OSHA to consider stricter work hour rules for medical residents

The Obama administration will "review and consider" changes to the rules governing the work hours of resident doctors — a group well known for working extensive shifts for months and years on end.

The move comes in response to a petition launched last week by a coalition of consumer and labor advocates who say the current hour limits aren't strict enough to ensure the well-being of either medical residents or the patients they treat.

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The White House said Thursday that it tends to agree. 

"We are very concerned about medical residents working extremely long hours, and we know of evidence linking sleep deprivation with an increased risk of needle sticks, puncture wounds, lacerations, medical errors and motor vehicle accidents," David Michaels, head of the Occupational Safety and Health Administration (OSHA), said in a statement issued late Thursday. 

"We will review and consider the petition on this subject."

Additionally, Michaels hinted that OSHA is eying work-hour reforms well outside the realm of medicine. He noted, for instance, that investigators examining the causes of a deadly 2005 Texas oil refinery explosion found that "worker fatigue and long work hours" likely contributed to the disaster, which killed 15 workers.

"The relationship of long hours, worker fatigue and safety is a concern beyond medical residents, since there is extensive evidence linking fatigue with operator error," Michaels said.

Additionally, the OSHA chief made clear that employers should bear the responsibility for the safety of their workers. 

"All employers must recognize and prevent workplace hazards — that is the law," he said. "Hospitals and medical training programs are not exempt from ensuring that their employees' health and safety are protected." 

He doesn't have to convince the folks at Public Citizen, SEIU or the American Medical Student Association. Those groups spearheaded the petition to OSHA officials this week, calling on the agency to assume the responsibility of monitoring the work hours of medical residents.

Current work-hour rules — which are established and monitored by the Accreditation Council for Graduate Medical Education (ACGME) — are simply too lenient to ensure the safety of physician residents and the patients they see, the advocates argue.

The stress and fatigue related to long hours not only heightens the risk of depression and car wrecks, but can also lead to medical errors, they say.

"Working these extreme hours for years at a time, predictably, has ill effects on personal health and safety," the groups wrote to Michaels.

"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."

Among the new worker protections, the advocates are pushing OSHA (1) to limit medical residents' hours to a strict 80 per week (by contrast, ACGME caps the workweek at 80 hours averaged over four weeks); (2) to limit single shifts to 16 consecutive hours (whereas ACGME rules effectively allow 30-hour shifts); and (3) to grant residents at least one full day off per week, "without averaging" (ACGME rules also require one day off per week, but average the provision over four weeks).

How OSHA responds remains to be seen. But Michaels said the agency is well aware of the issue. 

"It is clear that long work hours can lead to tragic mistakes, endangering workers, patients and the public," he said. 

"No worker, whether low-skilled and low-wage, or highly trained, should be injured, or lose his or her life for a paycheck."