May 1, 2001 (Washington) -- Young doctors-in-training are worried that their long hours are damaging not only their health and safety, but that of their patients.
The consumer advocacy group Public Citizen, the 11,000-member Committee of Interns and Residents, and the 30,000-member American Medical Student Association yesterday petitioned the federal government to begin regulating the hours worked by residents.
The petition, filed to the Occupational Health and Safety Administration (OSHA), asks for uniform federal rules that would cap work weeks at 80 hours for all specialties, with no shifts longer than 24 hours.
New York is the only state with a law that sets a work hour maximum for residents. The nation's accreditation council for graduate medical programs already sets workload guidelines, but they vary widely among specialties and often include no "maximum" for hours worked.
The medical student group says that it is working with Rep. John Conyers (D, Mich.) to introduce national legislation to establish standards for resident work hours.
It may take a lot for some doctors to otherwise place their faith in regulations from Washington, but sleep deprivation can be a serious problem for these physicians.
According to a 1991 national resident survey cited by the petitioners, about 25% of residents reported being on-call in the hospital a total of over 80 hours each week. Although there are only 168 hours in a week, many students reported working more than 100 hours a week.
The petitioners today invited comparisons to other professions, noting that the government regulates how many hours that truckers, airline pilots, railroad operators, and maritime pilots can legally work.
But residency work regulations might be unlikely under a Bush Administration that is emphasizing smaller government. An OSHA spokesperson tells WebMD that the agency had received the petition, but that oversight of work hours is not directly addressed in the legislation that governs the agency's operations.
The petitioners view the situation, however, as critical. Josh Rising, legislative affairs director for the medical students group, says residency is "the most abusive and inhumane ordeal which any professional in the United States is subjected." He noted that physicians have twice the suicide risk of the general population.
Sonya Rasminsky, MD, a second-year psychiatry resident at Cambridge Hospital in Boston, tells WebMD that overworked physicians can lose their compassion for patients, seeing them more as an impediment to sleeping rather than as individuals needing care.
The petition argues, "Multiple studies in the medical literature demonstrate that sleep-deprived and overworked residents are at increased risk of being involved in motor vehicle collisions, suffering from depressed mood and depression, and giving birth to growth-retarded and/or premature infants."
The petition also claims that research has demonstrated that sleep deprivation has hurt residents' performance on interpreting electrocardiograms, monitoring anesthesia, intubating mannequins, and even removing gall bladders.
According to Sidney Wolfe, MD, director of Public Citizen's Health Research Group, there is "no question" that patients die each year because of fatigued residents.
As an intern last year, Rasminsky says she sometimes worked up to 36 hours in a row. "The culture of medical education celebrates such acts of self-destruction by calling them self-discipline and self-reliance," she says.
But Jordan Cohen, MD, president of the Association of American Medical Colleges (AAMC), tells WebMD that federal rules are not the right way. "There is an issue about assuring that patients are safely cared for," he says, but control over resident working conditions should stay with the "residency review committees" that are run through the accrediting council for graduate programs. The council is partially controlled by AAMC.
According to Cohen, the "vast majority" of residency programs comply with the council's standards. He adds, however, that some hospitals may be forced to require more of residents. But that, he says, is to ensure that often-uninsured patients receive care as hospitals struggle with tight budgets.
Regardless of the success of today's petition, the climate is generally warming to improved rights for residents.
In November 1999, the National Labor Relations Board made a landmark ruling that gave 90,000 residents, interns, and fellows in private hospitals the right to collectively bargain over their working conditions.
And last year for the first time, the governing body for residency programs published overall work-hour violation tallies for the nation's residency programs.