Hopkins IM residency loses accred

[tkim]

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[uclacrewdude]

Still beats going to Osteo!

 

[Winged Scapula]

Moving to General Residency Issues...

 

[tkim]

Originally posted by uclacrewdude
Still beats going to Osteo!

What brought this on?

- Tae

 

[DOtobe]

I think he just wants some attention... He's had quite a few anti-osteopathic posts. Just ignore him and maybe he'll go away.

 

[irlandesa]

Although I think 2 months after the institution of "official rules" on resident work hours is a little too soon to pull a residency program accreditation all together, I think that Hopkins probably did need a wake-up call with regard to some of their policies. JHU has always had the reputation of being competitive and cutthroat, and too much of that sort of attitude can really hurt residency programs. I also think that the point in the article that if such drastic action can be taken at a powerhouse like Hopkins, than it can be taken at ANY residency program (yes, this goes for both allopathic and osteopathic programs!), is very well-taken as well. I really doubt that Hopkins will have much trouble getting their accreditation back, but I kind of wish that they'd apologize and make specific plans to adjust to the regulations instead of bitching and moaning about how unfair, etc.. then again, I do tend toward wishful thinking..

 

[Pilot Doc]

Although I think 2 months after the institution of "official rules" on resident work hours is a little too soon to pull...

I think that's the point the ACGME is trying to make. No grace period, no allowance for new interns, etc. They want Congress to know (think?) that they mean business.

yes, this goes for both allopathic and osteopathic programs!)

Doesn't the AOA (instead of the ACGME) oversee osteopathic residencies?

 

[Deuce 007 MD]

Now I don't feel so bad about Drew loosing their surgery accred. I felt really bad about my program when I heard they lost surg, but seems like programs just correct the problem and reapply and that it shouldn't be a problem.

 

[chef]

i wouldnt wanna be teh first yr who ratted on the program.. what a joyous and pleasant next 4 yrs he's facing.. lol

 

[Winged Scapula]

Originally posted by chef
i wouldnt wanna be teh first yr who ratted on the program.. what a joyous and pleasant next 4 yrs he's facing.. lol

What makes you think it was a first year who "ratted" on the program? And additionally, because you are the 3rd person to mention this, I feel it necessary to restate that reports to the ACMGE are confidential. The RRC does *not * come in, tell everyone who ratted on them and then leaves the poor individual to fend for themselves.

This is not to say that it is not possible that the person outed themselves but fear of retribution and being found out should not prevent individuals who feel strongly from making a report to the ACGME. When the RRC holds a site visit (whether for routine accredidation or review) , representatives from all years are spoken to about the program and anyone who wishes may be included. The RRC does not publish or inform the program of individual comments, positive or negative.

 

[Ludy]

Originally posted by Kimberli Cox
What makes you think it was a first year who "ratted" on the program? And additionally, because you are the 3rd person to mention this, I feel it necessary to restate that reports to the ACMGE are confidential. The RRC does *not * come in, tell everyone who ratted on them and then leaves the poor individual to fend for themselves.

This is not to say that it is not possible that the person outed themselves but fear of retribution and being found out should not prevent individuals who feel strongly from making a report to the ACGME. When the RRC holds a site visit (whether for routine accredidation or review) , representatives from all years are spoken to about the program and anyone who wishes may be included. The RRC does not publish or inform the program of individual comments, positive or negative.

I don't know how the information got out, but a friend of mine who's a first-year medicine resident at JHU now said it was an EM resident who rotated for a month in July that complained about the hours. Personally, I think that anyone who chose to go to JHU knew about the hours they'd be expected to work and chose it anyway because they felt the training they'd receive was worth the price. My friend was working long hours but loved it. Now he says morale has really dropped and there's definitely some tension between the EM and IM residents.

 

[Winged Scapula]

Originally posted by Ludy
I don't know how the information got out, but a friend of mine who's a first-year medicine resident at JHU now said it was an EM resident who rotated for a month in July that complained about the hours. Personally, I think that anyone who chose to go to JHU knew about the hours they'd be expected to work and chose it anyway because they felt the training they'd receive was worth the price. My friend was working long hours but loved it. Now he says morale has really dropped and there's definitely some tension between the EM and IM residents.

I'm not suprised the info got out - these things are usually open secrets among residents. I know who "outed" us, as well. However, I just wanted to point out that the information doesn't come from the ACGME or RRC but rather the residents themselves.

BTW, I agree that its not like the hours at JHU were a secret. Abd it appears that even with the sanctions the faculty are still defending the hours violations. Anyone remember the series Hopkins 24/7? One of the 3rd year surgical residents quit because of the hours.

 

[DALABROKA]

Originally posted by Kimberli Cox
What makes you think it was a first year who "ratted" on the program?

According to Hopkins, the primary complaint was that several first-year residents worked close to 90-hour weeks in early July.

DALA

 

[Winged Scapula]

Dala...

That still doesn't mean that a first year "ratted" on the program. While they might be more suspect because they are working 90 hours per week, I doubt they are the only ones, or the only ones with a vested interest in seeing the hours reduced. Nowhere in the statement quoted does it say that a first year reported the program to the RRC. As a matter of fact, if you read the above post, it appears that it wasn't even an IM resident but rather an EM resident who reported the violation.

.

