One year has passed since the legislation of the Act for the Improvement of Training Conditions and Status of Medical Residents but trainee physicians still suffer from demanding work environment, a recent survey showed. Medical interns and residents work 84.9 hours a week on average, and many of them work more than 100 hours a week.
The government started to enforce the Medical Resident Act on Dec 23. As the law limits trainee doctors’ weekly work hours to 80, hospitals that do not abide by the law will face up to 5 million won ($4,695) in fine.
The Korean Intern Resident Association (KIRA) on Sunday unveiled the results of its opinion poll on 3,800 interns and residents at 65 training hospitals, conducted from Sept. 29 to Oct. 31. The survey broke into four groups by hospital size – hospitals with 100 trainee physicians or lower, those with 101-199, those with 200-499, and those with 500 or more.
84.9 weekly work hours on average, still exceeding 80 mark
The survey showed that medical interns and residents at 65 hospitals worked 84.9 hours a week on average. Compared with 88.9 hours in 2016, the figure was a slight decline, but it still exceeded the legal limit of 80 hours.
Out of the 65 training hospitals, only 16 (24 percent) did not exceed the legal limit of 80 hours. At the other 49 hospitals (76 percent), residents worked more than 80 hours a week.
Trainee physicians worked 109.7 hours a week at Kyungpook National University Hospital, which was the longest among the total, followed by Bundang Jesaeng Hospital with 107.6 hours and Severance Hospital with 101.3 hours.
In contrast, Chungbuk National University Hospital offered the shortest 66 weekly work hours for residents, followed by Kangbuk Samsung Hospital with 66.3 hours and Korea Cancer Center Hospital with 67.5 hours. Among hospitals with more than 200 beds, Ewha Womans University Medical Center marked the shortest weekly work hours with 71.7 hours.
Residents worked less, as they became senior. Residents in their first year worked 92.38 hours a week on average, 85.2 hours in the second year, 79.12 hours in the third, and 69.58 hours in the fourth. Most of the residents in their first and second year worked overtime, more than 80 hours a week.
To the question, “Have you ever worked 36 hours straight in the past four weeks,” 426 out of 1,059 interns (40 percent) said “yes.”
Some worked even for nine days consecutively. Residents at Soon Chung Hyang University Cheonan Hospital said the maximum time they’ve experienced was nine days of continued work.
The Medical Resident Act states, “The head of any training hospital or institution shall not force a medical resident to attend training programs for more than 36 consecutive hours.”
The maximum days of continuous work at 65 training hospitals was 3.34 days on average. After Soon Chung Hyang University Cheonan Hospital, Kunkuk University Chungju Hospital ranked second with 5.3 days, and Inha University Hospital, third with 5.12 days.
Despite the long shifts, medical residents had only 5.7 hours of rest a week. The worst case was at Bundang Jesaeng Hospital where trainee doctors had only two hours of rest a week.
Trainee physicians received only 50,000 won for a shift on a weekday, and 75,000 won for duty on weekends or holidays. Some residents did not even know how much they received for a shift.
Samsung Medical Center paid the most, 133,800 won for a shift on average, while Kyunghee University Hospital, the least, 10,000 won a day.
For a holiday duty, Samsung Medical Center also paid the most, giving 271,000 won a day, while Kyunghee University Hospital, the least, 13,000 won a day.
Residents at Gwangju Veterans Hospital, Wonkwang University Sanbon Hospital (for a holiday shift), Kangbuk Samsung Hospital, Soon Chun Hyang University Hospital, and Gachon University Gil Medical Center answered that they did not know how much the payment for a shift was.
Trainee physicians were frequently deprived of personal time, getting at least one call during lunch.
Asked “How many times do you get a call during a meal,” they answered 1.59 times on average. At Gangnam Severance Hospital, it was 2.84 times, the most, followed by Bundang Jesaeng Hospital with 2.47 times, and Severance with 2.38 times.
During shift, trainee doctor sees 41.8 patients on average
The most urgent issue was the number of patients that trainee doctors had to care. The problem became controversial when news reports revealed that a medical resident had to take care of 160 newborns at Ewha Womans University Medical Center. The hospital was in the media’s spotlight as four newborns in the hospital’s neonatal intensive care unit died of Citrobacter sepsis within 90 minutes.
The latest poll showed that interns and residents had to care for 41.8 patients per doctor on duty.
At Chunbuk National University Hospital, residents handled 90.8 patients per doctor, which was the most among training hospitals with more than 200 residents.
By the hospital size, training hospitals with 100 trainee doctors or less had their residents care for 81.6 patients per doctor. Gangnam Severance Hospital residents took care of 69 patients per resident, the most among hospitals with 101-199 trainees. Severance Hospital residents handled 69.4 patients per trainee doctor, the most among hospitals with 500 trainee doctors or more.
On average, 15 percent of residents’ work was irrelevant to medical training.
On the question, “how much work is not related to medical training?” they said 14.9 percent on average. Residents at the National Medical Center reported 22.8 percent, which was the highest among training hospitals.
The second highest ratio was seen at Hanyang University Hospital with 21.8 percent, followed by Hallym University Kangnam Sacred Heart Hospital with 21.3 percent.
“According to the survey, many hospitals still do not meet their minimum obligations regulated by the law. The survey was conducted when only two months were left until the government enacted the Medical Resident Act’s Article 7 regarding training hours. But we could not find many hospitals that kept the legal limit of training time,” KIRA said. “Even the “Big 5” hospitals forced residents to work more than 100 hours a week.”
The KIRA said medical residents’ accumulated fatigues, insufficient sleep, and excessive work are all related to the number of patients they have to take care.
“The government should limit the number of patients that a resident can care for to secure patient safety and improve the quality of medical training,” the association said.
The KIRA went on to say that at some hospitals, as much as 21.5 percent of a resident’s work was irrelevant to medical training. Assuming that they work 100 hours a week on average, their 20 work hours go wasted for training-irrelevant work, the association said.
“If irrelevant work takes up 20 percent of their work hours, their quality of training conditions naturally drops. Hospitals should give them proper training and more opportunities for participation to improve the training conditions,” KIRA said.
KIRA President Ahn Chi-hyeon said, “The direction of improvement is clear. The government should financially support for better medical training and enhance the evaluation of training conditions.”
If hospitals receive state support, the burden on the hospitals will become lighter, and residents will receive better training, he said.
“To reinforce the evaluation of training conditions, the government should listen to opinions of medical residents who are receiving training,” Ahn said. “Based on the results of the evaluation, the government can devise up reasonable plans for improvement. It is also necessary to give sticks and carrots to training hospitals, depending on the evaluation results.”