Forskningsaktuellt #2 Doctors work hours in Sweden: Their impact on sleep, health, work-family balance, patient care and thoughts about work

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1 Forskningsaktuellt #2 Doctors work hours in Sweden: Their impact on sleep, health, work-family balance, patient care and thoughts about work Stressforskningsinstitutet

2 1 Doctors work hours in Sweden: Their impact on sleep, health, work-family balance, patient care and thoughts about work? En sammanfattning av rapporten med samma namn

3 Doctors work hours in Sweden: Their impact on sleep, health, work-family balance, patient care and thoughts about work? Doctors working in industrialised countries have traditionally worked very long hours, particularly in the early stages of their career, with overnight duties and on-call work being common. Following concerns about the negative affects such schedules have on both doc- tors own wellbeing and that of their patients, the last decade has seen moves towards the standardisation of doctors working conditions in Europe. This research describes for the first time the schedules that are being worked by doctors in Sweden. It also examines how those working time arrangements affect doctors 2

4 val of less than 8 hours between shifts at least once a month (see Figures 1 & 2). Such short rest periods between shifts ( quick returns ) may not provide adequate time for recuperation before returning to work, with potential implications for quality of patient care. Indeed, it was found in the current study that those doctors who most commonly worked quick returns (less than 11 Figure 1: How often is the time off (leave) between your shifts (including any on-call duty) less than 11 hours? (Sub-sample working non-standard hours) 50 42, , ,5 10 4,9 3,4 0 Never 1-2 times per month3-4 times per month5-6 times per month>6 times per month perceptions of their own wellbeing and their ability to do their jobs. A representative sample of 1534 doctors in Sweden completed a questionnaire about working conditions, wellbeing and patient care. The majority of respondents judged their working time arrangements favourably. Two thirds (64%) of the respondents expressed a positive attitude (either rather or very positive) towards their work hours, while 12.6% indicated quite negative or very negative attitudes. A substantial proportion of respondents reported occasionally having short intervals between successive shifts. Eighty nine per cent reported having an interval of less than 11 hours at least once a month, while more than one third (38%) said they had an inter- hours) were more likely to have been reported for malpractice in the preceding 5 years. Long work hours and weekend working were associated with several negative outcomes. Doctors working the longest weekly work hours, like those working frequent quick returns, were more likely to have been reported for malpractice in the recent past. Working a lot of unpaid overtime was asso- 3

5 Doctors who were able to exert influence over how and when their work hours were scheduled tended to report better sleep, health and work-family balance, more positive thoughts about their work, and more positive perceptions of patient care. Indeed, influence over work hours (and, to a lesser extent, access to flexitime) was one of the most consistent predictors of the various Figure 2: How often is the time off (leave) between your shifts (including any on-call duty) less than 8 hours? (Sub-sample working non-standard hours) , , ,3 2,6 1,7 Never 1-2 times per month 3-4 times per month 5-6 times per month >6 times per month ciated with impaired sleep, poorer wellbeing, greater work-family conflict, more negative attitudes, and greater concerns regarding the risk of malpractice. Doctors who worked frequent long shifts (longer than 12 hours) were more likely to report impaired sleep, to have considered changing their current job situation (e.g. changing employer), and to be concerned about the risk of malpractice due to high workload. Frequent weekend working was associated with poorer sleep, poorer wellbeing, more negative attitudes towards work, poorer patient care and greater work-family conflict. There were few negative associations with frequent night work, although there were indications that the combination of high work demands and night work leads to insufficient recovery. measures of sleep, wellbeing, attitudes and patient care. This highlights the importance of matching doctors work hours to their individual needs and preferences. This will be challenging in the complex work environment where effective cover needs to be maintained at all times. Nevertheless, imaginative solutions that optimize the balance between flexibility and patient needs will enhance physicians own health and well-being, reduce their levels of fatigue and its associated 4

6 consequences for patient care, and bolster recruitment and retention of medical staff When comparing between medical specialities, it was found that doctors working in the specialty areas of ear, nose and throat, orthopaedics, cardiology, surgery and anaesthesia reported some of the most negative attitudes towards work hours (See Figure 3). They tended to lack influence over their work hours, and were among the most likely to do a lot of on-call work and / or work frequent long shifts. In the comparisons between regions, respondents in Västra Götaland reported the lowest levels of influence over work hours. Respondents in Uppsala worked the most oncall. Respondents in Northern Sweden reported the highest frequencies of working the whole day before or after a night shift. Respondents in Stockholm worked the fewest hours resident on-call per month and were least likely to work frequent nonresident on-calls. The study s findings provide some of the Figure 3: Percentage expressing rather negative or very negative attitude towards work hours, by specialty. Ear, nose & throat * Orthopaedics Cardiology * Internal medicine Surgery Anaesthesia Geriatric medicine * Paediatrics Oncology * Radiology Gynaecology Other specialties General medicine Psychiatry Clinical laboratory medicine * Opthalmics * first detailed information regarding the nature and impact of doctors work hours in Sweden. The appropriate design of work schedules will help to maintain and promote doctors enthusiasm and commitment to their chosen profession. Moreover, it will help safeguard doctors own well-being, help them to maintain high standards of performance and patient care, reduce the risk of errors and concomitantly reduce the risk of patient harm. 5

7 2 Om Stressforskningsinstitutet Stressforskningsinstitutet är ett nationellt kunskapscentrum inom området stress och hälsa. Institutet tillhör den samhällsvetenskapliga fakulteten vid Stockholms universitet och bedriver grund- och tillämpad forskning utifrån tvärvetenskapliga och tvärmetodologiska ansatser. Verksamhetsidén är att studera hur individer och grupper påverkas av olika sociala miljöer, med särskilt fokus på stressreaktioner och hälsa. Den långsiktiga målsättningen med forskningen är att bidra till en förbättrad folkhälsa. Stressforskningsinstitutets broschyrer Forskningsaktuellt sammanfattar de senaste resultaten från institutets genomförda forskningsprojekt: Vad kännetecknar bra eller dåliga skiftscheman? - Sammanfattning av huvudresultaten från rapporten Vad kännetecknar bra och dåliga skiftscheman? (Stressforskningsrapporter nr 324). Torbjörn Åkerstedt, Michael Ingre, Göran Kecklund. Juni Doctors work hours in Sweden: Their impact on sleep, health, work-family balance, patient care and thoughts about work - Sammanfattning av rapporten med samma namn (Stressforskningsrapport 325). Philip Tucker, Eva Bejerot, Göran Kecklund, Gunnar Aronsson & Torbjorn Åkerstedt 2013 Broschyrerna finns i tryckt format men kan även laddas ned i pdf-format på På webbplatsen finns även information om Stressforskningsinstitutets senaste forskningsresultat, nya publikationer och aktuella projekt. Skicka e-post till info@stressforskning.su.se 6