Abstract about the changing situation of junior doctors.


With the well-functioning National Health Service of the UK has rearranged
the issues related to junior doctors, some problems have emerged. The main topic
of this dispute between junior doctors and NHS is the extended working hours. The
working hours are reorganized as from 7 a.m. to 10 p.m. and also Saturdays are involved
in working hours. However, enhanced working hours are correlated with the health complaints level (Raediker, Janssen, Schomann and Nachreiner (2009). Furthermore,
the work- family conflict is another important issue that can negatively affect
the work and family life of the employers (Baykal, 2014). According to the study
conducted by Adebayo, 2006; Kuntz, Mennicken & Scholtes (2011), the
suggested working hours are 5 days in a week and 8 hours in a day with breaks.  The two theories which are job demand control
and job demands resources have explanations about excessive work load and stress.
The job demand control model by Karasek (1979) indicates that the employers who
work in high demanding jobs are exposed to high stress levels. As an
intervention to this situation, this model offers that employees who have a lot
of workload should ask the manager about the control latitude level; likewise, employees
who have little or no influence about the work need more active job because he/she
has a stressful job (Mulder, 2017). On the other side, the job demands
resources model states that high job demands exhaust employers
physically and mentally, thus health problems occur and the commitment and
energy of the employers decrease; in response to this job resources increase
the role and engagement of the employer (Bakker, Hakanen, Demerouti & Xanthopoulou,
2007). To sum up, this report will mention about the regulations of the
existing contract and its problems and suggest some interventions about the changing
situation of junior doctors.

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The National Health Service (NHS) is an extensive health service system
which all United Kingdom citizens can use freely. This system is divided into 4
regions which comprise England, Scotland, Northern Ireland and Wales. It is
free for use which means that citizens are cured freely when they are poorly or
injured (http://www.bbc.co.uk). The foundation comes all from the taxes that
adult UK citizens have been paid. The budget of NHS was about £15 billion when it was founded in July 1948 at the
time of World War II and for 2015-2016 it has reached around £116.4 billion

 According to
Commonwealth Fund (2014), this health care system is the most impressive one
compared to the health systems of 10 countries which are Australia, Canada,
France, Germany, Norway, Sweden, Netherlands, Switzerland, New Zealand and the
US. Although its system had been mostly flawless, it made some innovations and
as a result of this junior doctors went on strike for the first time since
1970s. This dispute is about the disagreement on the contract that provides a
7-day NHS by the government.

The negotiations continued among the 3 pillars which
are junior doctors and the organization they belong to which is British Medical
Association (BMA), NHS employers and lastly the state. The reasons of the
dispute are mainly grounded on these following reasons.

First reason of this conflict about 7-day NHS is
extended working hours. Junior doctors used to work on a schedule from 7 a.m.to
7 p.m. from Monday to Friday. If they work outside these hours, such as being
on call, they get more pay. The renewed system obligates the official working
hours from 7 a.m. to 10 p.m. in a week. In addition to this, Saturdays are
included to the working schedule. In other words, the number of unsociable hours has been reduced. The increase of working hours from 12 hours to 15
hours in a day and working on Saturdays can accompany various disadvantages for
junior doctors which are mentioned below. 

The first problem that can be seen is physical
problems such as stress, chronic fatigue, cardiovascular and musculoskeletal disorders
(Johnson & Lipscomb, 2006). Likewise, a study conducted by Raediker, Janssen,
Schomann and Nachreiner (2009) revealed that the number of work hours in a week
and the rate of health complaints are significantly correlated. Similarly, in a
study it was observed that the intense weekly working, working on weekends and
nights, shift work have harmful effects on psychovegetative health (Wirtz &
Nachreiner, 2010).

Second of all, the work – family conflict is an
important issue that can have negative effects on the work and family life
(Baykal, 2014). It is in the
business-family conflict that the pressures on the fulfillment of
responsibilities in one area make it difficult to fulfill responsibilities in
the other. (Greenhaus & Beutell, 1985). In
other words, work-family conflict is that the individual has difficulty in
fulfilling his/her roles in work and family life in a balanced way. Work
family conflict is important for employees because research shows that the
tension created by work-family conflict triggers negative feelings and
attitudes towards work and increases work anxiety, work stress, work-related
exhaustion and work alienation (Burke, 1988; Kinnunen & Mauno, 1998;
Stephens, Franks, Atienza, 1997). Extended working hours,
overtime work, and disorganized working hours seems to increase the period of
time that employees spend for their work life, while it can cause to decrease
the time for their family members. This situation will probably disrupt the
work family balance and therefore the life balance. Depending on the changing
working hours in new contract, it will be difficult for junior doctors to be
able to balance family life and work life with extended working hours that
includes also Saturdays.

