80/24 Rule really enforced?

[Hardbody]

I am a pre med and I was recently shadowing a doctor that told me that this rule is a bunch of crap. In his words he said they can make any law or pass any rule they want, but this is not how it is done in real life. I am also reading posts on here where I am hearing people that are allegedly interns and residents talk about how this rule is being enforced.

My question is, who is right? Perhaps, it is mixed or the rule may not be strictly adhered to, but hours have been cut back?

---

Members don't see this ad.

 

[glorytaker]

He's pretty much right. At a lot of places, the residents are expected to fudge their reported hours. If you think about it it hurts them to actually tell the truth that they're working 100+ hours per week and have the program close down. Where do they go from there? They'd have to go to another program, probably in another city, start over in some cases, etc.

 

[Mumpu]

Conversely, there is actually muscle behind the law, as several programs (a lot of big names, apparently thinking they are above the law) learned the hard way with probations and risk of losing accreditation.

In general, surgical specialties have been hit the worst, with a lot of OB and Gen Surg programs still fudging and faking (which is scary -- do YOU want a surgeon who is sleep-deprived and overworked?). Internal medicine programs have done well for the most part -- I average about 75 hours a week as an intern.

p.s. The doctor you've been shadowing is obviously jaded and bitter. There is a camp of people who think it should be like the good ol' days with 120-hour workweeks and 30 admissions per night.

 

[OldPsychDoc]

...In general, surgical specialties have been hit the worst, with a lot of OB and Gen Surg programs still fudging and faking (which is scary -- do YOU want a surgeon who is sleep-deprived and overworked?). Internal medicine programs have done well for the most part -- I average about 75 hours a week as an intern.
...

Actually, what I find "scary" is the encouragement of "fudging and faking" in a profession which supposedly has a code of ethics about truthfulness in documentation.

 

[8744]

I have been at two different institutions for residency, Duke and my current program (although to be fair I've only been here for two weeks). The residency rules are strictly enforced at both places. They were very strictly adhered to at Duke to the point that when I was on a surgery rotation I was practically chased out of the hospital if it looked like I would go over.

On my medicine rotation, they had a "day-float" whose main job was to help the post-call team get out before 1300.

I also averaged about 75 hours a week on inpatient rotations last year (but much less on out-patient rotations). See my blog for a discussion of what I think about long hours.

It's stupid and dangerous to work somebody 120 hours a week. You'd get fired from your residency for being drunk on the job but you have a similar level of impairment when you are sleep deprived.

80 hours is no picnic by the way.

"Paying dues....back in the old days...resident's now days are week..blah...blah..blah." Without going into details, I've paid my share of dues in life and am pretty glad that I get to a good night's sleep most nights.

Fer' cryin' out loud. Sleep is not a privelege. If you think it is and want to deprive those under you of it then you are a psychopath.

 

[Faebinder]

I have been at two different institutions for residency, Duke and my current program (although to be fair I've only been here for two weeks). The residency rules are strictly enforced at both places. They were very strictly adhered to at Duke to the point that when I was on a surgery rotation I was practically chased out of the hospital if it looked like I would go over.

On my medicine rotation, they had a "day-float" whose main job was to help the post-call team get out before 1300.

I also averaged about 75 hours a week on inpatient rotations last year (but much less on out-patient rotations). See my blog for a discussion of what I think about long hours.

It's stupid and dangerous to work somebody 120 hours a week. You'd get fired from your residency for being drunk on the job but you have a similar level of impairment when you are sleep deprived.

80 hours is no picnic by the way.

"Paying dues....back in the old days...resident's now days are week..blah...blah..blah." Without going into details, I've paid my share of dues in life and am pretty glad that I get to a good night's sleep most nights.

Fer' cryin' out loud. Sleep is not a privelege. If you think it is and want to deprive those under you of it then you are a psychopath.

Life now is definitely not the same as before. To them it might look like it's easier... but the college loans and expenses now are way higher. There is a lot more info now than before that you have to leanr and commit. More procedures, more complications.

I don't buy how it was harder back in the days... they were paid more for their work, more respect back in the days and definitely less malpractice.

 

[Idiopathic]

He's pretty much right. At a lot of places, the residents are expected to fudge their reported hours. If you think about it it hurts them to actually tell the truth that they're working 100+ hours per week and have the program close down. Where do they go from there? They'd have to go to another program, probably in another city, start over in some cases, etc.

We are not encouraged to work more than 80 hours or to lie about it. My institution wants to be in full compliance. I believe that its probably dependent on the program.

