Duty hour violations

[IkeBoy18]

Im an intern at a categorical program and on the general surgery service interns apparently take 28hr call which is against the ACGME rules. The surgery residents falsify their hours from what I hear, but as a resident who is only on for a month, should I rock the boat and report the violations or should I just stay in my lane and suck it up for a month?

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[emergentmd]

Geeezzzz..... Do you even need to ask this question? When I was a resident.....

Forget it.... I would kill for 28hr calls.

 

[IkeBoy18]

I understand that things used to be different. While I dont mind doing the calls, Im just not sure what the repercussions to lying about violating duty hours would be.

 

[WholeLottaGame7]

Im an intern at a categorical program and on the general surgery service interns apparently take 28hr call which is against the ACGME rules. The surgery residents falsify their hours from what I hear, but as a resident who is only on for a month, should I rock the boat and report the violations or should I just stay in my lane and suck it up for a month?

For a second I was thinking that it was probably 24 hr call +4hrs for non-clinical stuff, which would be fine.... But then I remembered that that is no more! 16hrs now, right?

28 is not even close to 16; that is ballsy of that program to be so flagrant about it. Keep playing with fire long enough and eventually they will be burned.

It will also eventually come back and reflect poorly on your program, so I would report it to your program director and let him/her sort it out. Your program shouldn't be letting other services abuse their interns.

But no, I don't think reporting the violations to the surgery department will accomplish anything other than making life miserable for yourself.

 

[Agast]

The surgery residents falsify their hours from what I hear, but as a resident who is only on for a month, should I rock the boat and report the violations or should I just stay in my lane and suck it up for a month?

Are you insane? You're categorical. Meaning you're going to be working with this general surgery department for the next 4 years. By all means, blow the door open on their duties violations and potentially get their ACGME accreditation taken away, their residents will love you for it and the operating room will be a pleasant environment for you. What do you think the other anesthesiology residents have been doing for the last 4 years?

 

[IkeBoy18]

Are you insane? You're categorical. Meaning you're going to be working with this general surgery department for the next 4 years. By all means, blow the door open on their duties violations and potentially get their ACGME accreditation taken away, their residents will love you for it and the operating room will be a pleasant environment for you. What do you think the other anesthesiology residents have been doing for the last 4 years?

Then theres always this. From what I understand, this is a new thing, at least the CA2s didnt go through this, im not sure about the CA1s.

 

[IkeBoy18]

Obviously the writing is on the wall. Its just a month. Ill be fine.

 

[MJ978]

If your program is in the new I-Compare Trial, as mine is, the calls are 28h q4. This is approved by ACGME , and total weekly hours should still remain under 80. I agree the 28h shifts are rough, but it's only for intern year.

 

[aneftp]

If your program is in the new I-Compare Trial, as mine is, the calls are 28h q4. This is approved by ACGME , and total weekly hours should still remain under 80. I agree the 28h shifts are rough, but it's only for intern year.

Whoa. Times and thinking have truly changed. When I see "28h shifts are rough" quotes.

Us "old timers" and I am not even really old. I finished in 2004 right when the 80 hour work week was taking place. Of course the change happened AFTER I was doing 100-120 hours a week in the ICU. Routinely 30 hours easily straight. Calls 1:2 or 1:3 depending on if someone was on vacation.

The real issue with work hours changes these days (80 hours). Is residents aren't getting more sleep. I think some prelim studies have shown not only are residents not getting more sleep (residents are messing around on their time off doing various things besides sleep). Plus more mistakes are being made with patient care with LESS work hours. Because of lack of continuity of care and more sign offs.

 

[San Marzano]

I think that doctors used to be able to make a difference with a 30 hour shift, but that time has come and gone. Now we are just pager jockeys, bolusing and writing for antibiotics. The age of the doctor who needed to be on call 24/7 to handle emergencies is over. Shift work is in, and needs to start translating to resident education. If it doesn't, resident education will be phased out and replaced by whatever mechanism the government deems appropriate. Today residents are the affordable option to staff hospitals, but without a proper reform plan we will be stifled and replaced in due time.

