Should Surgeons’ Work Hours Be Capped Like Pilots’?
The burnout rates among doctors in New Zealand, the USA and Australia are increasing.
In New Zealand, it’s highest among female consultants in their first five years of practice. The burnout rate in this group is over 50%. The increasing rate of burnout is not only due to work hours, but also conditions at work. If we have to do all the paperwork without any secretarial support, if there is no support from managers, if problems get hidden rather than discussed and solved, then the rates of burnout will continue even if we worked less.
In the recent editorial published in the Journal of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (JISAKOS), the orthopaedic surgeon C Niek van Dijk proposed that the number of hours worked by surgeons should be capped to reduce harmful mistakes caused by exhaustion and burnout.
Capped Hours of Work
Airline pilots, train and truck drivers have capped hours that they are allowed to work. This rule is to prevent accidents which often lead to loss of lives. The most stringent hours are those of airline pilots. In New Zealand, airline pilots cannot fly for more than 6.5 hours in a day, 30 hrs in any seven consecutive days, 90 hours in any 30 days. They can’t be on duty for longer than 12 hours. If pilots are working for 12 hours, they are required to have 12 hours rest minimum between the next shift.
Specialist Hours
As a surgeon, if I were on call for a weekend, I would start being on-call at 8 am Friday and finish at 8 am Monday. Depending on how busy the call is, I would on average spend 24 to 36 hours during this time in the hospital and the rest from home.
I would work regular working hours Monday to Thursday preceding the weekend on-call and Monday to Friday following the weekend on-call. And this is much better than our colleagues in the USA.
If we are on overnight call during the week and have to spend time operating/working after midnight, most of us if not all would be back at work at 7:30 or 8 am next morning. Why do we do this?
The hours for junior doctors are capped, but not for specialists. Should it be the same for specialists?
Why Are Hours Not Capped?
I am not exactly sure. One reason is that we, as specialists, have always worked like this. It’s almost an expectation. We cannot be seen as weak or not coping.
Another reason is that we feel guilty about cancelling operations or clinics the next day. Our patients have waited for weeks or months for their appointment. They may have cancer, and we do not want to delay their operation or appointment. Unfortunately, hospitals do not have a backup plan for these situations.
If the hours are capped, then the salaries/income will be lower and hours will become fewer. And the majority of people are not prepared for this to happen when you often have significant student loans to pay off.
Reason To Cap Working Hours
The rates of burnout and drug addiction among the medical profession are high. Burnout is anywhere between 30-65% and slowly increasing. These rates of burnout are impacting the quality of healthcare that we are delivering to our patients. So if 30% of us suffer from burnout, how many patients are under risk? I believe that hours that specialists work should be capped. However, this is not the only solution in combating burnout, but conditions of work should also be improved.