work hour violations

[psymed]

So I'm rotating at an affiliate hospital where there is a gross work hour violation. We end up working over 80 hours every week. The residents were asked to complete a work hour survey. The ones who honestly filled out the survey stating that they were going over the 80 hours were asked by the program authorities to refill the forms. They basically tried to convince us and I'm not kidding that it only seems like we are working over 80 hours to us........Yeah right! So was I just told that I'm delusional. There is no time keeping log.

I felt like I was being told that the reason I went over my hours was because I was a slow worker which is not true. I've gotten excellent evaluations from everyone so far and the one thing I always get appreciated for is my ability to multitask.

I refused to redo the survey. What happens now?

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[sam1999]

There are so many threads here, where resident is either fired, refused to promote to next year or fired resident is suing the hospital.

Please read those to see where do you want to belong. By the way what is a big deal if you have to work lets say 90 hours instead of 80?

 

[Law2Doc]

By the way what is a big deal if you have to work lets say 90 hours instead of 80?

That's a pretty foolish statement. If it weren't a big deal, programs wouldn't be at risk of losing residency accredidation/funding for violating this. These are rules set up to protect residents and patients because many people thought this was a VERY big deal. Sorry, but you are going to be a lot more tired if you are averaging 90 hours per week instead of 80. And it is suggested, although not proven, that you will make poorer decision and possibly more mistakes as the amount of time for sleep drops off. And certainly will get in more traffic accidents (this part has been shown). So yeah, if a program violates the rules, it's a big deal. That's not the issue. The issue is whether you want to suffer through it or martyr yourself for the cause, which I think is the point you otherwise were making before you got to this poorly thought out statement. So yes big deal, but no way most of us are going to sidetrack our careers for a few extra hours.

 

[buckley]

Had the same problem! I was basically told to decrease the hours by averaging how it would be if I was EFFICIENT. And that since we can do dictations at home, I should count those off "work hours" as well. You can rage against the machine all you want, but at the end of the day, I just want to get away from residency. It's up to you to rock the boat or not. Just be aware of the consequences. I don't think there's a right or wrong way of dealing with it. It's all about choices. Don't listen to people who will call you a wuss or a wimp or a braveheart. At the end of the day--it's YOUR decision.

 

[dragonfly99]

Honestly, there were times when I definitely was over 80 hrs/week and I don't think it was all my inefficiency. Violating the 30 hour thing was more of a problem in my IM program, vs. actually violating the 80 hour thing, which happened very infrequently I'd say. There are always ways to be more "efficient" but at some point the so-called efficiency becomes the enemy of patient care also...you can always write shorter and crappier notes, or refuse to talk to a patient's family because it's going to make you go over work hours by 15 minutes, but at some point it hurts patient care and perhaps outcomes. If multiple people are saying on their evaluations that they are over the hours, the my money is on the presence of a systemic problem causing this.

Unfortunately, your decision at this point is likely whether you are willing to throw yourself on your sword to address this problem, which ultimately is temporary for you. If you are a prelim, then could consider ratting them out after you are no longer rotating through that hospital, and have progressed to an advanced position. Personally, if you're in a categorical program I'd advise leaving it alone just because they can always hurt you more. At this point the hospital(s) and your PD still have the upper hand, by far, and unless the program and PD really want this addressed it likely won't be, regardless of what you say. They probably already know about the problem but are either in denial or counting on the power differential to make sure they don't really have to change things. The hospital also may be relatively understaffed and not have a lot of money to take on some of the ancillary tasks that the house staff may be doing now (such as getting outside records, drawing labs, etc.).

 

[Rendar5]

So I'm rotating at an affiliate hospital where there is a gross work hour violation. We end up working over 80 hours every week. The residents were asked to complete a work hour survey. The ones who honestly filled out the survey stating that they were going over the 80 hours were asked by the program authorities to refill the forms. They basically tried to convince us and I'm not kidding that it only seems like we are working over 80 hours to us........Yeah right! So was I just told that I'm delusional. There is no time keeping log.

I felt like I was being told that the reason I went over my hours was because I was a slow worker which is not true. I've gotten excellent evaluations from everyone so far and the one thing I always get appreciated for is my ability to multitask.

I refused to redo the survey. What happens now?

If you refused to redo it, then start documenting everything now unti the end of residency.

 

[ANCAdoc]

I agree with Rendar, document every communication you have with the directorship regarding the issue. Document everything you remember regarding the meeting that already took place (date, time, attendees, etc) as you may not remember these small details later. Out of an abundance of caution.

