OSHA May Limit Residents' Work Hours
Assistant Secretary Dr. David Michaels issued a statement Thursday saying the agency will review and consider a petition seeking an 80-hour maximum per week.
The head of OSHA, Dr. David Michaels, said Thursday his agency will consider a petition seeking a limit of 80 work hours per week for medical residents and other rest and hours limits. The petition was filed by Public Citizen; the Committee of Interns and Residents/SEIU Healthcare; the American Medical Student Association; Dr. Charles Czeisler, Baldino professor of sleep medicine and director of the division of sleep medicine at Harvard Medical School; Dr. Christopher Landrigan, assistant professor of pediatrics and medicine at Harvard Medical School; and Dr. Bertrand Bell, professor of medicine at Albert Einstein College of Medicine.
"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. We will review and consider the petition on this subject submitted by Public Citizen and others," Michaels said. "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. In its investigation of the root causes of the BP Texas City oil refinery explosion in 2005, in which 15 workers were killed and approximately 170 injured, the U.S. Chemical Safety Board identified worker fatigue and long work hours as a likely contributing factor to the explosion."
The petition seeks these limits:
(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.
The petitioners say proposed changes in resident hours by the private-sector Accreditation Council on Graduate Medical Education (ACGME) are not sufficient. "In the past, Public Citizen has successfully petitioned OSHA to protect workers by lowering the allowable workplace levels of various toxic exposures, such as hexavalent chromium, ethylene oxide, benzene, and cadmium. The dangerously excessive number of hours resident physicians are currently allowed to work is a similarly toxic exposure that OSHA has the authority to regulate and reduce in order to protect these physicians from harm," said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group. "This is especially urgent since the current private-sector regulating organization, ACGME, has continued to abdicate its responsibility to adequately protect resident physicians."
The petitioners ask Michaels to exercise his authority under section 3(8) of the Occupational Safety and Health Act on grounds that working longer than the requested limits is harmful to resident physicians and subspecialty resident physicians, so a federal standard is necessary to provide them with safe employment. They claim research connects the typical resident work schedule to harm in four specific areas: motor vehicle accidents, mental health, pregnancy, and injuries such as needlesticks.
"Based on what we have learned from research evidence, we don't recommend that any physician stay awake for 24 hours or more, which is the case today," said CIR/SEIU Healthcare President Dr. Farbod Raiszadeh. "OSHA must intervene so that physicians in training are no longer at risk for needlestick injuries, car crashes, and other hazards that we know stem from chronic sleep deprivation."