Towards effective retention policies: working hours and EWTD compliance in Junior Doctors in Europe 2022

Authors: Dr Alvaro Cerame, Dr Ellen McCourt, Dr Francisco Ribeiro


Increasing attention is being paid to the improvement of working conditions as means to achieve effective retention policies. Working conditions of Junior doctors (JDs) affect postgraduate training (PGT) outcomes and training, patient safety and physician’s health. 

Summary of work 

A summary of European Working Time Directive (EWTD) compliance data gathered by the European Junior Doctors (EJD) during the year 2022 is presented alongside a review of the relevant literature. 

Summary of results 

EJD’s data gathered for the 2022 National Interim Report Survey shows that 18 countries (75%) have transposed the EWTD for JDs into national legislation. 6 Countries, 25% of the sample decided not to implement the directive. In terms of enforcement of the directive, in the countries which implemented the European regulation our members report that it was not enforced in 14 countries (77%). In those countries, the National Junior Doctors’ Associations report that no oversight system is put into place at the level of the PGT program, institution or regional/national level. Some countries report 60-70h per week as regular working hours. Only 4 members reported that the 48h-limit was enforced (Germany, Poland, Norway, UK). Those countries describe that there are oversight systems at the level of the program and the institution. Some countries report partial implementation of European regulations and the possibility of opting out from national regulations on a voluntary basis. 

Discussion And Conclusion 

Excessive working hours beyond EWTD and the absence of adequate resting times and facilities pose a serious threat to the wellbeing of JDs. Available literature shows that physicians with high burnout rates, high hourly loads, long hours and working extended night-shifts had a strong negative impact on patient safety. Evidence suggests that reducing working hours from long or continuous shifts and ensuring appropriate rest has been linked to fewer medical errors and fewer accidents. Moreover, reducing working hours where there is excess does not negatively impact PGT or patient outcomes. 

Take Home Messages 

More data needs to be gathered and on a regular basis on EWTD compliance in JD. 

Oversight systems must be implemented as well as penalty systems when the working hours regulations are not complied with. 

Reducing working hours and ensuring adequate rest time has proven to be a beneficial measure to improve JDs wellbeing and patient safety and does not negatively impact PGT.