 

[ItsGavinC]

Originally posted by Ludy
I don't know how the information got out, but a friend of mine who's a first-year medicine resident at JHU now said it was an EM resident who rotated for a month in July that complained about the hours.

But nearly everybody complains about the hours they work in residency -- they just aren't channeling their complaints to the right (or wrong?) group.

 

[Idiopathic]

Originally posted by uclacrewdude
Still beats going to Osteo!

I was holding out judgement, but you are officially a tool.

Have a nice day, "dude"

 

[VienneseWaltz]

Someone pointed out to me that the ACMGE might be shooting itself in the foot. It's true that a school can fix the problem and reapply immediately, but if a loss of accreditation goes through, the complainant runs the risk of having to find another program and potentially repeating part of residency. If a resident who speaks up risks losing the program altogether, not many residents are going to speak up--unless, as rumor in this case indicates, the complainant isn't actually in the program being sanctioned.

Revoking accreditation without warning or probation is ridiculous.
It's fine to say Hopkins had it coming to them, it's too competitive, etc, but the 70 or so residents who are not in the final year of their program do not deserve to be screwed like that. Fortunately, all my sources indicate that the disaccreditation will most likely not take effect.

 

[Thewonderer]

I believe that the article linked at the above talked about the 80-hr work week rule being in effects since 1988 in the field of internal medicine. I do not know how accurate that is but the article tried to say that it is not as though the new rule only exists since July 1, 2003.

I know for a fact that many hospitals at least started changing in 2000. And if Hopkins and other institutions, such as Yale, cannot get their acts together for 3 years, then when if ever they will act the work-hours down to 80 hours? After all, when Yale was warned, miraculously, they cut the hours down and found an alternative schedule and get to keep accreditation. If that's case, it is probably better for Hopkins to lose accreditation NOW so they can fix the problem NOW.

The bottomline is that there is a lot of down time and stupid things that residents do and eat into their work weeks (ex. make appointments for their patients, waiting for attendings to come back from sugeries, etc.). These big chunks of time need to be cut out and outsourced to secretaries, social workers or whoever. People do not need to go through med schools and into residencies to learn how to make appointments and wheel pts down to MRI (nor do students). Hospitals need to start hiring some PA and NP. They are expensive but if the hospitals want to seriously put the work week down to 80 hours, they need to spend the money.

Lastly, at my institution, residents are always complaining about the various alternative schedules that they are experimenting. In one, they said that the continuity of care is compromised. In another, they complain that they have to work with different residents every night. Docs are a really whinny group. They do not realize that there is no "perfect" scheduling. It is best for residency programs to find one and stick with it. After all, the old schedule of 100-110 hour week DEFINITELY was not conducive to learning in an efficient manner. Let's make the changes and move on, not keep on holding onto the past.

 

[DALABROKA]

Originally posted by Kimberli Cox
Dala...

That still doesn't mean that a first year "ratted" on the program. While they might be more suspect because they are working 90 hours per week, I doubt they are the only ones, or the only ones with a vested interest in seeing the hours reduced. Nowhere in the statement quoted does it say that a first year reported the program to the RRC. As a matter of fact, if you read the above post, it appears that it wasn't even an IM resident but rather an EM resident who reported the violation.

.

Kim,
I wasn't disagreeing with you, I just saw that and thought that you may have missed it.

I personally think that the only way this whole thing is going to be resolved is by having some oversight agency that doesn't have a vested interest in medicine (i.e., ACMGE) take over as the watchdog group. It seems that New York is doing fine with their system. I just can't see how OSHA hasn't been able to sink their teeth in to the whole GME system yet. When OSHA finds out that a truck driver worked too many hours in a row, they have a fit, but when surgeons are performing operations after being awake for 36+ hours, no one says a thing. Not only is the patient at increased risk for a screw-up, but the surgeon is at an increased risk of injury as well. I don't see how residency programs have got away with it for as long as they have (even with as much political pull as the health care industry has.)

DALA

 

[ckent]

Originally posted by Thewonderer
I believe that the article linked at the above talked about the 80-hr work week rule being in effects since 1988 in the field of internal medicine. I do not know how accurate that is but the article tried to say that it is not as though the new rule only exists since July 1, 2003.

I've actually heard that the 80 our work week has been in effect only for internal medicine for several years now too. I'm not sure, but I imagine the either the SGIM or ACP made the 80 hr work week some time ago, but never had the "teeth" to actually enforce it. Now that the ACGME has adapted it (July 2003), it's finally getting to be an issue for programs that were previously ignoring the previous rule for IM like Hopkins. It's really not a big deal, even though they did lose accredidation, nothing will formally happen until July 2004, so they have until then to get into compliance. I agree that doctors are, on a whole, a whiny bunch and will never be satisfied with whatever ends up happening. Many will argue that the night float system actually jeapordizes patient safety more then having more sleep deprived residents does, particularly in medicine. I know that during my sub-I, I was frequently called on patients who I had a 2 line history written on in my sign out and being asked questions that I could not answer better then the primary resident responsible for their care could. But you can't expect residents to actually be residents of a hospital anymore, eventually, everyone needs a family life.

 

[supercut]

Programs should be very careful about hiring PA/NP to help with hours.

While I wholehartedly agree that residents should not have to spend time making appointments, finding nursing homes and filling out discharge paperwork, I also have exeperienced that giving PA's too much control can be a bad thing.