 

[docB]

Life now is definitely not the same as before. To them it might look like it's easier... but the college loans and expenses now are way higher. There is a lot more info now than before that you have to leanr and commit. More procedures, more complications.

I don't buy how it was harder back in the days... they were paid more for their work, more respect back in the days and definitely less malpractice.

Are you basing these statements on any data? Are the expenses higher after you adjust for inflation? Are there more procedures or have old procedures just been replaced by new procedures with fewer complications (I'll be surprised if you've done a DPL, a culdocentesis or dropped a Blakemore tube)? Were they paid more (again inflation)? Malpractice is worse, I'll grant you that. Otherwise I'd say that either group (old or young) have to be really careful about saying how much harder they have it.

 

[footcramp]

Actually, what I find "scary" is the encouragement of "fudging and faking" in a profession which supposedly has a code of ethics about truthfulness in documentation.

damn straight

 

[Winged Scapula]

The is a great deal of variation - between programs and between rotations.

I've been on rotations that routinely exceed the work hours and others which were adhered to (a lot depends on the census, the ancillary help, and of course, the attendings buying into the restrictions).

I've never been asked to lie about my hours, and never have, but I know others feel compelled to for fear of losing program accreditation. MY feeling is that in a large program, especially one with many Prelims (both designed and non-designated), it only takes one person to be honest about their hours, call the RRC, etc. to have a program site-visited early. It is highly unlikely to get a large group of people to agree on anything, much less so when it entails ethical concerns like lying about work hours.

I'm at a new program now and although I don't take call and have no problem with work hour violations, there seem to be many more safeguards in place to reduce hours here than at my old program (ie, night float, short call, days off, etc.) Some programs are better at it than others, some have more resources to hire allied caregivers to reduce the work load, etc.

But anecdotally, it is true that some programs do not enforce the work hour restrictions and make no attempt to do so.

 

[Hardbody]

Actually, what I find "scary" is the encouragement of "fudging and faking" in a profession which supposedly has a code of ethics about truthfulness in documentation.

This is so true, it is a paradox that should not exist. While I do not agree with MANY laws, I still abide by them because that is what is expected of a professional or soon to be professional. A resident should not be asked or pressured (even through the grapvevine, or indirect retalliation) to fudge numbers.

I do not have solid information to back up the statement I am about to make, but I believe that these 80/24 max laws were made to protect the PATIENTS and NOT the RESIDENTS. If what I just stated is true than it should never be a choice for a resident to break the hour maximums. I think everyone would agree that patient safety is most important right?

Everyone, thanks for the input. As a pre-med applying for the 2007 admssion cycle I was curious about these new residency rules.

 

[Hardbody]

Conversely, there is actually muscle behind the law, as several programs (a lot of big names, apparently thinking they are above the law) learned the hard way with probations and risk of losing accreditation.

In general, surgical specialties have been hit the worst, with a lot of OB and Gen Surg programs still fudging and faking (which is scary -- do YOU want a surgeon who is sleep-deprived and overworked?). Internal medicine programs have done well for the most part -- I average about 75 hours a week as an intern.

p.s. The doctor you've been shadowing is obviously jaded and bitter. There is a camp of people who think it should be like the good ol' days with 120-hour workweeks and 30 admissions per night.

Actually I asked him about this, and he is definitely not a bitter person. Every physician/surgeon I come in contact with I ask them if they would recommend medicine for their children and/or would you do it all over again (get into and go through medical school), and this doctor said yes to both (he is a very successful Ophthalmologist). Actually he was a super nice guy.

I don't doubt for one minute that many docs would love to see it go back to the good ol' days because they had to go through it, and perhaps they have a bit of a chip on their shoulders over it, but everything changes with time, including competitiveness and compensation in fields. Thanks for the input.

 

[signomi]

Life now is definitely not the same as before. To them it might look like it's easier... but the college loans and expenses now are way higher. There is a lot more info now than before that you have to leanr and commit. More procedures, more complications

I did my internship the last year before the work hour rules went into effect. Nothing miraculously changed overnight - I didn't have it easier. I went from 120 hour weeks where I worked shift averaging 38 hours on call without sleep every 3 days, carrying 15 patients from day one and admitting 8-15 per night...to watching interns work 80/30 with a cap of 4 patients. Blew me away.

Yes, work hour laws needed to happen. Did they really happen? Not everywhere. Where I did residency the interns got the 80/30 and the R2s worked more than that to do the intern work that the interns couldn't do because they had to leave. We didn't have to fudge our work hour logs because we never had any. It was made clear to us that complaining to the RRC when they came would cost the residency its accreditation and then we would be residents in an unaccredited program. So we lied like good soldiers. I blame the particular residency. They hid their heads in the sand and hoped the laws would blow over.

