“For 20 years, my daily life has been defined by 24/7 shifts, including nights and holidays, consistently working overtime,” Francesca Mattiuzzo, MD, an anesthesiologist and intensive care specialist in Rome, Italy, told Medscape News Europe. “This has made my presence at home an exception rather than the rule.”

Mattiuzzo, who is 48 and a mother to two teenagers, is one of many physicians who have backed a campaign by the European Federation of Salaried Doctors (FEMS) to formally recognize medicine as an “arduous occupation.” It is the subject of a conference organized by the federation at the European Parliament on January 27.

Mattiuzzo says her professional life has turned work-life balance into “an exhausting struggle” and that it is “essential” for medical practice to be formally recognized as arduous. Intensive care in particular carries an immense clinical responsibility combined with a relentless pace, she said, and is performed in a persistently tense hospital environment. This exposes physicians to a critical risk for burnout that erodes both physical health and psychological stability.

“After two decades of sleep deprivation and professional stagnation, the constant fear of falling ill — knowing it would unfairly burden my colleagues — and the emotional exhaustion I bring home make this profession a biological sacrifice that is no longer sustainable,” she said.

Formally recognizing her work as arduous would mean acknowledging that “the stress we endure is anything but ordinary; it undermines the physician’s well-being and, consequently, the safety of the care we provide.”

High Personal Price

Anna Farina, MD, is also an anesthesiologist-intensivist, which she describes as “one of the most beautiful jobs in the world.” However, “in Italy, the personal price to pay is extremely high and the work is not fairly compensated,” she told Medscape News Europe. At 42, with one daughter, she echoes Mattiuzzo’s concerns and hopes for appropriate protections.

“Our job is, on one side, extremely physically demanding and should include adequate countermeasures, such as earlier retirement and a reduction in night and holiday shifts. On the other side, it carries a very high psychological burden as we deal directly with human suffering and death,” she said.

“Most of my female colleagues of the same age would like to change their work setting,” she added. Some would like to change their profession altogether. Many suffer from burnout, while others “adapt to very demanding work schedules in order to prove their competence, often at the expense of their private life and family.”

World Health Organization (WHO): Working Conditions Unacceptable

The upcoming FEMS event follows a warning from the WHO last October that working conditions place an “unacceptable burden” on Europe’s frontline healthcare workers.

In a WHO survey of more than 90,000 healthcare professionals across the EU, Iceland, and Norway, 28% of doctors said they worked more than 50 hours/wk. One in three doctors and nurses reported symptoms of anxiety and/or depression; a third reported exposure to bullying or violent threats at work in the past year; and 10% reported physical violence or sexual harassment.

Health workers who faced violence, consistently long hours, and shift work were more likely to be depressed, anxious, or to have suicidal thoughts. Beyond the individual toll, burnout and mental health problems can have serious consequences for patients, the WHO said.

Between 11% and 34% of health workers, depending on their countries, were thinking about leaving their jobs amid an ongoing worker shortage projected to reach 940,000 by 2030.

Health workers taking sick leave to cope with the mental health toll of their work, or leaving the profession altogether, adds to the pressure on health systems and means patients may face longer wait times and receive worse medical care, the WHO said.

Arduous Recognition Crucial

FEMS said that recognizing medical practice as an arduous occupation is “crucial,” not just to protect physicians’ health but also to improve recruitment and retention.

Its policy paper notes that doctors face high emotional pressure, long shifts, sleepless nights, and continual exposure to stress due to clinical complexity and organizational challenges. They must also deal with increasing administrative burdens, chronic understaffing, aggressive work environments, and confrontation with suffering and death.

A supporting joint statement by the European Medical Organisations Standing Committee highlighted that doctors’ working conditions “are increasingly characterized by physical strain, psychological pressure, organizational stress, and moral and legal responsibility that cumulatively place a significant burden on their health and well-being.”

Heavy and Unique Responsibilities

Doctors bear “heavy and unique responsibilities,” FEMS said. These responsibilities pose a risk to doctors’ physical and mental health, yet none of the 14 FEMS member countries currently recognizes doctors’ work as arduous in either legal or social security terms. In other jobs with recognized arduous working conditions, protective and compensatory measures offer workplace mitigations.

Alessandra Spedicato, FEMS president, said the campaign stems from both personal and collective evidence. She and many colleagues experience on a daily basis “the fatigue, exhaustion, and wear associated with medical work,” she told Medscape News Europe. Stresses have been steadily increasing due to progressive depletion of healthcare system resources alongside growing demands and expectations of the population, she said. A prime objective of the campaign is to safeguard physicians’ health, which is also essential to guarantee continuity and quality of care. Such recognition would “represent a strategic tool to strengthen recruitment and retention of the medical workforce across Europe,” she said. “Younger generations, in particular, place strong emphasis on work-life balance and on sustainable working conditions over the long term.”

Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.