オーストリアでも医師の長時間労働が問題に

EIROnlineから、オーストリアの医師の長時間労働の話題。

http://www.eurofound.europa.eu/eiro/2008/01/articles/at0801039i.htm

病院の１０に９つは労働時間規制に違反している、と。

まず、オーストリアの医師に関する労働時間規制ですが、

>In Austria, the 1997 Hospitals’ Working Time Act (Krankenanstalten-Arbeitszeitgesetz, KA-AZG (in German, 50Kb PDF)) restricts the average working week of hospital doctors to a maximum average of 48 hours. The working week may be extended to a maximum of 60 hours in a single week, provided that the normal working week does not exceed the 48 hours’ average over a specific reference period. In addition, the individual working day must not exceed a maximum of 13 hours. However, the KA-AZG also provides for the possibility of extending these working hours through a company-level works agreement. In this respect, the law provides for working time limits as follows: a maximum of 60 working hours a week on average, with a maximum of 72 hours in a single working week; a maximum of 32 hours during the working week and of 49 hours during weekend work, including rest periods that have to be observed for each period of service.

原則週４８時間、変形制で週６０時間、１日の上限は１３時間、さらに企業レベル協定で原則週６０時間、変形週７２時間(最後の週末４９時間というのがよく判りませんが)、とかなりの長時間労働が認められているのですが、現実はそんなものではない。

>Despite these working time restrictions, the results of occasional workplace inspections at hospitals carried out by the Austrian Labour Inspectorate (Arbeitsinspektorat) have revealed that seven out of 10 Austrian hospitals – in at least one of their departments – systematically breach these working time regulations. At the Vienna General Hospital (Allgemeines Krankenhaus, AKH), for instance, which is the country’s largest hospital, the employees do not even have the possibility to register their overtime hours in the online service schedule. Moreover, the Austrian Chamber of Doctors (Österreichische Ärztekammer, ÖÄK), which organises both employed and self-employed doctors, has uncovered cases of employees recording up to 100 working hours a week. According to the chamber, disregard of the working time regulations is a widespread cost-reducing strategy of hospital managers, since it saves them having to recruit additional staff.

労働監督の結果、１０に９つの病院で違反が見つかり、中には週１００時間というのもあった、と。

>Interestingly, the infringements of working time regulations are found almost exclusively in the public hospital sector, which employs about three quarters of the sector’s employees. This is mainly because private hospital providers – in the case of administrative offences such as the breaching of working time regulations – are subject to administrative fines. In the public sector, however, a similar form of penalisation does not exist and, as a result, infringements of employee protection law committed by public authorities go completely unpunished. Theoretically, the Labour Inspectorate could initiate proceedings against the public hospital managers responsible and/or the public authorities operating these hospitals; in practice, however, such attempts of prosecuting authorities have remained completely ineffective.

しかも、違反しているのは公的病院ばかり。これは、民間病院は違反が見つかると罰金を払わなければならないが、公的病院は違反してても罰金を払わなくて済むからだとか。つうか、理論上は公的病院にもできるんだけど、実際はやってない、と。

>As a result of these findings, ÖÄK, in line with the trade unions which also represent doctors employed by hospitals, have demanded the introduction of appropriate administrative fines for public hospital managers who violate the regulations, based on a system similar to that used in the private sector. ÖÄK argues that these fines, particularly in cases of repeated and systematic disregard of the working time regulations, should be high enough to force hospital managers to invest in additional personnel rather than infringing the law.

で、医師会議所(開業医と勤務医の両方を組織していると書いてあるので、日本の医師会と同じですね)が、労働組合と協力して、公的病院にも罰金を課せと要求している、と。

>The Minister of Economy and Labour Affairs, Martin Bartenstein, has already signalled his willingness to take appropriate legal measures to curb these practices. The minister announced that he would immediately enter into negotiations with representatives of the provinces (Länder), which operate most of the public hospitals, as well as the social partners, in order to implement a sanction mechanism which targets public authorities running hospitals and their managers in the event of illegal employment practices. Such sanctions would be inevitable not only for employee protection and the patients’ right to optimal medical treatment by sufficiently rested personnel, but also in order to avert unequal conditions of competition in the sector to the detriment of private hospital providers.

経済労働大臣も公的病院を運営する州政府との交渉に動き出した、と。

>In Austria, the hospital sector employs almost 20,000 doctors overall, about three quarters of whom are public sector employees. Thus, the Labour Inspectorate’s findings suggest that several thousands of hospital doctors in Austria are – at least occasionally – being faced with illegally long working hours. The systematic disregard of working time regulations is deemed by experts to be the main cause of fatigue among many doctors, which can directly endanger patients’ health. For instance, a recent study carried out by a surgeon at a hospital in Steyr, Upper Austria, revealed a significant correlation between the duration of the hospital doctors’ uninterrupted service rendered and the incidence of malpractice committed by them. Another study carried out by ÖÄK found that the overall working conditions of hospital doctors have deteriorated in the period 2003–2006, in particular in terms of time pressure, long working hours or overtime and night work. All of these findings underline the need for the introduction of enforcement practices with regard to existing working time regulations in public sector hospitals.

長時間労働による医師の疲れが、医療過誤の原因になっている、と。

なんだか、すごく日本の話と同じところと、違うところがあって、同じところは同じところなりに、違うところは違うところなりに、大変考えさせられます。