Anyone else working >100 hrs/wk?

If your program is so flagrantly violating the 80 hour work week, perhaps you should consider reporting them.

Can'tGoOn said:

I've just finished up my third week of Internship (finally a day off) and am wondering if anyone else is spending >100 hrs/wk at the hospital. A number of us have to begin pre-rounding between 2:30 and 3:00am. When I'm on-call I work between 36 and 38 hrs/shift. Post-call I get out as late as 8pm. I seriously don't think I can take even a few more days of this. My seniors will freq page me to the OR to write transfer/admit orders for pts, while they sit there on their @sses. I'm beginning to think that the 80 hr work week is a complete lie that programs sell during interviews. Anyone else feeling the same? How do you keep going on when you get torn apart by the people you work with, and never have a chance to have any life away from them?
BTW...I'm at a program that isn't typically regarded as "hardcore."

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I'm not trying to be insulting or anything, but why are you starting pre-rounding at 2:30 AM? I assume since you're talking about the OR that you're in a Surgery program, and I understand that you have early rounds so that attendings can get into the OR, but that's out of control, even on a service like CT. Would you feel comfortable telling us what program that is?

P.S. Welcome to residency. They sell you the crap during the interview with flowery words and show the attendings and residents tongue-kissing, but when you get there for real you get to see how things really work. I have a problem with this because the same people complaining about it are the ones who propogate it when interview season rolls around. When people are interviewing, you can't find one resident who will say anything bad about their program. It's ridiculous. It'll be like, "the only concern I have is that the attendings are TOO nice to me ...I feel all guilty. *tee hee hee*"

Can'tGoOn said:

I've just finished up my third week of Internship (finally a day off) and am wondering if anyone else is spending >100 hrs/wk at the hospital. A number of us have to begin pre-rounding between 2:30 and 3:00am. When I'm on-call I work between 36 and 38 hrs/shift. Post-call I get out as late as 8pm.

BTW...I'm at a program that isn't typically regarded as "hardcore."

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I gotta say that is the most malignant story I have heard so far. There are weeks when I'll clock about 98 hours, but even then we get off post call before noon the next day.

I must say these things you tell us are the reasons I ruled out surgery pretty early. Also it doesn't have to be a "malignant" program for people to use and abuse residents.

All it has to have ==> is nothing to stop people from abusing you(80 hour scare rule). Basically looks like nobody there cares to look out after your interest/livelyhood.

To answer your question, NO I have not heard of anybody working close to what you are doing in any field (surgery included). I think you are at a place that is in FLAGRANT violation of all of the new work hour regulations, and they should loose their accreditation for these alleged human rights violations.

I don't know what else to say. It saddens me to hear such abuse is still prevalent.

I think you should consider reporting this/these incidents.
HOWEVER, I realize this is a difficult decision with a lot of reprecussions. The original whistle-blower protections got dropped at last minute from the legislation, so we are all still at risk for reporting this sort of outright injustice.

Can'tGoOn said:

Sadly, almost all of the interns on the surgery service are pre-rounding that early. Huge services and lack of any work ethic in the ancillary staff makes things difficult. Dragging the 450lb gastric bypass pts out of bed for their required "q5am standing wt" is quite an undertaking. You'd think it'd be ok to get the wt at 8am when the nurses would actually do it for you instead of waiting for the shift change would be ok...but the 100 year old attending insists on 5am wts. It's the crap like that with a large census that takes up so much time. If we just had to check vitals and swing by to see the pts life would be much easier.

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(a) What did they tell you when you were interviewing there?
(b) When you say "on the surgery service," that confuses me. Are you a transitional year?
(c) If you don't want to tell us what program it is, can you at least tell us if it is a university or community program?

Is it a common practice across the US for surgery services to be assigned a color?

Can'tGoOn said:

It's a university program. I'm a categorical surgery intern. There are several surgery services (red, blue, green, etc). During interviews they talked about how they were in compliance and had no problems. There is a large cohort of senior/chief residents who don't agree with the 80 hr work week and very much like to enforce the hierarchy(eg will sit and wait 20 minutes for me to come write orders on their pt in the or, instead of writing them themselves just so they can enforce the idea that the intern should do every bit of their menial scut.
I'm reluctant to mention the name of the program. I was a med student at Hopkins when the whistle was blown on the internal med program (which was flagrantly and openly violating the rules), and I saw what happened to Troy Madsen and how he was treated.