I recommend talking to interns and residents in any future program and seeing how many hours they are really working before you decide to go there. Not every program follows the new laws.

 

[Hardbody]

I did my internship the last year before the work hour rules went into effect. Nothing miraculously changed overnight - I didn't have it easier. I went from 120 hour weeks where I worked shift averaging 38 hours on call without sleep every 3 days, carrying 15 patients from day one and admitting 8-15 per night...to watching interns work 80/30 with a cap of 4 patients. Blew me away.

Yes, work hour laws needed to happen. Did they really happen? Not everywhere. Where I did residency the interns got the 80/30 and the R2s worked more than that to do the intern work that the interns couldn't do because they had to leave. We didn't have to fudge our work hour logs because we never had any. It was made clear to us that complaining to the RRC when they came would cost the residency its accreditation and then we would be residents in an unaccredited program. So we lied like good soldiers. I blame the particular residency. They hid their heads in the sand and hoped the laws would blow over.
I recommend talking to interns and residents in any future program and seeing how many hours they are really working before you decide to go there. Not every program follows the new laws.

That truly is a **** sandwich with no bread. I would be really pissed off that i would have to compromise my integrity by lying for an unethical residency program. I in no way an dissin on you for doing what you did, but that is some real bull**** that the program holds over your head. I personally would do the 120 hours if that is what is required and LEGAL, but it is now ILLEGAL. Sorry about your luck, nice advice on checking with current interns and residents before applying to a program. Thank you.

 

[Blade28]

I always find it amusing to hear that programs actually have the 80/24 rule - I'm used to the 80/30 rule.

 

[signomi]

Sorry about your luck, nice advice on checking with current interns and residents before applying to a program. Thank you.

Most of us wouldn't lie if we were asked by applicants. Which probably explains why the program was in the scramble every year. They also started filling the program with attending level docs from foreign countries and phasing out actual american grads coming straight out of med school.

Blade...what about that 10 hours off between shifts rule? We were luck if we got 7-8! Our program argued that the GOAL was 10, but that 8 was fine.

Anyway, it's fun to shock people with the crap we put up with, but I'm over it and can laugh now. Hospitalism and shift work...how sweet it is!

 

[Hardbody]

I always find it amusing to hear that programs actually have the 80/24 rule - I'm used to the 80/30 rule.

LOL, that is what you will get when you have a pre-med such as myself start the thread.

 

[Blade28]

Blade...what about that 10 hours off between shifts rule? We were luck if we got 7-8! Our program argued that the GOAL was 10, but that 8 was fine.

Yeah, that one's tough to comply with as well.

The one day off every seven (averaged over four weeks) doesn't always happen either.

 

[signomi]

Our chiefs felt that any work done after midnight (or before 7:30am) did not count towards work hours. So if your "day off" was supposed to be saturday and you worked all day friday and didn't leave the hospital until 6am saturday, those six hours of work on your "day off" don't count!
The same applied for intern pre-rounding. If an intern came in at 5am to round on his/her 15 patients (plus 3 new admissions overnight), the work from 5-7:30am didn't count as work hours. Hilarious!

 

[Hardbody]

Our chiefs felt that any work done after midnight (or before 7:30am) did not count towards work hours. So if your "day off" was supposed to be saturday and you worked all day friday and didn't leave the hospital until 6am saturday, those six hours of work on your "day off" don't count!The same applied for intern pre-rounding. If an intern came in at 5am to round on his/her 15 patients (plus 3 new admissions overnight), the work from 5-7:30am didn't count as work hours. Hilarious!

Sounds like some real fuzzy math those chiefs like to use !

 

[dynx]

I have been at two different institutions for residency, Duke and my current program (although to be fair I've only been here for two weeks). The residency rules are strictly enforced at both places.

What field?

The 80 is easy in Psych, not so much so in surgery.

 

[DRDARIA]

I'll echo what other's have said... it is really program dependent (though it shouldn't be). I'm fortunate. At my program they are COMPULSIVE about adhering to the rules. The senior residents (who have a night float system) are practically pushing us out the door by noon on post call days.

 

[Nerdoscience]

It is the 80/24 rule, sort of. You are only allowed to work 24 consecutive hours, but that does not include up to 6 hours of time to provide continuity of care. That means that you can't admit patients for more than 24 hours in a row, but you do have to stay until you finish wrapping up loose ends and taking care of your old patients, provided that it's less than 6 hours. That's how you get 30.