At my program, the PA run the floor. They have the power to override anything the residents do and frequrently exercise that power with the blessing of the attendings. They round with the attendings, and residents are not included in those rounds. The residents round on their own. So we have essentially two competing teams with two plans, and the PA always win because they have the attending backing. I've been told by my PD there is nothing that he can do about this and the only complaint we have about PAs that will get any action is if we aren't getting to the OR

However, sometimes the discharge stuff doesn't get done. So then the intern is stuck doing it, sometimes even when the PA is scrubbed in the OR!!! (my complaint about this resulted in a reprimand to the involved parties, but still I rarely get to do anything in the OR)

So I'm not learning how to manage floor pts, I'm not learning OR skills, and the PA's have more say in what goes on than I do. The culture is is that the attendings bend over backwards to keep the PAs happy becuase the PA s are permanently with the attendings and the residents rotate. So no one cares if the residents are happy or not.

There has got to be a better way to follow the 80 hour limit than giving control of the service to PA (BTW, my program is in NY an so has been under the 80 hours for a longer time, thus the PA system is firmly entrenched)

 

[Winged Scapula]

Originally posted by DALABROKA
Kim,
I wasn't disagreeing with you, I just saw that and thought that you may have missed it.

DALA

Sorry if I came across as curt - I just wanted to make sure YOU knew I was aware of the above statement. No hard feelings.

 

[MacGyver]

Supercut,

Unfortunately the hospital has the upper hand in your situation because even if all american med students boycotted the residency program it will have no effect because the hospital could just take as many FMGs as they want.

I wish you would tell us the program though so the word gets out and the hospital is stuck with the FMG label (generally FMGs go to the undesired programs).

Ideally the ACGME should step in and permanently revoke its accreditation going into effect the next couple of years so all current residents can get out before it loses accred. That would show those idiots that they cant just screw residents over like that. Of course, the ACGME will probably never do that, even if faced with a mountain of evidence that your program sucks royally.

 

[MacGyver]

vienna,

I know you go to Hopkins so you're a little biased I'm sure. Hopkins needs to be punished here. No slap on the wrist, no winking at hte problem with no real changes.

The people in charge of Hopkins IM are either incredibly stupid/naive or incredibly stubborn. Either way, they need to take their medicine and the ACGME has just the right potion.

I somewhat agree with you that it sucks that the current residents will be hurt by the ACGME's action, but what is the alternative?

How do you punish a residency program without hurting the residents? Sorry, but theres just no way to distinguish between the two. Its like the embargo on Iraq--it hurt both Saddam Hussein AND the Iraqi public. Similarly, residents and the program itself are inseparable.

If you have an idea of how to punish the Hopkins IM residency program without hurting the residents themselves, I'm all for it.

But we cant just look the other way and pretend that Hopkins is in compliance. They KNEW the ACGME was cracking down and STILL failed to do enough to correct the problem. This isnt rocket science folks, the rules are cut and dry. I'm sure Hopkins will start whining about "oh the rules are just too complex, we didnt understand, blah blah blah" like a bunch of whiny babies. Its time for them to stand accountable for their idiotic failure to heed the many warnings that ACGME gave out across the country.

 

[daddymd]

Macgyver,

You come across like a ranting *****. What, did Hopkins reject you?

 

[ItsGavinC]

Originally posted by daddymd
Macgyver,

You come across like a ranting *****. What, did Hopkins reject you?

Although he makes some excellent points.

 

[Thewonderer]

Regarding PA's taking over residents' jobs and learning opportunities, that should not happen. If it happens, its accreditation could be lost.

 

[Linie]

I really doubt that Hopkins will have much
trouble getting their accreditation back, but I kind
of wish that they'd apologize and make specific plans
to adjust to the regulations instead of bitching and
moaning about how unfair, etc.. then again, I do tend
toward wishful thinking..

JHU has always had the reputation of being
competitive and cutthroat, and too much of that sort
of attitude can really hurt residency programs.

**I tried submitting this a coupld days ago, but files were being downloaded and I guess it didn't work**

I'm a third year medicine resident at Hopkins and I
take issue with a few things you said in your post.

First, JH's cutthroat reputation is not deserved.
We're actually a very friendly group, I think you
would find us pleasant to work with. It's a supportive
atmosphere. And we have fun too, believe it or not!
Even these days, under the microscope, we're STILL
having a good time.

Also, about Hopkins apologizing- although I think
Hopkins IS at fault for not making super-sure we were
compliant with the work hours rules, the rules are
incredibly nit-picky and seem to have been made up by
someone who has never worked in a hospital.
Additionally, the same workload that takes 70 hours in
December takes a new intern 90 hours in July. Swooping
in to shut down an entire program on July 10th (that's
when the letter was written) is nuts if you ask me. I
would like to point out too that this has the
potential to affect the careers not only of the 100
interns and residents, but also of all the medicine
subspecialty fellows as the fellowships also will lose
their accreditation as of July 1, 2004. Finally, the
ACGME went straight for the jugular by revoking our
certification, completely bypassing probation.

Were they trying to make an example of Hopkins? I have
no doubt!

Was their action draconian? Absolutely! And rash! And
destructive to over 100 people's careers!

