Different views about work-hour limitations in medicine: a qualitative content analysis of surgeons', lawyers', and pilots' positive and negative arguments.

Reto M Kaderli,Robert K Hills,Adrian P Businger

doi:10.1371/journal.pone.0113578

Abstract

BackgroundWhereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate. The aim of the present study was to evaluate arguments in favour of and against work-hour limitations in medicine given by Swiss surgeons, lawyers, and pilots.MethodsAn electronic questionnaire survey with four free-response items addressing the question of what arguments speak in favour of or against work-hour limitations in general and in medicine was sent to a random sample of board-certified surgeons, lawyers in labour law, and pilots from SWISS International Airlines Ltd.ResultsIn all, 279/497 (56%) of the respondents answered the survey: 67/117 surgeons, 92/226 lawyers, and 120/154 pilots. Support for work-hour limitations in general and in medicine was present and higher among lawyers and pilots than it was in surgeons (p<0.001). The latter agreed more with work-hour limitations in general than in medicine (p<0.001). The most often cited arguments in favour of work-hour limitations were “quality and patient safety,” “health and fitness,” and “leisure and work-family balance,” whereas the lack of “flexibility” was the most important argument against. Surgeons expected more often that their “education” and the “quality of their work” would be threatened (p<0.001).ConclusionsWork-hour limitations should be supported in medicine also, but a way must be found to reduce problems resulting from discontinuity in patient care and to minimise the work in medicine, which has no education value.

Highlights

Whereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate
The circumstances that led to the tragic death of Libby Zion in a New York teaching hospital in 1984 opened a debate about patient safety in medicine [1]
Extended work shifts were found to be linked with more serious medical errors and impaired performance in simulated surgical tasks [3,4,5]

Summary

Introduction

Whereas work-hour regulations have been taken for granted since 1940 in other occupational settings, such as commercial aviation, they have been implemented only recently in medical professions, where they lead to a lively debate. Whereas the US Accreditation Council for Graduate Medical Education implemented nationwide duty-hours standards beginning July 1, 2003, with work hours limited to 80 hours per week for junior doctors [8], work-hour limitations for all residency programs in Switzerland were set on January 1, 2005, by the Swiss government [9]. They include a 50-hour weekly limit with a maximum overtime of 2 hours per day and 140 hours per year, respectively, and at least 11 hours of rest between duty periods. Rest time may be reduced to 9 hours several times per week, as long as the average resting time over a two-week period amounts to 12 hours daily

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