I don't know of any program that has kept track of that, but most do not have you admit after a certain time in the early morning, so it is taken care of.

 

[tuscanito]

Actually, what I find "scary" is the encouragement of "fudging and faking" in a profession which supposedly has a code of ethics about truthfulness in documentation.

Hey guys welcome to the real world!!! What doctors are not supposed to lie or fake? hmmm i think that you really need an insight in tha real world man!
You may say that im pessimistic but in this world all is about the$$$$$!!! Sad but true...

 

[Apollyon]

It is the 80/24 rule, sort of. You are only allowed to work 24 consecutive hours, but that does not include up to 6 hours of time to provide continuity of care. That means that you can't admit patients for more than 24 hours in a row, but you do have to stay until you finish wrapping up loose ends and taking care of your old patients, provided that it's less than 6 hours. That's how you get 30.

There is one glaring part you left out - you can also go to clinic post-call for up to 6 hours - as long as you don't have any new patients. I've seen medicine residents do that, and that SUCKS, in my book.

 

[medst]

I think/hope a lot of residency programs try to comply with work hours. However, when working outside of residency, there is no law saying you have to work 80 hours/week, 30 hours in a row max. I know that there are many private physicians who put in many many hours a week, are on call overnights, etc. I guess they probably average to less than residency hours overall but still some people work a ton more after residency than during it.

 

[3dtp]

Our chiefs felt that any work done after midnight (or before 7:30am) did not count towards work hours. So if your "day off" was supposed to be saturday and you worked all day friday and didn't leave the hospital until 6am saturday, those six hours of work on your "day off" don't count!
The same applied for intern pre-rounding. If an intern came in at 5am to round on his/her 15 patients (plus 3 new admissions overnight), the work from 5-7:30am didn't count as work hours. Hilarious!

Yumpin' Yimini! Did we go to the same program?

The PD got up and said, "The rules are a goal, but the needs of the hospital come first." Ours was 110-120/wk with call around 40 hours and there was no sleeping at all on call. Pre-rounding the same deal. It didn't exist, but Lord help the poor sucker who took it literally and wasn't ready at 7. I had 24 patients, the senior was off (they got their 1/7, come hell or high water and we weren't near New Orleans), 4 were ICU patients from our service and were highly dynamic patients.

One of our chiefs tried the same up to midnight garbage. Fortunately for all of us, an abused off service floater blew the whistle and saved us all from having a day be defined as 12 hours long and 1/7 being defined as 2 blocks of 12 hours sometime during what most people considered a 7 day week. And beware of vacation scams. Frieda used to list vacation in days. Programs count Saturdays and Sundays even though the clinics are closed and there are rules disallowing vacations on call/in-house rotations, so 20 days of vacation could only be taken in 7 day blocks hence 20/7=2 weeks instead of the 4 you were expecting. The Frieda folks apparently got wind of that scam and now they list how many weeks you get off.

Yup, it's about extracting hte maximum labor with the minimum bucks from a captive audience who cannot go anywhere or say anything lest they be banished from medicine $200k in debt, a degree worth absolutely zip without board certification, qualified to work at Wal-Mart.

Our program did not keep hours logs, using the theory, if it didn't get written down, it didn't happen. One or two brave souls who spoke out were made examples of and were gone, almost overnight. Those remaining got the message loud and clear. After living in a large pile of horsemanure you don't notice the stink and the fly bites.

For those who reminisce about the "good old days," things have changed.

Hospital admissions a generation ago were for two weeks, for IV antibiotics, rehap, pulm, cardiac, post-op. The fact that the level of acuity is much higher now is well documented. Stable patients go home and get their IV antibiotics through the visiting nurses.

Now, we have drive through deliveries, home antibiotics, sub-acute step-down hospitals for rehab, a typical admission is 3-4 days, even for major abdominal surgery or an acute MI with cath. These are "active" patients require substantially greater and more proactive care and hence consume much more time than hospitalized patients did even a decade ago. Post-partum patients were kept in the hospital for 4-5 days, now, the only reason some are kept 3 days is because there's a law that says they're entitled at least 24-48 hours of post-partum care.

A patient load of 30 on abx for pneumonia for 10 days is a lot easier to manage than 15 patients who are on ICU stepdown with usually several active issues. And if they don't have several active issues these days, the DRGs and Third party payers say, get them out the door today.

So, youse guys out dere lookin' at programs, make darn sure the program is complying with the spirit and the letter of the rules. IF they're willing to break the work hour rules or fudge, then what are they doing in other areas that are harder to see on a brief interview trail. Also be wary of "plants--residents who are the chosen few. Programs will go out of their way to hide candid residents who while they may actually like the program will point out the pits in the cherries. If everything is milk and honey, then question whether you are being told the whole truth.

