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European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence.

ABSTRACT: To summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians.A systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria.Physicians of any medical, surgical or community specialty, working in any possible setting (hospitals, primary healthcare, etc), as well as trainees, residents, junior house officers or postgraduate interns, were included.The total number of participants was 14?338.Health effects classified under the International Classification of Diseases (ICD-10).Over 3000 citations and 110 full articles were reviewed. From these, 11 studies of high or intermediate quality carried out in North America, Europe and Japan met the inclusion criteria. Six studies included medical residents, junior doctors or house officers and the five others included medical specialists or consultants, medical, dental, and general practitioners and hospital physicians. Evidence of an association was found between percutaneous injuries and road traffic accidents with extended long working hours (LWH)/days or very LWH/weeks. The evidence was insufficient for mood disorders and general health. No studies on other health outcomes were identified.LWH could increase the risk of percutaneous injuries and road traffic accidents, and possibly other incidents at work through the same pathway. While associations are clear, the existing evidence does not allow for an established causal or 'dose-response' relationship between LWH and incidents at work, or for a threshold number of extended hours above which there is a significantly higher risk and the hours physicians could work and remain safe and healthy. Policymakers should consider safety issues when working on relaxing EWTD for doctors.

SUBMITTER: Rodriguez-Jareno MC

PROVIDER: S-EPMC4091509 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence.

Rodriguez-Jareño Maria Cruz MC Demou Evangelia E Vargas-Prada Sergio S Sanati Kaveh A KA Skerjanc Alenka A Reis Pedro G PG Helimäki-Aro Ritva R Macdonald Ewan B EB Serra Consol C

BMJ open 20140707 7

<h4>Objective</h4>To summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians.<h4>Design</h4>A systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria.<h4>Setting</h4>Physicians of any medical, surgical or community ...[more]

PMID: 25001394

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Project description:BackgroundThe European Working Time Directive (EWTD) became law in 1993 but only applied to doctors in training in the United Kingdom in 2004. The trainees have in consequence had a reduction in their working hours but also a change to a shift pattern of working. For craft specialities, such as anaesthesia, there are concerns that a reduction in working hours has also led to a reduction in the time available for learning and that ultimately this may affect patient care. However, there is scant research on the perceptions of trainees concerning the impact of the EWTD on their training and working lives. This study investigated what the anaesthetic Specialist Registrars (SpRs) on the Mersey Deanery SpR rotation perceived to be training and also what effect the EWTD has had on that training and their quality of life, both within and outside work.MethodsThe project was a cross sectional survey, using a quantitative questionnaire with qualitative free text comments which were aggregated into overarching themes and sub themes.Results117 SpRs were sent questionnaires in April 2005; 73 completed questionnaires were returned (response rate 62.4%). Hierarchies of training opportunities emerged with training by consultants being most valued. 71.8% (95% CI 60.7-81.3) of trainees believed the EWTD has had a deleterious effect on their training and experience and 74.3% (95% CI 63.2-83.4) thought that they will be less prepared for a consultant post. 69.9% (95% CI 58.7-79.5) considered that their quality of life outside work had deteriorated, with only 15% (95% CI 8.3-24.6) finding improvement. 38.6% (95% CI 27.8-50.3) felt that they were not functioning as well as doctors, only 14.3% (95% CI 7.6-23.9) noting improvement. The trainees were still positive about anaesthesia and 73.2% (95% CI 62.2-82.5) would recommend this specialty to a student.ConclusionThe majority of anaesthetic SpRs in the Mersey Deanery have not welcomed the changes brought by the EWTD to their training, experience and quality of life outside work.

Project description:BackgroundMaintaining a health professional workforce in rural and remote areas poses a significant challenge internationally. A range of recruitment and retention strategies have had varying success and these are generally developed from the collective experience of all health professions, rather than targeted to professional groups with differing educational and support contexts. This review explores, compares and synthesises the evidence examining the experience of early career rural and remote allied health professionals and doctors to better understand both the profession specific, and common factors that influence their experience.MethodsQualitative studies that include early career allied health professionals' or doctors' experiences of working in rural or remote areas and the personal and professional factors that impact on this experience were considered. A systematic search was completed across five databases and three grey literature repositories to identify published and unpublished studies. Studies published since 2000 in English were considered. Studies were screened for inclusion and critically appraised by two independent reviewers. Data was extracted and assigned a level of credibility. Data synthesis adhered to the JBI meta-aggregative approach.ResultsOf the 1408 identified articles, 30 papers were eligible for inclusion, with one rated as low in quality and all others moderate or high quality. A total of 23 categories, 334 findings and illustrations were aggregated into three synthesised findings for both professional groups including: making a difference through professional and organisational factors, working in rural areas can offer unique and rewarding opportunities for early career allied health professionals and doctors, and personal and community influences make a difference. A rich dataset was obtained and findings illustrate similarities including the need to consider personal factors, and differences, including discipline specific supervision for allied health professionals and local supervision for doctors.ConclusionsStrategies to enhance the experience of both allied health professionals and doctors in rural and remote areas include enabling career paths through structured training programs, hands on learning opportunities, quality supervision and community immersion.Systematic review registration numberPROSPERO CRD42021223187.

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European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence.

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European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence.

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