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2016 年至 2019 年期间挪威医生每周工作时间的变化、每周工作时间超过欧洲工作时间指令(EWTD)限制的医生比例以及用于直接患者护理的时间:一项基于重复调查的研究。

Changes in weekly working hours, proportion of doctors with hours above the limitations of European Working Time Directive (EWTD) and time spent on direct patient care for doctors in Norway from 2016 to 2019: a study based on repeated surveys.

机构信息

Institute for Studies of the Medical Profession, Oslo, Norway

Institute for Studies of the Medical Profession, Oslo, Norway.

出版信息

BMJ Open. 2023 Jun 22;13(6):e069331. doi: 10.1136/bmjopen-2022-069331.

Abstract

OBJECTIVES

To compare the total weekly working hours, proportions with work hours above the limitations of European working time directive (EWTD) and time spent on direct patient care in 2016 and 2019 for doctors working in different job positions in Norway.

DESIGN

Repeated postal surveys in 2016 and 2019.

SETTING

Norway.

PARTICIPANTS

Representative samples of doctors; the response rates were 73.1% (1604/2195) in 2016 and 72.5% (1511/2084) in 2019.

MAIN OUTCOME MEASURES

Self-reported weekly working hours, proportions with hours above the limitations of EWTD defined as >48 hours/week and time spent on direct patient care.

ANALYSES

Linear mixed models with estimated marginal means and proportions.

RESULTS

From 2016 to 2019, the weekly working hours increased significantly for male general practitioners (GPs) (48.7 hours to 50.9 hours) and male hospital doctors in leading positions (48.2 hours to 50.5 hours), and significantly decreased for female specialists in private practice (48.6 hours to 44.9 hours). The proportion of time spent on direct patient care was noted to be similar between genders and over time. In 2019, it was higher for specialists in private practice (66.4%) and GPs (65.5%) than for doctors in other positions, such as senior hospital consultants (43.5%), specialty registrars (39.8%) and hospital doctors in leading positions (34.3%). Working >48 hours/week increased significantly for both male and female GPs (m: 45.2% to 57.7%; f: 27.8% to 47.0%) and hospital doctors in leading positions (m: 34.4% to 57.1%; f: 17.4% to 46.4%), while it significantly decreased for female specialty registrars (13.2% to 6.9%).

CONCLUSIONS

Working hours increased significantly for GPs and hospital doctors in leading positions from 2016 to 2019, resulting in increased proportions of doctors with work hours above the EWTD. As work hours above the EWTD can be harmful for health personnel and for safety at work, initiatives to reduce long working weeks are needed.

摘要

目的

比较 2016 年和 2019 年在挪威从事不同工作岗位的医生的每周总工作时间、超过欧洲工作时间指令(EWTD)限制的工作时间比例以及直接患者护理时间。

设计

2016 年和 2019 年重复邮寄调查。

地点

挪威。

参与者

医生的代表性样本;2016 年的回复率为 73.1%(1604/2195),2019 年为 72.5%(1511/2084)。

主要观察指标

自我报告的每周工作时间、超过 EWTD 限制(每周>48 小时)的时间比例以及直接患者护理时间。

分析

采用估计边缘均值和比例的线性混合模型。

结果

从 2016 年到 2019 年,男性全科医生(GP)的每周工作时间(48.7 小时至 50.9 小时)和男性领导职位的医院医生(48.2 小时至 50.5 小时)显著增加,而女性私人执业专家的工作时间(48.6 小时至 44.9 小时)显著减少。性别之间和随时间推移,直接患者护理时间的比例相似。2019 年,私人执业专家(66.4%)和全科医生(65.5%)的比例高于其他职位的医生,如高级医院顾问(43.5%)、专科住院医师(39.8%)和领导职位的医院医生(34.3%)。2019 年,男性和女性全科医生(男性:45.2%至 57.7%;女性:27.8%至 47.0%)和领导职位的医院医生(男性:34.4%至 57.1%;女性:17.4%至 46.4%)的工作时间超过 48 小时/周显著增加,而女性专科住院医师的工作时间(13.2%至 6.9%)则显著减少。

结论

2016 年至 2019 年,全科医生和领导职位的医院医生的工作时间显著增加,导致超过 EWTD 工作时间的医生比例增加。由于超过 EWTD 的工作时间可能对卫生人员和工作安全有害,因此需要采取措施减少长时间的工作周。

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