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I understand. Well, I hope at the least you don't feed the medical students B.S. when interview season rolls around. Hope you pull through.

Apollyon said:

Is it a common practice across the US for surgery services to be assigned a color?

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Are you trying to determine indirectly where he's a resident?

kinetic said:

Are you trying to determine indirectly where he's a resident?

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No - I'm trying to prevent this person from outing himself.

I just find a little irony in you asking where this person is house staff...

Apollyon said:

No - I'm trying to prevent this person from outing himself.

I just find a little irony in you asking where this person is house staff...

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Hey, we all have our natural curiosity. Plus, I don't believe I ever got angry at anyone for asking.

Can'tGoOn said:

Ah hah....tricky! I actually picked colors b/c that's how the services were named in med school. They're actually not colors where I am now

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It didn't sound like you were at Duke. They ARE adhering (more or less) to the 80, under penalty of, well, penalties.

Your anonymity is maintained.

If that's truly what's going on at that place, then I feel for you. That really sucks. I hope they're being honest to the applicants when they interview (like on the tour or something).

There is going to be a change with how the ACGME/RRC determine work hour violations.

From what I have been told, individuals will be mailed ID numbers. Residents call an 800 number or visit a website to report workhour violations. This way it is anonymous...

HOWEVER, I was under the impression that the current reporting status remained anonymous. Maybe individuals who have reported violations decided to come forward with their names.

southerndoc said:

There is going to be a change with how the ACGME/RRC determine work hour violations.

From what I have been told, individuals will be mailed ID numbers. Residents call an 800 number or visit a website to report workhour violations. This way it is anonymous...

HOWEVER, I was under the impression that the current reporting status remained anonymous. Maybe individuals who have reported violations decided to come forward with their names.

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Anonymity under any situation is just an illusion. First of all, you're talking about an entire program that may be comprised of 16-20 people. Then, you basically focus on the interns because (a) they're the ones most likely to be in violation and (b) once you make it past that, you're less likely to complain ("Hello? Three years ago, I had to work 100 hrs/wk and I just wanted to let you know that. Thanks!"). What's sad is that there are reprisals against people for actually wanting programs to follow rules -- moreso because the medical field spends so much time talking the talk about ethics.

Can'tGoOn said:

It's a university program. I'm a categorical surgery intern. There are several surgery services (red, blue, green, etc). During interviews they talked about how they were in compliance and had no problems. There is a large cohort of senior/chief residents who don't agree with the 80 hr work week and very much like to enforce the hierarchy(eg will sit and wait 20 minutes for me to come write orders on their pt in the or, instead of writing them themselves just so they can enforce the idea that the intern should do every bit of their menial scut.
I'm reluctant to mention the name of the program. I was a med student at Hopkins when the whistle was blown on the internal med program (which was flagrantly and openly violating the rules), and I saw what happened to Troy Madsen and how he was treated.

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Talk with the other interns on your service and "unionize". Quit getting the daily weights until the nurses get them for you at 8 AM. If the 100 year old attending wants them sooner, inform him that he needs to talk with the nurses abotu their refusal. If you really want to piss him off, you could ask him to point you to the study that shows 5 AM weights ar better than 8 am weights...better yet, show you the study that shows daily weights do anything to improve pt outcome. Anyway...After that, talk with your seniors and let them know that you won't be hanging around past noon to do their scut while they sit on their ass. Make sure you let everyone know that you are doing this to "save your progarm" from getting the ax for being in violation of the 80 hor rule. If they gve you ****, let them know that it isn't hard for the ACGME and the RRC to find out about the current working standards. Trust me, your seniors have put in too much tiome to lose their program.

Odds are, there will be a lot of pissed off attendings and seniors if you do this, but it is the only way it will change without reporting them. They may make your life miserable for a while, so you would have to ask yourself is it worse to be miserable for a while at 80 hours, or miserable for a long time at 110 hours. I would also make sure you have all the interns with you on this. It would be much harder to do it on your own.

