To The Editor:

I read with great interest the article by Pellegrini, et al, about resident working hours guidelines in the USA. The effect of work hour guidelines was described as negative by about 75%, positive by 17% and neutral by 7% of the programme directors. The residents attitude was positive in 54%, negative in 42% and neutral in 4%.

The Royal College of Surgeons and British Orthopaedic Trauma Association carried out a similar survey in the UK after the implementation of the European Working Time Directive(1). Eighty two per cent of survey respondents said that their training time in theatre had decreased, and almost three quarters considered that direct contact time with their trainer(s) had decreased. More than half (58%) said that training time in outpatient clinics had also decreased. As far as quality of life is concerned 42% of the trainees said it had worsened, 33% said it had improved and rest were unsure.

There is a huge discrepancy in the working hour patterns in the two countries. While our counterparts in the USA are still working 80 hours a week; the European Working Time Directive which is followed in the UK limits the working week for junior doctors to a maximum of 58 hours, with a reduction to 56 hours in 2007 and 48 hours in 2009. Surgeons who trained several years ago in the UK would have accumulated approximately 32000 hours of training, but now it has fallen to 6000(1). Training a surgeon takes time and that time must be spent in theatre, out patient clinics, and the wards and if nothing is done about it the safety of tomorrow’s patients may be in jeopardy.

Regards,

Arif Gul MS, MRCS

S. Sambandam MS, MRCS

Reference:

1.Mayor S. UK surgeons report that EU directive has cut training time. BMJ Mar 5 2005;330(7490):499.