In many neighboring countries, its format is localized on-call, not face-to-face.
Spain is one of the few countries of the European Union in which 24 hour guards to cover certain service needs. For example, in the Netherlands these shifts were banished years ago and in the United Kingdom they have even suspended doctors for working this period of time without a break. However, there are also territories where these days are observed, although the rest conditions and remuneration they are very different.
Luis Pérez has settled in Germany since June 2021. The German country has, according to the report of the Organization for Economic Cooperation and Development (OECD), a ratio of doctors per thousand inhabitants of 4.5 (lower than the Spanish figure located at 4, 6). Currently, this doctor of Argentine nationality is doing the residency of Cardiovascular Surgery in the Herz- und Gefäßzentrum Bad Bevensen HGZ, located in the municipality of Bad Bevensen. Speaking to Medical Writing explains that in the German country “there are different guard shifts for physicians and vary depending on the institution.
Ensures that the most common are morning shifts or eight-hour afternoon (from 8 a.m. to 4 p.m. or from 1 p.m. to 9 p.m.) although “additionally there are 12, 24 hour shifts and availability in which the doctor does not necessarily have to work, but should only be available for any emergency that may need to be addressed”, known as located guards in Spain.
“After one 24 hour guard there is a break at the same time as the guard and, regularly, no more than two 12 hour shifts on consecutive days”, explains the resident. The total number of these shifts per month depends on the number of physicians who are on vacation during that period. “Commonly between four and six monthly guards. It must be remembered that in Germany vacations are generally 28 working days, so it is common for a colleague to always be enjoying their rest time,” Pérez clarifies.
According to the economic compensation stipulated in Germany for doctors who perform on-call days “is calculated depending on the hours of shift, the rank of the doctor and his experience, as well as whether it is night time or a holiday. retribution starts at approximately 650 euros gross per 24-hour shift for first-year residents”.
Pérez: “In Germany the remuneration starts at 650 euros gross for each 24-hour shift”
The seniority of the doctor in healthcare practice, it determines both the number of on-call shifts and the financial allocation. “Generally the heads of service they do not work shifts or are called only in specific urgent situations and the assistants average five shifts per month”, Pérez ditch.
A 24-hour guard system supported by the MIR
In Belgium the situation is similar and the greater weight of these days falls on the residents both in “emergencies, wards or weekends”, while the deputies are “located”, as explained to this newspaper by Deborah Repullo Jennen, secretary of the Association of Spanish doctors in Europe and a specialist in General Surgery at the Hôpitaux Iris Sud in Brussels.
“The MIR have two contracting options: a base contract of 48 hours a week, which includes an average of four guards a month and they can sign a 60-hour option charging those 12 hours of difference at the extra hour price and could increase up to six guards a month on average”. For each guard they receive economic compensation, not the price of the guard, but supplementary when it is done on holidays or weekends is higher. The release of these is minimum of 12 hours but the usual thing is that the break is 24 hours.
It is also common for specialties such as Dermatology, Ophthalmology or Traumatology to “lose” their shifts in the third year of residency and start to be located, above all, with a second-line assistant, except in very large hospitals. In this case they don’t have a order awarded, they can be remunerated by contract or as an extra by location.
While on the side of the attending physiciansit is “very unusual” that guards be made except for the Emergency, ICU or Anesthesia specialtieswhere being a hospital employee by contract has to make a minimum number of guards. There are always 12 hours off immediately after and the remuneration ranges from 40 to 80 euros gross per hour. “It is also common for guards to be made in a timely manner, like one or two a month, to increase the monthly economic remuneration.”
Repullo: “The Belgian guards are more flexible, you can make your days ‘à la carte’ and the remuneration is higher”
Autonomous doctors must also be differentiated, something very widespread in this country where the ratio is 3.2 doctors per 1,000 inhabitants. “We are members of a cooperative and we take turns, for example we charge 100 euros for each guard located” Thus, Repullo considers that, even without having experienced the guards in Spain firsthand, “the Belgian system is much more flexible, since you can make your days ‘à la carte’ and the remuneration is higher; so it allows you to always do these days just for the sake of earning more money”. However, it is not such a good option for the MIR, who on occasion have asked for more face-to-face assistants during the difficult hours on call in the ER .
The doctor decides the total number of shifts to perform
In France, whose ratio of doctors per thousand inhabitants is 3.2 according to the OECD, the situation is somewhat different. Irene Mas is a resident of General medicine in the Gallic country and explains to Medical Writing that guards are held from 6:30 p.m. to 8:30 a.m. and that there are also 24-hour shifts. It ensures that all doctors, regardless of their rank, perform this type of shift and the outgoing day is established as rest. Where there are differences according to experience is in terms of financial compensation.
“The remuneration received for the 24 hour guard It depends on the rank of the doctor. Students receive 50 euros and residents between 150 and 160 euros. However, there is currently an increase in this amount of 50 percent, what we do not know is how long this measure will last. As you go up, the more you earn for 24-hour shifts. There are doctors who receive 300 or 400 euros, but there are also those who earn 2,000 euros.”
More: “France pays between 150 and 160 euros to residents for each shift on duty”
Regarding the number total guards that are carried out per month, Mas explains to this newspaper that they are distributed according to how each doctor wishes. “You can do none or do ten, although the legal maximum that they can demand is five a month,” he concludes.
The information published in Redacción Médica contains affirmations, data and statements from official institutions and health professionals. However, if you have any questions related to your health, consult your corresponding health specialist.