Was it an EM intern who complained? That's the word on
the street. I have read the letter (with identifying
info removed) and one thing was clear- it was written
by someone who has been here for more than 10 days
because the letter referred to a lot of aspects of the
medicine residency program that you would not be aware
of if you had just begun working here. If it was an
intern, it was someone who went to med school here.
Otherwise, it must have been a resident. The EM intern
who most people think is the letter-writer went to
school here.

How has this event impacted me? Well, my chief is
often away at meetings so rounds get delayed (adding
about 5 hours to my week), her thoughts are consumed
by this stuff so I get taught less, and my interns are
stressed about getting out in time. My education is
definitely suffering. Since I'm supposed to be a
fellow here in 2004, I'm extremely stressed about
what's going to become of my career.

I really wonder about the letter-writer's motivations.
Did s/he think s/he was doing the rest of us a favor?
I would hope that before complaining (bitterly, I
might add- the tone of the letter was quite nasty),
s/he would pause to think about the repercussions on
so many people who have worked hard for many years to
get to where we are, and who are strongly loyal to
this place. I don't know who this person is, but I
would like to have a word or two with him/her.

What's going to happen in the end? Probably we'll get
re-certified and life will go on. It gives us an
opportunity to re-organize and fix a few things that
are less than perfect. Think for a moment what would
happen if the Hopkins medicine residency shut down- a
large chunk of Baltimore would not get health care,
the ER would close....

Did I mind working more than 80 hours a week? Frankly,
no. I don't think the number of hours is really the
point- I find it annoying that everyone is so fixated
on it. As long as I'm learning, the people around me
are pleasant to work with, and the patients are
interesting, then I'll be happy working 100 hours.
It's other things that get me down- the institutional
quirks that make getting studies done a pain in the
rear. The ACGME/RRC also examines those things and
judges training programs based on their performance in
those areas- that's something I really appreciate.

I could go on and on, but I'm pushing 80 hours this
week so I have to go home (but if I had worked more, I
wouldn't admit it!) ... ;-)

 

[Idiopathic]

Seems like a lot of stress has been added to your life. Do you feel that JHU or the ACGME (or the informant) is to blame? Or is anybody to blame? Was there anything wrong?

 

[MacGyver]

Did I mind working more than 80 hours a week? Frankly,
no. I don't think the number of hours is really the
point- I find it annoying that everyone is so fixated
on it. As long as I'm learning, the people around me
are pleasant to work with, and the patients are
interesting, then I'll be happy working 100 hours.

Linie,

With all due respect, you just dont get it. Its not always about YOU. Thats what got the Hopkins people in trouble in teh first place, thinking they were "above" the regulations and not taking them seriously. YOU dont get to set the regulations. YOU do not get the privilege of deciding whether to follow them or not. YOU are not in charge or calling the shots.

Now if you dont agree with the regulations then fine, take that up with the ACGME. But I'm not buying this "the regs are too complicated, we dont understand them, etc" excuses. Any doctor who cant understand a set of simple regulations obviously lacks the mental capacity to understand complex interactions in pharmacology needed by IM residents.

Again, if theres a way to punish Hopkins without hurting all the residents in the program, then I'm all ears. Sorry to say though, theres no way to separate the two entities and something must be done. Obviously just letting Hopkins do their own thing hasnt worked.

 

[chef]

so, do u folks think it'll get easier to match at hopkins im? last time i checked only superstars around the country matched at hopkins im....

 

[Mirror Form]

Originally posted by Linie

Additionally, the same workload that takes 70 hours in
December takes a new intern 90 hours in July. Swooping
in to shut down an entire program on July 10th (that's
when the letter was written) is nuts if you ask me.

I'm going to have to agree w/ mcgyver on this one. The 80hr rule wasn't just implemented for your own personal edification. A major reason was that it was unsafe for the patients to have sleep deprived doctors taking care of them (24 hours of sleep is equivalent to a blood alcohol level of way past the legal driving limit). So, your reasoning that it's okay to work over 80 hours provided the interns doing it are unexperienced and don't know what they're doing yet is ridiculous!

Originally posted by Linie

I really wonder about the letter-writer's motivations.
Did s/he think s/he was doing the rest of us a favor?
I would hope that before complaining (bitterly, I
might add- the tone of the letter was quite nasty),
s/he would pause to think about the repercussions on
so many people who have worked hard for many years to
get to where we are, and who are strongly loyal to
this place. I don't know who this person is, but I
would like to have a word or two with him/her.

Did you ever stop to think that maybe the EM intern had children they'd like to see grow up? Maybe the intern's spouse or fiance was threatening to leave if the intern didn't make more time for them. My point is that there are a lot of good reasons for not wanting to work insane hours. And as far as the repercussions go, none of them will happen as long as the Hopkin's faculty and program gets in line. If they fail to do so, then the blame is on them as much if not more then the whistle blower.

Originally posted by Linie

Did I mind working more than 80 hours a week? Frankly,
no. I don't think the number of hours is really the
point- I find it annoying that everyone is so fixated
on it. As long as I'm learning, the people around me
are pleasant to work with, and the patients are
interesting, then I'll be happy working 100 hours.

You're dedication is admirable and you'll probably make a very good doctor. I can see why you were accepted into a prestigous program like Hopkins. However, most people value their personal lives. Maybe you're one of the people who can balance a personal life on top of a 100 hour work week (w/o taking crystal meth), but otherwise you might want to make your personal life a little bit more of a priority. Otherwise you may end up alone, bitter, and unhappy like a lot of today's doctors are.

