April 30, 2001
Public Citizen, Medical Resident and Student Organizations Petition OSHA to Limit Work Hours for Medical Residents
More Auto Crashes, More Depression and More Pregnancy Complications
Among Sleep-Deprived Medical Residents
WASHINGTON, D.C. ? The federal government should limit the number of hours worked by medical residents and fellows because sleep-deprived students are at increased risk of being in auto crashes, suffering depression and giving birth to premature infants, according to a petition filed today with the Occupational Safety and Health Administration (OSHA).
The petition was filed by Public Citizen, a 150,000-member national consumer advocacy organization; the Committee of Interns and Residents (CIR/SEIU), a union representing more than 11,000 medical residents and a national affiliate of the Service Employees International Union; the American Medical Student Association (AMSA), an organization representing more than 30,000 physicians-in-training; Bertrand Bell, M.D., who wrote a New York state health code restricting resident work hours; and Kingman P. Strohl, M.D., director of the Center for Sleep Disorders Research at Case Western Reserve University.
Currently, there is no national work-hour limit for medical residents. American residents regularly work 95 hours a week, sometimes logging as many as 136 out of the available 168 hours in a week. Like a New York state regulation promulgated in 1989, the petition seeks a work-hour cap of 80 hours per week, with shifts not to exceed 24 hours. However, compliance with the New York regulation has been inadequate.
“By not capping the hours for these residents, OSHA is abdicating its responsibility to ensure a safe workplace and protect those who care for the nation?s sick and dying,” said Anandev Gurjala, a second-year medical student at Northwestern Medical School currently doing research for Public Citizen. “The hours required now can endanger the health of the residents and the patients they are treating.”
In addition, the petition calls for a limit of on-call shifts to every third night, a minimum of 10 hours between shifts, and at least one 24-hour period of off-duty time per week. To ensure compliance, the petition requests strict enforcement of work-hour regulations, including frequent unannounced inspections. Resident schedules should be recorded and kept as public records, an official and confidential procedure should be established to report violations, and violations should lead to strict penalties, the petition states.
The petition departs from previous efforts to reduce hours through state or federal legislation. Instead, it attempts to address the problem through regulations by OSHA. The petition points out that in protecting the health of residents, the regulations also would protect the health of patients from overworked, error-prone residents.
The petition is based on a multitude of studies. For example, emergency medical residents are almost seven times more likely to be in auto accidents during their residencies compared to before their residencies. Sleep-deprived residents reported greater rates of depression, with rates as high as 32 percent while working in the intensive care unit. Research also shows that high levels of work-related fatigue are associated with obstetric complications among women residents. In one study, pre-term delivery was nearly twice as common among women residents with heavy work schedules as among those with lighter work schedules.
“When we became physicians, all of us promised to devote ourselves to improving our patients? quality of life,” said Sonya Rasminsky, M.D., a resident in psychiatry at Cambridge Hospital in Massachusetts and co-president of the Cambridge branch of CIR. “But it is a painful irony that we are forced to treat our own lives with less respect as a result.”
Added Josh Rising, a medical student and AMSA?s legislative affairs director, “State and federal government have abrogated their responsibility to ensure the health and safety of the nation?s health care workers and patients. In addition to the dangers that this poses to resident health, over-fatigued physicians pose a health risk to the patients that they are forced to treat while in an impaired condition. These reasonable limitations will ensure that hospitals are safe places for all who enter their doors.”
The closest thing to a national standard is a set of requirements drawn up by the Accreditation Council for Graduate Medical Education (ACGME), an organization responsible for overseeing residency programs. The organization has drawn up work-hour requirements that vary by specialty, but compliance with even these often weak requirements is voluntary.
The petition notes that the government has set strict work-hour limits for truckers, pilots and railroad operators.
“Our government rightly recognizes the importance of capping work hours for those who could kill people if they get too tired, such as truckers and pilots,” said Dr. Sidney Wolfe, director of Public Citizen?s Health Research Group. “The government?s obligation should be no less for doctors-in-training, who usually work even longer hours.”