EU’s working time rules ignored, Greek doctors take case to EU institutions

Understaffing is keeping hospital doctors far from the EU’s 11-hour rest period. In Greece, hospital administrations are reported as breaching the 48-hour work-week rule, while in Sweden, doctors can be ordered to be on-call at home, rather than in hospitals, to get their regulated rest. 

The 2003 EU Working Time Directive (EWTD) is still being challenged in Europe's healthcare sector. This applies both to the regulated 11 hours of consecutive rest in a 24-hour period and to the maximum of a 48-hour working week - which includes overtime.

The problem is most often the result of understaffing, as in the case of Greece and Sweden.

“The Panhellenic Medical Association has started all the legal procedures to appeal to European institutions for the violation of the European Working Time Directive (EWTD) which allows a maximum of 48 hours of weekly working time for doctors employed in the public health system,” Dimitris Varnavas, the Association's general secretary, told Euractiv.

This isn’t the first time Greek doctors have had to turn to the European Union to address similar violations of their working hours.

“An appeal was made back in 2007 by the Greek Federation of Unions of Hospital Doctors (OENGE). We were vindicated, and the Greek Health Ministry had to sit at the table and negotiate with the doctors, resulting in a sectoral agreement in 2009, which was ratified by law – the first and, unfortunately, the only one of its kind for the public sector,” he said.

But then the financial crisis hit Greece, and “with the memoranda, everything was suspended, even the presidential decrees that enabled the implementation of the European Union directives.”

As the Panhellenic Medical Association’s General Secretary explains, “All of the above gave the hospital administrations the opportunity to force doctors to work limitless hours. So, a doctor is forced to work more on-call shifts in a month, plus the morning working hours, resulting in 110 hours of work a week, far from the 48-hour EU standard.”

In Greece, an on-call shift is 17 hours during the working week and 24 hours during the weekend, and those are added to the seven-hour morning shift.

The EWTD calls for a maximum of 13 hours working period in a 24-hour period. However, there are exemptions. For example, an on-call shift could last a maximum of 20 hours in some cases. And only in very exceptional cases 24 hours. This must be followed by an adequate duration of rest.

According to Varnavas, burnout syndrome is common among hospital doctors as a direct result of these working conditions. “That, in return, is one of the reasons doctors massively quit the national health system,” he says, alongside the bad salaries and the insufficient incentives.

The nursing staff also faces similar challenges as the ratio between nurses and patients has been reduced, Varnavas adds.

Understaffing, a major problem also in Sweden

Currently, 63,000 nurses, midwives and biomedical analysts across Sweden are blocking overtime, which was close to three million hours last year, according to their union. This came as a reaction to the breakdown of central negotiations on working time and pay.

A few years ago, an ambulance nurse involved in a road accident took Sweden to the EU Commission, pointing out that Sweden was violating the EU’s Working Time Directive.

The Commission warned Sweden that it would take the case to the EU Court of Justice if it did not tighten up its rules.

This was a wake-up call that led to new collective agreements in 2023. A special committee of the unions and the employers can now grant exemptions from the 11-hour rest period. For example, the on-call time for specialists in a particular hospital department could be extended to 24 hours.

Exceptions, special circumstances

However, the reasons must be special circumstances such as emergencies, critical organ transplantations, organisational criticalities linked to staff shortages, sudden illness or holiday periods.

A new collective agreement for doctors in Sweden came into effect in February 2024.

So far, the ECMO unit in Stockholm, the anaesthesia and intensive care unit and the gynaecology and obstetrics unit at Visby Hospital on the island of Gotland, have received such exemptions one year in advance.

A further ten or more applications have now been submitted for a one-year exemption from the mandatory rest period, affecting up to 200 specialists, according to Ann Garö, the ombudsman at the Swedish Medical Association.

Bending the rules

Lars Rocksén, first vice-president of the association and also a hospital consultant in northern Sweden, says that hospitals are getting around the rest rules, he said: “I think there should be even more requests for exemptions because we see today that the regions are very creative in finding alternative ways to solve the 11-hour rest period rules for specialists."

Rocksén told Euractiv: "In many cases, the regions are solving their problems with the regulations calling the on-call shift at home a standby shift much more often. It is only called an on-call shift when the doctor is at the hospital.”

He added: “They do so because a standby shift at home can be counted as rest time. The problem arises when you are at home and get a call from the hospital every hour since a standby shift is not always followed by a rest period like the on-call shifts.”

Euractiv requested comment from the employers’ organisation SKR, the Swedish Association of Local Authorities and Regions, but had not received a reply at the time of publication.

A pan-European issue

The standby time can also be a problem in other EU countries, according to a 2023 survey by the FEMS, the European Federation of Salaried Doctors, which looked at the current conditions faced by public health professionals in its member countries, among them ten EU member states.

According to the survey, when standby duty is converted into active working time, compensatory rest is not provided for in Italy, Spain, Portugal, Netherlands (and Turkey), or it is not of sufficient duration to compensate for long working hours.

“This problem can cause serious damage if you consider that in some European countries, the stand-by duties can be even 24 hours!” the report says.

It also states that in some countries, including Sweden, the Directive is sometimes seen as a restriction on work organisation. Even by doctors, as “old traditions force doctors to believe they are in full capacity even after long shifts,” according to the FEMS’ report.

Alessandra Spedicato, a doctor responsible for working time issues at the FEMS, is not aware of any plans by the EU Commission to increase compliance with the Directive.

But, as she told Euractiv, “My idea is that without any political pressure or any lobbying, nothing is going to change.”

[By Monica Kleja, Vasiliki Angouridi, edited by Brian Maguire | Euractiv’s Advocacy Lab]