Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries

Rina Maoz Breuer, Ruth Waitzberg, Adin Breuer, Peter Cram, Lucie Bryndova, Gemma A. Williams, Kaija Kasekamp, Ilmo Keskimaki, Liina Kaisa Tynkkynen, Verena van Ginneken, Eszter Kovács, Sara Burke, Domhnall McGlacken-Byrne, Carol Norton, Barbara Whiston, Daiga Behmane, Ieva Grike, Ronald Batenburg, Tit Albreh, Rade PribakovicEnrique Bernal-Delgado, Francisco Estupiñan-Romero, Ester Angulo-Pueyo, Adam J. Rose

Research output: Contribution to journalReview articlepeer-review


Background: Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents’ work hours. Objectives: We aimed to review residents’ work hours regulations in different countries with an emphasis on night shifts. Methods: Standardized qualitative data on residents’ working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. Results: All countries reviewed limit the weekly working hours; North-American countries limit to 60–80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. Conclusions: In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents’ quality of life with mixed effects on quality of care and residents’ education.

Original languageEnglish (US)
Article number104753
JournalHealth policy
StatePublished - Apr 2023
Externally publishedYes


  • Cross-country analysis
  • EWTD
  • Medical residents
  • Nightshifts
  • Work hours

ASJC Scopus subject areas

  • Health Policy


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