How to Report your Program to ACGME?

[Haybrant]

Hi, I am a prelim on a rotation on which I am working over 95 hrs a wk (and this was a 6 day wk!). Still learning to get organized but the way our system works makes this happen. I would like to report this to acgme. I know there is a survey at the end of the rotation but is there another way to let acgme know what is going on. I am not the only one staying 30+ hrs on call days. Thank you

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[dpmd]

Two issues:
1. It is perfectly allowable for you to work over 95 hours a week as long as over the four week period the average is not more than 80 hrs. Not sure how it is counted if you are scheduled to begin duty at lets say 6 am but you come at 4 am because you take longer than everyone else and you want to avoid getting in trouble.

2. Why are you staying more than 30 hrs? Are you getting assigned some tasks earlier than that with the assumption you should finish before the 30 hrs but you aren't able to and instead of letting someone know you are taking it upon yourself to stay late? Or is someone telling you to keep working at the 30th hour.

You may think I am overly mean asking you this stuff, but I am sure this is the kind of thing that the program is going to say if they have to answer to the ACGME. Then the ACGME is going to ask what steps you have taken to resolve the issue within your program and if you say none that is going to let the program off the hook even more (they will say they didn't know there was a problem and pin it on you not following the rules).

 

[Haybrant]

no, i think those are fair questions. At this rate there is no way ill avg less than 80 hrs for 4 wks. Furthermore, I am getting there maybe 20 minutes before others not >1 hr. the issue is we have 3 floors to cover and we round sequentially. Nobody is going to go out of their way when there are four teams on the service to let the postcall team round on all their pts first. You cant simply drop everything at the 30th hour and walk out. Furthermore I am not the only one staying past 30 hrs. also, on our wknd calls we cover the other teams patients. this forces you to get there at least an hour and a half earlier than you might depending on how sick those pts are and how many there are. Discharges post-call should simply be disallowed. Bt putting orders in and discharging patients and rounding till 1130 at best its just not possible. maybe better to report through the ombudsman or whoever first but

 

[Law2Doc]

no, i think those are fair questions. At this rate there is no way ill avg less than 80 hrs for 4 wks. Furthermore, I am getting there maybe 20 minutes before others not >1 hr. the issue is we have 3 floors to cover and we round sequentially. Nobody is going to go out of their way when there are four teams on the service to let the postcall team round on all their pts first. You cant simply drop everything at the 30th hour and walk out. Furthermore I am not the only one staying past 30 hrs. also, on our wknd calls we cover the other teams patients. this forces you to get there at least an hour and a half earlier than you might depending on how sick those pts are and how many there are. Discharges post-call should simply be disallowed. Bt putting orders in and discharging patients and rounding till 1130 at best its just not possible. maybe better to report through the ombudsman or whoever first but

First, you have to endure a 4 week block where you average over 80 hours before you are allowed to do anything. You can't take the stance that "at this rate there is no way ill average less than 80" -- it has to actually happen.

Second, you probably should give your program director a heads up that because of the rounding you aren't going to stay within the hour requirements. Some programs will take notice and give you a day off once you hit 320 hours for the 4 week block -- saw that happen twice, but usually for folks who ran up two 100 hour weeks back to back and didn't complain. Maybe your program doesn't mean to be malignant and simply doesn't realize that there's an easy fix.

Third, stop coming in earlier than everyone else, unless mandated. That 20 minutes a day is another 8 hours during that 4 week block. You shouldn't be unilaterally putting yourself over the limit and then complaining about it, if your own inefficiency is making you violate the programs hour rules.

Fourth, bear in mind that there is a downside to whistle-blowing. It usually doesn't take a rocket scientist to figure out who complained in the typical small program, and although the program itself won't generally take any direct retribution, your peers, whose careers you put in jeopardy by putting their residency in jeopardy, might not be as magnanimous. Expect to be given the cold shoulder and not get a lot of peer support after doing this. Often PDs will start making a file of all your screw ups once something like this goes down so that they may have grounds to let you go at a later point. Meaning if you report, you will get your 80 hour work week, but may end up deciding to finish residency someplace else when all is said and done, because it will be a cold unfriendly place once you whistle blow and every minor issue you have from then on makes its way into your evals, which will follow you. Shouldn't be like this, but this is the reality and why few programs actually get the whistle blown on them.

Fifth, bear in mind that as you and the other interns get more efficient, the hours will decrease, you will be able to cover for each other efficiently and probably will be able to decrease the hours dramatically. Of course if you whistle blow in september, lots of luck getting someone to cover for you in april.

 

[Doctor Bob]

maybe better to report through the ombudsman or whoever first but

I presume you're asking this question because you haven't gotten the desired results from going up the hospital chain. If not (which I don't see evidence of from the posts)...

Follow the chain of reporting... first mention the problem to your attending... if you don't get resolution, mention the problem to your PD... if you don't get resolution, mention the problem to your hospital GME director... if you don't get resolution, -then- go to ACGME.

ACGME is not as interested in punishing programs as it is in fixing issues. So if you haven't gone through the proper channels, they're likely to send you back to do that before they intervene.

