Medical Specialist Training Under Pressure – Working Hours, Part-Time and Rotation Compared

What the 2026 German Medical Assembly changed

The 130th German Medical Assembly met in Hanover from 12 to 15 May 2026. On 14 May the delegates decided that the specialist training regulations of the state medical chambers should in future speak of a "minimum training period" rather than the "training period". Henrik Herrmann summed up the principle behind it as "content before time". The change makes it possible to give more weight to individual acquisition of competence than to the sheer number of months served.

The same package of decisions recalibrated training periods in eight fields: anatomy falls from 48 to 36 months, pathology from 72 to 60 months, hygiene and environmental medicine as well as clinical pharmacology from 60 to 48 months each, and public health from 60 to 54 months. The specialist qualification in biochemistry is discontinued; in the previous year seven certifications had been issued in it nationwide.

The decision comes at the end of a reform running over several years. On 28 May 2025 in Leipzig, the 129th German Medical Assembly reorganised Section C of the model specialist training regulations and divided the 56 supplementary qualifications into three categories: interdisciplinary supplementary qualifications with a minimum period and an eLogbook, in-service ones without a binding minimum period, and purely course-based ones. Section B, covering fields and specialist qualifications, was revised in 2026. As early as 9 May 2024, the 128th German Medical Assembly in Mainz had called, by 199 votes to 16, for part-time training from 50 percent upwards to be recognised as a matter of course without separate approval.

Working hours between the law and survey reality

The legal framework is set by the Working Hours Act. Under Section 3 of that Act, daily working time on working days may not exceed eight hours; it can be extended to up to ten hours provided that an average of eight hours per working day is not exceeded within six calendar months or 24 weeks. The European Working Time Directive caps average weekly working time at 48 hours and requires a daily rest period of eleven consecutive hours.

How that plays out in hospital practice is shown by the MB-Monitor 2024, the member survey of the Marburger Bund, in which 9,649 salaried doctors nationwide took part. Full-time employees reported around 55 hours a week on average including all on-call duties and overtime; 24 percent regularly reached 60 hours or more. 91 percent wanted working time of no more than 48 hours. 49 percent frequently felt overloaded and 11 percent said they were constantly pushing beyond their limits. 28 percent were considering giving up clinical practice altogether – among doctors in specialist training the figure was 33 percent.

The German Medical Association's workforce statistics as at 31 December 2025 report around 446,000 doctors in active practice, an increase of two percent on the previous year. For the first time the share of women, at 50.5 percent, was above half; among doctors in specialist training it is 59 percent. The statistics put average weekly working time at 40.3 hours, with a downward trend over the past decade.

Part-time work is no longer the exception

The part-time rate is perhaps the clearest structural change. According to the MB-Monitor it rose among the salaried doctors surveyed from 15 percent in 2013 to 36 percent in 2024. The workforce statistics show an increase for the profession as a whole from 15 percent (2014) to 28 percent (2024). What is notable is that part-time work in practice often does not mean a half post: part-time employees reported around 39 hours a week including on-call duties in the MB-Monitor; 55 percent would prefer to work 30 to 39 hours and 30 percent less than 30 hours.

For specialist training this raises a series of concrete planning questions:

• The calendar time until specialist certification lengthens proportionally, while rotation plans are usually designed around full-time blocks.
• Target figures and procedure numbers in the eLogbook have to be reached spread over longer periods.
• Participation in on-call rotas, specialist courses and rotation windows has to remain compatible with reduced hours.
• When moving between state medical chambers, different approval practices for part-time periods can arise – which is precisely what the 2024 decision addresses.
• Predictability of duty rosters becomes a mark of quality, because care arrangements outside the hospital have to be fixed in advance.

Rotation planning and training networks

In a Marburger Bund survey of 3,238 doctors in specialist training (September to October 2021), 84 percent named staffing levels as the most important obstacle to good training, 38 percent rigid rotation plans and 19 percent a lack of childcare. Only 20 percent said their employer supported the reconciliation of family and work. 41 percent planned to work in outpatient care after specialist certification, while 51 percent wanted to stay in the hospital.

Training networks address exactly this interface: hospitals and practices agree rotations so that the required blocks can be completed without repeated job hunting. In the discussion summarised by Deutsches Ärzteblatt on 26 June 2026, certified networks, workable rules for cross-sector deployment of staff and an alignment of training conditions between hospital and practice were named as the central building blocks.

Financial support has existed since 1999 through the funding of specialist training, based since July 2015 on Section 75a of the Social Code Book V. For outpatient training in "further specialist fields", 2,000 funded posts were available nationwide according to the German Medical Association (as at 24 June 2019); a new funding agreement of 23 September 2024 has applied since 1 January 2025. In February 2024 the Marburger Bund pointed out that the number of salaried doctors in the outpatient sector has almost doubled since 2014, from 23,693 to 46,109 – an argument for building training into that sector structurally.

Quality of supervision – what the evaluations show

The German Medical Association had specialist training evaluated centrally from 2009 to 2014, using an instrument developed at ETH Zurich. Since 2022 the state medical chambers have collected the data locally, but with a common core questionnaire that can be supplemented with regional questions.

The eighth evaluation round of the Westphalia-Lippe Medical Chamber provides robust figures: of 8,246 doctors in specialist training invited, 3,672 responded, a response rate of 44.5 percent. On a scale from 0 (poor) to 100 (excellent), the subject areas scored between 65 and 76 points, two to three points higher than in 2022. 46 percent would definitely recommend their training institution and a further 27 percent probably would. 83 percent reported at least one training review meeting a year. At the same time only 40 percent said they had received a written training plan, even though one is required. The ninth round is running in 2026, with results expected in the autumn.

