September 3, 2010 Celeste Monforton, DrPH, MPH 8Comment

Public Citizen, the American Medical Student Association (AMSA) and other worker advocates petitioned the Occupational Safety and Health Administration (OSHA) to issue a regulation limiting the number of hours worked by medical residents. The petitioners argue that the excessive hours expected by the employers (hospitals) of these physicians-in-training cause chronic sleep deprivation and stress, which contributes to motor vehicle crashes, depression and mood disorders, needlestick injuries and other health problems. Among the compelling evidence provided are studies demonstrating significantly diminished mental acuity for sleep-deprived medical residents at levels comparable to 0.05% blood alcohol levels. One cited study indicated:

“Reaction times were 7% slower (p<.001), commission of errors was 40% higher (p< 0.001), speed variability was 71% greater (p<0.001) in heavy-call residents compared to light-call resident physicians."*

The petitioners use anecdotes to illustrate how a working condition—in this case excessive hours on-the-job—has a latent effect on the worker once they’ve left the workplace.

“Almost every resident I know in that program [surgery] has fallen asleep at the wheel driving home from work. And many of them have been in car accidents.”

Were injuries sustained in these car accident work-related? I would say so. I doubt though that many employers (including the administrators of these hospitals) label them work-related. [Current OSHA regulations also exempt them.**]

As Sid Wolfe, MD of Public Citizen’s Health Research Group notes:

“The dangerously excessive number of hours resident physicians are currently allowed to work is a similarly toxic exposure that OSHA has the authority to regulate and reduce in order to protect these physicians from harm.”

The link between work hours and safety is well recognized by other regulatory agencies, such as the FAA for airline pilots and DOT for commercial drivers. They’ve had regulations on the books for decades to limit work hours and mandate rest breaks. The justification for these rules is likely public safety, not protection per se of the drivers or pilots, but common sense (and our own experience) tells us that working too many hours and/or too many days in the row takes it toll on the body and mind. Our colleagues at Hazards magazine offer a compilation of research on work hours and health. It reveals a litany of adverse consequences of shiftwork, from increased risk of cancers, accidents, heart disease and pregnancy problems.

OSHA’s assistant secretary David Michaels responded immediately to the petition through a written statement. Dr. Michaels said the agency would “review and consider the petition” and acknowledged the relationship between worker fatigue and safety beyond the experience of medical residents. He said:

“It is clear that long work hours can lead to tragic mistakes, endangering workers, patients and the public. All employers must recognize and prevent workplace hazards. That is the law.”

The OSHA chief suggests that long work hours are an occupational exposure that employers are required to “recognize and prevent.” What’s less clear is whether OSHA will use its enforcement authority to compel employers to eliminate or control this hazard. Without a regulation on the books, the agency (or its legal advisors in the Solicitor’s Office) are reluctant to use the OSH Act’s general duty clause. This is likely the reason Public Citizen and the other petitioners are urging OSHA to put the following rules in place:

*A limit of 80 hours of work in each and every week;

*A limit of 16 consecutive hours worked in one shift for all resident physicians;

*At least one 24-hour period of time off work per week and one 48-hour period off of work per month;

*In-hospital on-call frequency no more than once per every three nights, no averaging;

*A minimum of at least 10 hours off work after a day shift, and a minimum of 12 hours off work after a night shift;

*A maximum of four consecutive night shifts with a minimum of 48 hours off after a sequence of three or four night shifts.

As I noted in a post earlier this week, worker fatigue was identified in the Kleen Energy explosion by family members and others as a contributor to the disaster. The Hartford Courant’s Josh Kovner reported that some of the laborers were working 84 or more hours per week, for weeks on end, to meet production deadlines.

Whether its working 80 hours in a hospital, laboring at a construction site, or toiling in a field, 80 hours of work is not sustainable or healthy for the vast majority of us. Economists may call U.S. workers the most productive in the world, but there’s a cost for that skewed measure of performance. Mr. Robert Owen (1771-1858) was on the right track with his slogan: 8 hours work, 8 hours recreation, 8 hours rest.

