Implementation of the working time directive has had an adverse impact on training in the UK, taskforce saysBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2599 (Published 04 April 2014) Cite this as: BMJ 2014;348:g2599
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Re: Implementation of the working time directive has had an adverse impact on training in the UK, taskforce says
I read with interest the article on how implementation of the European Work Time Directive (EWTD) has adversely affected surgical training. Surgical trainee groups, such as the Association of Surgeons in Training (ASiT), have previously stated that surgical trainees should be allowed to work up to a maximum of 60/65hours per week instead of the current 48 hour week dictated by the Directive.
The article describes how many doctors work longer hours voluntarily to enhance training and, indeed, this is my practice. As a higher surgical trainee in Otolaryngology, we still work a 24 hour on-call system, rather than a shift system like many other surgical specialties with heavier emergency workloads, such as General Surgery. My current working week is probably somewhere between 60 and 65 hours once on-call cover and voluntary theatre time is included.
My main concern regarding officially extending working hours to a 60 or 65 hour week is that the extra time will be used for service provision rather than providing training, especially in this time of austerity and budget cuts. Furthermore, in this current frugal climate, an extension of the working week would most likely not see an increase in doctors’ pay. We have already been denied a less than inflation (1%) pay rise by the Health Secretary this year and 2014/15 will be the fifth consecutive year that NHS staff have faced a pay cut in real terms.
At least in the current arrangement, I am free to augment my training during my two Continued Professional Development (CPD) half day sessions per week as I see fit. This generally means I attend 5 or 6 theatre sessions per week, with the ones I attend during my CPD sessions always being covered by consultants, so real training is available. Current Otolaryngology Special Advisory Committee (SAC) requirements are for specialist trainees to have at least 4 theatre and 3 clinic sessions per week. Although the idea of having more protected education and training time during officially extended working hours is admirable, I doubt that my current level of theatre exposure would remain, as I find it hard to believe that hospital management would be able to resist eking out further service provision.
One final interesting point to be raised is whether allowances should be made for the volume of training depending on the intensity of each respective specialty, whether surgical or otherwise? For instance, should specialties regarded as ‘craft specialties’ increase working hours whilst those with traditionally light on-call commitments remain on the 48 hour week? If this were to happen, how would this be reflected in remuneration? Clearly, this would call for a completely new NHS pay structure.
Competing interests: No competing interests