Emergency service doctors strike over excessive working hours

A decline in employment, combined with measures regarding the reduction of working time which have not been compensated by sufficient increases in staffing, has since 2000 led to industrial tension in public hospitals regarding working time. Consequently, the number of hours and days worked, but not paid or taken as time-off, has accumulated. On 7 February 2008, the Ministry of Health and five trade unions signed a draft agreement providing for a solution to the problem.

By 31 December 2007, hospital staff had worked 23 million hours of overtime which had neither been paid nor taken as time-off, mainly because of a lack of personnel. Moreover, 3.5 million days had accumulated in time savings accounts (comptes épargne temps, CET), which were created in order to keep track of days-off owing as a result of the reduction of working time (Réduction du temps de travail, RTT) (FR9806113F).

Non-medical workers have accumulated the most overtime, while medical employees have stockpiled more RTT days-off in their CETs. On average, doctors have accumulated 22 days of time off, compared with 3.5 days for non-medical personnel.

Industrial action and negotiations

Following protests and pressure from the various trade unions and professional associations, negotiations began on ways to manage this problem of excess working time. Proposals included the payment of unpaid overtime and buying RTT days-off or converting them into pension contributions. Separate discussions were held for doctors and other staff.

The negotiations for doctors – known as hospital practitioners (praticiens hospitaliers, PH) – took place with the four trade union organisations representing them: the Hospital Medical Coordination (Coordination Médicale Hospitalière, CMH), the Confederation of Hospital Practitioners (Confédération des Praticiens des Hôpitaux, CPH), the National Association of Hospital Practitioners (Intersyndicat National des Praticiens Hospitaliers, INPH), and the National Union of Doctors, Surgeons, Specialists and Biologists in Public Hospitals (Syndicat National des Médecins, Chirurgiens, Spécialistes et Biologistes des Hôpitaux Publics, SNAM-HP).

Discussions for other staff were held with the eight representative trade unions in the public hospital service (Fonction publique hospitalière, FPH): the General Confederation of Labour (Confédération générale du travail, CGT), the General Confederation of Labour – Force ouvrière (Confédération générale du travail – Force ouvrière, CGT-FO), the French Democratic Confederation of Labour (Confédération française démocratique du travail, CFDT), the National Federation of Independent Unions (Union nationale des syndicats autonomes, UNSA), the French Confederation of Professional and Managerial Staff – General Confederation of Professional and Managerial Staff (Confédération française de l’encadrement – Confédération générale des cadres, CFE-CGC), the French Christian Workers’ Confederation (Confédération française des travailleurs chrétiens, CFTC), the independent union Solidarity, Unity, Democracy (Solidaire, Unitaire, Démocratique, SUD) and the National Union of Hospital Executives (Syndicat national des cadres hospitaliers, SNCH) (FR0803019I).

Special case of emergency service doctors

Demands on working time are considerable for doctors who work according to a scheduled routine without emergencies. Such pressures are even greater for emergency service doctors, anaesthetists and intensive care doctors, who are particularly subject to the vagaries of unplanned work. These circumstances are most evident in medical emergency services and those providing 24-hour care (permanence des soins), which are mainly found in public hospitals.

In November 2007, the main organisations representing emergency service doctors, anaesthetists and intensive care doctors joined forces in the Federation of 24-Hour Care in Hospitals (Fédération de la Permanence des Soins Hospitalière, FPSH). The new federation aims to win greater recognition for the doctors’ situation and to compel hospitals to take better account of 24-hour care.

Demands of new federation

FPSH’s demands include better definition, value and recognition of working time for those providing 24-hour care. More specifically, the federation is seeking working time calculations based on the number of hours worked rather than the number of half-days, and that overtime should be calculated on the basis of a weekly lower limit of 39 hours and an upper limit of 48 hours, thus leading to overtime payments for any time worked beyond 39 hours. FPSH is also demanding specific negotiations for the doctors it represents regarding CETs.

Moreover, the federation demands that the arduous nature of the doctors’ work should be recognised, notably by increasing on-call payments, as well as increasing overtime pay and pay for night shifts, as well as work on Sundays and public holidays (FR0610029I).

In the longer term, FPSH wants to tackle fundamental issues concerning funding, medical demography and the way the work is carried out. It also aims to discuss the tasks of hospitals, as well as training and transfer of skills.

FPSH launched an ultimatum that an agreement should be reached by 15 December 2007, after which the federation threatened unlimited strike action by those providing 24-hour care from 24 December 2007 onwards.

Government response

For hospital doctors in general, the Ministry of Health, Youth, Sports and Community Life (Ministère de la Santé, de la Jeunesse, des Sports et de la Vie associative) signed a draft agreement on 15 January 2008 on working time with three of the four organisations representing hospital practitioners (CMH, INPH and SNAM-HP). The fourth trade union (CPH) refused to sign, and FPSH also denounced the agreement as being too unfavourable for doctors. In their opinion, the rates at which RTT days-off can be bought are too low and the accumulated days-off that are not bought will be lost, as they can ‘never be taken’ by the practitioners.

In response to the pressure from the emergency service doctors, the government created a working group on 25 January 2008 on the issue of 24-hour care. Its task is to assess the situation and formulate proposals on dealing with unplanned treatment in hospitals and on employment and pay conditions for those providing 24-hour hospital care.

On 7 February 2008, the ministry finally signed a draft agreement with the five trade unions within FPSH. The agreement takes into account their demands and initiates dialogue.

Étienne Lecomte, Institute for Economic and Social Research (IRES)