Should OSHA create work rules for physicians in training?

Recent rules issued by the Accreditation Council for Graduate Medical Education (ACGME) for resident work hours have further limited the consecutive and total number of hours that medical trainees may work.  These measures, originally created because of safety concerns, are intended to decrease the number of fatigue-related errors made by physicians in training.  They have received broad support within the medical community.

A recent story published by Mike Lillis in The Hill, reported that a coalition of organizations is requesting that OSHA intervene and create work rules for physicians in training.  They have requested the following:

  • A limit of 80 hours of work per week, without averaging (current rules allow for averaging, meaning that resident physicians may work 100 hours one week and 60 hours the next);
  • A limit of 16 hours worked in one shift for all resident physicians (the ACGME’s proposed guidelines limit the length of shifts to 16 hours only for first-year residents, also known as interns);
  • At least one 24-hour period of off-duty time per week and one 48-hour period per month, for a total of five days off per month;
  • In-hospital on-call frequency no more than once every three nights, without averaging;
  • At least 10 hours free between duty periods; and
  • No more than four consecutive night shifts and 48 hours off after working three or four of these.

Although these recommendations seem very appropriate, the fact that a combination of public advocacy groups, a labor union representing 13,000 interns and residents and the American Medical Student Association have chosen to take this issue to OSHA raises serious implications about the loss of professional autonomy in medicine.

While it is hard to argue that physicians in training have not been taken advantage of throughout the past century (working unreasonably long hours under poor conditions for ridiculously low pay), enlisting a government regulatory agency to enforce rules determined not by the professional consensus of the involved parties, but by government edict, can only erode further the values that have guided physicians for the past century.

This appears to be another step on the road to making medicine a trade rather than a profession.  The fact that two organizations representing thousands of future physicians find it necessary and appropriate to involve OSHA in the process of reforming medical education, suggests that medical leadership in the US has failed and that our future physicians do not fully understand the special role of their future profession in society.

By all means, let’s fix the problems in residency training.  But we should do it as a profession, bringing the trainees, the trainers and others with an interest in the process, such as public advocates, into the negotiations without invoking the power of the government.  Involving government in regulating medical education puts all physicians one step closer to being technicians with the government mandating specific decisions in patient care. That isn’t likely to benefit us or our patients.

Richard Leff is Chief Medical Officer of Conisus.

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  • Maryann

    Besides fatigue, there’s another consideration. It’s possible that those long calls with little recovery time before turning around and coming back to work put young doctors at higher risk for work-related musculoskeletal disorders. From a training standpoint there is probably no good substitute for putting in the time, but recognize there may be unpleasant consequences down the line.

  • Happy Hospitalist

    Please don’t bring OSHA into the mix. Then I can’t have food or drink at the nurses station.

  • Mike

    Dr. Leff, great post. I could not resist responding, and you can check my reaction over at my site,
    Basically, I support stricter work hour rules in accordance with the IOM 2008 recommendations, which have been called “unworkable” by ACGME. I am not certain that going to OSHA is the ideal strategy to achieve this goal, but I applaud several groups’ effort to push harder for better resident work conditions. I am not affiliated with any of the organizations that asked OSHA for tougher regulations, just a guy who graduated residency six years ago.

  • John Ludlow

    If the house of medicine would fix the problems in graduate medical education once and for all, then young physicians wouldn’t be attempting to change the system. It’s just history repeating itself, and we’ll have a worse outcome because of the lack of action of organized medicine on this issue. It’s why we got EMTALA in the 80′s and HIPPA in the 90′s; neither one of those would have occurred if medicine had self regulated. It didn’t then, and it hasn’t now with graduate medical education, and now we’ll see how it plays out with OSHA.

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