 

[Nerdoscience]

This is kind of irrelevant, since programs interpret things the way they want, but the ACGME guidelines are as such:

1. No more than 80 hours per week averaged out over a 4 week period unless there is some legitimate educational rationale behind going over this amount of time (there's an out!).

2. No more than 24 hours per shift, but 6 hours can be used following that for continuity of care. (Nowhere does it say you can spend more time in clinic) This is known as the 24+6 rule.

3. 10 hours rest between each shift of work (I've never seen this one enforced.).

 

[njbmd]

I think/hope a lot of residency programs try to comply with work hours. However, when working outside of residency, there is no law saying you have to work 80 hours/week, 30 hours in a row max. I know that there are many private physicians who put in many many hours a week, are on call overnights, etc. I guess they probably average to less than residency hours overall but still some people work a ton more after residency than during it.

Hi there,
I am a senior General Surgery resident at present. My program and every place that I have rotated through or been affiliated with, has strictly complied with the 80-hour work week and the 24 (30) hour rule. Of course, there were emergencies where we went above 30 hours but these were extremely rare (hurricane/illness) and the battered team was given plenty of time off after the emergency passed.

Places that do not comply with the RRC regs are in danger of being shut down. If you keep your mouth shut and go along, your residency can be pulled from under you because your program director and chiefs are not compliant. If you have residents from other services or programs rotating though, they have nothing to lose by "blowing the whistle on your program" and you do.

Do whatever you can to make sure that your program is compliant. Your chief residents will finish so they won't be affected by probation/shutdown and your program director is done with residency so they are not affected by program probation or shut-down. Offer any solutions that you can think of to get your hours in compliance.

Outside of residency is a different ballgame but you HAVE to get through residency in order to play. As an attending, you set your own hours according to your needs (and preferences in some cases). As an attending, you are also paid under a different system too.

For those people starting residency or moving into the residency interview/application process, I would strongly recommend reading and understanding the RRC work hour rules. It is also a good idea to ask about work hours and scheduling while you are interviewing.

If you encouter a program that skirts the RRC rules on a regular basis, are you going want to be there? Do you want the spector of program probation or closure over your head for the entire residency? The "whistle-blower" system is a crappy system but it is reality as are the RRC rules. There are plenty of places that bend and break these rules but they are still there.

njbmd

 

[8744]

...The PD got up and said, "The rules are a goal, but the needs of the hospital come first." Ours was 110-120/wk with call around 40 hours and there was no sleeping at all on call. Pre-rounding the same deal. It didn't exist, but Lord help the poor sucker who took it literally and wasn't ready at 7. I had 24 patients, the senior was off (they got their 1/7, come hell or high water and we weren't near New Orleans), 4 were ICU patients from our service and were highly dynamic patients....

Your program director is an idiot. They are not goals at all but solid rules. I bet he wouldn't say that if he were talking to the RRC. You should have him put that in writing and see how fast he'll back-peddle.

If you get stuck in a situation like that you have to ask yourself whether you want to stand up for yourself or be somebody's bitch for your entire residency career.

As for the "needs of the hospital," that's the biggest load of crap I've ever heard. Hospitals have plenty of money. If it came down to it they could hire extra help or "gap" coverage to fill in the holes in the schedule which they used to fill by abusing their captive employees (you, obviously). The program director is just too much of a wimp to stand up for you. His boss tells him that he needs to provide a certain amount of coverage and instead of being a man and looking after your interests he folds like a cheap suit and passes his cowardice on to you.

 

[Winged Scapula]

Our chiefs felt that any work done after midnight (or before 7:30am) did not count towards work hours. So if your "day off" was supposed to be saturday and you worked all day friday and didn't leave the hospital until 6am saturday, those six hours of work on your "day off" don't count!
The same applied for intern pre-rounding. If an intern came in at 5am to round on his/her 15 patients (plus 3 new admissions overnight), the work from 5-7:30am didn't count as work hours. Hilarious!

Although hardly amusing, it is interesting to see what blinders people can put on.

I've found that many believe that the 30 hrs on call is up at noon. I've tried to explain to attendings (when I let interns go "early", ie, before noon), that noon assumes the intern came in at 0600 the day before. Since rounds on many services started at 0530 and the interns were in before that, it only makes sense that they would be over hours at noon.

One of my fellow senior residents got criticized on some evaluations (at an outside hospital) for leaving early - she never left before 30 hours were up, but since it was before NOON, she was leaving early.