 

[eddieberetta]

Originally posted by Linie
Additionally, the same workload that takes 70 hours in
December takes a new intern 90 hours in July. Swooping
in to shut down an entire program on July 10th (that's
when the letter was written) is nuts if you ask me.

Fair enough...

Originally posted by Linie
I have read the letter (with identifying
info removed) and one thing was clear- it was written
by someone who has been here for more than 10 days...

So the letter writer knew what the scoop was no?

I think it was a bit drastic to go directly to revocation but it it likely that big-name schools like JHU would not respond otherwise. ..

 

[Thewonderer]

1) I think we actually need more whistle blower in medicine. Docs protect each other too much to the point of being detrimental to themselves and to their patients. Why do you think malpractice insurance is so high? People who do not care about patients manage to gradute from med school, find a residency spot, and become board certified. Since they do not care, they make the same mistakes over the over again. A small percentage of docs make up most of the payouts from malpractice lawsuits. Docs protect each other too much and turn away from errors, leading to worse care for patients.

2) As Linie said, the chief was away for conference and thereby adds another 5 hours to his or her day! There are many down times in medicine and they need to be cut out. Regulation is regluation. You cannot drive if you are drunk even though some chronic alcoholics say that even if their blood alcohol level is twice the legal limit, they can still drive fine.

The ONLY good reason against the 80-hour work week is the lack of continuity of care (not for education because if you need more than 80 hours to learn something, you are learning it inefficiently and on sleep deprivation). However, no pain, no gain. If you write good notes and sign off patients appropriately, continuity of care should not be an issue (in an ideal world of course).

 

[VienneseWaltz]

MacGyver--

There must be some intermediary step between revoking accreditation and a slap on the wrist. A hefty fine comes to mind, for example.

My point was that such an overreaction can have the undesirable effect of discouraging whistle-blowers. I'm not saying that revocation was a bad idea because it's unfair; I'm saying it's a bad idea because it could discourage abused residents from coming forward.

I'm not satisfied with your argument that residents in a bad program might as well lose it, which is what your inseperability notion seems to say (unless I'm misreading it). If I'm being abused by my program, I'm not going to be any happier by losing my program altogether than I would be working the bad hours. In fact, I will probably be much unhappier.

 

[Linie]

With all due respect, you just dont get it. Its not always about YOU. Thats what got the Hopkins people in trouble in teh first place, thinking they were "above" the regulations and not taking them seriously. YOU dont get to set the regulations. YOU do not get the privilege of deciding whether to follow them or not. YOU are not in charge or calling the shots.

Thanks for reminding me that all of this is out of my control. As if I could forget for one second that someone in an office somewhere is dictating when I should leave the hospital even if it puts an extra burden on my team, even if there's a sick patient who I don't want to leave until I see them appropriately cared for, or if my intern needs help.

Now if you dont agree with the regulations then fine, take that up with the ACGME. But I'm not buying this "the regs are too complicated, we dont understand them, etc" excuses. Any doctor who cant understand a set of simple regulations obviously lacks the mental capacity to understand complex interactions in pharmacology needed by IM residents.

Where did you get the idea that Hopkins is using such excuses?

A major reason was that it was unsafe for the patients to have sleep deprived doctors taking care of them (24 hours of sleep is equivalent to a blood alcohol level of way past the legal driving limit). So, your reasoning that it's okay to work over 80 hours provided the interns doing it are unexperienced and don't know what they're doing yet is ridiculous!

The interns in July and August have 24-hour one-to-one backing by a resident and through the rest of the year have someone available at all times for help. At any rate, when you are crashing, it's better to be taken care of by someone who knows you well and is tired than by someone who is well-rested and heard a three-liner on you.

Maybe the intern's spouse or fiance was threatening to leave if the intern didn't make more time for them.

I'm sorry to take a shot at this one because I do see your point, but....
I'm supposed to change what I do and possibly lose my fellowship because someone not even in my program is upset?

but otherwise you might want to make your personal life a little bit more of a priority. Otherwise you may end up alone, bitter, and unhappy like a lot of today's doctors are.

Please don't preach. I have to laugh, because I have a very active life outside of medicine.

Let me make this clear because it seems I edited a critical sentence out of my original posting: I SUPPORT THE 80-HR WORK WEEK. I have a life outside of medicine, and I think 80-hrs is a whole lot of time to spend at work as it is. And I support the ACGME in forcing programs to provide a better work environment - like providing phlebotomy and IV services, transport for patients, clerical services, a safe working environment, clean safe call rooms, not allowing residents to admit and cover patients on non-teaching services. All of that stuff is GREAT! It makes programs that rely on us bc we're cheap provide enough support so we can focus our efforts on the meat of the issue- taking care of patients, teaching those coming behind us, and continuing our education through reading and research.

What I don't support is this ridiculous hour-counting stuff. I did not become a doctor because I wanted to be punching in and out. I like the system that I am training in, I think it makes good doctors. If you're arguing that working more than 80-hrs a week is incompatible with learning I would like to point you in the direction of my predecessors who are incredible physicians.

