Co-resident breaking Moonlighting Rules. What should I do?

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twospadz

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At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
 
twospadz said:
At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
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:corny:
 
twospadz said:
At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
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Don't get involved.

If you really feel it should be reported, can consider doing so via an anonymous mechanism and never tell anyone.

But really, just don't get involved.
 
twospadz said:
At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
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What evidence do you have that this has been “detrimental to patient safety “? If you do not have a documented incident... that you were involved in ....stay out of it...the likely outcome is that YOU get burned.

It’s nunya...
 
If you really think your college is putting patients at risk, it is your moral and professional obligation to speak up. If it were a nurse and you knew they were putting patients at risk, wouldn’t you say something?

First remind your colleague about your program’s policy. And that you think it’s putting patients at risk (if you really think it is) and that if they don’t stop working nights against policy, you may have to report them.

Keep in mind, if something happens and the program finds out the resident was working nights, and that you knew and thought it was a patient safety issue (which you’ve documented here in writing...) that could drag you into any potential mess, should one arise.

Remember, we are professionals. That means that we as a profession are responsible for regulating ourselves and ensuring the public’s safety.
 
twospadz said:
At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
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Mind your own business.
 
GdmiGVe.gif


Unless the person is putting patients at risk, or it's resulting in him/her taking advantage of other residents by avoiding shifts at the home program, leave it alone.
 
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twospadz said:
At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
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You “feel” this can be detrimental? Or do you have actual proof that’s this has caused patient safety issues? I wouldn’t say a word and mind your own business

Everyone has a different tolerance for fatigue and how much they can work. This guy sounds like he’s doing fine. I used to moonlight as well - our fellowship program had to give the official BS “cannot be during X or Y” guidelines for duty hours but it was generally totally okay and they didn’t care as long as we came to work and got things done
 
So you overheard a conversation and you assume it’s breaking the rules? You said he is working nights during the week but say he has permission from the PD often moonlighting is done at night...it has the word moon in it.

Seems you just like to gossip
 
I kind of agree with the majority saying to not get involved here you actually know that patient care is or has been compromised.

During training I moonlighted at a long term care facility a few nights a month where I was the in house doc and only handled codes or urgent issues. For the vast majority of shifts I sleep all night and it had no impact on my regular work duties. Honestly with 2 kids at home i got more sleep there than I did at home....
 
Mind your own damn business. How old are you? Eight or 28?
Please behave like an adult not a little child who likes to tattle.
Unless he’s walking around like a zombie AND you know for a fact he’s hurting patients, stay out of it.
 
If they aren’t falling asleep at work, stay out of it. 100%, not your problem

If they are falling asleep and risking patients or not pulling their weight on shift with you then it’s a face to face talk. “Hey bro, do your job or I have to speak up and I don’t want to be involved”
 
sb247 said:
If they aren’t falling asleep at work, stay out of it. 100%, not your problem

If they are falling asleep and risking patients or not pulling their weight on shift with you then it’s a face to face talk. “Hey bro, do your job or I have to speak up and I don’t want to be involved”
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I think this is a key point. If you think there's a real problem, then you need to bring it up with him first.
 
Also resident in question is a psych resident. By far more chill than most residency hours

This isn’t some neurosurgery intern moonlighting in between his “28” hour shifts who might kill patients if he’s sleep deprived

This is a non issue and I think we’ve beaten it to death
 
RangerBob said:
If you really think your college is putting patients at risk, it is your moral and professional obligation to speak up. If it were a nurse and you knew they were putting patients at risk, wouldn’t you say something?

First remind your colleague about your program’s policy. And that you think it’s putting patients at risk (if you really think it is) and that if they don’t stop working nights against policy, you may have to report them.

Keep in mind, if something happens and the program finds out the resident was working nights, and that you knew and thought it was a patient safety issue (which you’ve documented here in writing...) that could drag you into any potential mess, should one arise.

Remember, we are professionals. That means that we as a profession are responsible for regulating ourselves and ensuring the public’s safety.
Click to expand...

