Regulation of junior doctors’ work hours: an analysis of British and American doctors’ experiences and attitudes

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Reshma Jagsi ^, a and Rebecca Surender ^, , b

^a Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3, 100 Blossom Street, Boston, MA 02114, USA

^b Department of Social Policy, University of Oxford, Barnett House, 32 Wellington Square, Oxford 0x1 2ER, UK

Available online 25 September 2003. 

Abstract

Regulations of junior doctors’ work hours were first enacted in the United States (US) and United Kingdom (UK) over a decade ago, with the goals of improving patient care and doctors’ well-being while maintaining a high quality of medical training. This study examines experiences and attitudes regarding the implementation of these regulations among physicians and surgeons at two teaching hospitals, one in South-East England, and the other in New England, US. This paper presents the findings of a survey questionnaire and a series of in-depth interviews administered to a sample of junior doctors and the consultants responsible for their supervision. The study finds that the different policy mechanisms employed in the two countries have had different degrees of success in reducing the work hours of junior doctors. The results also indicate, however, that even in settings in which hours have been reduced significantly, the regulations have only had limited effects on the quality of medical care, junior doctors’ well-being, and the quality of medical education. A number of barriers to the success of the regulations in achieving their objectives are identified, and the relative merits of political action and professional self-regulation are discussed. This research suggests that recently enacted policies requiring further reductions in junior doctors’ hours in both the US and UK may face similar barriers when implemented. Understanding the lessons that emerge from implementation of the original regulations is essential if future reforms are to succeed and a high-quality system of health care is to be sustained.

Author Keywords: Author Keywords: Junior doctor; Work hours; Legislation; Professional regulation; Medical education; UK; USA

Article Outline

• Introduction

• Methods

• Results

• Work hours and patterns

• Quality of medical care

• Medical education

• Physician well-being

• Gender

• Barriers to implementation

• Attitudes towards further hours reductions

• Discussion

• References

Corresponding author. Tel.: +44-1865-270325; fax: +44-1865-270324

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Social Science & Medicine Volume 58, Issue 11, June 2004, Pages 2181-2191