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Implications for health and safety of junior doctors’ working arrangements

August 2000

Introduction
The BMA’s Health Policy and Economic Research Unit (HPERU) has undertaken a review of the scientific literature on the implications for health and safety of junior doctors’ working arrangements. The review was designed to identify principles that could be applied to the organisation of junior doctors’ working patterns that would ensure protection both for the doctors themselves and patients. Educational issues relating to juniors’ working arrangements, however, were not within the remit of the review.

The HPERU literature review gives a detailed account of the effects of long working hours, sleep deprivation and disruption of circadian rhythms on performance and safety; health and wellbeing; and family and social life. Although for convenience these factors are addressed individually in this report, it is clear that in reality they interact. (Spurgeon A, Harrington J. Work performance and health of junior hospital doctors – a review of the literature. Work and Stress 1989;3(2):117-128)

The health and safety problems associated with juniors’ working patterns result from a combination of long periods of time spent working, insufficient sleep and working at times when the biological clock is programmed for resting and sleeping. Although it is difficult to separate the influence of these factors on health and safety, each one can be clearly identified with aspects of juniors’ working arrangements: number of hours worked each week, intensity of work and the type of pattern being worked.

Examination of the findings of the literature review suggests that the existing arrangements for junior doctors have serious implications for their health and wellbeing and for their performance and safety as medical practitioners. From the evidence, certain principles for the design of working patterns can be highlighted which would maximise effective working practices and, therefore, minimise the risk to the doctors themselves and to patients. However, such arrangements are incompatible with the current system of patient care provided by junior doctors. If such arrangements were to be introduced, fundamental changes would be needed to junior doctors’ current training requirements and service commitments.