88 hour rule exemption

[toxic-megacolon]

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Tried searching the forum, as well as the ACGME website, but no luck, so here goes:

Does anyone know which general surgery programs have been granted an extension from 80 to 88 hours / week for their residents? I've heard RUMORS that Cedars-Sinai in LA and Emory have this, but I don't have a source.

 

[fedor]

Not sure which ones but there are quite a few:

"Programs in some specialties may apply for an 8-hour increase weekly duty hours. Out of the 8,037 ACGME-accredited programs operating in academic year 2004-05, 68 programs were functioning under the 88-hour a week limit; most of these programs were in neurological surgery (42), orthopaedic surgery (9) and general and thoracic surgery (7). "


http://www.acgme.org/acWebsite/newsReleases/newsRel_09_21_05.asp

 

[njbmd]

Hi there,
UVa was granted 88-hour max on two rotations: Trauma and Transplant. The rest of the rotations strictly adhere to the 80-hour work week. Most people are well under 80-hours and even Trauma and Transplant are just over 80.

njbmd 🙂

 

[Blade28]

Pretty sure we have 88 hours here.

 

[toxic-megacolon]

Pretty sure we have 88 hours here.

"Here" = Emory?

 

[mmmmdonuts]

"Here" = Emory?

yes, that's where he's at.

 

[yrome]

We have no such exemption at Emory.

We are told as residents that it is our responsibility to keep our hours within guidelines. This is often difficult or impossible especially as you go up through the years and lose the cush off service rotations.

 

[toxic-megacolon]

In my humble opinion, self reported hours are manipulative, and put residents in a lose-lose situation. Yuck.

 

[mmmmdonuts]

In my humble opinion, self reported hours are manipulative, and put residents in a lose-lose situation. Yuck.

are you insinuating that programs are leaning on their residents to report factually erroneous work-hours?

😉

someone call the presses.

 

[mmmmdonuts]

We are told as residents that it is our responsibility to keep our hours within guidelines. This is often difficult or impossible especially as you go up through the years and lose the cush off service rotations.

don't you love it? the administration tells you on day one 'it's your responsibility to follow the rules.' so the burden is on you. and then they schedule you so that it's impossible for you to do so. and then they hand you a form to fill out where you either incriminate yourself for breaking the rules or you lie and say the program is following guidelines.

i 😍 it!

 

[toxic-megacolon]

don't you love it? the administration tells you on day one 'it's your responsibility to follow the rules.' so the burden is on you. and then they schedule you so that it's impossible for you to do so. and then they hand you a form to fill out where you either incriminate yourself for breaking the rules or you lie and say the program is following guidelines.

Yup, I'd rather work 85 hours/week under an 88 hour rule, than work 81 hours/week under the 80 hour rule. Just out of principle... I know I'm being ridiculous

 

[shag]

don't you love it? the administration tells you on day one 'it's your responsibility to follow the rules.' so the burden is on you. and then they schedule you so that it's impossible for you to do so. and then they hand you a form to fill out where you either incriminate yourself for breaking the rules or you lie and say the program is following guidelines.

Not only are you breaking the rules by going over 80 (or 88, or 120, etc), but you are "inefficient" as well. Any good surgical resident should be able to clock 80 hours when scheduled for 100+.

 

[toxic-megacolon]

Not only are you breaking the rules by going over 80 (or 88, or 120, etc), but you are "inefficient" as well. Any good surgical resident should be able to clock 80 hours when scheduled for 100+.

What's even more frustrating, is many surgical residents happily falsify their hours because they think they are "taking one for the team." When in fact, all they are doing is covering for some lazy secretary (or PD) who isn't putting the right amount of residents on a rotation. 😡

 

[mmmmdonuts]

Not only are you breaking the rules by going over 80 (or 88, or 120, etc), but you are "inefficient" as well. Any good surgical resident should be able to clock 80 hours when scheduled for 100+.

yeah they're like if you can't do under 80 hours, you're inefficient and obviously pathetic. but if you do it under 80 hours, then you have it way too cush and i have disdain for you. it's marvelous.

 

[fourthyear]

How about the fact that we need to learn how to do surgery? Sometimes leaving post-call or leaving at the end of the day to go home before you are over hours means missing out on a case - at some programs this may be okay b/c some other resident gets the case, but at a mid-size or small program (where all most available residents may already be busy with other things), this means an intern assists on a case that a senior resident could actually do, so the senior loses out on the experience, the intern has fun but can't count the case...and the case numbers and your technical expertise go down.

Or how about learning how to take care of patients - if your patient is crashing you're supposed to leave and pass it on to the on-call person, which doesn't really simulate the real-world when we get out of residency. Some days you just can't leave on time as planned.

Personally, I love the days off rule, but the strict 80 hours and the post-call rules are hurting our experience to a certian extent in my opinion.

