To be absolutely clear, we are only asking OSHA to regulate and enforceresident physician work hours, a responsibility that is clearly within the agency’s jurisdiction. We are not asking the administration to assume oversight of residentphysician education and supervision functions. We believe the AccreditationCouncil for Graduate Medical Education (ACGME), the professional medicalorganization that currently oversees all resident physician training, should retainthat function.
PART 1: RESIDENT PHYSICIANS WORK EXCESSIVE HOURSA.
Depending on the type of residency, physicians-in-training can work anywherefrom 60 to 100 or more hours a week, sometimes without a day off for two weeksor more. Specifics come from a nationwide prospective cohort study of US first-year resident physicians (interns) conducted by Landrigan
., which evaluatedhours worked in 2002-2003 and 2003-2004.
Four thousand and fifteen internsparticipated in the study, providing 29,477 monthly reports of their work andsleep hours. Even after implementation of the ACGME’s Common Duty HourStandards in 2003,
The average work week was 66.6 hours (95% confidence interval [CI]66.3-66.9);
The mean length of an extended shift was 29.9 hours (95% CI, 29.8-30);
29% of all work weeks were more than 80 hours in duration, 12.1%were 90 or more, and 3.9% were 100 hours or more;
83.6% of all interns reported hours of work in violation of theprofessional self-regulations that were established and are beingmonitored by the ACGME. This number far exceeds the rates of violationsreported by resident physicians and residency programs to the ACGME,indicating both that widespread under-reporting exists, and that theACGME’s enforcement has been ineffective.
Resident physicians must deal with multiple stresses of patient care, patientdeath, the need for constant learning, the task of teaching medical students, therequirements of attending physicians and senior resident physicians, and thenecessities of family and personal life — all while being subjected to the chronicsleep-deprivation and exhaustion caused by their excessive work schedules. In astudy conducted by Schwartz
., 377 resident physicians answered a surveyin which they were asked to rate the most stressful factors in their residency.Among choices such as “high mortality among patients” and “large patient load,”