80 Hours...yeah right!

[Sparhawk]

Is it just me or this 80 hour thing in not working out?

How does everyone weekend coverage work for you all? I am almost there every weekend, is that the norm? Even when I am not on call, I have to come in to the hospital to write notes.

Anyway, what has to be done will get done...

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[fourthyear]

You're program is going to get in big trouble. You MUST have an average of 1/7 days off - that's 4 days/month completely off, no morning rounds, no nothing. That's the way it is.

And personally, I think these days off are the easiest part of the 80 hour week to accommodate. It makes complete sense - really, does everyone have to be there for weekend rounds? now way! I'd rather write twice as many notes while I'm there by covering someone else's patients, so that they can see my patients while I'm having a nice saturday to sleep in. If you're programs doesn't see things this way yet, they'd better start b/c its the law now.

 

[edinOH]

.If you're programs doesn't see things this way yet, they'd better start b/c its the law now

breakin' the law, breakin' the law! Man I miss Beavis and Butthead.

I assume the one out of seven rule is averaged over the month, correct? Because I had the weekend before last off and I have the last weekend off as well. (I worked this out with my team, not through direction from on-high).

I assume the 80 hour thing is averaged as well? Because between now and Friday the 29th, I am essentially on q2 in house call. I've only had two calls up to this point. Don't ask

 

[fourthyear]

yep, edin - those two assumptions are correct - 80 hour/week and 1/7 days are both for a 4-week average. So when you're busier, you can go over the 80, but you'd better get home early when you can the following week to make up for it. I am glad the 1/7 days is average too - kinda nice to have a whole weekend off like person with a "normal" job.

 

[ckent]

It's actually not the law since the federal government work regulatory people refused to adopt it. It's only an ACGME requirement for accredidation, which might as well be the law for most programs, but clearly, many programs are not trembling in fear at the ACGME's supposed power. That's why a lot of residents wanted the federal government to make it a law, but they refused.

 

[Apollyon]

At our hospital in NYC (NY - home of the Bell Commission), every block had a guaranteed "golden weekend" (post-call Friday, didn't come back until Monday morning). Friday long call, post Saturday, Sunday off. Saturday long call was the bummer, because you were there the whole weekend, but still got out Sunday morning, so you had the 24 off (Monday morning, you didn't have to be in until 9am). Sunday long call had Saturday off.

Teams would sign out to each other, and the resident would write the notes for the team opposite them, with the intern covering their own team.

It worked out well, and meant that you weren't guaranteed the Saturday morning screw around/busywork session.

And it was mondo cool for the golden weekend; even better was when Monday was a holiday. That meant two teams got a golden weekend.

It works!

Oh, and, HHC had the agreement we had to sign, in that, if we were working over the 80 hours, and didn't get it straightened out, they could fire us.

 

[edinOH]

.Oh, and, HHC had the agreement we had to sign, in that, if we were working over the 80 hours, and didn't get it straightened out, they could fire us.

Gotta love it. "I'm sorry Dr. Apollyon, you have been working just too much. You're fired!" Sounds like something the AFL-CIO worked out.

 

[edfig99]

Originally posted by ckent
It's actually not the law since the federal government work regulatory people refused to adopt it. It's only an ACGME requirement for accredidation, which might as well be the law for most programs, but clearly, many programs are not trembling in fear at the ACGME's supposed power. That's why a lot of residents wanted the federal government to make it a law, but they refused.

it's "law enough". The ACGME has power to pull accreditation. No accreditation => no GME money from Medicare => no money to pay residents, or more importantly for the hospital, no GME money for the hospital. Also, a program without accreditation (supposing the hospital is willing to foot the bill for the salaries) cannot recruit new residents, so the hospital will lose able bodies and may be forced to spend even more money to replace them. Finally, you need to complete an accredited program in order to take specialty boards.

Hospitals get A LOT of money to train residents and so they don't play around with anything that threatens accreditation. Honestly, medicine is screwed up enough with all the outside regulatory agencies....ACGME doesn't need one for work hours.

And for the poster who mentioned s/he is on call q2, add up those calls and divide them into the month -- ACGME also states that you cannot be on call more frequently than 1 in 3 averaged over one month (figure 10 overnight calls a month) so if you have more than 10 calls, that's a violation too.

My last few months of residency (in NY) we were surveyed about 3 times -- one was scheduled, the other two were surprise surveys because a resident complained about their hours. Those complaints are taken VERY seriously and in NY hospitals can get fines from $6K to 250K. My hospital didn't have a "we can fire you" agreement though...that's just odd....