It will be about money when the Marburger Bund (MB) meets with the Association of Municipal Employers (VKA) on October 14 for the first round of collective bargaining for the approximately 55,000 doctors at the 500 municipal hospitals in Germany. The hospital doctors' union wants to achieve a salary increase of 5.5 percent for its members, with a term of one year. But something else is at least as important to it this time: the tightening of better working conditions through more stringent regulations on rest periods, on-call and on-call services in hospitals.

Previous exceptions to this, so the reproach of MB boss Susanne Johna, were "deliberately misinterpreted" by the employers in order not to have to employ additional doctors. For this reason - with a view to protecting the health of those affected, but also in the interest of patients who do not want to be operated on by overtired doctors - "the limits of what is permissible must now be defined even more clearly".Since January 1, 2020, however, physicians in municipal hospitals have been entitled to at least two work-free weekends per month. And they are also generally only required to perform up to four on-call duties per month. Both limits may only be exceeded if there would otherwise be a "threat to patient safety".

According to the Marburger Bund, however, the exception granted has become the rule for physicians in many hospitals. "We have had to learn that a threat to patient safety is understood to mean very different things," says Johna, summarizing the union's observations. One could almost have "the impression that the employers already regard the mere observance of working time regulations as a threat to patient safety." This cannot continue.

To illustrate the need for action, the head of the association refers to the results of a survey conducted last spring. According to this, in the second half of the 2020 calendar year, around 40 percent of the clinicians surveyed were on call for more than four hours per month on average. According to Johna, such "permanent overruns" cannot be explained solely by the fact that in all these cases the safety of patients was at risk. Many hospitals simply wanted to cut costs and were shifting more and more regular work to on-call time. "In other words, on-call time is being abused as a substitute for full time work because it's more expensive to hire additional staff and it's cheaper for the clinic to pay existing doctors on-call compensation."

Therefore, the Marburger Bund will now try to sharpen the existing exceptions. On the one hand, the order of additional services is to be permissible in the future only "in the emergency" and no longer only with alleged "endangerment of the patient security", which can be caused for example also and possibly even regularly by bad personnel planning or economy maneuvers of the hospital operator. The definition would then reliably refer to paragraph 14 in the Working Hours Act, according to which deviations from the regulations may only be made "in the case of temporary work in emergencies and in exceptional cases that occur regardless of the will of those affected and whose consequences cannot be eliminated in any other way".

On the other hand, the frame of reference for the limits and the entitlement to weekends off is to be changed. Up to now, it has been the case that more services can be demanded per month if only the average is maintained for half the year. Here one wants now "to a pure monthly consideration", says Johna. The advantage of this is that it would make the regulations "clearer, more transparent and easier to handle. No one would then have to work in advance with additional services over the limit and possibly physically overexert themselves in the hope of later compensation. In addition, doctors will no longer have to apply for their weekends off; they will be entitled to them automatically. And one weekend off per calendar month is to be guaranteed in any case.

A separate problem from the union's point of view is the on-call duty of hospital doctors. Here one needs not only clarifications, but a fundamental reform, stresses MB deputy Andreas Botzlar. Unlike on-call duty, on-call duty is part of the rest period under working time law. Utilization, i.e. work performed during on-call duty, should therefore only be the exception. "In fact, however, we are experiencing an increase in utilization here, for example via telephone or telemedicine," says Botzlar. Work that can hardly be done in the regular time because of the shortage of doctors is "regularly transferred to on-call duty. The result: rest is "in many cases no longer possible at all.

There is also survey evidence for this claim. In the spring, around 80 percent, i.e. four out of five of those surveyed, stated that they also had to work "in almost every on-call period". And about 70 percent said they were called to work at fixed times during their on-call time - for rounds, for example. This "clearly shows that hospitals are misusing on-call duty to compensate for a lack of staff," says Botzlar. 47 percent of those surveyed remained in the hospital despite being on call and continued to work directly. The on-call duty becomes "the gap filler, in order to cover home-made deficits". And the employers exploited the readiness of those who were concerned about the well-being of their patients to "keep the store running".

In the future, the union therefore wants to establish a "core rest period" between midnight and 6 a.m. for doctors on call. In the event of interruptions during this phase of the night, the rest period is to be extended. Physicians, who therefore could not start a service then, should "not suffer any disadvantages". And also differentiations after the form of medical demand must fall, demand Botzlar. It must be "finally recognized that also the interruption of the recovery by constant calls in the night is in high measure load-carrying". At the same time, the maximum number of on-call duties should be limited to 12 per month. Until now, there has been no cap at all here.

As far as payment for services during rest periods is concerned, the Marburger Bund is only seeking a higher standby allowance. Instead of twice the normal hourly rate during the week and four times on weekends and public holidays, it is now demanding three or six times the normal rate. With the remuneration of demands during rest times it is to remain with the past fourfold remuneration. According to the information the Marburger federation wants to send its demands still in this week to the employers. Botzlar said that this would avoid the usual preliminary skirmishing in the first round of negotiations and would allow them to get straight to the point. He hopes for constructive talks, otherwise the colleagues will probably be prepared to "give the necessary emphasis" to the demands.

Image by Sasin Tipchai