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More Information on Medical Resident Work Hours

Letter Responding to OSHA's Denial of Resident Work Hours Petition, November 3, 2011
Petition to Reduce Resident Work Hours, September 2, 2010
Press Release: Patient Safety Advocates Give Plan to Reform Medical Residency a Failing Grade, June 23, 2010
Article in BMC Medicine on Public Support of Reducing Resident Physician Work Hours, June 1, 2010
Letter Advocating Reduction of Resident Work Hours, February 4, 2010
Statement: Institute of Medicine Report on Resident Work Hours Misses Opportunity, Fails to Endorse Significant Federal Oversight, December 12, 2008
Congressional Testimony on Resident Work Hours, September 18, 2009
Comments on Joint Commission’s Draft 2008 Patient Safety Goal on Health Care Worker Fatigue, January 26, 2007
Letter Criticizing Institute of Medicine’s Recent Report on Sleep Disorders for Failure to Address the Issue of Resident Work Hours, June 9, 2006
Letter Responding to ACGME's False Claims on Resident Work Hours, January 9, 2003
Letter on Medical Resident Duty Hours, August 1, 2002
Letter in Internal Medicine News on Medical Resident Work Hours, September 1, 2001
Petition to OSHA Requesting that Limits be Placed on Hours Worked by Medical Residents, April 30, 2001

ACGME Proposed Limits on Resident Physician Work Hours Are Inadequate

February 11, 2002

View updated table (August 1, 2002)

Read the original petition

	Public Citizen AMSA/CIR	AAMC	ACGME
Maximum Hours/week	80 hours	80 hours	125 hours
Maximum Shift Length	24 hours	24 hours	36 hour call shifts 16 hour regular shifts
Minimum Time Off Between Shifts	10 hours after every shift	8 hours after every shift	12 hours only after on call shift
Mandatory Time Off	Bill: One 24-hour period every 7 days and 1 full weekend off per month. Petition: One 24-hour period every 7 days.	One 24-hour period every 7 days	One 24-hour period every 7 days averaged over 4 weeks.
Maximum On-Call Frequency	Every third night	Every third night averaged over 4 weeks	Every third night averaged over 4 weeks
Verification Mechanism	Bill: Annual anonymous survey of residents Bill & Petition: Frequent unannounced inspections	Defers to the ACGME	Site visits (ranging from every 6 months to once every 5 years) Annual resident survey
Whistleblower Protections	Yes	None	None
Hospital/Program Violation Disclosure	Bill: Annual report to Congress on hospital compliance Petition: Inspection results and work schedules are accessible to public through the Freedom of Information Act	None	None
Enforcement Mechanism	Civil monetary penalties	Defers to ACGME	More frequent review of programs

References

[1] The Association of American Medical Colleges (AAMC), a group representing US medical schools, released their resident work hour policy guidance in October, 2001.

[2] A 125-hour work week is possible under the ACGME’s proposed guidelines because averaging the on-call frequency over a 4-week period allows for weeks in which residents are on-call every other night. Also, averaging days off over 4 weeks allows for weeks which lack a day off. Therefore, once a month, residents may work a 125-hour week consisting of 3 ½ 36-hour call shifts. When averaged over a month, the ACGME’s standards allow for an average of 104-hour work weeks.

[3] “Continuous hours during on-call assignments should be limited to 32 hours. Continuous time on duty may be extended to 36 hours at the resident’s request, when the resident has had a minimum of four hours of sleep during the on-call period between 10 pm and 6 am.”

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