80+ hour weeks, 24+ hr call?

[vietcongs]

Hello,

Anyone else having issues with going over 80 hrs? I have been in my residency program (OB/GYN) for only 1 week and in the first week, I have 92 hrs and did a 24 hr call that lasted 30 hrs...Yikes! I'm afraid to report to my director, because s/he gets upset since s/he has to file all sorts of paperwork explaining why I had to go over 80 hrs..yadayada. So what do you do in this situation?

---

Members don't see this ad.

 

[P Diddy]

Hello,

Anyone else having issues with going over 80 hrs? I have been in my residency program (OB/GYN) for only 1 week and in the first week, I have 92 hrs and did a 24 hr call that lasted 30 hrs...Yikes! I'm afraid to report to my director, because s/he gets upset since s/he has to file all sorts of paperwork explaining why I had to go over 80 hrs..yadayada. So what do you do in this situation?

you're allowed to take 30hr call as the rule is 24+6.

92 hrs, however, is a problem. if other interns are also over, you could talk to your director en masse.

P Diddy

 

[drewpydog]

you're allowed to take 30hr call as the rule is 24+6.

92 hrs, however, is a problem. if other interns are also over, you could talk to your director en masse.

P Diddy

The rule is hours are to be averaged over 4 weeks. There were weeks on trauma where I did ~100, but the schedule was such that the next week I did ~60. See what the averages come out to be, then complain.

 

[blue2000]

Clearly, it's not in the rules, but I also think there's a fudge factor inherent in the first week of the academic year. We are all slow right now, from the chiefs to the interns, since we're all doing a new job. Look at your hours for July as an intern group; I bet you'll all work less in August.

 

[Justin4563]

report it
report it
report it


report it to the hospital administrator

report it to the acgme

report it to anyone who wil care

threaten them with a lawsuit.. its time that residents stop getting used and abused....... seriously.. and im not even a resident anymore

 

[Seaglass]

Actually the OB RRC permits only 24 hour calls, not 30.

 

[cytoborg]

I agree with the poster who commented about July...you have to expect that you will be slow and inefficient at first. Once you get the hang of things, see how your August hours turn out, then decide if it's worth complaining. I think in a lot of programs, 80 hrs is a pipedream on the tougher services at least...you make it through that rotation, and move on to something easier. If it's consistently brutal, then perhaps you can all complain together. I wouldn't want to be the only one reporting the violations though. Come August, send out feelers to your colleagues before reporting.

 

[njbmd]

Hi there,
As other people have correctly posted, your 80-hour work week is averaged over four weeks. If you are consistently running into 90+ hours and others are doing the same, you need to do some serious work with your program director. Your program can be placed on probation and closed if work hour violations are not solved. Work with your program directors on these matters as opposed to rushing to report things. Any good program director will take every step possible to comply with RRC standards.

It is your responsibility to make sure that your hours are in compliance. Make sure that you are getting your days off. Remember that post-call days are not days off. If you work overnight, go home at 9am post call, that is not a day off but your post call day. You are entitled to a 24-hour period free from patient care duties.

If you are having efficiency problems, ask your senior residents for assistance. Realize that you are adjusting to a new job and that the adjustment will take some time. You will become more efficient as your experience grows so keep an open mind about the workload until you become more efficient. July 1st is the changing day for all of us so we all have some adjustments to make.

njbmd

 

[southerndoc]

92 hours is NOT a problem. It's 80 hours/week averaged over a 4-week period.

So if by chance he works only 68 hours the following week, then he hasn't violated any rule.

You can work 120 hours one week and then 65 hours the next 3 weeks and you're still in compliance.

However, it's unlikely that your workweek will go from 92 hours to less than 80.

 

[southerndoc]

Actually the OB RRC permits only 24 hour calls, not 30.

They do not allow a 6-hour extension for follow up activities, education, etc.? Is the 24-hour limit referring only to "being on call" meaning patient care duties?

