European Working Time Directive : a prescription for regulating junior doctors' Working Time?

摘要

This study explores attempts to regulate working time in a particular part of the medical sector. The specific focus is upon the perceptions and experiences of those in whose benefit the legislation purports to be, namely the junior doctors. It considers how the broader debates surrounding the European Working Time Directive (EWTD) are manifested in this specific section of the medical profession. The study argues that historical modes of regulation through self-governance, professional autonomy and minimal state intervention have helped to foster opposition to the EC law among many senior doctors. Their views about working-time regulation are compared to those provided by junior doctors. This enables an assessment of the ways in which traditional self-regulation has been overtaken by subsequent forms of governance in the medical profession, namely new public management and statutory control. The accommodation in process underlines the significance of the medical profession's exclusive culture and socialisation processes. These processes facilitate the transmission of ideas on issues such as work conditions, and occupational resistance to measures such as the Directive. Conversely, the difference in attitudes between senior and junior doctors reflects the evolving nature of the profession in response to increasing in managerial authority and state intervention. Following on from these debates, the study explores the processes by which the various modes of regulation have been implemented and enforced. It considers the respective roles played by the state, hospital managers and the medical profession, exploring the impact of working time regulation, with particular reference to doctors' health, medical training, and medical staffing and services. The study provides an assessment of the emerging impact of the regulation itself. The study draws upon a mix of methods including semi-structured interviews with Pre-Registration House Officers and elite figures. The latter comprise policy-makers at EC, UK and devolved levels senior figures within the medical and health services, including employer and employee representatives and members of both the UK and European judiciary. Questionnaire surveys were also administered to all PRHOs practising in Wales. The study concludes that a combination of factors have diluted the potential impact of the EWTD. These include the inadequate monitoring and enforcement mechanisms of a regulation whose fundamental terms have been 'fudged' by the state on the one hand, and the widespread application of a rigid shift system by the medical profession and hospital managers to junior doctors' training and service on the other. As a result, views on the EWTD are inconsistent and the degree of compliance with its provisions is variable.