Personally, if it seems like they are going to choose the way of putting the burden back on the housestaff, then I'd put in an anonymous report to the ACGME (though, is anything ever anonymous?). Do what's right. History has shown that cultural change is made by those who speak out against what is not right, not by covering up what is wrong.

I wish you the best of luck. What a tough place to be in.

 

[psymed]

Thanks for all the advice and support. I've told my story and I'm sticking to it. I'm not alone in refusing to redo the survery. There are others. If they make rules then they should abide by them. I have never been one to back down. Why start now? They can edit the form if they want to. We're not doing it.

 

[Saipan]

If you refused to redo it, then start documenting everything now unti the end of residency.

Actually, I advise people to start documentation BEFORE a problem like this occurs.

Your documentation will show that you were a decent employee, that there was a violation on the part of your employer, and that after you reported the violation, that retaliatory actions were taken against you, and suddenly you were a crap employee.

To protect yourself properly in a modern legal environment, you need to be proactive in advance.

I don't feel that this is cynical. You can still enjoy your work environment. Just remember to keep copies of all important papers.

 

[xxyyzz]

I was on my IM rotation as an intern and received a failing grade on my rotation from my senior resident. (Although both of my attendings gave me excellent ratings).

I was called in multiple times, with the program director and my advisor.

Want to know what made them back off and rescind everything?

Well, my senior resident for some reason was such a douche and abusing the team having us violating work hours all over the place while he/she/it was out going for runs or coffee or some other nonsense. So for weeks I documented my time in and time off, on a computer system that our residency encouraged us to use but did not require us to use.

My meetings went: so xxyyzz, although you have outstanding reviews by your attendings, your senior said you should basically quit because you are an idiot. No matter what I said, it seemed I was doomed...until I whipped out my time sheets.

And BAM. The senior was now in danger of being dismissed from the program. And me, well I went on to do happy things. I think this awful individual is in some rural clinic providing care that is probably more endangering than helpful.

The point: anticipate, document, and protect yourself.

 

[TaeK]

Anytime this happens at our hospital, the intern is made aware of going over his hours (at our meeting) and they are told that they must have made a mistake and to 'go fix it'. It's usually by <10 hours over the 80 so nobody speaks up. It's just not worth it, especially because it gets better next year.

 

[NuMD97]

I have never been one to back down. Why start now?

Do you want the short list or the long list of reasons? I admire your steadfastness, and your principles. Sadly, as someone earlier noted, the "powers that be" hold all the cards. Medical students and residents are so low on the totem pole, and in the end, at least for now, it's about getting beyond residency with all body parts intact. Once beyond residency, things can, perhaps, be corrected, as the playing field becomes more level at that point.

A friend of mine, now an attending, told me that while in residency, an independent body wanted the residents to fill out an anonymous survey about the conditions at the hospital my friend was rotating in and then submit it back to the organization independent of the department's secretarial staff for obvious reasons. The department "reassured" the residents "not to bother" sending it back individually and that they would "save the residents' time" and send it all out en masse. Like that?

Sadly, there are just too many stories like the one cited above. And sadly those nefarious programs will continue to get away with the abuse for a long time yet to come, until which time there is an overseeing organization that has the independence and the muscle to effectuate change.

Until then, just try and survive.

Nu

 

[NotAProgDirector]

History has shown that cultural change is made by those who speak out against what is not right, not by covering up what is wrong.

Of course, history also shows that those who take the front lines in cultural shifts usually get imprisoned or assassinated.

I agree with others. You can try and fight the good fight, and probably end up taking some lumps, with the hope that your sacrifice will help others in the future.

You can do nothing, and hope someone else will make a difference.

You can try to take a middle ground, and deal with the problem without making yourself a target. This often means doing something with less impact, that might have a slow/minor effect but might change things over time.

What could you do?

1. You could speak to the GME office. They might protect you / back you up. They might not.

2. You could report them to the ACGME, after you graduate. Once you have your first job, you should be OK esp if you've got all of your paperwork in FCVS already.

3. You could report them to the media, also after you leave.

4. You could report them to Medicare. It might be possible to construe this as Medicare fraud in some way (not so sure about that).

 

[buckley]

Residency has residents tied up on all fours with a gun to our heads. As my senior told me--If the program gets into trouble---we lose.

 

[ANCAdoc]

Of course, history also shows that those who take the front lines in cultural shifts usually get imprisoned or assassinated.

Very true. It's not easy. Perhaps most people in similar situations would back down. I, however, would not. The issue is just too important.