This is assuming there even is a patient safety issue which I see no evidence of based on the original post
 
Wtf?? Haha why would you get involved this is NONE of your business! Also, how the hell is him moonlighting affecting patient safety? Also, why the hell would you go directly to the PD rather than talk to him about it first (which you shouldn’t do either because it’s none of your business). Lastly, this is a PSYCH resident? Are you joking? They work like 50hrs a week bro him moonlighting an extra 20 hrs or whatever on the side is not affecting pt safety..
 
Unless you have proof that this is compromising patient safety, you don't get involved with this. If the person is not doing his job properly (for any reason, but potentially b/c of moonlighting) then you talk to him/her about it and escalate from there as necessary. If there truly is a patient safety incident then OK.

But if you are 'concerned' about patient safety without an actual event, I recommend silence.

Neuronix said:
Ask the resident if the moonlighting opportunity is open to you as well.
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Best response ITT.
 
RangerBob said:
If you really think your college is putting patients at risk, it is your moral and professional obligation to speak up. If it were a nurse and you knew they were putting patients at risk, wouldn’t you say something?

First remind your colleague about your program’s policy. And that you think it’s putting patients at risk (if you really think it is) and that if they don’t stop working nights against policy, you may have to report them.

Keep in mind, if something happens and the program finds out the resident was working nights, and that you knew and thought it was a patient safety issue (which you’ve documented here in writing...) that could drag you into any potential mess, should one arise.

Remember, we are professionals. That means that we as a profession are responsible for regulating ourselves and ensuring the public’s safety.
Click to expand...

Not sure why so many people are suggesting you let someone get away with breaking the rules.
I agree with the “anonymous” way of reporting but the person who told you would know..
 
FutureInternist said:
Not sure why so many people are suggesting you let someone get away with breaking the rules.
I agree with the “anonymous” way of reporting but the person who told you would know..
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Because it’s none of your business...
 
Merely said:
Because it’s none of your business...
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You’re expected or (depending on issue) required to report docs doing things that are not kosher.
Rationalising it as “not your business” is what allows ****ty docs to continue breaking rules, harming pts and not getting in any trouble.

Would you want a pilot to report a suspected drunk pilot?
 
FutureInternist said:
You’re expected or (depending on issue) required to report docs doing things that are not kosher.
Rationalising it as “not your business” is what allows ****ty docs to continue breaking rules, harming pts and not getting in any trouble.

Would you want a pilot to report a suspected drunk pilot?
Click to expand...

Not every rule "harms patients". Some rules are purely administrative, cultural, or institutional. We all like to quote doing things in the name of patient care/safety, but often they are in the name of reducing liability or appeasing administrators, sometimes even to the detriment of the patient. If patient care is truly at risk, and problems, such as near misses, where a patient is not necessarily harmed, but could have been, occurs, then by all means, report away.

An intoxicated pilot is more akin to an intoxicated physician. You should be able to see a distinction between that and what the OP's co-resident is doing.
 
FutureInternist said:
You’re expected or (depending on issue) required to report docs doing things that are not kosher.
Rationalising it as “not your business” is what allows ****ty docs to continue breaking rules, harming pts and not getting in any trouble.

Would you want a pilot to report a suspected drunk pilot?
Click to expand...
You are however not expected to pass on overheard conversation,gossip, or a “feeling” as something creditable...that is frankly just as irresponsible.
How does the OP Know that the PD isn’t aware of the other resident’s moonlighting...how does he KNOW that this is having an effect on patient safety? He doesn’t so he should just mind his own business.
 
hallowmann said:
Not every rule "harms patients". Some rules are purely administrative, cultural, or institutional. We all like to quote doing things in the name of patient care/safety, but often they are in the name of reducing liability or appeasing administrators, sometimes even to the detriment of the patient. If patient care is truly at risk, and problems, such as near misses, where a patient is not necessarily harmed, but could have been, occurs, then by all means, report away.

An intoxicated pilot is more akin to an intoxicated physician. You should be able to see a distinction between that and what the OP's co-resident is doing.
Click to expand...

Moonlighting and not having enough sleep can affect pt care.
Sure some folks may not have any manifestations, while others fall asleep on the way home from a shift, so its better to have a blanket rule that protects everyone.

