We recently ran a survey amongst trainee surgeons in the UK with regard to the 48 hour EWTD week and opt out. The concept of opting out from the 48 hour working week is not a new one and all but one respondant in our EWTD survey had heard about the 48 hour week and opting out. Many industries outside of medicine have been asking their employees to opt out of the 48 hour week for years. In medicine the 48 hour week had a staged introduction, but on August 1st this year the rule came into effect for UK medics.

John Black has made some excellent points in his EWTD statement available on the RCS website. I think  that most NHS trusts have not made adequate provision for the implementation of the 48 hour EWTD working week and there are just not the number of doctors available to make a 48 hour week work. I also think that the importance of continuity of care has not been appreciated. Handovers are inherently dangerous and reduction in working hours necessitates an increase in the number of handovers between staff. There is a lot to be said for the re-evaluation of a patient during their period of care and the subtly of an abdominal examination is not easily handed over from one clinician to another. A number of the respondants to the EWTD survey believe that patient care will suffer (88%) because of the 48 hour week. Another important aspect of patient care is the rapour and trust between the patient and their doctors. This will be made all more difficult with multiple clinians sometimes with differing but equaly valid views.

Most of the surgical trainees that responded felt that there training would suffe, both in normal working hours (84%) and overall (90%). I think it is clear that most of us don't think we can get adequate experience and hands on exposure with such little time at work. Interestingly the majority don't think that the 48 hour week would make an improvement to their work life balance or ability to carry out research projects, something usually done in trainees own time.

I think a major effect of the junior doctors contract and EWTD is that we have become de-professionalised as a group and we need to try and re-establish our professional standing and not clock watching shifts. I am not really sure how we achieve this. Maybe moving to a fixed salary and then just carring out "the job" is a way forward, but I can see how this may be exploited. We certainly need a solution and one that we unite behind, but working to a 48 hour in a vocation that requires hands on experience will result in a cohort of surgeons that are just not fit for purpose.

The full survey results are available on-line via this link http://surveys.surgeons.org.uk/results.php?sid=26372 .