Young doctors want better working conditions

Flextime, home working and sabbaticals are all foreign phrases in medicine – after all, patients need to be cared for around the clock. For years now, the trend has been towards a steady increase in workloads. While around a quarter of all beds have been eliminated since 1991, patient volumes have risen by about 25% during the same period. In addition, operations, diagnostic measures and outpatient treatment are on the increase. According to the German Health Report, the number of operations carried out between 2005 and 2018 have almost doubled. At the same time, patients are spending less and less time in hospital. While the average hospital stay was 13 days in 1992, it is currently only seven. This is accompanied by an increase in workload, mainly due to the growing bureaucratic burden.

However, this development is offset by insufficient staffing levels. For example, the number of doctors has only increased by about a third since the turn of the millennium. The consequences of this are overtime, increasing workloads and growing dissatisfaction.
Even though German employment law allows a maximum weekly working time of 48 hours, the majority of physicians working in hospitals state that they work between 49 and 59 hours per week. For many, even 70-hour weeks are not a rarity. Opening clauses or opt-out regulations make this possible. Frequently, current employment law is also deliberately ignored.

Besides regular overtime, on-call services in particular contribute to the workload. It is not uncommon for up to 16 hours of on-call duty following a regular working day to mean 24 hours of work without a significant break.

But the workload is also increasing in the outpatient sector. Although being on-call is not required and weekly working hours are fewer than in hospitals, doctors in private surgeries in Germany report that they work on average around 50 hours per week. An important part of this work involves administrative tasks, which take up roughly one extra working day per week.

The combination of a demanding job with a high workload and typically insufficient periods of rest leaves its mark. Depression and suicide are more common among doctors than among the general population. They often also resort to addictive drugs and medication to cope with everyday life.

The young generation of doctors, however, do not wish to accept these conditions any longer and present their demands with growing self-confidence. For the new generation, the compatibility of family and work is more important than career and good earning opportunities. A survey conducted in 2017 by the German Chemists’ and Doctors’ Bank (Deutsche Apotheker- und Ärztebank) showed that family life and partnership are the top priorities for the majority of the medical profession. Similarly, more than 60% of those surveyed wanted more flexible working arrangements. Other surveys even showed that up to 80% of doctors would like to see a reduction in working hours. It is not only more women who wish to reduce their working hours after starting a family. Their male counterparts now also want the option of working part-time.

At present, one in seven doctors can fulfill this wish – and the trend is rising.
Part-time employment does not only improve the physical and mental health of doctors. With the same level of productivity, they are demonstrably more motivated and content and thus also contribute to improved patient care. Even though this trend may be in the interest of doctors and patients, it also has a downside. The current shortage of doctors is further exacerbated by the increasing proportion of part-time doctors. At the same time, however, more flexible working arrangements have the potential to attract doctors who, for family reasons, can or only wish to work part-time or who are currently not working as doctors.

The improvement of working conditions, including the introduction of flexible working models, will remain one of the key challenges in the health service in the near future. Models pertaining to working conditions and working hours are likely to be an even more important factor in the competition for the currently insufficient number of doctors and will ultimately result in the employers having to rethink the situation.
Whether structural and organisational hurdles also stand in the way of this development, it is undoubtedly in the interest of doctors and patients and can lead to a noticeable increase in the quality of the health service.