Every resident is limited to 24-hours "on call," but is not limited to 24 hours of consecutive duty. Does the RRC for OB/Gyn limit to 24 on call, or 24 hours of consecutive duty?

 

[Smurfette]

You violating the work hours is not your fault, and your PD should find a way to fix it if this is a consistent problem (although it's only week 1. I'm over 80 hours this week too. But I don't know what the next few weeks will bring, so I don't feel the need to 'report' it.) You can't just up and leave if no one else is there to take care of your patients, so you should not be feeling guilty about it. What you need is people in charge helping you to get out earlier.

 

[APACHE3]

I just fiinshed a surg rotation at a Texas med school and the residents ALWAYS did 24+6 on their call day. I'm not sure if the program "split" the time to two days but basically, they were seeing patients for 30 hours!!!

 

[blue2000]

I just fiinshed a surg rotation at a Texas med school and the residents ALWAYS did 24+6 on their call day. I'm not sure if the program "split" the time to two days but basically, they were seeing patients for 30 hours!!!

My understanding is that the ACGME 24+6 call rules means that while you can be in house for 30 hours at a time, after 24 hours you can no longer take part in "direct patient care." I don't know how explicit they are as to what constitutes direct patient care, but I'm in a surgery program that is totally committed to the 80 hour work week, and all our overnights are 30. In my program, the definition of "direct patient care" is where it gets sticky -- I operate after 24 hours, write orders, round with the team. I think ACGME wouldn't be so happy with the operating & writing orders, but I haven't read the policy in detail, so I'm not sure whether it's kosher or not.

 

[southerndoc]

I think you can write orders, but I do not think you can perform any procedures.

 

[jumpin bean]

I think you can write orders, but I do not think you can perform any procedures.

You are allowed to participate in continuity of care in the 6 hours after a 24 hour in-house call. I interpret that to mean rounding/doing procedures on the people you have already admitted, but no new admissions or consults.

If you are in a q4 situation you will have one week over 90 and the other three in the 70's. The week with the tuesday-sat call is the long week.

One trick that my program uses is averaging the last two weeks of a light month with the first two weeks of a tough month. That's how they keep the ICU months in regulation.

 

[GeneGoddess]

One thing to note is that not all programs do the "4 wk average". Some, you must be less than 80hr/wk PERIOD (not an average over 4wks). Pedi is an average, but I heard that medicine was not.

 

[cytoborg]

One thing to note is that not all programs do the "4 wk average". Some, you must be less than 80hr/wk PERIOD (not an average over 4wks). Pedi is an average, but I heard that medicine was not.

Yeah, at my new institution at least, medicine is not averaged, it's 80/wk period. I wonder why medicine, and not anything else?

 

[undecided05]

suck it up. That's about all I can say. What a bunch of cry babies.

 

[Blade28]

I'm WAY over 80 hr/wk. Sometimes the work just needs to be done...and you can't rush cases in the OR (or schedule less of them)!

 

[Vincristine]

My feeling right now is that it's the first freakin' month. I think it's a bit hard to tell how well your program abides by the ACGME guidelines at this point. Are you at full speed? Is your team at full speed? I doubt it.

 

[DOtobe]

First week of general surgery (July 1-9) --> 87 hours.

One week down, 3 to go, and then no more surgery for me! I really give you general surgery residents credit...I could never do what you guys do.

 

[doc05]

First week of general surgery (July 1-9) --> 87 hours.

One week down, 3 to go, and then no more surgery for me! I really give you general surgery residents credit...I could never do what you guys do.

you do realize that 9 days does not constitute a week?

 

[Blade28]

First week of general surgery (July 1-9) --> 87 hours.

But that's not 7 days.

My first week of general surgery: 112 hours. Yikes, didn't realize it was so much until I just added it up.

 

[DOtobe]

Sorry, typing error.