I respectfully disagree with ortho2003. Not because he's wrong, but because he's not being realistic (i.e., making too much sense). I doubt the attending would care if you gave him the "show me the study" line; his mentality is probably closer to "I said it, so you go do it." And as for the intern coalition, that's a BAD idea. Because here's what happens:

(a) You're in the call room on your soapbox and everyone is cheering you on and patting you on the back. You feel good. Really good.
(b) You charge out of the call room on fire. A man of action. The man with the plan.
(c) You tell your seniors/attendings "what's what" and "how it's gonna be" because "all us interns think so!"
(d) You turn around and say, "...right, guys??"
(e) You realize that you're the only one in the hall.

People talk a big game of support on anonymous forums and when nobody else is around, but trust me: most people care more about getting paid than doing the right thing. Bank it.

P.S. If you even hint that you will turn the program in for ACGME violations, see how long it is before you get written up for being "unprofessional" or some other charge. You think programs don't collect dirt on you that they are willing to use if need be to keep you in line? Think again.

Sounds like it might be time to start looking around for a PGY2 position for next year (there's usually a fairly good attrition rate in surgery).

BTW, I sent you an PM.

Can'tGoOn said:

I've just finished up my third week of Internship (finally a day off) and am wondering if anyone else is spending >100 hrs/wk at the hospital. A number of us have to begin pre-rounding between 2:30 and 3:00am. When I'm on-call I work between 36 and 38 hrs/shift. Post-call I get out as late as 8pm. I seriously don't think I can take even a few more days of this. My seniors will freq page me to the OR to write transfer/admit orders for pts, while they sit there on their @sses. I'm beginning to think that the 80 hr work week is a complete lie that programs sell during interviews. Anyone else feeling the same? How do you keep going on when you get torn apart by the people you work with, and never have a chance to have any life away from them?
BTW...I'm at a program that isn't typically regarded as "hardcore."

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Welcome to surgery... I often have to make sure I am hearing right when people say their program is strictly adhering to the 80-hour workweek. I'm sure there are some, but bear in mind that not only is the rule relatively new, but most attendings & remaining upper level residents are hard-core and aren't exactly dying to abide by the rules. Even better, most hospitals don't have the $$ or desire to employ people to help pick up the slack that the enforcement of the 80 hour rule would leave.

Though extensive, the hours alone didn't bother me as much as the enormous amount of time you spend on menial work that anyone with a pea between their ears could do. Long story short, the hours are all the more miserable when you are doing mundane chores while not going to the OR. It can be VERY easy to lose sight of why you signed yourself up to do this, I understand that.

I wish I could say that it is all gratification and glory in the end, but I can't; however, if you really do enjoy operating, hopefully, you'll be able to work things out.

You need to quickly and quietly transfer to another program. You may end up off cycle, but it's better than your other options! This is not as hard as you might think...I know because I had to do it myself!

I didn't read from the above posts that you were looking for advice, rather you are just wanting to see what your colleagues are going through. Darnit, b/c I want to just scream out what I think you should do!

I think it's utterly ridiculous this $&#* is still goin on in medicine. The unethical, archaic, and inhumane system which old-timers and AR-newcomers uphold in the name of "education," just makes me sick.

Good luck to you sir, in whatever route you decide to follow. Keep us updated

my advice...suck it up. change is slow and if you are in this much violation, eventually the ACGME will catch on. believe it or not, you will get used to working this much and learning how to function. also, if attendings/seniors smell unhappiness, your OR experience will suffer. you have to remember that out in practice as a surgeon (general or subspecialty) you will eventually be called upon to make important decisions and do challenging cases when you are well past the 80 hour mark. hope things get better for you.

Can'tGoOn said:

A number of us have to begin pre-rounding between 2:30 and 3:00am. When I'm on-call I work between 36 and 38 hrs/shift. Post-call I get out as late as 8pm. I seriously don't think I can take even a few more days of this. My seniors will freq page me to the OR to write transfer/admit orders for pts, while they sit there on their @sses. I'm beginning to think that the 80 hr work week is a complete lie that programs sell during interviews. Anyone else feeling the same? "

Anyone else working>100 hours/week

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Uh...no. I'm impressed that they were ALL willing to lie to you at interview time. I guess the only thing worse than working 100 hours a week is working 100 hours a week without a new crop of interns to come in and help.