New math, I guess.

 

[8744]

Hi there,
I am a senior General Surgery resident at present. My program and every place that I have rotated through or been affiliated with, has strictly complied with the 80-hour work week and the 24 (30) hour rule. Of course, there were emergencies where we went above 30 hours but these were extremely rare (hurricane/illness) and the battered team was given plenty of time off after the emergency passed.

Places that do not comply with the RRC regs are in danger of being shut down. If you keep your mouth shut and go along, your residency can be pulled from under you because your program director and chiefs are not compliant. If you have residents from other services or programs rotating though, they have nothing to lose by "blowing the whistle on your program" and you do.

Do whatever you can to make sure that your program is compliant. Your chief residents will finish so they won't be affected by probation/shutdown and your program director is done with residency so they are not affected by program probation or shut-down. Offer any solutions that you can think of to get your hours in compliance.

Outside of residency is a different ballgame but you HAVE to get through residency in order to play. As an attending, you set your own hours according to your needs (and preferences in some cases). As an attending, you are also paid under a different system too.

For those people starting residency or moving into the residency interview/application process, I would strongly recommend reading and understanding the RRC work hour rules. It is also a good idea to ask about work hours and scheduling while you are interviewing.

If you encouter a program that skirts the RRC rules on a regular basis, are you going want to be there? Do you want the spector of program probation or closure over your head for the entire residency? The "whistle-blower" system is a crappy system but it is reality as are the RRC rules. There are plenty of places that bend and break these rules but they are still there.

njbmd

As usual, you have cut to the chase and crystalized the issues involved succintly.

 

[Winged Scapula]

I recommend talking to interns and residents in any future program and seeing how many hours they are really working before you decide to go there. Not every program follows the new laws.

Good advice but I'm not sure how you ferret out those who are telling you the truth.

I recently found out that one of our former Chiefs lied to interview candidates (this was a few years back) about a lot of stuff - those that ended up matching and had interviewed with him (rather than some of us who are honest about the problems) felt cheated, rightfully so. While not suprised (knowing this particular Chief), I was horrified and embarassed.

If *everything* sounds rosy in an interview, I would be more likely to assume that someone is gilding the lily. Every program has some pits in the cherries.

 

[Apollyon]

2. No more than 24 hours per shift, but 6 hours can be used following that for continuity of care. (Nowhere does it say you can spend more time in clinic) This is known as the 24+6 rule.

Directly from www.acgme.org (IM program requirements, page 26 of 33):

"Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to 6 additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care."

As always, don't take SDN as gospel - do your due diligence and your own research.

 

[signomi]

There is one glaring part you left out - you can also go to clinic post-call for up to 6 hours - as long as you don't have any new patients. I've seen medicine residents do that, and that SUCKS, in my book.

Ah yes, but see how do you define "new" patients? At my old program they were considered new only if they had never been to the clinic before. So you would have 8 patients booked, all of which were brand new to you, but you were listed as their PCP. Tricky.

Did we go to the same program?

Massachusetts IM program affiliated with a university everybody here has heard of.

If you have residents from other services or programs rotating though, they have nothing to lose by "blowing the whistle on your program" and you do.

At that hospital there was no psych residency and the ER residents did not do one single month of med wards. The only program that rotated through was ob-gyn and it was one month as in intern, so they sucked it up.

And beware of vacation scams

I swear we went to the same program! In my program a week was 5 days when it came to vacations. And, this is the best...you could get stuck with home phone "call" for the clinics on your vacation! And when vacations rolled around at xmas time everyone got q2 call.

The PD got up and said, "The rules are a goal, but the needs of the hospital come first."

This is getting creepy! Our PD said, "These are not hard and fast rules, they are goals. Patient care comes first."

I must agree with the above posters, the residencies cherry pick who gets to talk to interviewing candidates. So keep that in mind during interviews and try to talk to other residents that you meet that weren't at the luncheon. There is another tell-tale sign. Where I did residency, the med students from the affiliated med school rarely (and I mean rarely) ever applied for our residency in IM. They weren't applying for a reason.

 

[8744]

...Our PD said, "These are not hard and fast rules, they are goals. Patient care comes first."

Again, this is a load of crap. If patient care comes first then your program director needs to get his happy ass on the wards and pick up some of the slack. Obviously he's not going to do this for many reasons, none of which are valid if patient care comes first.

He's just too lazy, weak, or malicious to arrange schedules and get appropriate coverage, preferring to live his ideals on your hard work.

If patient care comes first then we'd never leave the hospital at all. We'd just admit more patients and go without sleep for our entire residency. Obviously there is a time when sleep comes first. Or eating. Or getting married.

