Doctors' Working Lives News
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Friday, January 27, 2006
Surviving the night shift
A working group led by the RCP has just produced a booklet for junior doctors full of advice on how to cope with night shift work. Working the night shift: preparation, survival and recovery is downloadable free from the RCP website or can be purchased from the RCP. Well-referenced and with a huge breadth of contributors, it looks like a useful guide - and just in time for induction and rotations too.
The working group also recommends that doctors should not work more than four nights in a row, and there will be more recommendations on this to follow. We've discussed this recently when the prospect of single nights was mooted in the BMJ, and in our poll on the subject, split weeks of 3 and 4 nights emerged as the favoured option. It looks as if that may become a common view, so worth keeping in mind for new rotas.
The working group also recommends that doctors should not work more than four nights in a row, and there will be more recommendations on this to follow. We've discussed this recently when the prospect of single nights was mooted in the BMJ, and in our poll on the subject, split weeks of 3 and 4 nights emerged as the favoured option. It looks as if that may become a common view, so worth keeping in mind for new rotas.
New MMC diagram
UK MMC Career Framework Proposal. Don't get excited - the run through grades are just one big box - but it is a straightforward presentation of what we already know. There is also an explanation, which reveals the exciting news that each run through programme will have a curriculum, and that the length of training will vary. (I confess to not having read this in huge detail yet, so if you find more useful details, let me know.) Apparently however PMETB have agreed principles for entry to specialist training (BMJ Career Focus).
Tuesday, January 10, 2006
ECJ ruling: SiMAP/Jaeger upheld, but can't be used in pay claims
Happy New Year! Yes, it's another huge update - but the coming updates will be a bit more regular in 2006.
As you may know, there has been another European Court of Justice ruling on working hours, given on 1st December 2005: Abdelkader Dellas and Others v Premier ministre and Others: C-14/04. This confirmed the SiMAP and Jaeger rulings and did not add any further restriction on non-resident on call.
So why did this case come to court? Well, the working time issue had got tangled up with pay calculations. In France, some medical and social workers doing resident on call at night are paid according to a weighting mechanism which takes account of the fact there is "inactive time" involved. In effect, their pay for resident on call is lower than full time working rates, and depends on intensity of actual work (rather like flexible trainee banding or consultants' availability supplements).
More controversially, French law then allowed employers to calculate working time on the basis of this pay mechanism - effectively excluding inactive time from their hours calculations. Clever, eh?
So, there were two questions to be resolved. If pay and EWTD were bound up together, could French employers get away with excluding inactive resident time by using this pay mechanism? Alternatively, since all resident duty counts as work under SiMAP/Jaeger, should employees be paid at the full working rate for all their resident duty?
The ECJ's answer was "No" to both questions. They ruled that SiMAP/Jaeger/EWTD is a health and safety issue and completely unrelated to remuneration. In other words, regardless of pay calculations, resident time counts towards your EWTD maximum hours, and the employers can't exclude inactive time just because it's paid differently. At the same time, being resident on call doesn't give staff an entitlement to be paid the full working rate.
There is a really good summary of this by LexisNexis at medical-journals.com. Also useful are the official press release and the report at EUPolitix.com.
A couple of other highlights: BMJ Career Focus has some more of their always-useful tips on surviving night shifts - worth keeping handy for new doctors or anyone moving onto a new shift system. I’ll add it to the growing shift work advice section, too.
JAMA Archives of Internal Medicine has a number of articles on burnout, training and the effect of work hours restrictions – you can access them all from underneath the burnout article here. Fairly standard findings (doctors are at risk of burnout, appreciate work hours restrictions, but say that it affects training and patient care) but worth noting. (The University of Pennsylvania also has some new research on burnout among junior doctors – see research update below.)
By the way, apologies again for lack of free online access to many BMJ articles - a controversial decision by the journal - but hopefully those of you who can't get online access can get access to the paper copies! Happily, Career Focus (BMJCF) is still freely accessible.
New ways of working
The nursing profession's coming of age – article and huge response on the rise of nurse practitioners (BMJ)
Rise and demise of the hospital: a reappraisal of nursing (BMJ)
MMC and general training issues
Foundation and beyond: is the future any clearer? (BMJCF)
Will modernised medical careers produce a better surgeon? (and responses) (BMJ)
Letter: EWTD has negative impact on training for surgeons (ENT doctors) (BMJ)
Imperatives in medical education and training in response to demands for a sustainable workforce (MJA)
Thoracic surgery: new training for an old specialty (BMJCF)
Hospital grand rounds in Australia - becoming less common? (MJA)
Who is a doctor, and what does a doctor do? (MJA)
Research
Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Rosen IM et al, Acad Med 2006;81(1):82-5.
Distinguishing sleepiness and fatigue: focus on definition and measurement. Shen J et al, Sleep Med Rev 2005, Dec 20.