 

[backontop]

i'm sorry but i just find these hours completely cockamamie regardless of averaging. My friend is a pilot and if his boss found out he had been up for over 24hrs he would be fired. I like to think that what we do is just as important safetywise if not more than a pilot. This is an issue as a lot of the work done by residents can be done by people without an MD/DO. If you look thru the most recent literature, you;ll see that the latest development in this problem is whistle-blower laws. these are not currently in effect everywhere but the general gist is that people who rat on programs are protected. 80+ hours is a problem and patient care is suffering cause of it. As of now, 2-3% of med students are so fed up that they are not even pursuing residency. Society is losing our brightest, best talent and it's kinda scary...


justin, i am 100% behind you.

undecided05, it would be cool to meet up with you outside of this forum. you are very brave on-line, but it would be nice to see you crack right in front on my face. Oh yeah, that would never happen cause you are always freakin' working you tool!
remember this post when your wife divorces you.

 

[southerndoc]

Backontop, I agree with you. 80-hour workweeks and 24-hour on-calls are dangerous. At the same time the ACGME adopted the 80-hour workweek rules, most people didn't realize that Congress had proposed legislation limiting workweek hours of residents to only 60 hours. This legislation was pulled because the ACGME agreed to regulate the hours.

Personally, I think 60 hour workweeks with a maximum of about 16 hours onduty should be the standard and norm.

Regarding medical students not pursuing residency, the stats have always been around 3-5% of medical students not pursuing a residency. These graduates usually enter into research.

 

[Annette]

From what I remember, residents in the UK have a 56-60 hour work week, and get paid overtime for anything about that. THAT would certainly limit the hours programs would allow residents to work. But wait, at $8/hr, and overtime= $12, which is still much less than they pay most of the staff . . . Well, it was a thought.

What really gets me mad is when the hospitals won't provide ancillary staff to help out the residents, even when it is in the hospital's best interests. The census in my hospital's MICU regularly explodes into the 30's. Most months, we have 1 resident and 2 interns. Because the ICU is closed, ICU is considered a "consult" service, and is not subject to the RRC cap. The residents have asked the program, med ed, and the hospital to provide someone to help with the paperwork so that we can attend to all these patients (I once had two patients who were on 10 drips each. The interns were too scared to approach the patients!). No one wants to pay to get us help, and there are no extra residents to be had. Wonder what a lawsuit will cost them?

 

[anonymousEM]

While i agree that there needs to be real attempts mad eto adhere to the hours I agree with those who say see how it goes after a month after you and your seniors all have had a chance to settle into your new roles.

Secondly, approach your chief, approach as a group...and by all means don't start at the top with the GME office. If you do, your PD WILL take action. He/SHe will be forced to attend to your issues but you may not reach a solution that is in the best interest of the residnets.

As in EM...we work a max of 12 hour shifts and a total of 72 hours a week. When our residents complained about regularly staying over after their 12 hour shifts we nearly had to switch to all 8 hour shifts. That'd be ok, except then you lose most of your days off to get the same coverage in the dept. It would make the numbers better but not necessarily make the residents lives better or happier...just realize that you force hands when you go straight to the top of the command and sometimes issues can be dealt with better from the bottom up.

Hang in there, once you know who to call and how to call them and how to navigate the computer it does get better.

 

[Blade28]

I've heard that eventually all residencies will cap the workweek at 60 hr/wk...the downside is, they might extend the length of residencies by one year, which I'm not in favor of.

 

[fourthyear]

This is kind of funny, kind of sad - these regulations have been here over 2 years now, and none of you is really clear on them or how to interpret them.

The call rule is...past 24 hours you have an additional 6 allowed for sign out/continuity of care issues - finishing through the care of the patients you admitted last night and securing that someone else there the next day knows enough about them to continue the workup/treatment plan. You are allowed to do procedures past 24 hours - i've never seen any ACGME rule against this - and I hope I never do b/c it would definitely hurt the case numbers of surgery residents. You are NOT allowed to see new consults or admits after your 24 hours.

These rules are all spelled out in several documents at acgme.org - take a look at them yourself if you are confused. Some of the above statements in this thread are inaccurate.