80 hours itself sounds great. But in-patient care is continuous, it does not stop at the end of a 30-hour shift. I don't want other people doing my work on my patients because I have to leave at a certain time or else we all lose our careers.

What Hopkins did wrong was not adequately road-test the system that we had devised for July 1, 2003.

What the letter-writer did wrong was not complain to the people who could have addressed the issue in a more constructive way. People like the supervising residents, the attending on the service, the program director, the chair of the department, etc.

What the ACGME did wrong was to de-certify us without putting us on probation first -- note that on previous visits they had never sited us for work hours violations.

And the rules are wrong for being so rigid. Period.

 

[ArrogantSurgeon]

Originally posted by Linie
What the letter-writer did wrong was not complain to the people who could have addressed the issue in a more constructive way. People like the supervising residents, the attending on the service, the program director, the chair of the department, etc.

Right as if a resident complaining to an attending, chief, or PD will change the problem. Do you actually believe this? Sometimes somebody with much more power than a resident (or attending, chief, etc) has to step in and make sure the rules are being followed and ENFORCE them when they are not. Big time places like Hopkins are unlikely to change if their only punishment was a fine and a token "warning" letter.


And the rules are wrong for being so rigid. Period.

According to who? You? Sometimes it takes "rigid" rules to keep programs in line and prevent them from ignoring the rules like they have for years with little to no consequences.

 

[Idiopathic]

Did JHU lose certification because of this one incident? Or is there a pattern here. Either this one person wrote an incredibly thorough letter, detailing several violations, or the ACGME wanted a scapegoat?

 

[Linie]

According to who? You? Sometimes it takes "rigid" rules to keep programs in line and prevent them from ignoring the rules like they have for years with little to no consequences.

Yes, of course according to me! That's why I wrote it and signed my name... Thanks for pointing that out. ;-)

 

[Linie]

Did JHU lose certification because of this one incident? Or is there a pattern here. Either this one person wrote an incredibly thorough letter, detailing several violations, or the ACGME wanted a scapegoat?

Hopkins has never been sited before for work hours violations. We've been sited for other things- but not work hours violations. The decertification was specifically over the work hours issue, and it was based on one letter written July 9, 2003 (I said July 10 before, I double checked- it was the 9th). The person wrote about several work hours violations in a single letter.

 

[edfig99]

It's been rather amusing following this thread, seeing 1st and 2nd year med students who have no clue whatsoever about the rigors of residency chomping down on a residency program that if push came to shove, and they had an opportunity to go to it, would do so in a heartbeat.

The ACGME did it wrong this time. There is no question JHU IM was made a target. Their "normal" procedure is to either give a warning, or put a program on probation, not strip accreditation from the get go unless it is some persistent or egregious error. One whistle blower's letter is probably not the cause, and there's probably a lot more under the surface that's unbeknownst to us. If there was NEVER any mention of work hours on a previous review then JHU is being scapegoated.

I have to say I hate the 80 hours work limitation. I'm in NYS so it's nothing new to us, but it creates a HORRIBLE menality. THe only place where shiftwork is "okay" in medicine is in the ER - and even then shifts are staggered. To have shift work on an inpatient floor is just wrong. As an intern, my senior trained me to "just do enough until the nightfloat gets here and then sign the rest over to them". "I'm just here until 6pm" - medicine has no time limits.

Don't get me wrong - I am not in favor of slave labor. I think phlebotomists and EKG techs have their jobs to do, as do transporters. My job is to get to know my patients and their illness - though that's getting harder. A study reported on in an AMA newspaper two years ago showed that patients spend almost 23 hours a day alone in their room - with approximately 9-12 minutes being time with a physician (or resident) and the remainder with the nurse....

And residents can and should complain to the powers that be - there is a chain you can follow, and you play it safe by complaining in writing -- if there is stuff in writing, they are forced to act on it and you should not be afraid of repercussions if what you are doing is for the betterment of the residency. I fought with my PD and chair all three years of my residency. I felt I was able to make change and I didn't suffer for it. Most schools also have a GME committee residents can turn to. there are other ways than writing the acgme.

Then there is all this BS about "what about my personal life...." That does not play into residency. Residency is like the military -- you sign up for it, and you do as you are told and you follow their schedule. It's for a short time and after that you can do whatever the hell you want.

What this system is creating is a bunch unknowledgable and unprepared (as well as unmotivated) yet well-rested and socially comfortable physicians.

oh and by the way as an attending i'm workin' a lot more than i did as a resident.


good luck with the fellowship stuff Linie.

 

[Linie]

Then there is all this BS about "what about my personal life...." That does not play into residency. Residency is like the military -- you sign up for it, and you do as you are told and you follow their schedule. It's for a short time and after that you can do whatever the hell you want.

Thank you! I agree whole-heartedly. Residency has been tough, but I really truly don't mind. No one ever promised me it would be easy. I came here to be trained, not to be able to eat dinner every night with my boyfriend, or go for a run every day. I'm here to devote 3 years of my life to learning through doing. It chafes when I am told to leave the hospital when there's more good learning, teaching or helping out that I can do.

Shiftworkers do not make good doctors.

oh and by the way as an attending i'm workin' a lot more than i did as a resident.

Is the next step regulating the hours of practicing, licensed physicians?

 

[Pilot Doc]

With due respect to the current Hopkins residents who are pawns in this issue, does anyone seriously believe July 2004 will come without Hopkins regaining its accreditation?