One of the frequently measured forms of work-family conflict
is time-based conflict (Baykal, 2014). Time-based
conflict can be defined as a situation in which making it difficult to fulfill
the requirements of another role because it takes too much time to
allocate a role (Greenhaus &
Beutell, 1985). Increased work hours induce employees to experience time-based conflict
between their families and work thereby it can be compulsory for the employees
who try to balance these two things (Ahmad,

Moreover, work-family conflict can cause psychological
and organizational consequences such as; stress, burnout, low life
satisfaction, low organizational commitment, low performance and absenteeism (Frone, Russell & Cooper, 1997; Bruck, Allen & Spector, 2002; Duxburry &
Higgins, 2003). In the view of all this information, the renewed decision about that
NHS extends work hours is a kind of change that may lead junior doctors to
experience negative psychological and organizational results due to imbalanced
work-family life.

In today’s working life, different approaches are
being taken to solve the problem of balancing work and life (Yücel, 2017). As an example to these approaches,
flexibility can
be defined as the ability to satisfy the needs of the workforce and to ensure
employee satisfaction by creating different working times and practices in
changing working conditions (Horwitz  Smith, 
1998). In this context,
flexibility practices in the working life can provide an important opportunity
for enterprises and employees to adapt to the changing structure. As indicated by Clark (2000), the balance between
work and life is being able to provide by the lowest level of the conflict
between the roles that the individual undertakes in his / her work and out of
work life. If employees are unable to fulfill their roles in home and if they
delay family and home responsibilities due to the intensity of time in their
jobs that means their work-life balance is in danger (Pichler, 2008). Mainly providing work-life
balance aims to create both objective and subjective life with quality which
means that in a subjective sense, the work-life balance is expressed as satisfaction
in business and personal life; and, in an objective sense, it means success in
health, career and private life (Hilderbrandt, 2006).  Moving to flexible work practices in the
workplace is necessary to ensure work-life balance (Dogrul & Tekeli, 2010).
Countries that have completed development in economic and social terms consider
the term of flexibility as a positive element that provides balance between
workers’ personal and work lives (Dogrul & Tekeli, 2010).

All this information expresses the fact that flexible
working hours have an importance in order to redress the balance between work
and life. The new regulation introduced by the NHS seems not to allow junior
doctors for freedom during working hours. For this reason, it seems that the
regulation may make it difficult for doctors to establish a work-life balance.
In addition to inflexible working hours, increased working hours can also
reduce the time junior doctors spend on other roles, and the work-life balance can be disrupted. As a consequence, in an
organizational manner, a decrease in employment and productivity in the field
of health care can be encountered, meanwhile in an individual manner, decrease
in job satisfaction and stress problems may come across.

There are many roles that a person
has to fulfill over the course of his / her life while the necessity of fulfilling more than
one role and demanding the energy and time to be spent on them constitutes a
work-life conflict (Duxbury & Higgins, 2001). Surveys on work-life balance express
that individuals with work-family conflict have lower performance in the
workplace than other employees. In addition to this, the stress created by the
need to fulfill more than one role increases the percentage of absenteeism in
the individual. In order to avoid these problems, more flexibility should be
given to junior doctors when and where they should work (Dogrul & Tekeli, 2010). Establishing a work-life balance in
the hospital alone may not be enough. The important thing can be applying
supportive policies for junior doctors in a flexible working environment. This
will be possible if junior doctors are informed more about the policies that
are going to be implemented.

Another practice that may be appropriate is to provide stress-coping
training for junior doctors in hospitals. Junior doctors will definitely benefit if a continuous and regular
training schedule is provided. In addition to this, governments should
make legally enforceable regulations, particularly for flexible working, and
establish criminal sanctions for imperfections in implementation to ensure that
work-life balance policies are properly implemented (Dogrul & Tekeli, 2010).

The third subject that is needed to be mentioned about
this case is increased work load for junior doctors. Work load, which is one of
the main subjects of work life, refers to the amount of work required to be
done by a certain period of time and it indicates time and energy for doing
business from an individual point of view, and productivity from an organizational
point of view (Baltac?, 2017). It is generally suggested that an employee
should be working five days a week and eight hours a day, taking breaks at
certain intervals, and having weekly leave days, while being affected by the
individual, organizational and social factors and individual’s work capacity
(Adebayo, 2006; Kuntz, Mennicken & Scholtes, 2011).  As a result, it can be conveniently said that
working 15 hours a day and 6 days a week is more than it should be according to
the study mentioned.

The level of work load of individuals affects their working
performance and health (Cerit, and Ozdemir, 2015). Especially
when the burnout syndrome is examined, it is one of the most basic reasons for
the finding that the individual is under heavy workload (Cedoline, 1982). In
other words, excessive workload is one of the most important and most common
causes of work-related stress. Burnout is defined as a syndrome that is
mostly seen in a type of person who is exposed to intense emotional demands and
who constantly has to work face to face with other people; and emerged towards
work, life and other people as a reaction to physical fatigue, prolonged fatigue, desperation and hopelessness
(Maslach & Jackson, 1981). In a simpler
expression, burnout is described as emotional exhaustion, depersonalization,
and low personal accomplishment in individuals who are in intensive relationship
with people for work (Maslach and Zimbardo, 1982, Maslach, et al., 2001).
According to research conducted by Schaufeli and Bakker (2004), Lourel et al.
(2008) and Shimmin (2010), as the workload of the employees’ increases, the
burnout levels also increase. In other words, there is a positive correlation
between burnout and increase in work load. As associated with the information
above, it can be easily predicted that burnout levels of junior doctors may
show an increase due to the extension in working hours and work load.
Furthermore it should certainly be considered that a rise in burnout levels of
employees in a field that directly affects society, which is health, may also
cause uneasiness in other individuals living in that community.