 

[Buzz Me]

Does your program ask you to log hours somewhere? Have they seen the hours you've logged thus far?

 

[Envmed]

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[Law2Doc]

OSHA right now is considering a petition from Public Citizen, SEIU, AMSA, and others to limit work weeks to 80 hours with no averaging. I think that your situation, where you don't even know how to go about reporting the excessive hours you are working, and not feeling like you have any good option as far as not coming in early/staying late is something that they would be very interested in. This is an issue which is acutely affecting you--95+ hours a week!!--but is actually much bigger than yourself. It demonstrates the continued abuse of resident and the inadequate reporting/enforcement measures that are in place. Best of luck to you in a very tough situation. I sincerely hope that this problem is taken seriously and something is done asap.

Um no. Really bad advice. The OP's issue isn't bigger than himself, it is that size and no more. That AMSA et al want to petition for different hours has NOTHING TO DO WITH THE OP, WHO IS OPERATING UNDER AN EXISTING RULE. The basic rule of administrative law is that you need to exhaust the avenues of internal reporting before you can go external, eg to a government agency. So you still would have to go through your program director, the hospital and the ACGME before it would be appropriate for a governmental organization to hear you out, even if this were the right governmental agency, which it isn't. OSHA cannot hear your case, doesn't want to hear your case, and your case adds nothing to what AMSA et al are trying to accomplish. Your PD is the person you really need to talk to, or if they are the issue or provide no resolution, then there presumably is someone in hospital administration (eg a duty hour hotline), and if that is not reasonable, then the ACGME has a whistleblowing arm. But no, do not try to go outside of the system and expect helpful results. Bad bad bad idea.

If AMSA wants to lobby for something, that's great, but this is NOT YOUR (OPs) issue. Stay far away from this with your personal details. YOUR only issue is your own hospital's compliance with duty hours. And that has to be dealt with internally, or at most through the ACGME.

And please reread the post I did above listing why you might not want to complain at all at this juncture.

 

[eforest]

Be careful about reporting a program as a prelim. You might be suspect.

Also- think about what you can gain from reporting the program. Our program goes over hours, but it the way it is set up, major changes would have to occur in order for us to comply. I just want to graduate from an accredited program!

 

[glade]

This entire thread illustrates the stupidity of the ACGME and medical education. Everyone tells you to "follow the chain" to fix the problem internally. And then what? Because there's a 99.95% chance it won't get fixed because there's a 100% chance that they already know the problem exists and don't give a ****. And guess what? Now you go to the ACGME and "anonymously" report the problem and you immediately get terminated and the ACGME tells you politely that they have no recourse and cannot aid you in getting your position back, but they will "fully pursue" the complaint that you lodged. And for that you're supposed to throw a party. Congratulations, you made a difference in the system!

The only people who get hurt in medical education are residents because at worst the program is put on probation and they make changes which are generally burdensome rules for the resident to follow and which make the resident the one who is responsible for "maintaining program compliance." Which means now if you report the program, you're REALLY saying "I suck too much to be able to be compliant." Which is what everyone is getting at when they say "first, tell us what have YOU done to solve YOUR problem of working too long?" That's a f**king joke of a question.

 

[Buzz Me]

While I'm not a believer in resident abuse and ridiculous work hours (obviously), just know that if you're going to pursue this route of reporting your program, be very, VERY careful. Nothing is anonymous. If and when your program finds out you're reporting them to the ACGME/RRC, know that they'll start a file on you and any transgressions you may have will be added to the paper trail.

By all means, if you're working way too much, talk to others about it - coresidents that you trust, or your chief residents; just be careful before you lodge a formal complaint and make sure you're protected.

 

[nico20]

do not wast your time, I had same problem last year, some rotations up to 115 h. We could not enter the hours, system says if it is more than 80h your superviser must cosign. what does it mean? yah, S* up work and no talk. so we did. in March ACGME sent a stupid guy, my friends and me (>10) said to him, but nothing changed, even program director never said any thing.I was in surgery in NYC.

 

[dragonfly99]

Yeah...LOL. I was going to say 96 hrs...it could be worse. Hopefully the OP is at least getting some days off.

Some of the surgical programs are still probably egregiously over the work hours limits. NYC is notorious for having surgical and prelim programs that do that. IMHO ACGME doesn't really want to fix this problem or it would.

In the OP's situation, if it's just one or a few rotations during the year that are like this, I would not report it. The PD and program likely already know and they don't care and they certainly don't want to hear about it from you. If the program isn't totally malignant, then having the interns, as a group, mention it to the PD or chief resident or something at some later point in the year (as a problem w/ a specific rotation) might help a little, but probably will not help YOU personally. You may help some future intern if the program decides to restructure the rotation in some way.

The work hours probably will get to be less as the interns get more efficient later on in the year, but the fact that you are over the hours doesn't necessarily mean that you are that inefficient. Interns @this point in the year should not be as fast and efficient as interns at the end of the year, and programs need to design systems so that the work can reasonablly be done in 80 hrs.