title: Working time of neurosurgical residents in Europe--results of a multinational survey.
abstract: BACKGROUND
  The introduction of the European Working Time directive 2003/88/EC has led to a reduction of the working hours with distinct impact on the clinical and surgical activity of neurosurgical residents in training.
  
  
  METHODS
  A survey was performed among European neurosurgical residents between 06/2014 and 03/2015. Multiple logistic regression was used to assess the relationship between responder-specific variables (e.g., age, gender, country, postgraduate year (PGY)) and outcome (e.g., working time).
  
  
  RESULTS
  A total of 652 responses were collected, of which n = 532 responses were taken into consideration. In total, 17.5, 22.1, 29.5, 19.5, 5.9, and 5.5 % of European residents indicated to work <40, 40-50, 51-60, 61-70, 71-80, or >80 h/week, respectively. Residents from France and Turkey (OR 4.72, 95 % CI 1.29-17.17, p = 0.019) and Germany (OR 2.06, 95 % CI 1.15-3.67, p = 0.014) were more likely to work >60 h/week than residents from other European countries. In total, 29 % of European residents were satisfied with their current working time, 11.3 % indicated to prefer reduced working time. More than half (55 %) would prefer to work more hours/week if this would improve their clinical education. Residents that rated their operative exposure as insufficient were 2.3 times as likely as others to be willing to work more hours (OR 2.32, 95 % CI 1.47-3.70, p < 0.001). Less than every fifth European resident spends >50 % of his/her working time in the operating room. By contrast, 77.4 % indicate to devote >25 % of their daily working time to administrative work. For every advanced PGY, the likelihood to spend >50 % of the working time in the OR increases by 19 % (OR 1.19, 95 % CI 1.02-1.40, p = 0.024) and the likelihood to spend >50 % of the working time with administrative work decreases by 18 % (OR 0.84, 95 % CI 0.76-0.94, p = 0.002).
  
  
  CONCLUSIONS
  The results of this survey on >500 European neurosurgical residents clearly prove that less than 40 % conform with the 48-h week as claimed by the WTD2003/88/EC. Still, more than half of them would chose to work even more hours/week if their clinical education were to improve; probably due to subjective impression of insufficient training.
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland. mnstienen@gmail.com.
authors.forename: Martin N
authors.initials: MN
authors.lastname: Stienen
authors.affiliation: Department of Neurosurgery, Central Military Hospital, 1st Medical Faculty, Charles University, Prague, Czech Republic.
authors.forename: David
authors.initials: D
authors.lastname: Netuka
authors.affiliation: Department of Neurosurgery, Western General Hospital, Edinburgh, EH4 2XU, UK.
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Demetriades
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Ringel
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
authors.affiliation: Department of Neurosurgery, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Gempt
authors.affiliation: Department of Neurosurgery, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
authors.forename: Dominique
authors.initials: D
authors.lastname: Kuhlen
authors.affiliation: Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
mesh_terms: D000328:Adult; D000367:Age Factors; D002568:Certification; D005060:Europe; D005178:Faculty; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000193:education* / Q000706:statistics & numerical data*; D009873:Operating Rooms / Q000458:organization & administration; D012737:Sex Factors; D066231:Surgeons / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D000078329:Workforce; D016526:Workload / Q000706:statistics & numerical data*
keywords: European working time directive; Future; Neurosurgery; Neurosurgical training; Resident education