The 2021 Marburger Bund survey painted a similar picture on structure: 15 percent of respondents had a structured training plan, 10 percent received regular feedback, 45 percent once a year and 45 percent none at all. 38 percent were satisfied or very satisfied with their training. The Marburger Bund has since called for binding training plans reviewed at least annually, named training officers and mandatory teaching qualifications for trainers.

What research says about learning climate and workload

The international literature is comparatively clear on this point. A systematic review with meta-analysis in PLOS ONE (2018) drew together 26 cross-sectional studies with 4,664 doctors in specialist training and found a burnout prevalence of 35.7 percent across all specialties. High depersonalisation appeared in 43.6 percent and high emotional exhaustion in 38.9 percent. Prevalence varied considerably between specialties, from 40.8 percent in surgical and emergency-oriented fields to 15.4 percent in ENT and neurology.

That the learning environment is no side issue here is shown by a study in Advances in Health Sciences Education (2019): among 271 residents from 21 Dutch training programmes, the learning climate was measured with the D-RECT instrument across nine dimensions. A better learning climate went with higher work engagement (b = 0.58; p = 0.004) and higher job satisfaction (b = 0.80; p < 0.001); the dimensions "learning atmosphere" and "formal teaching" had a particularly strong effect.

There is German data too: an analysis by the Bavarian competence centre for general practice training evaluated 197 of 368 invited doctors in specialist training (53.4 percent) and combined the Maslach Burnout Inventory with a professionalism scale. Higher professionalisation scores went with lower emotional exhaustion and depersonalisation; participants in network-based training achieved higher scores towards patients (p = 0.031), medical colleagues (p = 0.012) and society (p = 0.007). Structured curricula together with train-the-trainer and mentoring programmes are recommended there as permanent components.

Working hours and specialist training compared internationally

Other health systems have answered the same questions earlier or differently. The comparison is worthwhile because it shows which levers actually have an effect.

United States: two large studies on flexibility

The United States has investigated the working-hours question experimentally. The FIRST trial randomised 117 surgical training programmes and surveyed 3,795 residents with a 95 percent response rate; more flexible duty hours led neither to worse patient outcomes nor to a worse self-assessment of training quality and wellbeing, and 86 percent of respondents preferred the flexible arrangement or had no preference. The iCOMPARE trial in 63 internal medicine programmes likewise found no significant differences in 30-day mortality or in training examination results. At the same time, residents in the flexible arm were less satisfied with the quality of training (odds ratio 1.67), with their wellbeing (2.47) and with the effects on their private lives (6.11), while programme directors rated the flexible variant more positively. Taken together, both studies suggest that the number of hours alone explains little – what matters is how the time is distributed and supported.

United Kingdom: rota gaps as a metric

The GMC National Training Survey is the largest annual survey of its kind. In 2026 over 74,000 doctors took part, of whom 51,727 were in training and 22,923 in trainer roles; the response rate was 68 and 34 percent respectively. Measured with the Copenhagen Burnout Inventory, 19 percent of trainees were classified as at high risk of burnout and 42 percent at moderate risk. 26 percent of trainees and 29 percent of trainers in the hospital sector said gaps in the rota were not being dealt with adequately. 87 percent rated clinical supervision as good or very good and 76 percent said the same of teaching. Only 53 percent of trainers were able to use their allocated training time as intended. A survey by the three Royal Colleges of Physicians of 2,038 doctors between 12 March and 2 June 2025 found that 59 percent of consultants reported unfilled posts at their own level.

Scandinavia: protected daytime hours rather than a pure cap on hours

The Norwegian approach is notable. Alongside the collectively agreed standard working time of 37.5 hours and an upper limit of 60 hours in any single week, the agreement requires that at least 20 hours a week fall on weekdays between 7 a.m. and 5 p.m. – explicitly in order to safeguard learning opportunities. This regulates not only the amount of working time but its position in the day. Denmark works with a 37-hour week averaged over a standard period and with rotas that have to be available at least four weeks in advance – a point regularly named in surveys as a precondition for predictability and work-life balance.

Hospital reform and the shift to outpatient care as context

The Hospital Care Improvement Act (KHVVG) came into force on 12 December 2024, with implementation beginning on 1 January 2025. The assignment of service groups and the changeover in the funding structure are changing which procedures are carried out at which site. For specialist training this is immediately relevant: where service portfolios are redistributed, rotations between sites and sectors have to be planned alongside them so that the content required in the eLogbook remains attainable. In parallel, the shift towards outpatient care is moving parts of provision into a sector where training structures are historically less developed. The German Medical Association responded to the draft legislation in September 2024 and set out the training perspective in doing so.

The combination of competence-oriented training regulations, a higher part-time rate and a changed care landscape leads to a clear conclusion: rotation planning is moving from an organisational side task to a core process of specialist training.

What young doctors can take from this

For everyone still at the beginning – in the degree or before it – these figures are not a cause for concern but a useful map. They show what characterises a good training post and how to recognise one: a written training plan, an annual training review meeting, named training officers, a functioning rotation plan, network structures with practices, and a chamber evaluation whose results can be inspected. In Westphalia-Lippe, for example, the institution-level analyses are accessible through the chamber's search for accredited training providers.

Anyone taking the route of a medical degree elsewhere in Europe enters the same training landscape: the degree is recognised under EU Directive 2005/36/EC, and specialist training then follows the training regulations of the responsible state medical chamber. If you would like to know which study route fits your own life plans, you can book a free consultation with us.

This article reflects the state of research as at 14 August 2026 and does not replace legal advice. What is authoritative are the versions of the Working Hours Act, the collective agreements and the training regulations of the responsible state medical chamber in force at the time.