January 7, 2023

The 16 hour watch as a step prior to the suppression of the 24. This is one of the ideas that is gaining strength in Spanish healthcare in recent months. In fact, in regions such as the Community of Madrid, they will begin to study the real possibilities and the impact of a measure of this caliber and that it might suppose an expense for the whole of the National Health System (SNS) of 643 million euros to support medical salaries.

The formula preferred by the medical community to alleviate the salary loss that would mean going from 24 hours to 16 hours in overtime goes through increase salaries, and not by increasing the price of the hour guard. And it is that the end of the guards is a debate that has begun to take off, that is why the solution passes inexorably through wages. In this sense, the coordinator of the Study Center of the Andalusian Medical Union (SMA), Vincent Matasproposes that, in order to maintain the purchasing power of doctors by reducing on-call hours, the average salary becomes an average of 3,000 euros net throughout the country.

Said increase would have an impact on the Spanish public coffers of 643 million euros, and would benefit around 165,000 physicians who practice in our country. This means improving remuneration, on average, by 300 euros per month, since the current average salary of a doctor in Spain is 2,700 euros net per month. In another sense, the amounts to be received by professionals who practice medicine would pass from the current 50,000 euros gross per year to around 60,000.

However, for Matas, the first great challenge faced by the 16-hour day is “deficit of professionals” suffered by the Spanish health system. A lack of manpower that “seriously complicates” that, currently, it is possible to reduce shifts from 24 to 16 hours without them occurring “holes” in the templates.

“I don’t know how the health administrations might do it, because there is a lack of doctors”, explains the coordinator of the SMA Study Center. In addition, he maintains that in most of the autonomous communities the ordinary working day is 7 hours, so it would be necessary “a 17-hour shift on duty”.

Sermas will study abolishing 24-hour guards

Recently, the Madrid Assembly has urged the Health Department of the regional government to study the abolition of 24-hour guards in health centers dependent on the Madrid Health Service (Sermas). Specifically, the department headed by Enrique Ruiz Escudero is called upon to carry out a study that includes the needs of professionals, the necessary improvements in their management and the organizational changes necessary to plan the elimination of these continuous shifts.

Said study must include the budgetary needs to carry out the proposed measures. In addition, the PNL maintains that the obligation of public institutions to “gguarantee the right to a certain period of uninterrupted rest of the workers of the Madrid Health Service”, as reflected in the legislation and current resolutions.

In a complementary way, it is established that “measures will be implemented to reduce the impact on health of those shifts that, despite not lasting more than 16 hourshave particular shift or night shifts that may negatively affect the health of workers and workers.

Medical shifts of more than 16 hours, ‘high risk’

The debate regarding removing the 24 hour guards have to do with the conditions of fatigue and stress in which the professional is forced to practicewhich in turn translates into a reduction in patient safety and an increase in the risks of working with little rest.

In fact, the risk that a Medicine resident commits a fatal error that results in the death of the patient during their shifts is reduced by up to 63 percent if these are limited to 16 hours, according to a study by the Harvard University which suggests that, with more rest, the effectiveness of the MIR improves by 32 percent.

These are some of the main conclusions drawn from this research on patient safety during long 24-hour shifts for medical residents published in the specialized magazine The BMJ.

The results of the study, which has taken almost 15,000 US residents, reveal that following the entry into force of the 16-hour limit for shifts, the MIRs (in force between 2011 and 2017) reported a third less medical errors and adverse events caused by fatigue. Likewise, failures “resulting in the death of patients decreased by almost two thirds” with this system.