Residents' duty hours in the province of Quebec, Canada

The author describes the five decades of efforts by residents in the medical schools of the province of Quebec, Canada, to negotiate scientific, cultural, social, and economic issues that affect them as trainees. At present, the residents' association, the Fédération des Médecine résidents du Quebec negotiates collective agreements on working conditions and other issues with the Quebec Ministry of Health, not the hospital association. The federation has become recognized as an important body throughout Canada, and its representatives regularly participate in meetings concerning the country's health care system. The author describes the duty hours provisions of the current collective agreement (1996-2002), and remarks that in general, the agreement's regulations are helpful to residents, prevent the possibility of abusive work schedules, and, among other benefits, provide generous time off for conferences, examinations, and study time. However, some residents, particularly those in surgical disciplines, believe that the work-hours provisions are too restrictive, as they wish to maximize their acute-care surgical experiences in the operating room via frequent on-call hours. At present, residents in all disciplines are allowed to remain in the hospital to attend to patient care duties as much as they wish, but they may not be on official call more than is stipulated by the collective agreement. These agreements have also created some difficulties in providing coverage for patients; the author discusses various solutions to this problem.