From: kate@cogsci.ed.ac.uk (Kate Jeffery)
Newsgroups: sci.med
Subject: Re: Doctor's hours
Date: 9 Sep 92 19:24:45 GMT
Organization: Centre for Cognitive Science, Edinburgh, UK

In article <1992Sep8.140132.6109@midway.uchicago.edu> scb1@midway.uchicago.edu writes:

>Perhaps the guy from the U.K. who's words I'm responding to could tell us a
>bit about the work actions taken by some of the jr. doctors in England (it 
>surprises me that interns and residents in the U.S. don't stand up for them-
>selves more - comments, anyone?)
>
>-- Sam

Mmmm. Well. I couldn't resist butting in here...

Similar action was taken by junior doctors in New Zealand a few years
ago - the medical establishment there is a little smaller and less
constricted at the registrar/consultant interface so people were
easier to unify and not so worried about shredding their future
employment prospects. Basically they threatened to go on strike if the
hospitals refused to negotiate more reasonable working hours. They
demanded a reappraisal of overtime pay rates which at that time stood
at about 1/3 of normal pay rates (*not* an extra 1/3 *above* normal
rates) and a reduction of the maximum working hours/week. The threat
of strike action was absolutely unheard-of prior to this and
profoundly shocked the older doctors who felt it violated something
very fundamental about the practice of medicine.

Without wishing to get tangled up in the pros and cons of what they
did, the result astonished everyone including themselves - the
overtime rate was increased from 1/3 to 1+1/3 for hours between 56 and
80 per week and then went up to double for hours over and above that.
For the first year or so however, house officers continued to work the
same long hours as before, getting rich (by NZ standards anyhow) but
still overworked. I quit medicine at this point and went into
research, deciding I preferred sleep and chasing Big Questions to
money!  However, I went back to NZ a couple of years later and did a
brief hospital locum and the situation at that point was this: the
high rates of pay, being unsustainable by the health system (a
nationalised system similar to the British one, or it was then before
it collapsed) had resulted in fragmentation of junior doctor's hours
so that as few people as possible worked more than the basic 56 hour
week. The nights were covered by a set of night doctors doing 3-month
rotations and covering the whole hospital. Evenings were covered in
turn by the day doctors. The three shifts were interfaced by handovers
from one person to the next and the extra doctors needed were brought
in from overseas (mainly the UK I think).

As far as I could see the system was a complete shambles. My father,
being a hospital consultant and therefore on the other side of the
"fence" from me, described abysmal ward rounds where the house officer
desperately tried to present a patient that they themselves had only
just met, who had come in the previous evening when the ward but not
they had been on call (having already worked their 56 hours).
Consultants began ignoring them (politely or not depending on
personality and political stance during the whole nightmare) and
interacting with the registrars preferentially. Continuity of care had
passed over the heads of the junior doctors who felt dispossessed and
redundant and trudged home at 5pm every evening feeling pretty
unsatisfied.

I don't know what has happened since then. Frankly, I'm glad I got out
when I did. The last I heard of the NZ health system, our beloved
socialised medicine system (once regarded as one of the best in the
world) was being erased by a right-wing government to make way for a
system based on American-style user-pays. It's pretty sad.

I would hesitate to blame the collapse of socialised medicine in NZ
just on the rearrangement of junior doctors' working hours! The system
we had then was expensive to run and fueled by sleepless haggard young
docotrs and was unsustainable for both reasons: something had to give
I guess. I feel strongly that the issue of over-work of junior doctors
needs to be tackled, especially as medicine grows exponentially in
complexity. Perfect continuity of care is a utopian fiction (at least
until AI can provide us with Robodoc). However there's got to be a
better way than the one we chose.

Yours, blissfully happy in research(!) 


Kate Jeffery
Dept. of Pharmacology,
University of Edinburgh
Newsgroups: sci.med.nutrition