Safe Work Hours, Safe Patients

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OSHA Should Regulate Work Hours for Doctors-in-Training, Groups Tell Labor Department

Medical Residents Need Shorter Shifts, Enforced Policies to Protect Themselves and Patients

WASHINGTON, D.C. (September 2, 2010)– The Occupational Safety and Health Administration (OSHA), which is tasked with enforcing safety and health legislation, should take doctors-in-training under its purview, consumer and health advocacy groups said today in a petition sent to the agency.

Download the Petition

Resident physicians work shifts as long as 30 hours as often as three times a week, which can lead to physician fatigue and medical errors. Exhausted resident physicians are at increased risk of being in a car crash and suffering from depression, pregnancy complications and needle sticks, research shows.

Because OSHA, which is part of the Department of Labor, is supposed to ensure the safety and health of workers, it has jurisdiction over resident physicians and should protect them, the groups said. Those petitioning OSHA include: 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.

Patient Safety Advocates Give Plan to Reform Medical Residency a Failing Grade

Wednesday, 23 June 2010 17:01

The Accreditation Council on Graduate Medical Education (ACGME) released their proposal to restructure medical residency programs by means of an article published in The New England Journal of Medicine.

The bottom line: they didn't make the grade.

We created a "report card" comparing the ACGME's proposal to the the landmark 2008 report by the Institute of Medicine (IOM), Resident Duty Hours: Enhancing Sleep, Supervision and Safety. Although ACGME demonstrated some progress in reconciling its regulations with the mounting body of scientific evidence linking acute and chronic sleep deprivation with preventable medical errors, the coalition judged that the proposal fails compared to the more comprehensive recommendations of the IOM report.

Missing: A Patient Perspective on the Need to Reduce Resident Work Hours

The Problem: You've seen them on Scrubs, ER and Grey's Anatomy -- deeply fatigued interns and residents. But truth is stranger than fiction. More than 100,000 resident physicians in teaching hospitals across the country are routinely scheduled to work shifts of 24-30 consecutive hours, with little or no sleep. They work in operating rooms and ERs, on the wards and in the clinics. And when they are finished working, they get behind the wheel of a car and drive home. After that, they are likely to be back in the hospital for two days of "short" 8 or 12-hour shifts. Then it is another up-to 30-hour "on-call" shift. This brutal schedule can continue for years.

The Evidence: There is substantial scientific evidence that these marathon work hours are linked to a significant increase in attentional failures, performance deficits and medical errors - and to increased car accidents that harm residents and the drivers and passengers they crash into. In fact, resident fatigue was the subject of a gold-standard, randomized controlled trial proving the efficacy of reduced work hours in reducing medical errors. The prestigious Institute of Medicine (IOM) has also concluded that there should be a further reduction in work hours. Other industries responsible for public safety (e.g., the transportation and nuclear power industries) have been subject to federal regulations that limit the number of hours their employees can work for decades. Why not in medicine, where the stakes are at least as high or higher?

Public Strongly Supports Substantially Reducing Work Hours for Resident Physicians, New Research Finds

Only 1 Percent of General Public Supports Widespread Practice of Resident Physicians Working Shifts Longer Than 24 Hours

WASHINGTON, D.C. (June 1, 2010) - The American public greatly underestimates the extended hours currently worked by resident physicians nationwide and overwhelmingly disapproves of shifts lasting longer than 24 hours, which are currently required by teaching hospitals. New findings, published in today's edition of the online journal BMC Medicine, indicate that Americans strongly favor tighter regulation of the number of consecutive hours that resident physicians are allowed to work. This is the first systematic study of public perceptions of resident work hours.

The authors of the manuscript, which included academic experts as well as consumer and labor advocates, found that 90 percent of Americans believe that the maximum shift duration for resident physicians should be 16 hours or less, as recommended by the Institute of Medicine (IOM). The IOM concluded in 2008 that allowing resident physicians to work more than 16 consecutive hours without sleep is unsafe both for patients and resident physicians themselves. More than four of five respondents in the study believe patients should be informed if the doctor treating them has been working for 24 hours; a similar majority of respondents said that if told that their doctor had been awake for a day, they would request care from a different doctor.

The Accreditation Council on Graduate Medical Education (ACGME), the group that oversees the training of physicians in the U.S., has yet to implement the IOM recommendations. The ACGME currently allows resident physicians to work for 30 consecutive hours and allows such extended shifts to occur up to twice per week. The ACGME has been reviewing the IOM recommendations for limiting resident physician work hours for the past 18 months and is expected to announce its decision later this month.