Jagsi Reshma, Surender Rebecca
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Cox 3, 100 Blossom Street, Boston, MA 02114, USA.
Soc Sci Med. 2004 Jun;58(11):2181-91. doi: 10.1016/j.socscimed.2003.08.016.
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.
初级医生工作时间的规定早在十多年前就在美国和英国颁布了，目的是改善患者护理和医生的福祉，同时维持高质量的医学培训。本研究调查了英格兰东南部一家教学医院和美国新英格兰地区一家教学医院的内科医生和外科医生对这些规定实施情况的体验和态度。本文介绍了对一组初级医生以及负责监督他们的顾问进行问卷调查和一系列深度访谈的结果。研究发现，两国采用的不同政策机制在减少初级医生工作时间方面取得了不同程度的成功。然而，结果还表明，即使在工作时间大幅减少的情况下，这些规定对医疗质量、初级医生的福祉和医学教育质量的影响也很有限。研究确定了这些规定在实现其目标方面取得成功的一些障碍，并讨论了政治行动和专业自我监管的相对优点。这项研究表明，美国和英国最近颁布的要求进一步减少初级医生工作时间的政策在实施时可能会面临类似的障碍。如果未来的改革要取得成功并维持高质量的医疗保健系统，了解从最初规定的实施中吸取的教训至关重要。
