Abstract
Compiling a daily hospital roster which complies with existing laws and tariff regulations and meets the requirements for ongoing professional training while also taking the legal regulations on the health of employees into account makes planning the duty roster a challenge. The aim of this study was to obtain a realistic picture of existing duty roster systems and of the current workloads of obstetricians in Germany. This online survey was sent to 2770 physicians training to become obstetricians or specializing in specific areas of obstetric care. The survey consisted of an anonymized 95-item questionnaire which collected data on different types of duty roster systems and the workload of obstetricians in Germany for the period from 17.02.2015 to 16.05.2015. Out of a total of 2770 physicians who were contacted, 437 (16%) completed the questionnaire. Across all forms of care, the care provided outside normal working hours usually (75%) consisted of a combination of regular working times and on-call duty or even consisted entirely of standby duty. Level I perinatal centers were most likely 20% (n = 88) to have a shift system in place. Working a shift system was significantly more common in care facilities which had previously carried out a job analysis. The number of physicians in hospitals who are present during the night shift was higher in facilities with higher numbers of births and in facilities which offered higher levels of care. In addition to regularly working overtime and the fact that often not all the hours worked were recorded, it was notable that the systems used to compile duty rosters often did not comply with legal regulations or with collectively agreed working hours nor were they compatible with the staff planning requirements. The results of this study show that the conditions of work, the working times, and the organization of working times in obstetric departments are in need of improvement. Recording the actual times worked together with an analysis of the activities performed during working times and while on standby would increase the level of transparency for employers and employees.
Highlights
Since 2005, all perinatal centers (PNCs) in Germany are classified into one of four levels of care, based on the complexity of the care provided at the center and on the regional provision of care and health services: level I perinatal centers I (PNC I), level II perinatal centers (PNC II), obstetric departments offering secondary care and short-term perinatal care (PC), and maternity hospitals which offer standard maternity care (MH)
The distribution of respondents according to the level of perinatal care offered by their facility is shown in ▶ Fig. 1
We found no significant differences between facilities offering short-term perinatal care and level II PNCs (p = 0.42). 31 % of all participants (n = 137) reported that no specialist physician was on duty in the hospital during the night shift
Summary
Since 2005, all perinatal centers (PNCs) in Germany are classified into one of four levels of care, based on the complexity of the care provided at the center and on the regional provision of care and health services: level I perinatal centers I (PNC I), level II perinatal centers (PNC II), obstetric departments offering secondary care and short-term perinatal care (PC), and maternity hospitals which offer standard maternity care (MH). Level I and level II perinatal centers provide high-level tertiary or quaternary care for mother and child, with level I centers offering the most specialized treatment. This classification into four levels of care was done to ensure that comprehensive, high quality obstetric care is available across all of Germany [1]. The Agreement did not give any further specifications on how work should be distributed or what form the duty rosters of obstetricians should take; full-time work and on-call duty are both possible. PNC I facilities are expected to function as recognized training centers for the medical specialty “specialized obstetric care and perinatal medicine” to ensure that high-quality medical care will continue to be available in the future.
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