A new survey on the impact of working time and work organization among physicians has revealed “persistent derogations and shortcomings in the implementation of the European Working Time Directive (EWTD).” The effects include the deterioration of doctors’ physical and mental health, and a significant association with intentions to leave the profession.

The survey, “Shaping the Future of Doctors’ Health,” was conducted by the European Federation of Salaried Doctors (FEMS) between 15 May 2025 and 31 December 2025. Responses were received from 8062 salaried physicians working across a range of European healthcare systems including in Italy, Sweden, Croatia, Spain, and Greece.

Preliminary analysis of the first data subset revealed “a substantial gap” between the EWTD and physicians’ daily reality. Almost all respondents (91.1%) reported that they sometimes exceed daily or weekly working-time limits. Of these, 73.8% reported negative effects on physical or psychological health.

Medical Workforce Sustainability Affected

There was a strong relationship between excessive working hours and medical workforce sustainability. The maximum of 48 hours per week established by the directive was exceeded by 33.8%, and as weekly hours increased, so did reports of physicians’ intention to leave their job, or even to quit the medical profession altogether. Night work was a major concern, with emotional and physical health progressively declining as the frequency of night shifts increased.

FEMS president Alessandra Spedicato, MD, told Medscape News Europe that the survey findings were “both very interesting and quite alarming,” and pointed to “a persistent and systemic problem.” Working beyond contracted or expected hours has an impact on both mental and physical health, she said, and the effect, somewhat paradoxically, seemed to be even more pronounced among younger generations.

“One interesting finding from the current survey is that doctors who are able to take holidays flexibly are less likely to report an intention to leave their job,” she said.

Just 51% of physicians said they could take vacation flexibly, 32.1% said only sometimes, and 16.9% said they could not. Physicians without flexible leave were much more likely to report an intention to resign.

“I think this may be because the ability to take holidays flexibly is, in itself, an indicator of adequate organization and staffing levels,” Spedicato said.

Direct Impact on Physicians’ Health

Renata Čulinović-Čaić, MD, a general and digestive surgeon in Zagreb, Croatia, and president of the Croatian Medical Union, agreed. “There is no doubt that the way medical work is organized has a direct impact on physicians’ health and on their decision to remain in the profession.”

“Night work, shifts, excessive overtime, and inadequate periods of rest are associated with sleep disturbances, burnout, and disruption of the circadian rhythm, with potentially serious long-term consequences for both physical and mental health,” she said. “Research has linked circadian disruption associated with shift and night work to an increased incidence of metabolic syndrome, cardiovascular disease, and adverse reproductive health outcomes, while evidence has also raised concerns about cancer risk.” The International Agency for Research on Cancer has classified night shift work as “probably carcinogenic to humans.”

Working Time Limits Essential for Retention

“The EWTD was introduced precisely to protect workers’ health, and its provisions should not be weakened because of physician shortages,” Čulinović-Čaić said. “On the contrary, ensuring compliance with limits on working hours and adequate daily and weekly rest is essential for retaining doctors.”

“Younger generations of physicians increasingly place a high value on work-life balance, and healthcare systems that depend on excessive workloads risk pushing doctors away from the profession or toward less demanding specialties. Protecting the EWTD is therefore not only a matter of workers’ rights, but an important investment in physician retention, physicians’ health, and the long-term sustainability of healthcare systems.”

In the survey report, Spedicato wrote, “The gap between EU law and practice remains too wide in healthcare. This is no longer only a labor law issue. It is a workforce retention issue, a patient safety issue, and a sustainability issue for European health systems.”

The full study will be publicly available by the end of 2026.

Spedicato and Čulinović-Čaić reported no relevant financial relationships.

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.