The continuity of medical care cannot depend indefinitely on the controlled exhaustion of doctors

In recent days, I have read several testimonies from doctors about their experience of hospital duty shifts in public hospitals.

Beyond differences in specialty, age or workplace, the picture they describe keeps returning to the same themes: modest pay for on-call hours, constant stress, accumulated fatigue, time taken away from family and the risk of aggression from patients or their relatives.

I stopped and asked myself, quite simply, how long a doctor can endure such conditions and, above all, why they continue to do so. I did not find a simple answer, but several hypotheses are worth formulating.

Is it professional inertia? After years or decades spent in the same place, perhaps one becomes attached to a team, to a hospital, to a professional space that has shaped an entire career.

Is it responsibility toward patients? Undoubtedly, many doctors have what we call a vocation, and this vocation can take the form of a harsh professional loyalty, sometimes almost against the instinct of self-preservation.

Is it access to complex cases? For doctors at the beginning of their careers, but also for those for whom clinical development remains essential, the public hospital is the place where emergencies, rare cases and severe clinical situations arrive — cases that the private system does not absorb to the same extent. In university centers, the public hospital also remains closely linked to training, research and academic careers.

The public system depends on a form of controlled exhaustion of its staff

However valid these hypotheses may be, the question that remains after such accounts is not only how much longer an individual doctor can endure, but how much longer the public system can continue to depend on this individual endurance. During on-call shifts, volumes of more than 300 presentations in 24 hours have become commonplace.

As in mechanics, large systems do not stop suddenly. They continue to function for a long time through improvisations, phone calls, colleagues covering for colleagues, overstretched on-call lines, residents pushed further than they should be, and doctors who accept one more night, one more weekend, one more extra shift. This creates the illusion that “it still works somehow.”

The breakdown comes locally, piece by piece, first in smaller towns: an on-call line that can no longer be covered, a hospital without a functioning ICU, pediatrics or cardiology department, more transfers, overcrowded emergency units, exhausted doctors, patients sent elsewhere, longer waiting times.

The overall data support this background: Romania has fewer doctors relative to its population than the EU average — 3.7 doctors per 1,000 inhabitants compared with an EU average of 4.3, according to the OECD 2025 report — while the system remains strongly hospital-centered, with major pressure on secondary and tertiary care.

Some patients or relatives reproach doctors for “no longer wanting to work.” But this is a dangerous reversal of the problem. The issue is not that doctors refuse to work, but precisely that too many doctors still accept working in conditions we should not consider normal.

A national study conducted on a sample of 1,100 doctors shows an alarming reality in the healthcare system: 9 out of 10 doctors who work hospital duty shifts are at high risk of professional burnout.

The reservoir of doctors’ professional sacrifice is not a public policy. It is a finite resource, and the signs of exhaustion should not be read merely as salary claims or professional grievances. They are indicators of the fragility of a system that continues to function by consuming its own people.

The continuity of medical care cannot depend indefinitely on the controlled exhaustion of doctors. A hospital duty shift does not mean only extra hours. It means critical decisions, professional risk, medico-legal responsibility, lack of sleep and, increasingly often, exposure to aggression.

That is why the discussion about hospital duty shifts is not merely a discussion about doctors’ pay. It is a discussion about patient safety, about hospitals’ capacity to remain functional and about the real limits of a system that still confuses professional resilience with an unlimited willingness to sacrifice.

If we want functional public hospitals, we must begin by recognizing that doctors are not an inexhaustible infrastructure. And a system that rests its continuity on their fatigue is not stable; it is merely postponing the moment when the cracks become visible to everyone.