Even though that doesn't help you now, I feel your pain.
I worked 110 hours per week for some time and it was horrible. I don't know who wants to suck that up and live for years like that. I don't. I have seen this so many times-seniors abusing their juniors, nurses don't giving a damn, ... the list is endless, it's sad, but it doesn't have to be that way.
I agree with kinetic, the program has greater leverage than you. Therefore be careful. Transfer out of that program! One would think that the laws give residents some protection, but that isn't the case, as people have already mentioned.

Damn that really sucks, bro. But atleast you only have 11 more days of this rotation, hopefully next month you'll be doing an easy rotation (have NO idea what that would be in a GS program).

I haven't heard of any program with residents workign that many hours. The surgeyr residents at my program work 80 hours exactly. Weird how that worked out but when I was on trauma surgery it totalled 80 hours exactly averaged over four weeks.

Q, DO

Just as an example of the problems inherent in the reporting of work-hour violations, I was reading an article in one of those crap medical journals you get as soon as you graduate medical school. The basic gist was that, even if a program is in gross violation, nobody will report. Not only because of internal retribution (which I had been emphasizing more), but because loss of accreditation will have an impact on you and the program (ranging from loss of money to not being board-eligible, apparently).

Here are a couple of links addressing the concerns that have been raised about whistleblower protection. It would seem that work hours regs mean nothing if protection doesn't exist for those who report violations:

http://www.ama-assn.org/amednews/2004/07/19/prl10719.htm

www.amsa.org/tnp/perspectives.cfm

Can'tGoOn said:

I've just finished up my third week of Internship (finally a day off) and am wondering if anyone else is spending >100 hrs/wk at the hospital. A number of us have to begin pre-rounding between 2:30 and 3:00am. When I'm on-call I work between 36 and 38 hrs/shift. Post-call I get out as late as 8pm. I seriously don't think I can take even a few more days of this. My seniors will freq page me to the OR to write transfer/admit orders for pts, while they sit there on their @sses. I'm beginning to think that the 80 hr work week is a complete lie that programs sell during interviews. Anyone else feeling the same? How do you keep going on when you get torn apart by the people you work with, and never have a chance to have any life away from them?
BTW...I'm at a program that isn't typically regarded as "hardcore."

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If you do to choose to report it, make sure to keep yourself anonymous! Reporting needs to be executed as a knife in the back operation. In other words, absolutely don't let out a peep of your dissatisfaction to your fellow interns or the program director. It would probably be a challenge, but, if possible, claim you like the hard work and challenge. And, don't file the complaint until you're on a different service.

From reading his story, I gathered that the main reason the Hopkins guy got fingered specifically (his personal information had been blotted out of the letter sent by the accreditation people to Hopkins) was that he had already done some complaining while on service and it was pretty easy to hunt him down after that. He also probably didn't deny, deny, deny, which was also a mistake.

What bothers me is that the ACGME didn't step in and protect this guy from Hopkins. At least he was able to transfer elsewhere. But, the prick director of Hopkins IM ("we're barring you from the ICU for reporting my unethical behavior and flagrant violation of regulations") really should have some kind of punishment meted out to him.

I feel it is truly unfortunate how the culture of Hopkins got the better of them. I have quite a few friends (who started med sch at the same time as me) who have done external rotations at Hopkins. Interestingly enough, not one of those ended up going to Hopkins, but all of them ranked Hopkins pretty low on their list. Note, however, that they eventually matched at MGHx2, Brigham, UPenn, and Columbia, so it was definitely not a case of "sour grapes". Most of them said, what one of the previous posters expressed: "Hopkins is a better place to be from than at". This is the main reason that Hopkins is the only big school in the Northeast I will not even apply for. I hope that eventually Hopkins comes to their senses. What matters most in my choice for a residency, is to find a place where I will learn the most (about actual medicine, not scut), and be able to dynamically blend a research carrier with patient care. Hopkins, despite their excellent research facillities, is definitely off of my list due to the culture of the place.
Just my 2c.
Alex
(Vandy MSTP 2006)