The upcoming workhour limit on pregnant trainee physicians has become a problem for the female trainees themselves.
From March 1, the Labor Standards Act will limit the work hours to 40 per week for pregnant medical residents. However, a majority of them are expressing concerns that their reduced training time might hurt their career without proper countermeasures.
The Ministry of Health and Welfare’s Committee for Assessment of Training Conditions said it would implement the revised bill on standard training rules for medical residents from March.
The committee asked for each medical society’s opinions about the need for additional training for pregnant residents. The revision to training rules is by the Labor Standards Act’s Article 74 on Protection of Pregnant Women and Nursing Mothers. The labor law prohibits pregnant women from working more than 40 hours a week and doing extra work.
Accordingly, additional training for them will be up to the decision of the ministry’s training assessment committee.
The Act for the Improvement of Training Conditions and Status of Medical Residents states that any training hospital should not force residents to work for more than 80 hours a week. For pregnant and nursing trainees, the Labor Standards Act allows three-month maternity leave, before or after childbirth.
The Health-Welfare Ministry decided to apply the Labor Standard Act to pregnant trainee doctors after the ministry asked the Ministry of Employment and Labor to make its authoritative interpretation. However, the health and welfare ministry has failed to provide rules for additional training as of Wednesday, a day before the implementation of the 40-hour workweek rule for pregnant residents.
Pregnant trainees are criticizing the government for ignoring their needs for medical training and applying the Labor Standards Act universally. As medical residents are both trainees and workers, a shortened time for training hours may lead to fewer opportunities for education and a worsened quality of training, observers said.
|Pregnant trainee physicians will face the working hour limit of 40 hours a week from March when the revision bill on medial training rules goes into effect.|
Trainee doctors call for criteria for additional training
Female trainee physicians do not agree with the idea of compulsory additional training to make up for reduced training time during pregnancy. They worry that the upcoming workhour limit could delay their acquisition of medical licenses and make training hospitals avoid hiring woman residents.
The Korean Medical Women’s Association recently received a complaint from a physician who said, “Restricting working hours of pregnant residents to 40 hours a week is unfair because they would not only face disadvantages during training but can be deprived of the opportunity to work (full-time) as a resident.”
“I saw a lot of pregnant residents struggling to do shifts and work until the last month of pregnancy before giving birth. I also saw seniors and colleagues experiencing miscarriage or stillbirth,” said a female resident in the second year of training at a large hospital in Seoul, wanting to be known by just her surname Ji. “Limiting working hours to 40 hours a week for pregnant residents is a human right that we must protect. But if following such rule is difficult in reality, the government should first discuss how to back up the shortage in the workforce.”
She went on to note that some female residents are opposed to putting a work hour limit.
“People say many hospitals will be reluctant to hire woman residents in the future. Some pregnant trainees say they would rather keep the 80-hour workweek because they feel uncomfortable in front of other residents,” Ji said. “It’s not that they would not work hard. They’re just demanding that the government come up with reasonable training targets and contents.”
Ahn Chi-hyeon, president of the Korean Intern Resident Association, said medical societies do not have clear criteria as to skills are precisely needed to become a specialist.
“Under such circumstances, simply making pregnant trainees receive additional training just because they had less training time is like treating residents as someone to exploit labor,” Ahn said. “It is not only for pregnant residents but also for all trainee doctors across the nation. We need discussions about what kind of capabilities and training programs are needed to help them become specialists.”
He noted that he was not opposed to additional training.
“If the government provides appropriate criteria, pregnant trainees can receive additional training. This issue can be resolved by establishing the standards and making trainees follow them,” Ahn said. “We need to know what kind of skills pregnant residents missed under a 40-hour work limit and how much training they need to catch up. Then, we can decide how much additional training they will need.”
‘Some even suggest not hiring residents at all’
Medical societies, which have been asked by the training assessment committee to prepare additional training standards, have failed to decide their stances because calculating the exact training time was impossible. They complain about the government’s move, saying the enforcement of the law without an alternative was causing conflicts only.
Eom Joong-sik, training chief at the Korean Association of Internal Medicine and a professor at Gachon University Gil Medical Center, said his association tried to measure the actual working hours of residents, but it was impossible to do so.
“In internal medicine department, residents are required to receive training for up to 80 hours a week. It is hard to distinguish the necessary training from unnecessary ones,” Eom said. “If we reduce the training time, trainees might not get the full proficiency as an internal medicine specialist. If the working hours go down under 80 hours a week, they would need additional training. This is our association’s position.”
The Korean Society for Thoracic & Cardiovascular Surgery Chairman Oh Tae-yun said he was afraid that hospitals would not be able to carry out proper training.
“Although our training committee is preparing plans, basic training requirements must be provided. Basic training requirements will include assessments of the time assigned under the Residents Act and how much they participated in surgery and surgery assistance,” Oh said.
“Our society has to decide our stance by the competency evaluation of residents being prepared by the Korean Academy of Medical Sciences,” he added.
“Some even say if hospitals find it too difficult to train residents, they might be better off not to hire residents, use more fellows, and hire hospitalists or physician assistants instead. This issue can spread to the overall training system. This is a big problem,” Oh pointed out.
‘Why put a limit on pregnant trainees only, if 40 hours are enough?’
Many training hospitals say the 40-hour work limit a week for pregnant residents will make them receive additional training inevitably.
“If a pregnant trainee gets 40-hour training a week and gets recognized for completing the medical training course, why can’t other trainees do the same? Then we have to reduce the training hours to 40 hours a week for all of the trainee physicians,” a professor at a university hospital said.
In advanced countries such as the U.S., the authorities could not cut the working hours of trainee physicians under 80 hours a week because both trainees and trainers admit that a certain amount of training time should be invested to complete the trainee’s proficiency and skills, he said.
Shin Hyun-young, the former spokesperson for the Korean Medical Association and a professor of family medicine at Myongji Hospital, said American pregnant trainees do not get a separate leave while usually working 80 hours a week, although the rules are different from state to state.
“They usually use an official four-week vacation, given per year, for giving birth. They use six weeks for natural labor, and eight weeks for cesarean delivery. But, their completion of the medical training gets delayed by two to four weeks,” she said.
Shin went on to say that Korean training hospitals do not offer alternative staffs for pregnant trainees, making other trainees do extra work. Then, female trainees would instead get self-conscious, delay pregnancy, and hospitals might even avoid hiring female trainees, she added.
“I don’t think there is any logic to oppose additional training. But if each society sets a different stance on this issue, it might worsen the disparity in the sex ratio in medical departments,” Shin said.
The health and welfare ministry admitted that it was not easy to prepare countermeasures.
“There is no question that we must protect maternity. But female residents as workers and trainees might get disadvantages if hospitals avoid employing them,” an official at the health and welfare ministry said. “We should not produce low-quality specialists while we put excessive focus on maternity protection. But residents are opposed to additional training for pregnant trainees. So, this is a difficult problem. Our ministry is thoroughly reviewing various measures.”
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