Bah. I have neither sympathy nor respect for the old school attendings who want their residents to suffer like they did back in the good old days.

Patient care comes first when I'm working. I don't see how this translates into making us work 120 hours a week. (Not to mention that patient care is jeapordized by sleep deprived residents.)

 

[8744]

It is pointless to justify long residency hours by pointing to the long hours you may work as an attending or in private practice.

The key, and obvious difference, is that you get paid for your hours as an attending while you are on a fixed stipend as a resident. You can also quit a job as an attending with impunity and find another job realtively easily. It is extremely difficult to switch residency programs as you can only do it one time a year and will often have to repeat a year at your new program, even if it is in the same specialty.

 

[megacolon]

It seems that my new institution and my old both are very concerned about adhering to the rule and all 3 PD's (med, peds, med-peds) told us that if we were going over we should notify them immediately so they can examine the system and see what can be done to change it to make it compliant with the 80hr rule.

Sleep is not a privilege and working people over the work hour rule should never be tolerated. I think it's funny to juxtapose the attitude in the profession by older docs who say we should suck it up and take it with the attitude by many in our country that depriving folks of sleep down at Guantanamo is considered torture.

 

[KidDr]

Sleep is not a privilege and working people over the work hour rule should never be tolerated. I think it's funny to juxtapose the attitude in the profession by older docs who say we should suck it up and take it with the attitude by many in our country that depriving folks of sleep down at Guantanamo is considered torture.

Exactly. And being awake for 30+ hours straight is sleep deprivation, plain and simple. We still have a long, long way to go until work hours are truly evidence-based (i.e., safe).

 

[pillowhead]

3. 10 hours rest between each shift of work (I've never seen this one enforced.).

Actually the internal medicine program at my school just changed to try to accomodate this better. It used to be that new admissions were taken up until 8pm meaning you could easily get out at 11-midnight while finishing up admissions and rounding on all the admits that came in between 7-8. So now new admits go until 7pm and night float comes in one hour earlier. Of course, there's ever a guarantee you'll get 10 hrs, but it does help. (And this is coming from a program that several years ago was known for being quite malignant).

 

[Ice-1]

I'm on my first IM rotation and am already way over the 80 hr week thing only 2 weeks in. I think the only way it will average out 80 over 4 is if I get an entire week off which isn't going to happen since I have had to work every single day since starting. The PD said he didn't want to hear any whining about it, so I'm not going to say a darned thing to him and just log those hours in as they are. If the program gets put on probation then too bad. If I broke the law like this I'd be in a jail and not worrying about accreditation.

Anyone else in the same boat?

 

[DRDARIA]

Purely coincidentally, just today I was talking with someone (who knows I am a resident) whose uncle is a malpractice lawyer. She was telling me that when he has a case the first thing he looks at is the number of hours the doctor had worked. I asked her about residents because we, of course, have no control over our hours in residency, and apparently his line of arguement is that then the doctor shouldn't have gone to medical school. I asked where he thought doctors would come from then, and she said he didnt' care-- she did freely admit he is a jerk in general. Still, I think it is a good point-- it someone wants to file a malpractice suit, who better to attack then a doctor who was on duty for 30 hours in a 110 hour work week. Especially with the studies showing that after 24 hours our performance is that of being under the influence of alcohol. What an easy case to make!
"Had you been drinking?"
"NO, Sir!"
"Had you been awake for more than 24 hours?"
"Umm, well... yes."

(I suppose we don't hear more about it is because the ultimate responsibility would pass to the attending, and residents don't make enough to be worth suing) I don't know how successful he has been using this line of arguement, but the point is that is apparently the first thing he investigates.

One other point of clarification from above. People were talking about what the rule about doing continuity clinic post says.. and if I understand Apollyons post right, you can go to continuity clinic DURING THE SIX HOURS after 24, but NOT after 30, and those hours would still count toward the 80/week average.

My hint to interviewees this year is not to ask if they abide by the work hour rules ("Oh, of course we do"), but to ask how they track, who is held responsible if the hours are exceeded, and what they are doing to improve their ability to comply. If the answers are vague, or they seem upset by the questions, that is a clue.

I'm so sorry some of my fellow interns are having to put up with programs that are doing this. It's wrong.

 

[Apollyon]

Yep - continuity clinic post call - up to six hours, with no new patients (meaning being billed as "return visits" - even if YOU have never seen the patient before, but they've been seen in your clinic/office).

Lovely.

