Work hour violations- forced to lie?

[firewand]

Hi I'm a junior resident, and while on our Trauma rotation, I've been very dismayed by the pressure the senior residents have had thrust on them to lie on their work hour sheets. Most are going significantly over 80-hours, staying longer than 30-33 hours post-call and unfortunately we have a chairman that implicitly expects this of them. Additionally our program director is not capable of really keeping things in check. It is certainly compromises patient care. Is there any recourse to be taken? Any ideas from any of the other residents?

Thanks...

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[njbmd]

Unfortunately, there are some bad programs out there that do this. Your recourse is to notify the RRC but you can cut your own throat by doing this. When the 80-hour (30-hour continuous) regulations went into place, some programs did nothing and expected residents to do the same amount of work in less hours. When this became practically impossible, the alternatives were to hire mid levels (expensive and many programs would not do this) or lie about hours (told that this was the only way to keep the program).

Lying about hours is out there and there isn't much you can do (outside) that helps the situation without potentially destroying your program. My advice is to try to find a way among yourselves to help your situation that involves being able to shift folks around to get the work covered without violating work hour restrictions. This is definitely easier said than done, however, if everyone honestly pitches in and works together, you at least have a shot.

 

[jc7721]

There is no excuse for the flagrant disregard of the rules. Furthermore, the institution at large shares part of the blame for not monitoring the department of surgery.

The ACGME website for filing complaints is listed here, use it. Being at a program where other departments have been put on probation, I can assure you that there is nothing that will issue in change faster than a site visit from the RRC. Regarding confidentiality, I've quoted directly from the ACGME website. Basically, as long as the complaint doesn't have something to do with 'due process' (which in your case they wouldn't), then they will not report your name to the program.

http://www.acgme.org/acWebsite/resInfo/ri_complaint.asp

"Confidentiality

If the complaint involves failure of a program or institution to provide due process, the name of the complainant must be used when a response to the allegation is requested from the Program Director or institutional official. In all other cases, the AC GME shall keep the name of the complainant confidential throughout its processing of the complaint, except when a complainant specifically waives the right to confidentiality."

 

[dilated]

"Confidentiality"

This is mostly a crock. I remember the first major crackdown for the 80 hours rule was that ED dude at Hopkins; they took his name off the letter he sent and then showed the letter to the PD. In a completely unpredictable turn of events that allowed them to figure out who it was and they made his residency so crappy he quit.

 

[chrisisinnocent]

How so?

http://www.ncbi.nlm.nih.gov/pubmed/18173162

 

[ESU_MD]

every program breaks the guidelines in one way or another.

It is easy for people to give suggestions to tattle to the RRC about 80hr violations. Why not go to your chair/PD/Chief resident and tell them first?

I'm not saying I have the answers.. but be careful what you wish for

 

[surgeon2b forev]

There is this fear, unsubstantiated, that by filing a confidential complaint that you will be found out nonetheless. There is absolutely no evidence for this, except a few anectodotal reports, which, frankly, I think are fictitious.

Second of all, while I understand that there may be repercussions *IF* you are found out (which, won't happen), in the setting of the RRC agreeing with your complaint and marking that program as being in violation, then you have grounds for legal action if they harass you. Obviously you don't want it to go that far, but my point is that you actually have a lot more power than you think, and the vast majority of programs have at least some degree of professionalism and aren't going to be taking it personally.

Sometimes it just takes a wise and confident person to make the change - otherwise, patients will continue to suffer, as will residents.

 

[randomedstudent]

Something else to think about if you choose to report them.....do you really want to be at a program that's on probation or, worse, has lost accreditation. That is the unfortunate catch-22.

Obviously it's a little late now, but I think I would not have gone into surgery if I expected to work within the 80 hour "limit".

 

[Pir8DeacDoc]

There is this fear, unsubstantiated, that by filing a confidential complaint that you will be found out nonetheless. There is absolutely no evidence for this, except a few anectodotal reports, which, frankly, I think are fictitious.

Second of all, while I understand that there may be repercussions *IF* you are found out (which, won't happen), in the setting of the RRC agreeing with your complaint and marking that program as being in violation, then you have grounds for legal action if they harass you. Obviously you don't want it to go that far, but my point is that you actually have a lot more power than you think, and the vast majority of programs have at least some degree of professionalism and aren't going to be taking it personally.

Sometimes it just takes a wise and confident person to make the change - otherwise, patients will continue to suffer, as will residents.

Are you a resident or a pre-professional student? It's helpful to know where someone is coming from and unless you've mistitled yourself, you're a pre-professional. I get this sense that you want to contribute, which is awesome, but I also get the sense you don't have a clue what it's like to be a resident. Much of the "harassment" of which you speak would be subtle enough to drive you nuts but not so bad that your program would come under fire for treating you that way. If you're a resident, then please forgive me.

