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Petition to Reduce Medical Resident Work Hours

September 2, 2010

Honorable David Michaels, Ph.D., M.P.H.
Assistant Secretary for Occupational Safety and Health|
U.S. Department of Labor
Occupational Safety and Health Administration
200 Constitution Avenue, N.W.
Washington, D.C. 20210
(202) 693-2000

Dear Dr. Michaels

Public Citizen, a consumer and health advocacy group with 150,000 members and supporters; the Committee of Interns and Residents/SEIU Healthcare (CIR/SEIU), a housestaff union, part of SEIU, representing over 13,000 resident physicians; the American Medical Student Association (AMSA), a national organization representing over 33,000 physicians-in-training; Bertrand Bell, M.D., Professor of Medicine at Albert Einstein College of Medicine and author of New York State Health Code 405 restricting resident physician work hours; Charles A. Czeisler, Ph.D., M.D., Baldino Professor of Sleep Medicine, Harvard Medical School; and Christopher P. Landrigan, M.D., M.P.H., Assistant Professor of Pediatrics and Medicine, Harvard Medical School, hereby petition the Occupational Safety and Health Administration (OSHA) to implement the following key regulations for the work hours of resident physicians and subspecialty resident physicians, (i.e., medical and surgical fellows), building from the recommendations made by the Institute of Medicine in its 2009 Report, Resident Duty Hours: Enhancing Sleep, Supervision, and Safety:

(1)   A limit of 80 hours of work in each and every week, without averaging;

(2)   A limit of 16 consecutive hours worked in one shift for all resident physicians and subspecialty resident physicians;

(3)   At least one 24-hour period of time off work per week and one 48-hour period of time off work per month for a total of five days off work per month, without averaging;

(4)   In-hospital on-call frequency no more than once every three nights, no averaging;

(5)   A minimum of at least 10 hours off work after a day shift, and a minimum of 12 hours off after a night shift;

(6)   A maximum of four consecutive night shifts with a minimum of 48 hours off after a sequence of three or four night shifts.

These recommendations are necessary for protecting the safety of resident physicians and subspecialty resident physicians. Their implementation would also have the secondary benefit of resulting in a safer, better standard of care for patients nationwide.

The petitioners request the Assistant Secretary for Occupational Safety and Health to exercise his authority under section 3(8) of the Occupational Safety and Health Act,[1] on the grounds that work hours in excess of the requested limits are physically and mentally harmful to resident physicians and subspecialty resident physicians, and that a federal work-hour standard is necessary to provide them with safe employment. Research has connected the typical resident work schedule to harm in four specific areas: motor vehicle accidents, mental health, pregnancy, and percutaneous injuries (such as needlestick injuries).

Resident physicians in the U.S. work among the highest number of hours in the professional world. Working these extreme hours for years at a time, predictably, has ill effects on personal health and safety. Multiple studies in the medical literature demonstrate that sleep-deprived and overworked resident physicians are at increased risk of being involved in motor vehicle collisions, suffering from depressed mood and depression, giving birth to growth-retarded and/or premature infants, and getting more percutaneous injuries. The signers of this petition believe that these are grave health outcomes and that any system allowing its workers to be subjected to such direct threats to well being is seriously flawed. For OSHA not to regulate resident physician work hours is to abdicate its responsibility to protect the health of those who care for the nation’s sick and dying.

In order to fulfill OSHA’s mission “to send every worker home whole and healthy every day,”[2] you must act now to address the dangers that extreme work hours pose for resident physicians and subspecialty resident physicians. Whereas previous appeals to limit resident physicians’ work hours have focused on the well-documented risks patients face due to tired physicians, this petition concentrates on the often-overlooked health risks faced by the resident physicians who endure those long hours. As grounds for the work-hour standards requested above, we utilize a review of the medical literature to (1) characterize current working conditions in residency programs in the U.S., and to (2) provide evidence of the physical and mental harm that comes to resident physicians as a result of their long work hours. Next, we (3) review various responses to the problem of excessive work hours, including how other industrialized countries have acted to protect their resident physicians through mandated work-hour limits, and how our own federal government already protects workers and the public through hours-of-service regulations in a variety of transportation and other industries. Finally, we examine (4) the relevance of resident physician work-hours reduction to patient protection, (5) arguments against the reduction of resident physician work hours, and (6) the appropriate role of OSHA in regulating resident physician work hours.

To be absolutely clear, we are only asking OSHA to regulate and enforce resident physician work hours, a responsibility that is clearly within the agency’s jurisdiction. We are not asking the administration to assume oversight of resident physician education and supervision functions. We believe the Accreditation Council for Graduate Medical Education (ACGME), the professional medical organization that currently oversees all resident physician training, should retain that function.

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[1] 29 USC § 652(8).

[2] Occupational Safety and Health Administration. OSHA 30-year milestones. http://www.osha.gov/as/opa/osha30yearmilestones.html.