Context
Israeli medical residents complete regular overnight shifts during their residency, which seamlessly follow their daytime responsibilities (of eight hours), totalling 26 hours of continuous work. Israel has recently implemented several initiatives to improve the working conditions of medical residents (Breuer, Waitzberg, Breuer, et al., 2023).
Resident night shift hours were shortened from a maximum of 36 hours to a maximum of 26 hours in the 90s and last changed in 2012, when they were limited to eight night shifts a month. The working hours are limited to a maximum of 71.5 hours per week, which is a deviation from the Israeli labour law, which currently restricts work hours to a maximum of 42 hours per week (Ministry of Economy, 2015). Nevertheless, approximately one-third of residents still report working 71.5 hours or more on average each week.
Reducing residents’ working hours is difficult without a concurrent increase in the workforce; this change may potentially harm the quality of care, elevate workloads during shifts, jeopardize the continuity of patient care and have potential adverse impact on the education and training of residents (Breuer, Waitzberg, Breuer, et al. 2023).
Impetus for the reform
The Ministry of Health (MoH) established a joint professional committee for planning this reform and finding ways how to implement a reform to shorten residents’ working hours. The committee published its recommendations in March 2022 and in March 2023, the parties (MoH, MoF, IMA) reached a consensus on how to implement the reform, adopting most of the recommendations put forth by the MoH’s committee. Please see “Shorter Medical Residents’ Night Shifts: The Reform Process” for more details on the reform process.
Content/characteristics
Hospital residents’ working hours per night shift were reduced from 26 hours to a maximum of 21 hours. Working hours on the day of an overnight shift will begin at 13:00 (instead of at 8:00) and finish at 8:00 or 10:00 on the following morning. Residents who want to maintain the same salary will be able to add four-hour evening shifts (16:00–20:00), which pay three times as much per hour than a regular shift, to their working day.
As part of the reform, 180 staff positions were added to compensate for the reduced working hours. The calculation was based on an estimated additional 1.3–1.4 staff positions for each resident (Ministry of Health, 2022) (Knesset, 2023a). An additional budget of 30 million NIS was allocated from the government budget to hospitals for this reform, which will enable hospitals to add more staff positions (Knesset, 2023b).
Implementation steps taken
This change will initially be implemented in ten peripheral hospitals located in the North and South regions of Israel, during weekdays only. It is worth noting that some medical specialities, particularly surgical, are not included in the first implementation phase. The expansion of this reform to other hospitals, weekends or specialities remains uncertain at this stage.