European Working Time Directive (1)

Editor – McIntyre et al provide quantitative evidence for the deleterious effects of the European Working Time Directive (EWTD) on junior doctor well-being in terms of a higher sickness rate (Clin Med April 2010 pp 134–7). They correctly speculate that loss of cohesiveness of the traditional medical team is a key causal factor behind this increase in sickness, as well as the resultant loss in actual numbers of junior doctors available at any one time. While these factors are very likely to be implicated, another factor of ‘work compression’ should be appreciated, ie an increase in task density (the number of tasks per unit time) for every junior doctor due to the absolute decrease in work hours (in addition to the compounding effect of lack of available colleagues at one time on the ward). Work compression could also reduce job satisfaction and working conditions and further contribute to sickness absence although this is hypothetical and cannot be specifically concluded from this particular study. I would suggest that measures of task density (although difficult to quantify) as an index of work compression should be included in future studies on the effects of EWTD.

Other relevant measures that would have been informative from this study include job sickness rates among more senior medical staff and nursing staff to assess whether the deleterious effects of the EWTD among the well-being of junior medical staff had more far reaching effects on other staff as a consequence. As a final observation, the pre-EWTD sickness rate of having 14% of the total junior medical staff absent on more than one occasion per year seems high (albeit much less than the 38% post-EWTD). Could it be that even a 56-hour working week causes significant work compression (compared to previous longer working weeks) with its resultant adverse effects on well-being, which has been amplified further in the 48-hour week? Strategies and solutions should therefore focus on improvements in task density and other indices of work compression as useful endpoints, as well as the other factors discussed by McIntyre and colleagues in their study.

• © 2010 Royal College of Physicians