Seven out of 10 hospitals infringe working time regulations for doctors
According to the Labour Inspectorate, seven out of 10 Austrian hospitals systematically breach the Hospitals’ Working Time Act in order to save on personnel costs. Moreover, the infringements are found almost exclusively in the public hospital sector. In response to these findings, the Austrian Chamber of Doctors, along with trade unions and the responsible government ministry, have requested the introduction of sanctions that can be imposed on public hospital operators in breach of the labour law.
Working time in hospitals
In Austria, the 1997 Hospitals’ Working Time Act (Krankenanstalten-Arbeitszeitgesetz, KA-AZG (in German, 50Kb PDF)) restricts the average working week of hospital doctors to a maximum average of 48 hours. The working week may be extended to a maximum of 60 hours in a single week, provided that the normal working week does not exceed the 48 hours’ average over a specific reference period. In addition, the individual working day must not exceed a maximum of 13 hours. However, the KA-AZG also provides for the possibility of extending these working hours through a company-level works agreement. In this respect, the law provides for working time limits as follows: a maximum of 60 working hours a week on average, with a maximum of 72 hours in a single working week; a maximum of 32 hours during the working week and of 49 hours during weekend work, including rest periods that have to be observed for each period of service.
Labour Inspectorate findings
Despite these working time restrictions, the results of occasional workplace inspections at hospitals carried out by the Austrian Labour Inspectorate (Arbeitsinspektorat) have revealed that seven out of 10 Austrian hospitals – in at least one of their departments – systematically breach these working time regulations. At the Vienna General Hospital (Allgemeines Krankenhaus, AKH), for instance, which is the country’s largest hospital, the employees do not even have the possibility to register their overtime hours in the online service schedule. Moreover, the Austrian Chamber of Doctors (Österreichische Ärztekammer, ÖÄK), which organises both employed and self-employed doctors, has uncovered cases of employees recording up to 100 working hours a week. According to the chamber, disregard of the working time regulations is a widespread cost-reducing strategy of hospital managers, since it saves them having to recruit additional staff.
Interestingly, the infringements of working time regulations are found almost exclusively in the public hospital sector, which employs about three quarters of the sector’s employees. This is mainly because private hospital providers – in the case of administrative offences such as the breaching of working time regulations – are subject to administrative fines. In the public sector, however, a similar form of penalisation does not exist and, as a result, infringements of employee protection law committed by public authorities go completely unpunished. Theoretically, the Labour Inspectorate could initiate proceedings against the public hospital managers responsible and/or the public authorities operating these hospitals; in practice, however, such attempts of prosecuting authorities have remained completely ineffective.
As a result of these findings, ÖÄK, in line with the trade unions which also represent doctors employed by hospitals, have demanded the introduction of appropriate administrative fines for public hospital managers who violate the regulations, based on a system similar to that used in the private sector. ÖÄK argues that these fines, particularly in cases of repeated and systematic disregard of the working time regulations, should be high enough to force hospital managers to invest in additional personnel rather than infringing the law.
Proactive response of government
The Minister of Economy and Labour Affairs, Martin Bartenstein, has already signalled his willingness to take appropriate legal measures to curb these practices. The minister announced that he would immediately enter into negotiations with representatives of the provinces (Länder), which operate most of the public hospitals, as well as the social partners, in order to implement a sanction mechanism which targets public authorities running hospitals and their managers in the event of illegal employment practices. Such sanctions would be inevitable not only for employee protection and the patients’ right to optimal medical treatment by sufficiently rested personnel, but also in order to avert unequal conditions of competition in the sector to the detriment of private hospital providers.
In Austria, the hospital sector employs almost 20,000 doctors overall, about three quarters of whom are public sector employees. Thus, the Labour Inspectorate’s findings suggest that several thousands of hospital doctors in Austria are – at least occasionally – being faced with illegally long working hours. The systematic disregard of working time regulations is deemed by experts to be the main cause of fatigue among many doctors, which can directly endanger patients’ health. For instance, a recent study carried out by a surgeon at a hospital in Steyr, Upper Austria, revealed a significant correlation between the duration of the hospital doctors’ uninterrupted service rendered and the incidence of malpractice committed by them. Another study carried out by ÖÄK found that the overall working conditions of hospital doctors have deteriorated in the period 2003–2006, in particular in terms of time pressure, long working hours or overtime and night work. All of these findings underline the need for the introduction of enforcement practices with regard to existing working time regulations in public sector hospitals.
Georg Adam, Department of Industrial Sociology, University of Vienna