BACKGROUND: Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours. OBJECTIVES: We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts. METHODS: Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. RESULTS: All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. CONCLUSIONS: In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.

Center for Social and Economic Strategies Faculty of Social Sciences Charles University Czechia

Centre for Health Care at the National Institute of Public Health of Slovenia Slovenia

Centre for Health Care National Institute of Public Health Trubarjeva Slovenia

Centre for Health Policy and Management Trinity College Dublin Ireland

Department of Pediatrics Shaare Zedek Medical Center Jerusalem Israel

Department of Psychiatry Campus Benjamin Franklin Charité Universitätsmedizin Germany

European Observatory on Health Systems and Policies London School of Economics and Political Science Houghton Street London United Kingdom

Faculty of Public Health and Social Welfare Riga Stradins University Latvia

Faculty of Residency Manager of Residency study process Riga Stradins University Latvia

Faculty of Social Sciences Tampere University Finland

Faculty of Social Sciences Tampere University Finland; Welfare State Research and Reform Finnish Institute for Health and Welfare Finland

Health Science Institute in Aragon Spain

Health Service Executive Dublin Ireland

Health Workforce Planning Knowledge Centre Semmelweis University Hungary

Institute for Health Policy Management and Evaluation University of Toronto Canada

Netherlands institute for Health Services Research Radboud University Nijmegen Faculty of Social Sciences the Netherlands

Royal College of Physicians in Ireland Dublin Ireland

The Smokler Center for Health Policy Research Myers JDC Brookdale Institute Israel

The Smokler Center for Health Policy Research Myers JDC Brookdale Institute Israel; Department of Health Care Management Faculty of Economics and Management Technical University Berlin Germany

The Smokler Center for Health Policy Research Myers JDC Brookdale Institute Israel; School of Public Health Hebrew University Jerusalem Israel

University of Tartu Estonia

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