations of the EWTD occurs due to the fact that many healthcare institutions were already, previously to the pandemic, understaffed and underprepared for the increase in demand. The majority of the surveyed member organisations (83%) reported that during the COVID-19 pandemic JDs exceeded the maximum hours set by the European directive. (ie.75% of Spanish residents worked over 48 hours per week and saw an increase in their on-call shifts during that period of time) The French JD organisation ISNI has pointed to excessive working hours as one of the factors behind seven suicides of JDs in 2020 and 2021 in France, where working times amount to up to 58h/week on average and up to 70h/week in surgical specialties. Despite the fact that many countries reported the existence of monitoring systems for working hours, only a few reported (12%) a penalty system in case of transgressions/non-compliance.
Discussion
Excessive working hours beyond the limits set by the EWTD and the absence of adequate resting times and facilities pose a serious threat to JDs wellbeing. Available literature shows that physicians with high burnout rates, high hourly loads, long hours and working extended night-shifts have a strong negative impact on patient safety. Evidence suggests that reducing working hours from long or continuous shifts and ensuring appropriate rest is linked to fewer medical errors and fewer accidents. Moreover, reducing working hours where there is excess does not negatively impact PGT or patient outcomes.
More data needs to be gathered on EWTD/working hours compliance in JDs and monitoring systems must be implemented, along with penalty systems in case of non-compliance. Reducing working hours and ensuring adequate rest time has proven to be a beneficial measure to improve JDs wellbeing and patient safety while not negatively impact PGT.