End of working time opt-out in healthcare gives rise to problems

Hospitals in the Czech Republic are facing staff shortages because of changes to Labour Code rules on working hours. A transitional period which began in October 2008 ended on the last day of December 2013. It had allowed some flexibility on overtime hours, and some healthcare workers were exempted from maximum working time rules. The changes, combined with a longstanding shortage of medical staff in certain fields, mean a number of hospitals could now face serious problems.


The Czech Labour Code, Act No 262/2006 Coll, came into force on 1 January 2007. Unlike the previous Labour Code, Act No 65/1965 Coll that had been in force since 1965, limits were placed on the amount of overtime hours that could be worked. The code also outlawed so-called standby work, where staff were expected to remain on-call at the workplace. Standby time, under the code, would now not be included in the framework of a regular working time.

The Czech Republic has a long-standing shortage of qualified employees in a number of medical professions and, as a result, much healthcare provision has relied on overtime work.

To tackle the issue, it was felt there was a need to raise the legal number of overtime hours for some hospital workers.

In accordance with the EU working time directive, Directive 2003/88/EC, an amendment to the Labour Code was made in 2008. This extended the Labour Code, from 1 October 2008 to 31 December 2013, with a section that allowed extra overtime hours to be worked by some healthcare employees. The rule applied to doctors and pharmacists working in round-the-clock services of some healthcare facilities, including emergency services, and also to workers in the paramedical professions. The rule applied only to workers operating under a ‘continuous working’ system.

For all other workers the Labour Code sets a maximum of eight hours’ overtime a week or 416 hours a year. The employer can insist on 150 hours of overtime, but the other 266 hours are open to negotiation.

Under the transitional agreement emergency medical services personnel were allowed to work a further eight or 12 hours of overtime per week. For some medical staff this added up to a 56 or 60-hour working week, with a corresponding supplement to earnings.

End of transitional period

The ending of the transitional period means employers must now follow Labour Code rules. It has left many employers facing tough questions over who would take on the work previously covered by overtime arrangements. Smaller hospitals face particular challenges, as they lack both the healthcare professionals and the financial resources to take on more staff.

Some employees in healthcare were happy with the extra overtime allowed during the transition period, as it gave them the chance to substantially increase their wages. According to some sources, payments for overtime work for hospital doctors may account for up to 50% of their monthly salary.

According to the Czech Doctors’ Trade Union (LOK–SCL), however, the situation during the transitional period has become intolerable.

Extra overtime hours have been associated with a risk to both a doctor’s safety and the safety of the patient. Trade unions have long supported the restriction of overtime to a maximum of eight hours per week. Their claims for overtime limits and significant increase in wages were part of the Memorandum on settlement in the health sector (in Czech, 123 KB PDF) of 14 February 2011. The memorandum was signed by Minister of Health Leoš Heger and by Martin Engel, Chair of the LOK–SCL. It was an effort to put a stop to a campaign for better wages called ‘Thank you, we’re leaving’ (CZ1112029I).

Health ministers acknowledge problems

The situation was also discussed in November 2013 by a working team on health from the tripartite Council for Social and Economic Agreement of the Czech Republic (RSHD ČR) for Health .

Delegates from the Trade Union of Health and Social Care (OSZSP ČR) have said that they are keen to prevent contravening the Labour Code when addressing the issue of staff shortages.

The Ministry of Health (MZ ČR), meanwhile, has admitted that some healthcare facilities might face problems with ensuring the quality of healthcare provision. At the end of 2013, the Ministry of Health, together with the Ministry of Labour and Social Affairs (MPSV) started preparations for introducing a new law that would extend the transitional period for overtime rules in healthcare from mid-2014 to 31 December 2015, under the same conditions as before.


Political decisions are likely to shape strategies for dealing with this issue. A caretaker government was in power until 29 January 2014, and if the agreement negotiated by its members stays in place, the transition period will be extended.

However, if the overtime rules cannot be relaxed, given a lack of financial and human resources, it is feared employers will use methods that might be on the edge of the law.

This might include the introduction of so-called ‘contractual salaries’ whereby the legal maximum of overtime work is already taken into account. Another way round the regulations would be the payment for overtime hours on the basis of another employment contract, for instance an Agreement to Perform Work.

Aleš Kroupa, Research Institute for Labour and Social Affairs

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