The ACGME imposed the "death penalty" for a seemingly minor first offense, very early in the year to a large, nationally known program in Congress' backyard. How more transparent could this be as purposeful example-making. Hopkins will make changes, get their accreditation back (at least on probation) regardless of what they do, and every other PD in the nation will be running scared of the ACGME and pay attention to the rules.

 

[carddr]

Interesting thread...what I would like to know does anyone (besides me) want to get paid for 80 hrs. I work them but I don't get paid for them, because legally I can only work(or report) 40 hrs. Now that's a cause I would take to the streets to get resolved. Show me the money!!! Will it ever happen, not in my day, health systems are big business and they love cheap labor(interns,residents) and they take advantage of the fact that we are hard-workers, love what we are doing, and passionate about getting it right. We get paid less than PAs', so why bother changing the system. Do I think the JHP dilemna will help, yes, I think it will wake up the sleeping bear, and I think that letter writer is somewhat more courageous than most of us. Don't think h/s wrote the charges without a lot of forethought and anguish. There are days when I am dead tired and can hardly function and open that check and almost laugh out loud...what a rip off. But I'm here for the long haul and there's no stopping me now.

Furthermore i'm confident JHP is a strong program and will get over this and be a better program in the future. May help to remember this is just a friendly message forum and may not have all the facts or the history, or know all the reasons. We're only hearing how this may have happened and one persons')(so far)reaction to the actions taken. No one on this board is speaking for JHP or the ACGME.

 

[MacGyver]

Originally posted by Linie
Hopkins has never been sited before for work hours violations. We've been sited for other things- but not work hours violations. The decertification was specifically over the work hours issue, and it was based on one letter written July 9, 2003 (I said July 10 before, I double checked- it was the 9th). The person wrote about several work hours violations in a single letter.

Come on thats absolute BS and you know it. The person who wrote the letter was just the starting point. The ACGME didnt just read the letter, say "OK they must be breaking the rules, their accred is revoked and thats that"

After receiving allegations of violations, the ACGME routinely does thorough investigations in which the claims are substantiated and backed up by solid evidence.

Lets stop this conspiracy theory about the ACGME holding some kind of evil grudge against hopkins.

 

[MacGyver]

Originally posted by edfig99 It's been rather amusing following this thread, seeing 1st and 2nd year med students who have no clue whatsoever about the rigors of residency chomping down on a residency program that if push came to shove, and they had an opportunity to go to it, would do so in a heartbeat.

Oh please get off your high horse. The world does not revolve around you.

The ACGME did it wrong this time. There is no question JHU IM was made a target.

Do you have any EVIDENCE that the ACGME unfairly targeted Hopkins or are you just making up BS as you go along?

I'm wondering if you treat your patients this way by making stupid assumptions about them on which you have NO knowledge one way or the other.

Their "normal" procedure is to either give a warning, or put a program on probation, not strip accreditation from the get go unless it is some persistent or egregious error.

Again, do you have any EVIDENCE for these claims or are we just supposed to believe you because you claim to be a "hotshot" attending?

One whistle blower's letter is probably not the cause, and there's probably a lot more under the surface that's unbeknownst to us.

Finally, some common sense prevails

If there was NEVER any mention of work hours on a previous review then JHU is being scapegoated.

I refuse to believe that someone at the ACGME just said one day "Hey I got an idea, lets revoke Hopkins accred. That should make them squirm"

I have to say I hate the 80 hours work limitation. I'm in NYS so it's nothing new to us, but it creates a HORRIBLE menality.

Too bad--unless the regs are changed you are expected to follow the rules. If you were a program director and KNOWINGLY violated the rules you should be fired immediately.

I know the attendings like to think they are beyond reproach--that attitude is the cancer of the medical profession and needs to be excised.

THe only place where shiftwork is "okay" in medicine is in the ER - and even then shifts are staggered. To have shift work on an inpatient floor is just wrong. As an intern, my senior trained me to "just do enough until the nightfloat gets here and then sign the rest over to them". "I'm just here until 6pm" - medicine has no time limits.

If you REALLY think this way you would just buy an apt across from the hospital and spend every waking hour treating patients. Do you spend 168 hours a week either sleeping or treating patients? I doubt it.

You are a hypocrite, sir

What this system is creating is a bunch unknowledgable and unprepared (as well as unmotivated) yet well-rested and socially comfortable physicians.

This is one of the most foolish things I've ever heard. I guess you propose that residents who worked 100 hours a week are 20% more knowledgeable than the residents who work "only" 80 hours.

Again, if you REALLY believed that, you would support a residency system where residents did NOTHING else other than sleep and treat patients.

 

[edfig99]

Originally posted by MacGyver
Oh please get off your high horse. The world does not revolve around you.

dude...chill out.

Do you have any EVIDENCE that the ACGME unfairly targeted Hopkins or are you just making up BS as you go along?

nope. no evidence whatsoever. I just know info that was trickled to me as a member of a hospital's GME committee.

I'm wondering if you treat your patients this way by making stupid assumptions about them on which you have NO knowledge one way or the other.

the reality is that most treatments are actually based on stupid assumptions and very little science...which is why for most things not treating is just as good as treating. my patients are pretty well off.