Health and safety
Overseas doctors' health (BMJCF)
India: Nurses suffer backache while junior doctors sleep in beds (Chandigarh Newsline)
Pay, recruitment and working conditions
Doctors in Berlin strike over pay – threaten to move to UK (BMJ)
Next year’s pay rises should be 2% or less, government says (BMJ)
More money but NHS fails to recruit doctors (Scotsman)
Harmonisation of recruitment process: an alternative to centralisation (BMJCF)
GP contract settlement under threat (BMJ)
Communication
Professional discretion, courtesy and plain good manners: an anecdotal and personal view (MJA)
Communication and courtesy between medical professionals (MJA)
The perils of the “remote” radiologist (MJA)
Other news
Public concerns over EWTD-led changes to casualty services at Barnet & Chase Farm (Haringey Independent)
As you may know, there has been another European Court of Justice ruling on working hours, given on 1st December 2005: Abdelkader Dellas and Others v Premier ministre and Others: C-14/04. This confirmed the SiMAP and Jaeger rulings and did not add any further restriction on non-resident on call.
So why did this case come to court? Well, the working time issue had got tangled up with pay calculations. In France, some medical and social workers doing resident on call at night are paid according to a weighting mechanism which takes account of the fact there is "inactive time" involved. In effect, their pay for resident on call is lower than full time working rates, and depends on intensity of actual work (rather like flexible trainee banding or consultants' availability supplements).
More controversially, French law then allowed employers to calculate working time on the basis of this pay mechanism - effectively excluding inactive time from their hours calculations. Clever, eh?
So, there were two questions to be resolved. If pay and EWTD were bound up together, could French employers get away with excluding inactive resident time by using this pay mechanism? Alternatively, since all resident duty counts as work under SiMAP/Jaeger, should employees be paid at the full working rate for all their resident duty?
The ECJ's answer was "No" to both questions. They ruled that SiMAP/Jaeger/EWTD is a health and safety issue and completely unrelated to remuneration. In other words, regardless of pay calculations, resident time counts towards your EWTD maximum hours, and the employers can't exclude inactive time just because it's paid differently. At the same time, being resident on call doesn't give staff an entitlement to be paid the full working rate.
There is a really good summary of this by LexisNexis at medical-journals.com. Also useful are the official press release and the report at EUPolitix.com.
A couple of other highlights: BMJ Career Focus has some more of their always-useful tips on surviving night shifts - worth keeping handy for new doctors or anyone moving onto a new shift system. I’ll add it to the growing shift work advice section, too.
JAMA Archives of Internal Medicine has a number of articles on burnout, training and the effect of work hours restrictions – you can access them all from underneath the burnout article here. Fairly standard findings (doctors are at risk of burnout, appreciate work hours restrictions, but say that it affects training and patient care) but worth noting. (The University of Pennsylvania also has some new research on burnout among junior doctors – see research update below.)
By the way, apologies again for lack of free online access to many BMJ articles - a controversial decision by the journal - but hopefully those of you who can't get online access can get access to the paper copies! Happily, Career Focus (BMJCF) is still freely accessible.
New ways of working
The nursing profession's coming of age – article and huge response on the rise of nurse practitioners (BMJ)
Rise and demise of the hospital: a reappraisal of nursing (BMJ)
MMC and general training issues
Foundation and beyond: is the future any clearer? (BMJCF)
Will modernised medical careers produce a better surgeon? (and responses) (BMJ)
Letter: EWTD has negative impact on training for surgeons (ENT doctors) (BMJ)
Imperatives in medical education and training in response to demands for a sustainable workforce (MJA)
Thoracic surgery: new training for an old specialty (BMJCF)
Hospital grand rounds in Australia - becoming less common? (MJA)
Who is a doctor, and what does a doctor do? (MJA)
Research
Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Rosen IM et al, Acad Med 2006;81(1):82-5.
Distinguishing sleepiness and fatigue: focus on definition and measurement. Shen J et al, Sleep Med Rev 2005, Dec 20.
Health and safety
Overseas doctors' health (BMJCF)
India: Nurses suffer backache while junior doctors sleep in beds (Chandigarh Newsline)
Pay, recruitment and working conditions
Doctors in Berlin strike over pay – threaten to move to UK (BMJ)
Next year’s pay rises should be 2% or less, government says (BMJ)
More money but NHS fails to recruit doctors (Scotsman)
Harmonisation of recruitment process: an alternative to centralisation (BMJCF)
GP contract settlement under threat (BMJ)
Communication
Professional discretion, courtesy and plain good manners: an anecdotal and personal view (MJA)
Communication and courtesy between medical professionals (MJA)
The perils of the “remote” radiologist (MJA)
Other news
Public concerns over EWTD-led changes to casualty services at Barnet & Chase Farm (Haringey Independent)
This site is maintained by Ellie Pattinson. All rights reserved. This website is maintained independently of the NHS and the views expressed are not necessarily a reflection of the views of that organisation. For any queries, contributions or amendments, please email me on admin@idwl.info.