 

[ESU_MD]

let's face it... we all know which residents are shiftwork residents and which residents are Halsted residents.

Choose which route you want to take, its ultimately your career and your patients.

but dont think that your colleagues wont know which route you chose.


If you are hell bent on being an advocate and changing the system- calling in to some RRC anonymous hotline is a lame way to make change in your program.

 

[Winged Scapula]

There is this fear, unsubstantiated, that by filing a confidential complaint that you will be found out nonetheless. There is absolutely no evidence for this, except a few anectodotal reports, which, frankly, I think are fictitious.

Some may be fictitious, but Troy Madsen's story, well known here at SDN, was widely reported...here's just one link: http://www.amsa.org/tnp/articles/article.cfx?id=111

Given my knowledge of him over the years (even prior to this event) I have little doubt he was telling the truth.

Second of all, while I understand that there may be repercussions *IF* you are found out (which, won't happen), in the setting of the RRC agreeing with your complaint and marking that program as being in violation, then you have grounds for legal action if they harass you. Obviously you don't want it to go that far, but my point is that you actually have a lot more power than you think, and the vast majority of programs have at least some degree of professionalism and aren't going to be taking it personally.

Sometimes it just takes a wise and confident person to make the change - otherwise, patients will continue to suffer, as will residents.

As Pir8deacdoc notes, harassment can be a hard thing to prove and residency programs are very powerful and if they want to get rid of you, they can. The resident has no power in these type of situations and they DO take it personally, at least in surgical programs where such actions will quickly get you blackballed.

 

[smq123]

Are you a resident or a pre-professional student? It's helpful to know where someone is coming from and unless you've mistitled yourself, you're a pre-professional.

And judging by the posters on this board, that choice is made somewhere around the MSI year.

http://forums.studentdoctor.net/showpost.php?p=6371830&postcount=27
http://forums.studentdoctor.net/showpost.php?p=5370670&postcount=3

So he's not a resident yet, but definitely also not pre-pharm!

surgeon2b forev - changing that status thing under your profile would probably not be a bad idea.

 

[189362]

I know of quite a few residents that far superceed the 80-hr limitation. This thing is, w/o your name the complaint isnt creadible. I think that this is a problem the residents themselves must address.

 

[njbmd]

I know of quite a few residents that far superceed the 80-hr limitation. This thing is, w/o your name the complaint isnt creadible. I think that this is a problem the residents themselves must address.

I agree with this but I also know that the RRC/ACGME did not give residents any good tools to effect significant change through the RRC/ACGME. I have had some interaction with Dr. Troy Madsen and he's definitely on the up and up. He is also now an attending and still hoping to make effect some change to the resident work hour situation. What happened to him was sad but it happened.

Programs can make your life more of a he-- than you could ever realize. This is why always attempting to effect change from within is your best avenue. There is always strength in numbers but there is always are political repercussions that can happen if you find yourself in an adversarial relationship with your program.

Most program directors want you to get the best surgical education and excel as a surgeon under their tutelage. Be aware that there are some PDs that could care less about work hours or your professional development. If you find that you are in one of those types of programs, then try to get out fast (transfer and make some excuse that doesn't involve work hours) but be aware that transferring programs isn't always easily done.

My hope, as a potential attending, is that wherever I end up, I will not allow residents to have to lie about their hours in order to remain in the program or for the program to exist. This isn't good for the residents or the program. In the end, education suffers and education is what the program is there for in the first place.

I can tell you that when I was a chief resident, I was fortunate to be in a program with a PD and faculty who listened to what the residents had to say and worked with us as opposed to against us. I am also quite aware of programs that use residents as cheap labor so that the attending surgeons can see more patients and cover more hospitals (make more money) and could care less about the education of the resident. My hope is that these types of programs are the exception rather than the norm.

This is a very tough problem and even tougher for those residents who find themselves in programs where they have to consistently lie about work hours. Any lying in medicine is a very bad thing. The RRC/ACGME created this problem when they didn't address the need for more residents when these regs were created.

 

[189362]

I am also quite aware of programs that use residents as cheap labor so that the attending surgeons can see more patients and cover more hospitals (make more money) and could care less about the education of the resident

This is where the major problem lies.

 

[Blade28]

It's tough to report consistently working more than 80 hours/week, for a number of reasons:

*A truly anonymous complaint is very rare
*Fear of being labelled as a "whistleblower"
*Fear of being blacklisted
*Fear of retribution from senior residents, chief residents, attendings, program director or other people in authority
*Difficult for any program to make sudden changes to address your concerns anyway - it takes time to set up a night float system, or hire more PAs/NPs, etc.