Flexibility may hold the key on doctors' hours

PUBLISHED : Tuesday, 06 June, 2006, 12:00am
UPDATED : Tuesday, 06 June, 2006, 12:00am

The obvious question to ask about the $400 million-plus agreement between the Hospital Authority and its doctors about overtime pay is whether taxpayers will have to dig deep into their pockets to meet a similar claim again. Regrettably, as things stand, nobody can provide a sure answer. And that is totally unacceptable.

When public doctors took the authority to court over their long working hours, they said they were not doing it for the money. Instead, they were trying to force the authority to face up to the protracted issue of some doctors having to work excessively long shifts. Their reasoning was not entirely convincing, as the legal action could only take the form of a claim for compensation and would lead to a financial payout if the doctors won. That is what will now happen, after the court held in March that they should be compensated for having worked on rest days and statutory holidays.

It would have been nice if the current deal could settle the matter once and for all. But it won't, as it will not cover doctors' claims for the extra hours they have worked on regular days. On this crucial issue, the court held that doctors are already compensated by a monthly honorarium. Needless to say, doctors are highly critical of the ruling. As management and staff are locked in negotiations, the union has not ruled out launching an appeal. Should the case go back to court, both sides would have to spend more on legal fees, and a ruling in the doctors' favour might mean another hefty payout from the public coffers.

This scenario should be avoided as far as possible. There can be no doubt that no one should be required to work ridiculously long hours. However, the court is not necessarily the best arbiter on this sticky issue, which is about striking a balance between providing patients with proper medical care and doctors with healthy working conditions. The authority and the doctors must try to iron out their differences through sensible discussions. The authority has vowed that it will not try to tackle the problem by hiring more doctors. That is the right attitude, although it might upset the medics. The public purse is not a bottomless pit and manpower problems are never simply about adequacy of resources. What matters more is whether resources are properly used. Throwing money at a problem without addressing the issue of efficiency is never going to solve it at its root.

Still, the doctors have a case for being sceptical of a three-year plan by the authority to cap working hours. At present, about 20 per cent of public doctors work more than 65 hours a week, and the goal is that no one should exceed that limit. But the plan begs the question as to the basis on which the 65-hour rule is set. Assuming doctors work a six-day week, they would still have to work 11-hour shifts. That would not be healthy for doctors or patients as long hours can breed fatigue and increase the risk for errors.

But as the medical profession's demand on its practitioners is unique, it may not be appropriate for us to assess the plan from a layman's perspective. Taking care of patients can never be a nine-to-five job, as some will require round-the-clock attention. It is a fact that all prospective doctors are fully aware of when they decide to join the profession. Working occasionally long hours should not constitute a ground for compensation, although every effort should be made by the authority to ensure a fair distribution of the workload among doctors.

Our public doctors have a legitimate demand for shift arrangements that would allow them to maintain a healthy work-life balance. Perhaps the answers lie in the unions' proposals for more flexible employment conditions, so the same resources could be used to boost manpower by hiring a combination of full-time and part-time doctors. Whether that would work would require careful evaluation.

In the best interests of patients, we need a health-care workforce with high morale and good health.