Consumer, labor groups urge shorter shifts for medical residents

Medical residents working long hours risk harm to both themselves and the patients they treat, a group of consumer and labor advocates charged Thursday.

The coalition is urging the Occupational Safety and Health Administration (OSHA) to assume jurisdiction over the work hours of physician residents — and to put strict limits on what those hours can be.

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

"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."

The groups — which include Public Citizen, SEIU and the American Medical Student Association — say the rules established by the Accreditation Council for Graduate Medical Education (ACGME), which currently monitors the residents' work hours, don't go far enough to ensure the safety of residents and the patients they see.

Newly proposed ACGME standards, for instance, would still allow interns to work 20 consecutive 16-hour shifts, the critics argue.

The stress surrounding the extensive hours has been shown to increase the risk of depression, pregnancy complications and even car crashes as the residents commute to work. The fatigue can also lead to medical errors, including needle sticks.

"Harm to resident physicians and errors that adversely affect patient safety result from fatigue," the groups wrote, "and working 90 or 100 hours in a single week provides inadequate time for recovery sleep."

Among the reforms, the petitioners want OSHA:

• To cap the workweek at 80 hours — "without averaging." (ACGME limits the workweek to 80 hours — averaged over four weeks.)

• To establish a limit on single shifts of 16 consecutive hours. (ACGME set the maximum shift at 24 hours, while also allowing an additional six hours of educational activities. That, the groups write, "has been universally interpreted as a 30-hour shift.")

• To require at least one full day off per week, without averaging. (ACGME allows one day off per week, averaged over four weeks.)

• To limit the frequency of in-hospital on-call duty to once every three nights, without averaging. (ACGME has the same limit, averaged over four weeks.)

"To be absolutely clear," the petitioners write, "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."

That responsibility, they say, should remain with the ACGME.