 

[glorytaker]

I'm on my first IM rotation and am already way over the 80 hr week thing only 2 weeks in. I think the only way it will average out 80 over 4 is if I get an entire week off which isn't going to happen since I have had to work every single day since starting. The PD said he didn't want to hear any whining about it, so I'm not going to say a darned thing to him and just log those hours in as they are. If the program gets put on probation then too bad. If I broke the law like this I'd be in a jail and not worrying about accreditation.

Anyone else in the same boat?

Hey, are you at the same residency program I'm at? This sounds very familiar.

 

[8744]

I'm on my first IM rotation and am already way over the 80 hr week thing only 2 weeks in. I think the only way it will average out 80 over 4 is if I get an entire week off which isn't going to happen since I have had to work every single day since starting. The PD said he didn't want to hear any whining about it, so I'm not going to say a darned thing to him and just log those hours in as they are. If the program gets put on probation then too bad. If I broke the law like this I'd be in a jail and not worrying about accreditation.

Anyone else in the same boat?

I would definitely let the program director know that you are going over. there is no need to storm into his office and have a fit. Just send him an email or a letter at the end of the month detailing your hours and how far over you've gone. If it's a pattern than he will need to address it.

Now, fer cryin' out loud, a couple of hours here or there is no big deal and I would just suck that up, especially if your program is making a sincere effort to comply. On the other hand if they want you to fudge your hours or don't care about the rules then you have a decision to make, namely how badly do you want to stay on your program director's good side versus how much your free time and your sleep is worth over the next three years.

I'd say better to stand up now and let him know that you won't be treated like a bitch then to just put up with it because you are afraid of being harrassed.

If you're not IM and this is an off-service rotation you should let your PD know.

 

[pillowhead]

I'm on my first IM rotation and am already way over the 80 hr week thing only 2 weeks in. I think the only way it will average out 80 over 4 is if I get an entire week off which isn't going to happen since I have had to work every single day since starting. The PD said he didn't want to hear any whining about it, so I'm not going to say a darned thing to him and just log those hours in as they are. If the program gets put on probation then too bad. If I broke the law like this I'd be in a jail and not worrying about accreditation.

Anyone else in the same boat?

Just wanted to point out that there are no laws regulating resident work hours. There are regulations set up by an agency independently of any legal body. In fact, the hours regulations were set up precisely to avoid any law being passed which could not be violated to lightly. This seems to be a common misperception.

 

[edmadison]

Just wanted to point out that there are no laws regulating resident work hours. There are regulations set up by an agency independently of any legal body. In fact, the hours regulations were set up precisely to avoid any law being passed which could not be violated to lightly. This seems to be a common misperception.

Except in NY.

Ed

 

[Apollyon]

Just wanted to point out that there are no laws regulating resident work hours. There are regulations set up by an agency independently of any legal body. In fact, the hours regulations were set up precisely to avoid any law being passed which could not be violated too lightly. This seems to be a common misperception.

Well, not exactly.

When I was prelim, I was at Elmhurst in NY (Queens). Mt. Sinai paid me, but my contract was with the Health and Hospitals Corporation (wholly owned by New York City). Every month, we would have to document our work hours, and the first page was instructions that included a clause stating that it was a crime to falsify, and they provided the statute location.

So, the hours weren't legislated, but honest reporting of them under penalty of law was applied, and, therefore, there's some subtle de facto work-hour legislation.

 

[docB]

NY is different than everywhere else. They have laws about resident work hours. Everyone else is just trying to stay under the radar of ACGME who regulates them. No PD (outside of NY) is going to go to jail for ignoring the hours rule. They will just get smacked around by the ACGME.

NY is different because they were home to the Libby Zion mess where a resident gave Demerol to a psych pateint who was on MAOIs. She went into status and died. Her parents were reporters or lawyers or both and they sued the crap out of everyone involved. They went with the work hours angle because that meant they could sue the hospital instead of the individual resident. Resident = $. Hospital = $$$$$$. So just understand that all of this work hours stuff is based on the desire of teaching hospitals to limit liability. No one really cares how much you work. They just want you to be on your own when you mess up and not take the institution down with you.

 

[8744]

I'll tell you, this issue is my "trigger." You know, the one thing on SDN about which you always comment and about which you have the strongest feelings. I hate going without sleep and I hate having my time wasted. That's the problem with a lot of residency training, namely that it is extremely inefficient to the point that large blocks of your time are going to be frittered away and until recently there has been no incentive for change.

If you can't train a physician in 80 hours a week then something is wrong with your program. You need to eliminate some of the bull**** (ie paperwork) that pointlessly sucks up so much of our time.