 

[anaesthetic]

.

 

[Laryngophed]

For a second I was thinking that it was probably 24 hr call +4hrs for non-clinical stuff, which would be fine.... But then I remembered that that is no more! 16hrs now, right?

28 is not even close to 16; that is ballsy of that program to be so flagrant about it. Keep playing with fire long enough and eventually they will be burned.

It will also eventually come back and reflect poorly on your program, so I would report it to your program director and let him/her sort it out. Your program shouldn't be letting other services abuse their interns.

But no, I don't think reporting the violations to the surgery department will accomplish anything other than making life miserable for yourself.

Yep. I was in a not so dissimilar situation about this time last year. I reported my actual hours and my PD and I sat down. PD took care of it, but the other surgical residents hated me for "not being a team player." IMO, it wasn't worth it. I saw only two benefits from it, one my program wasn't going to be on the hook for me lying about my hours (remember, the surgical program won't take the hit, YOUR program is at risk because of YOUR hours OP) and two, I made it clear that I wasn't going to do something I thought to be wrong from day one. It was the right thing to do, but it made the year harder for me than it had to be and I felt I was constantly having to prove myself.

 

[Random Anesthesiologist]

I wouldn't fudge numbers, but I wouldn't report it either. Just record your actual hours, and when acgme says you're in violation choose a justification. Some rotations are just more demanding than others. And acgme and your PD need to know true hours you are there both for program needs and liability.

 

[Laryngophed]

I wouldn't fudge numbers, but I wouldn't report it either. Just record your actual hours, and when acgme says you're in violation choose a justification. Some rotations are just more demanding than others. And acgme and your PD need to know true hours you are there both for program needs and liability.

I think the problem comes when there is no real justification. There are absolutely times when a patient needs their doctor and the work-hour restrictions become a far second priority (as you well know). But there are times when rotations "require" a lot of hours because the people in charge don't care about the work hour restrictions. If they want to do that to their residents, then that is their business. When the residents are prelims or off-service, that becomes another issue entirely because the off-service residents' programs are liable for the hours violations not the rotation's program.

 

[deleted480308]

General surgery has a randomized trial ongoing for duty hours: http://www.thefirsttrial.org

Presumably any program using 24 hr calls (28 hours is legal...technically it's 24+4) is a part of the trial.

Before you try to go all whistleblower you'd be wise to find out if this is the case.

And for the trial (approved by the ACGME), the rules are extended to off-service residents like anesthesia who are rotating on general surgery services.

I have a friend in the trial....lots of hours

 

[deleted480308]

It hasn't changed our total hours at all. It has largely eliminated night float, which makes most of our residents happy. Everyone who has done both prefers 24s and post-call days to weeks at a time of nights.

I meant in a row....but yes

 

[IkeBoy18]

General surgery has a randomized trial ongoing for duty hours: http://www.thefirsttrial.org

Presumably any program using 24 hr calls (28 hours is legal...technically it's 24+4) is a part of the trial.

Before you try to go all whistleblower you'd be wise to find out if this is the case.

And for the trial (approved by the ACGME), the rules are extended to off-service residents like anesthesia who are rotating on general surgery services.

We're not participating the trial.

 

[Laryngophed]

General surgery has a randomized trial ongoing for duty hours: http://www.thefirsttrial.org

Presumably any program using 24 hr calls (28 hours is legal...technically it's 24+4) is a part of the trial.

Before you try to go all whistleblower you'd be wise to find out if this is the case.

And for the trial (approved by the ACGME), the rules are extended to off-service residents like anesthesia who are rotating on general surgery services.

I know people in the control arm of that trial who are working like they are in the experimental arm. I'd just love to know how they are going to validate the results.

 

[Orin]

FWIW, I think the duty hour restrictions are stupid, but you should document truthfully.

If someone is going to lie about something stupid like duty hours to not "rock the boat," I assume they will also lie about other more important stuff.