 

[geekgirl]

i will not speak to the wisdom or silliness of the 80 hr work week, but i do think the schedules have generally gotten easier.

that said, i have not worked in one single hospital (and currently i'm a travelling fool) where the surgery residents work anything remotely close to an 80 hr work week. and these are big, well-respected programs.

i challenge anyone to find a place that REALLY keeps to those hours. i haven't seen one yet.

but getting a day off now and again (or a weekend even) IS fabulous. so not all in the new system is bad, that's for sure. it just doesn't = 80 hrs in a wk.

 

[GreatSaphenous]

I was recently informed that this month will likely be one of them when we have to log our hours. Unfortunately this week, due to being scheduled for call on Sunday then Saturday, I will hit more like 95. This is not a typical week. The problem is that I cannot in good conscience lie about it, though if I do not, I have been told I won't see the inside of the OR. Frankly I don't have a problem with working more than 80 hours and I don't like the strictness of the rule. Has anyone else had similar problems or a suggested solution?

The not-feeling-so-great-saphenous

 

[FliteSurgn]

80 hours should be the average per week over a month's time. So, if you have a praticularly busy week, it will hopefully average out with the rest of the month to still reach 80/week.

My program strictly enforced the 8ohr and weekends off rules. You weren't made to lie about anything. While I don't believe the 80hr rule should be so "set in stone", I also don't believe that anyone should pressure you to lie about your hours. Quite frankly, that's fostering an attribute (deceitfulness) that we don't really need forced upon us. Threatening to keep you out of the OR if you don't falsify your hours? That's wrong on so many levels.

 

[mmmmdonuts]

The problem is that I cannot in good conscience lie about it, though if I do not, I have been told I won't see the inside of the OR.

ahhh, life ...

 

[Blue Haze]

Did any of you actually expect to be working just 80 hours a week when you went into surgery. I hate to say it, but I think that's just a little naive.

 

[happy puppet]

Did any of you actually expect to be working just 80 hours a week when you went into surgery. I hate to say it, but I think that's just a little naive.

Hopefully not, but the catch 22 it puts us into is ridiculous. I personally think that we need to either (a) make it an 100 hour week, perhaps with the goal or easing into fewer hours or (b) have the PDs change the system, and not just yell at the intern when they go over hours. Maybe talk to the chiefs and figure out why he had to log in 110 hours on vascular when the junior was on vacation and the chief took none of the slack. or (c) quit the bull**** and stop pretending there's an 80 hour week...in the meantime, we deal with pre-80 hour work people saying how surgery is so "easy" now.

 

[toofache32]

I don't really understand the problem here. I log my hours as they are. I go over sometimes, but I've never been accused of inefficiency. If it's that big of a deal the upper-levels should get off their asses and help get stuff done.

 

[mcindoe]

don't you love it? the administration tells you on day one 'it's your responsibility to follow the rules.' so the burden is on you. and then they schedule you so that it's impossible for you to do so. and then they hand you a form to fill out where you either incriminate yourself for breaking the rules or you lie and say the program is following guidelines.

amen! this has been bothering me ever since internship started. always put in these "damned if you do, damned if you don't" sort of situations that are always lose-lose for the intern. if you try to follow the rules as instructed, someone always insinuates that you're not being a team player. and i can't count the number of times i hear residents say "when i was the intern on this service, i never got a day off that month..." or "i used to work 120 hours a week back then" as if it matters.

to those who say that it's "impossible" to follow the 80 hour rule or suggest that it's not realistic--i completely disagree. there are way too many hours i spend here and there doing nothing meaningful or nothing that requires a medical degree. and i'm not just talking about scut, i'm talking about paperwork and other stupid stuff that has nothing to do with learning about how to take care of patients. i find that the rules if anything protect me from having to indulge the selfish residents and attendings who make no effort whatsoever to try to help you comply with the rules and make you clean up the messes that they've made because they're too lazy to do it themselves. these last few months of internship have really illuminated the wisdom of the rules.

The rules have changed, and so must the culture. i wish that the attendings and senior residents would try to adapt instead of whining about it all the time.

 

[davvid2700]

How about the fact that we need to learn how to do surgery? Sometimes leaving post-call or leaving at the end of the day to go home before you are over hours means missing out on a case - at some programs this may be okay b/c some other resident gets the case, but at a mid-size or small program (where all most available residents may already be busy with other things), this means an intern assists on a case that a senior resident could actually do, so the senior loses out on the experience, the intern has fun but can't count the case...and the case numbers and your technical expertise go down.

Or how about learning how to take care of patients - if your patient is crashing you're supposed to leave and pass it on to the on-call person, which doesn't really simulate the real-world when we get out of residency. Some days you just can't leave on time as planned.

Personally, I love the days off rule, but the strict 80 hours and the post-call rules are hurting our experience to a certian extent in my opinion.

DUDES,


if you cant learn how to be a surgeon for 80 hours a week for 5 straight years you best rethink the program you are applying to.