*Note: As I was hitting the “publish” button for this post, I received an email from Dr. Tony Carter, an occupational health researcher in Queensland Australia. He sent me a copy of his research on safety risk factors associated with fatigue among mine workers. As he explains: “Following 8 consecutive 12 hour day shifts cognitive processing deteriorated beyond what you would expect to see for a blood alcohol concentration of 0.05%. The mind boggles at the deterioration following 29 consecutive 12 hour shifts.”
**Note: I read a couple of provisions in OSHA’s regulations that lead me to say these work-related sleep deprivation motor vehicle incidents are exempt from OSHA’s current injury recording regulations. First, OSHA defines the work environment as a location where employees are working. If the injury didn’t occur in or was not exacerbated by the “work environment,” it is not an “OSHA recordable injury.” Second, an injury sustained in a motor vehicle accident in the worksite’s parking lot or on an access road is not recordable, let alone one occurring while a worker is driving from work after a 30-hour shift.

8 thoughts on “Excessive work hours: a serious safety hazards for workers

  1. It has always struck me that the excessive number of hours worked by residents in hospitals must be dangerous for patients, as well.

    Aside from that thought, if you were brought to a hospital after being in a car accident that you were involved in as a result of falling asleep at the wheel after working a 48 hour shift, the staff in the emergency room would most certainly let you know the stupidity of that idea.

    Pretty ironic.

  2. In India vast number of workers have no use of this research or such writings. In manufacturing sector, most workers work for 12 hours all 7 days. They may go on long leave once or twice in a year. These are migrant workers and they need long vacation when they visit their family. Locally, since they have no social connections, they too, prefer to work long and earn more.

    This must be true for many developing countries, too.

  3. In connection with my earlier post, there is Factory Act limiting working hours in manufacturing (units employing 10 or more workers)Units violate the law, workers are not organized and implementing authority is weak. I interviewed Chief Inspector of Factories (Now known as Director, Industrial safety & health- DISH)for the magazine I edit ( Bimonthly mag in Gujarati language, spoken by the majority in the State in India I live)and asked him this question and he replied that he can not do anything about it because he has only 40% staff that of sanctioned.No new recruitment are done by the Government.He informed me that they can only file prosecutions in the court against the violators and the cases keep on dragged in the court and his officers’ time is wasted in the courts.Attending court for the officers it self is an sentence to the officer,he said. Few,in the Society interested in such issues. Labor department is one most neglected. Government needs “Development’ for which industry department is important.

  4. One of the problems with the long working hours for resident doctors is the same one they had while still in medical school — no personal life, except medicine, including no sex. A recent survey of thousands of doctors found they do not feel comfortable talking about sex with their patients. And, medical students say that after their medical school education, they feel that they will be unable to discuss sex issues effectively with patients. The subject of sex is not covered in their educations — instead, med schools teach sex merely in relation to pregnancies and STDs. What if a patient needs factual info on correct size of condoms to be safe? The med students say they want sex education classes, PLEASE:

  5. “In India vast number of workers … work for 12 hours all 7 days … This must be true for many developing countries, too.”

    LOL, do you live in the US (no pun intended, sorry)? In my nephews work in Oregon they work like this all the time. 12 hour shifts with only 2-4 days off work (yep they work Sundays and Christmas). Some people came there from other employer and say it’s been even worse. This is industry job that requires minimum of Bachelors degree.

    What makes me sad is that too many people are unemployed while others work like crazy. We need some law to legally limit work hours.

  6. In my previos post I mean 2-4 days off PER MONTH. And sometimes not a single day off per month. Lots of places which use you like this and thouw to the street when you can’t bear it anymore. He’s still keeping on this job but it geat some toll on his health…

  7. How many consecutive hours can a pharmacist work without a single break. Currently, I am required to work as many as sixteen hours without a single break in a hospital. If I work other shift I am also not permitted breaks but can eat at my desk through lunch in NY state. What laws are being violated

  8. Thanks for informing the negative effects of excessive work hours on the physical and mental health of the worker. The warehouse is one of the most dangerous places to work. Increased work hours is directly proportional to the number of accidents happens in the warehouse. Any kind of accident in the warehouse not only cause a huge amount of product loss but also endangers the life of the worker. So, suitable initiatives need to be taken to prevent such kind of accidents and subsequent product loss.

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