The narrow rectangular ready rooms of on-call doctors at the Vinohrady Hospital in Prague 10 are packed in tight on the hospital's top floor, cloistered like the cells of a monastery. In each, there is barely enough floor space to maneuver between closets, table and the aged brown leather couch that doubles as a bed.

Taking a break from his duties as a radiologist, Martin Engel sits on the couch in his room, which he shares with several others. On-call doctors have always had problems staying under the average 40-hour workweek, he explains. It's part of the job.

The hospital provides 24-hour treatment, and so doctors must always be present — and there are never enough. This results in long shifts and extensive overtime, to the point of doctors making themselves available even when at rest.

"But it's not safe for patients when doctors have long overtime hours," said Engel, who is also president of the Doctors' Trade Union Club, which represents one-third of Czech doctors.

This is scheduled to change Jan. 1, when the new Labor Code, with its stricter overtime regulations, will take effect. Overnight the Czech Republic will face a shortage of 2,000 doctors in a country that has a total of 15,000, according to the Health Ministry.

The Czech Republic will be particularly short on surgeons and anesthesiologists.

Hospitals have not prepared for the upcoming overtime limits, despite knowing that reform would come to bring the country in line with European Union-mandated standards, Engel said.

Czech doctors are currently allowed to work 416 hours of overtime a year, with another 400 hours of "inactive overtime" available — time spent in their ready rooms, for which they are paid half their normal wage. The new law will kill "inactive overtime," said Eduard Sohlich, chairman of the Association of Czech and Moravian Hospitals.

"Our current overtime system allows our healthcare system to function," Sohlich said. "If we strictly follow the new Labor Code, we won't be able to ensure the operation of our country's hospitals."

Filling the void

The ministry, hospitals and union all expect to work around the law's limit of eight overtime hours a week, at least in the short term. Engel said he expects hospital doctors will continue to work 60 hours a week in upcoming months on a temporary basis.

But the country will still need more doctors, and, to help cover this gap, Health Minister Tomáš Julínek has said the country is preparing a controlled recruitment from poorer countries, such as Bulgaria, Romania and Ukraine. The ministry will train foreign doctors in the language, and says it has already had some success with foreigners working in the healthcare system, in particular, nurses from Slovakia.

"Foreign personnel seem to value and appreciate the opportunity to work in the Czech Republic," said Tomáš Cikrt, spokesman for the Health Ministry. "They'll do a good job."

But there is a big difference between Slovak nurses and Bulgarian brain surgeons, Engel said. Without fluency in Czech, they won't be able to give the same quality of care.

"I'm sure Julínek would not want to sit and explain his health troubles to a doctor not fluent in Czech," Engel said. "I know we're an open country, but we must do everything we can to keep Czech doctors here. It's not a one-to-one exchange when you replace a Czech doctor with one from Bulgaria."

Cikrt estimates that the Czech Republic has lost about 1,000 of its native doctors to practices in Western Europe, especially Germany and Great Britain. The doctors, often younger, are motivated by high wages and dissatisfaction with Czech hospitals.

"We're not talking about an exodus of Czech doctors," Cikrt said. "A lot of Czech doctors are afraid of the language barrier and firmly rooted in the Czech Republic."

Engel agrees that unease with other languages, particularly English, is keeping more Czech doctors at home.

One way to keep more Czech doctors, particularly those working in nonprofit and state-owned hospitals, would be to pay them more. The average hospital doctor draws a wage of 40,000 Kč ($1,900) a month, but over half of this wage comes from overtime. Engel is seeking a raise for all hospital doctors in the country, while the Health Ministry wants them to be paid on performance-based sliding scales in a system designed to retain the country's best.

The union has ruled out the possibility of a wage strike in 2007 and, aided by the German hospital doctors' union, is conducting an ad campaign designed to win public support for wage increases that would make doctors less reliant on overtime.

"Many of my colleagues are afraid for their incomes" and the losses that could come from reduced hours, Engel said.

Prior to 2001, overtime hours for doctors were virtually unlimited. Reforms passed that year limited them to 416 hours of overtime a year and 400 hours of "inactive" time.

This was meant to provide a transition to the new Labor Code, which brings Czech law into accordance with EU regulations. These standards remain controversial for doctors in all parts of Europe, with the United Kingdom explicitly allowing its doctors to opt for additional overtime. Reform to the EU's working time standards is in continued discussion in the European Parliament and European Commission.

Though he supports it, Engel does not consider the new Labor Code flawless.

"I'm not sure if only eight hours of overtime per week is enough for doctors," he said.

Naďa Černá contributed to this report.