The controversial proposed revision of the European Working Time Directive was the main topic of discussion during a meeting of the Permanent Working Group of European Junior Doctors held in Malta last week.
Central to the debate was the definition of work included in the proposed revision, the group's president, Nina Tiainen, told The Times.
Dr Tiainen explained that the European Commission was proposing a new category of working time - on-call work - that would cover all situations when the doctor was ordered to stay at the working place by his employer.
She said the directive proposed that the inactive part of on-call work would not be counted as working time, leading to the doctor only being considered as working during the on-call time when he was seeing patients.
The Permanent Working Group - made up of medical associations and which represents junior doctors - is vehemently opposing the proposal and Dr Tiainen said all 22 members, including the Medical Association of Malta, supported the stand at last week's meeting.
"If the doctor is at the work place, then he is working. There is no difference between whether the doctor is actually treating a patient or waiting for a patient to arrive and doing other activities," she said.
"This is a very worrying proposal because it could lead to abuse on doctors since employers could order them to stay at work for very long periods if only the 'active' part is considered as working time. Doctors' working hours could worsen significantly," the Finnish doctor, specialising in public health, added.
Although doctors might be able to sleep for short periods while on call at the working place, the doctor would be away from home and family in any case. She said scientific evidence showed that if sleep was continuously interrupted, this was not refreshing and the doctor would not be as rested as when he had a good night's sleep.
This could also have an adverse effect on patients since lack of rest could affect performance, she said.
Another bone of contention revolves around the on-call time while the doctor is at home. The working group argues that this should also be recognised as a form of work because the doctor would not be able to do what he wants during that time despite the fact that, thanks to the mobile phone, a person can be reached practically everywhere. If a doctor has to remain available and ready to go to the hospital within 30 minutes, he will not be able to carry out his normal leisure activities, she insisted.
On a positive note, the working group is in favour of the 48-hour work limit which will be introduced in Malta in 2007 through the directive. When the directive was initially drafted in 1993, this did not cover junior doctors and Dr Tiainen expressed the group's satisfaction that this was corrected in 2000. This means that doctors would be working an average of 48 hours per week during a reference period, meaning that there might be weeks when a doctor works more and others when he works less.
An issue on which the group's stand does not have the complete agreement of the Medical Association of Malta concerns the possibility of doctors to opt out of the upper limit of weekly working hours and decide to do more work.
The European Commission is suggesting that the possibility of opting out of the 48-hour limit is tightened, but the group is in favour of this being removed. However, the Maltese association has reservations about this. Dr Tiainen explained there were fears that doctors in European countries would be forced to agree to opt out of the working time limit by their employers.
In Malta, like in a number of other European countries, doctors want to work more to earn more money. Dr Tiainen said it was imperative that the basic salary of doctors was adequate and that such a salary would not force them to work more than 48 hours.
She also believes that there should be limits for overtime, always on the basis that if a doctor is tired, his performance could suffer.
MAM secretary general Martin Balzan reiterated the importance that the basic pay has to be adequate so that doctors would not to need to work longer hours. The association secured an industrial agreement laying down that as from January 2007 no doctor would be forced to work more than 48 hours a week.
However, he expressed the hope that there would not be financial pressures that would force doctors to still opt to forfeit their right to work 48 hours.