The whole surgical training thing is just ABUSE.. I agree that you must p ut in your dues.. but its ridiculous.. I did a surgical internship 5 years ago and after that year I left surgery all together and am content with my decision. I just couldnt take the inefficiency of the training requirements. I would spend at least 15-20 hours a week probably just waiting to round.. Ridiculous..

 

[mmmmdonuts]

Did any of you actually expect to be working just 80 hours a week when you went into surgery. I hate to say it, but I think that's just a little naive.

so you're saying that we should go into it knowing that we are being lied to. because i dont think the issue is whether we can hack it but the fact that this is what we're being told. if the reverse happened where i lied to my program what do you think would happen.

 

[toxic-megacolon]

Did any of you actually expect to be working just 80 hours a week when you went into surgery. I hate to say it, but I think that's just a little naive.

There ARE programs out there that do a good job of managing the 80 hour rule, by monitoring parking cards, etc. It just takes the pressure off the residents (who have enough things to worry about).

Oh, and seriously, when people stay post-call late, its more often doing scut/paperwork/social work than it is being in the OR. Filling out a few less discharge sheets is not going to severely impact the quality of my training. However, falling asleep in conferences and rounds might...

 

[Blue Haze]

so you're saying that we should go into it knowing that we are being lied to.

Yes.

 

[Blue Haze]

...in the meantime, we deal with pre-80 hour work people saying how surgery is so "easy" now.

Yeah, that sucks. But c'mon, if it wasn't the 80 hour week, they'd be busting your chops about something else. After all, they did have to walk ten miles uphill barefoot in the snow to work every day, didn't they?

 

[Blue Haze]

There ARE programs out there that do a good job of managing the 80 hour rule, by monitoring parking cards, etc. It just takes the pressure off the residents (who have enough things to worry about).

Yes, there ARE programs out there that do a good job of creating that impression. The reality is usually a tad different.

 

[toxic-megacolon]

After all, they did have to walk ten miles uphill barefoot in the snow to work every day, didn't they?

So true...

 

[Blade28]

80 hours should be the average per week over a month's time. So, if you have a praticularly busy week, it will hopefully average out with the rest of the month to still reach 80/week.

True, but it seems that weeks where you work less than 80 hours are VERY rare.

 

[FliteSurgn]

True, but it seems that weeks where you work less than 80 hours are VERY rare.

As with so many other things, that is really dependent on your particular residency, rotation, PGY level, etc. I was an intern under the old system and had several rotations where I averaged 120 hrs/week. Other rotations weren't nearly as demanding. Under that system, your schedule (especially in-house call) greatly diminshed over the ensuing years so that by the chief year you could average 40 hrs/wk of intense OR time.

After the 80-hr rule, the hours got redistributed. Now, the interns average 70-80 hours, second and third years 60-70, and seniors 50-60. There were rotations that would push those numbers up (vascular, in particular), but then there were rotations where you'd have way fewer hours than that (outpatient surgery, the VA, etc.). All in all, the net effect of the 80-hr rule was decreasing the OR time of the junior residents and shifting some extra work up the ladder to the senior residents. The juniors/interns still did a fair number of OR cases, but the difference was they were rarely available to "second-scrub" big cases. They didn't get to see the Whipple for example, ask/answer questions, assist with portions of the case, do parts of the case (j-tube, drains, closure, etc). At least in my residency, I really do feel that the 80-hr rule hurt the passage of knowledge to junior residents/interns. As a senior resident and then staff member, I saw a clear difference in the knowledge and skills of the post-restriction mid-level residents vs. the pre-restriction residents. They were still good, but they weren't outstanding. I hope it all averages out in the end, just like the hours. Time will tell.

 

[Chief Resident]

Maybe in the future they'll tack on an extra year or two to GS training to make up for the defecit created by the 80 hour rule...6 or 7 year long GS residency instead of the current 5 years (not including any research requirements).

 

[powermd]

Geez.. would it kill them to hire a few PAs to help with the floor work and give the interns/residents more OR time?

 

[FliteSurgn]

Geez.. would it kill them to hire a few PAs to help with the floor work and give the interns/residents more OR time?

If you're on call q3 or q4, that means that you go home 2 days per week without being allowed in the OR. There's nothing that hiring PAs will do about that. Effectively, the 80-hr rule diminshed the operative exposure of those residents by 40%.

When there wasn't the post-call go home rule, those residents could CHOOSE to stay and be in the OR. If they were too tired from call responsibities, they took a nap in the call room or asked their seniors if they could head out early. At least they made the choice based on how they felt. After the rule, they have no choice except to go home.

 

[FunkDoc]

So does Emory have an 80 or an 88 hour work week?

 

[fishmonger69]

not sure about emory, but i know that univ.of.louisville has a few rotations where 88hr exemptions are in place and that's with PAs and NPs.

 

[Blade28]

PM me if you want more info on Emory G Surg.