Oct. 10, 2002

OSHA Denies Petition to Reduce Work Hours for Doctors-in-Training

Voluntary Approach Will Not Work, Public Citizen Says

WASHINGTON, D.C. - The U.S. Occupational Safety and Health Administration (OSHA) has rejected a petition to restrict medical resident work hours, opting instead to rely on inadequate standards being adopted by the Accreditation Council on Graduate Medical Education (ACGME), the private trade association that represents and accredits residency programs.

Those standards are voluntary and contain loopholes that will not protect medical residents - doctors-in-training who often work more than 100 hours per week.

On April 30, 2001, Public Citizen, along with the American Medical Student Association (AMSA) and the Committee of Interns and Residents (CIR), filed a petition with OSHA requesting restrictions on resident work hours, based on data linking long work hours to depression, adverse pregnancy outcomes and motor vehicle crashes. The petition asked for mandatory 80-hour work weeks, one day off per week and work shifts no longer than 24 hours.

Being awake for more than 24 hours produces cognitive deficits equivalent to a 0.1 percent blood alcohol level, illegal in most states. Yet these physicians continue to attempt to diagnose illnesses, perform surgery and prescribe medication while under the influence of sleeplessness.

In a letter to Public Citizen, OSHA denied the petition, citing voluntary standards being adopted by the ACGME. But those are inadequate, said Peter Lurie, MD, MPH, deputy director of Public Citizen's Health Research Group.

"For decades, the ACGME has done very little as residents were abused and patients put at risk," Lurie said. "Now OSHA is asking the public to trust the very individuals who allowed this mess to continue. We don't."

While there are superficial similarities between the ACGME proposal and the position of the petitioners, closer examination reveals major differences that will make true reform unlikely. For example, the ACGME permits a 10 percent increase in hours if a program can provide an ill-defined "educational rationale." The ACGME can exempt whole specialties - throughout the country - if national representatives of those specialties can show that the residents can't complete their educational activities without working more hours.

"These and other loopholes are likely to make the ACGME proposal toothless, while creating the appearance of real reform. Apparently it has already deceived OSHA," Lurie said.

The ACGME has never adequately enforced even its current weak guidelines on work hours. Its new proposal makes no allowances for public disclosure of violating residency programs, and there will be no civil penalties imposed against violators, an option if OSHA were to regulate.

A table describing the various resident hours reform proposals can be found at http://www.citizen.org/publications/release.cfm?ID=7191#table.

The petitioners have also introduced bills in the Congress (HR 3236 and S. 2614) with similar requirements to the petition. The House bill now has more than 70 co-sponsors.

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