According to Maslach and Leiter (1997), it is thought
that any precautions that can be taken to improve the organizational conditions
(such as workload, control, awards, commitment, justice and values) can have a
preventive effect on the exhaustion of junior doctors. In addition, the
creation of opportunities for junior doctors to use their knowledge, skills and
abilities in order to enable them to experience positive experiences can be a
preventer that junior doctors can avoid the burnout and potential obstacles
that could lead to failure in the experiential process. It would be effective that junior doctors are
convinced and praised to use the knowledge, skills and abilities they have.
Apart from this, providing the junior doctors easy access to the information,
equipment and materials that are needed for the work will also be helpful in
reducing the burnout.

For all the inferences
mentioned above some general solutions may be suggested. First of all, employee
satisfaction should be considered and given priority for well being of junior
doctors. Job satisfaction is
described as the feelings about what employees have achieved at work and the degree
of their positive or negative feelings about their work (Schermerhorn et al.,
1994; Imparota, 1972). Nowadays satisfaction is seen as a priority for
not only of the enterprises but also of the employees. The
satisfaction of employees in their personal life and business life also affects
the employer in positive aspects (Dogrul &
Tekeli, 2010).

Secondly, giving the time
opportunity that employees need to be able to grow themselves and increasing
their quality and abilities are directly resulting in productivity (Yücel,
2017). Moreover, the policies and practices that support the continuity of
personal life increase the commitment of employees to work and work place
(Dogrul, and Tekeli, 2010). Therefore junior
doctors should be given opportunity that help develop their vocational
practices and take a step further in their way of being general practitioner or
consultant in a specialized area.

Thirdly, as it is known, the employer is also
responsible for the physical health of the employee (Sparks, Faragher, and
Cooper 2001). Under this responsibility, it is
necessary to prepare a healthy working environment. In the
preparation of the work schedule, the shifts can be arranged in such a way as
to provide sufficient rest and sleeping time for the employees. For this reason, in order to increase the quality and
skill of junior doctors, NHS needs to implement practices that will give the
doctors the time they need. The preparation of a judicious working schedule
will help junior doctors increase their commitment to work and make them work
more willingfully. As junior doctors take a rest sufficiently they can focus on
their work and be able to have enough energy to fulfill the requirements of
their out-of-office role.

As a theoretical model, job demand control model can
be used in this case. This model presented by US sociologist Robert Karasek
(1979), emphasizes 2 concepts; “demands” (height of strain) including work
rate, time pressure, availability, difficulty and effort that are occurred at
work; and “control” (decision latitude) which expresses the freedom an employer
has to manage and organize in work. The model displays that the strain itself is
not required to produce psychological stress, decision latitude accompanied by
work should also be together with strain (Mulder, 2017). Furthermore, the
limited latitude which partly allows employers to organize their work with
their own ideas induces stress symptoms, on the other hand if employers have
the freedom to regulate their work on their own; they can cope up with the
workload sufficiently and will definitely be more motivated (Mulder, 2017). It
is indicated by Karasek (1979) that the employers having demanding jobs are
exposed to lots of stress unless they determine when to do the work.

The job demand control model suggests some
interventions, for example that if an employee has a lot of workload based on
him/her tasks to complete; he/she should ask the manager about the level of
control latitude. Likewise, if the same employee has little or no impression about
the organization, it means that this employee is in need of more active job
because the job stress model indicates that he/she has a stressful job (Mulder,

Another theory that should be mentioned is job demands
resources (JD-R) model which is predictive for burnout and engagement of
employees and attendantly the organizational performance (Bakker & Demerouti, 2007).
JD-R model classifies the factors which employee well-being underlies into 2
categories; job demands and job resources and therefore, employees get tired mentally
and physically because of the high job demands and this causes discharge of the
energy and health problems. On the other hand, the job resources encourage the engagement
of the employee and enhance extra role performance in the work (Bakker, Hakanen,
Demerouti & Xanthopoulou, 2007). Moreover, several studies indicated that in
stress response, job resources can buffer the job demands affect and in
addition to this information, researches have supported the finding that job
resources include the potential of motivation in the situations when high job
demands exist (Bakker, Demerouti & Euwema, 2005). In the light of this
information, the high demands of junior doctors’ tasks may lead to high level
of stress, and in order to increase engagement and commitment of junior doctors
to the work, job resources should be increased. Thus the job resources may
overcome job demands. 


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