Again, do you have any EVIDENCE for these claims or are we just supposed to believe you because you claim to be a "hotshot" attending?

nope. and i'm not hotshot, just average thank you.

I refuse to believe that someone at the ACGME just said one day "Hey I got an idea, lets revoke Hopkins accred. That should make them squirm"

no, they probably didn't wake up with Hopkins specifically, but I bet someone there is saying, "you know what, even though they are hopkins, we can't hold them to a lesser standard than we would hold any other program. in fact, let's hold them to a stricter standard." do i have evidence for this? no. i was a member of a gme committee and did participate in mock RRC reviews and know of programs at "lesser" institutions with more severe violations who weren't getting cited unlike my home institution. that's of course anecdotal and i know means absolutely nothing to you mr. macgyver.

Too bad--unless the regs are changed you are expected to follow the rules. If you were a program director and KNOWINGLY violated the rules you should be fired immediately.

i agree with you. KNOWINGLY violating rules is a problem and should not be tolerated.

I know the attendings like to think they are beyond reproach--that attitude is the cancer of the medical profession and needs to be excised.

i agree with you again, no need for chips on anybody's shoulders. though in reality, most physicians in practice are beyond reproach to some extent -- those not under the employ of any other entity.

If you REALLY think this way you would just buy an apt across from the hospital and spend every waking hour treating patients. Do you spend 168 hours a week either sleeping or treating patients? I doubt it.

well i did get my apt pretty near to the hospital i worked at, but it was more for convenience than for patient care. and there were times i did work 90, 100 and 110 hours, but those were rare weeks. residency like anything else involves time management, but yes, the bulk of my hours in residency were dedicated to treating my patients. sure, i got married (over vacation) and kept up my hobbies, but my focus during those three years was my training...that's what i went to med school for and deferred making any money for.

You are a hypocrite, sir

no. just opinionated.

This is one of the most foolish things I've ever heard. I guess you propose that residents who worked 100 hours a week are 20% more knowledgeable than the residents who work "only" 80 hours.

i never said hours = knowledge. but again, residency is a "see one, do one, teach one" kind of place, and spending time away from the hospital means you see and do less.

Again, if you REALLY believed that, you would support a residency system where residents did NOTHING else other than sleep and treat patients.

absolutely i would. it's for a short time period, again like the military.

 

[Thewonderer]

1) Spending 100 hrs in the hospital does not mean you learn more than someone who spends 80hrs in the hospital. That's a misconception. 80hrs are plenty of time to learn things, assuming that you cut out all the dead times and bring in more social workers or PA to make the follow-up appointments and other mindless jobs.

2) If someone aims to do as little work as one can until nightfloat takes over, then that person will never become a good physician. Taking ownership is the first chapter in learning medicine. Unfortunately, I can tell that some of my classmates will adopt that "the less work is better" attitude. But I hope that they are the minority.

 

[Mirror Form]

Originally posted by edfig99
There is no question JHU IM was made a target. Their "normal" procedure is to either give a warning, or put a program on probation, not strip accreditation from the get go unless it is some persistent or egregious error.

I wouldn't be surprised if JHU was picked to be punished out of a few non-compliant programs b/c ACGME wanted to make an example of a well known program. However, since all JHU has to do is re-apply next year, their punishment is effectively nothing but a warning / probation. If they fail again to comply with the work hours, then there will be consequences other then bad publicity. But ofcourse, that won't happen.

Originally posted by edfig99
And residents can and should complain to the powers that be - there is a chain you can follow, and you play it safe by complaining in writing -- if there is stuff in writing, they are forced to act on it and you should not be afraid of repercussions if what you are doing is for the betterment of the residency.

The problem here is that having slave labor is good for the residency b/c it saves them money. They get to pay someone a 40hr per week salary for 100hrs of work. Hence, the complaints aren't really for the betterment of the residency, but for the residents and also the patients (in some people's opinions). Your statements in the next quote show how receptive attendings are to residents complaining about working too much.

Originally posted by edfig99
Then there is all this BS about "what about my personal life...." That does not play into residency. Residency is like the military -- you sign up for it, and you do as you are told and you follow their schedule. It's for a short time and after that you can do whatever the hell you want.

First of all, many residencies are longer then 3 years! Sorry but by the time I'm 30 I'm going to be sick of being hazed. Also you mentioned earlier that you worked 90 or 100 hrs per week on occasion, but a lot surgeons worked 120+ frequently. Then there's the fact that medicine isn't as great a field for the doctors as it used to be, so it only makes sense that the rights of passage wouldn't be as severe anymore.

Originally posted by edfig99
oh and by the way as an attending i'm workin' a lot more than i did as a resident.

According to your profile you're in family practice. That makes you the first family practice doctor I've ever heard of who works 85+ hours per week! Sure you're adding them up right? Keep in mind that residents have tons of reading and studying to do at home that isn't factored into their 80 hours work week.

 

[edfig99]

According to your profile you're in family practice. That makes you the first family practice doctor I've ever heard of who works 85+ hours per week! Sure you're adding them up right? Keep in mind that residents have tons of reading and studying to do at home that isn't factored into their 80 hours work week.

yeah...i'm working at two practices and working on my MPH fulltime so i'm in a little different category than my other FP colleagues. I will say the other doctors at one of my practices (a private practice) work about 60-70 hrs a week, whereas those at the clinic (residency practice) work less than 50.