ACGME isn't going to cut accreditation because you record your hours accurately.

 

[IlDestriero]

When you report your hours, report them honestly and if you're over, you're over. That's for your GME office to sort out. If they tell you to falsify them or change them just politely decline.

 

[WholeLottaGame7]

Doesn't surprise me at all that there's enough clinical equipoise to run another trial on it. As an intern the last year that 24 + hr shifts were OK, I had an interesting experience as I had some rotations that were the traditional q3/q4 30hr shifts, and some 12-hr day/night shifts. I definitely felt like I knew the patients better doing a longer shift, but I also felt like I missed a lot of little things and wrote ****ty notes and was probably just a more unpleasant person to be around when you're in hour 28.

I don't think patients even know what they want. Most of them seem to want the same person in the hospital with them the whole time, but somehow to magically get plenty of sleep. Good luck with getting both of those things...

I also find it insanely hypocritical that programs ostensibly try to select physicians with traits like honesty and professionalism, and then directly or indirectly encourage them to lie about duty hours.

 

[Random Anesthesiologist]

General surgery has a randomized trial ongoing for duty hours: http://www.thefirsttrial.org

Presumably any program using 24 hr calls (28 hours is legal...technically it's 24+4) is a part of the trial.

Before you try to go all whistleblower you'd be wise to find out if this is the case.

And for the trial (approved by the ACGME), the rules are extended to off-service residents like anesthesia who are rotating on general surgery services.

Our surgical program is in the experimental arm. I haven't heard too many complaints from them.

 

[kidthor]

You could always make an anonymous complaint to ACGME... this does come back to the program, yet it still protects you from personally being identified as a whistleblower.

 

[Doctor4Life1769]

You could always make an anonymous complaint to ACGME... this does come back to the program, yet it still protects you from personally being identified as a whistleblower.

I'm not so sure about that. I think the name of the whistleblower ends up being revealed.

 

[Docuronium]

Having done both, I'd much prefer 24-28 hour calls to night float. Often night float meant staying every day until 10-11 am, something that would never happen with the day residents (ie being kept until 10-11 PM)

 

[Twiggidy]

I say just bite the bullet, do the work for a month, and play the game. You never know who you might need in your corner one day

 

[Doctor4Life1769]

I say just bite the bullet, do the work for a month, and play the game. You never know who you might need in your corner one day

I'm not convinced anyone would come to anyone's corner in time of need, but indeed burning a bridge does guarantee one outcome.

 

[risnwb]

When I was an intern I had 3 months of surgery. When I violated significantly I informed my pd as he had told us to do so. He fixed it immediately and threatened removing the anesthesia residents from the surgery services all together if it wasn't immediately corrected. The surgery residents actually thanked us because they were never gonna make headway themselves. I suppose it depends how much your program director has your back and how important they feel duty houe violations are. I woulda sucked it up if he seemed like he didn't care.

 

[sleepallday]

Back when I was a resident, I would walk to the hospital.... up hill... both ways....in the snow.

But seriously, it depends on your program director. Will they have your back as the post above just mentioned?

 

[vector2]

Definitely find out what your PD's feelings are. Our PD would literally have a stroke if she found out other services were making us violate hours...other PD's...not so much.

 

[whydowork]

I'd make sure the hospital isn't part of the surgery 28 hour call experiment and then I'd talk to the PD.

 

[IlDestriero]

Back in the day it was just the 80hr work week and I think that was a new and revolutionary plan, however outside of the ICU time, it wasn't really close for us.
They'll whine themselves into an extra residency year before too long. Just wait.

 

[Vaporized]

An extra 6 m for low case volume and another 6 m to become periop specialists. Glad I am in my last year !

 

[Man o War]

Back in the day it was just the 80hr work week and I think that was a new and revolutionary plan, however outside of the ICU time, it wasn't really close for us.
They'll whine themselves into an extra residency year before too long. Just wait.

^^^^this.