We will perhaps agree to disagree 🙂
 
sb247 said:
If they are falling asleep and risking patients or not pulling their weight on shift with you then it’s a face to face talk. “Hey bro, do your job or I have to speak up and I don’t want to be involved”
Click to expand...
Disagree with this. If you think someone is a danger to patients you report them to the administration. If they're a danger to patients they need monitoring to make sure the problem gets and stays resolved, and the program administration is set up to do that in a way that a random coresident isn't. Also if you know they're lying to the PD, and you confront them about it, what are the odds that they don't just start lying to you as well? If its worth doing something at all its worth involving the PD.


rokshana said:
You are however not expected to pass on overheard conversation,gossip, or a “feeling” as something creditable.
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Depends entirely on your employer and your contract. Unless you are in the military you are not legally obligated to report someone breaking the rules, but you may or may not be contractually obligated to do so. You never need to report a feeling, and probably don't need to report hearsay, but overhearing a statement from a coresident that they are breaking the moonlighting rules is not a feeling or hearsay. If you have a duty to report in your contract and fail to do so you may be endangering your own career.
 
twospadz said:
At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
Click to expand...


I suppose if it makes you feel better you could rat the guy out. But first, make sure you report everyone for having drinks out in the open at the nursing station, wearing scrubs outside the hospital or not e-signing their charts on time. That's stuff administration might get hot and bothered enough about to send off a passive aggressive group email, give someone the stink eye in the hallway, or to take the penultimate, draconian measure of calling someone "not a team player."
 
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Birdstrike said:
When I did residency may of us had moonlighting jobs, I had two, and I don't think a single person cleared it with their program director. It seemed to be an unwritten rule that as long as the program director didn't know about it, he didn't care. On the other hand, I can't imagine, nor have I ever hear of anyone getting punished for getting caught doing this. I mean, what the hell are they going to do, kick you out of the program for being too hard of a worker?
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From what I've seen the culture of everyone moonlighting and breaking moonlighting rules seems to be nearly universal in ER, and pretty common, though very program dependent,, in family medicine. In most other kinds of residencies moonlighting seems to be much rarer, and the moonlighting rules are much more strictly observed.

Yes they can and do put residents on probation for breaking moonlighting rules.
 
Perrotfish said:
If you have a duty to report in your contract and fail to do so you may be endangering your own career.
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Unless the OP is working in 1960s East Germany, I don't think they should worry about repercussions for failure to report moonlighting violations. Employers have mandatory reporting language, but they are generally used for things like people committing fraud, theft or substance abuse issues. And unless it's an institutional policy (as opposed to a rule within the program which generally these things are), it's irrelevant.

Confronting the person first remains the professional thing to do. Yes, they may lie or tell you they'll stop. But for something like this it's the right thing to do to give them an opportunity to correct their own actions. If it continues to happen and it's negatively impacting patients or the residency program, then yes, talking to the PD may be appropriate.

Medicine is a small world. In the end, being the person with a reputation for tattling at the slightest infraction is going to impact your career more than not reporting moonlighting violations. If you don't believe that, consider solo private practice.
 
Birdstrike said:
Lemonade stands are illegal in 36 states without a permit. Now that you know this, you must act.
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I get moonlighting wasn't a big deal for you. Honestly it shouldn't have been. ER residents work much less than most other kinds of resident. When they throw another shift or two onto their week they're still barely working more than a full time job. That's not endangering patients. For many residencies, though, moonlighting means adding hours on top of an 80 hour week that's really 100 hours, and the only way they're adding another shift on top of those hours is to take it out of sleep. No that's not remotely safe. Things that aren't safe need to get addressed, and yes a PD will and should put you on probation for endangering patients.

If you saw another doctor drunk you would (I hope) report him. No keep your mouth shut, not have a heart to heart, you would get the administration involved that second. For some residencies moonlighting is just as bad. Use some judgement. If you just did the same rotation the moonlighter is on and you had 4 hours/night to play fortnite then keep your mouth shut. On the other hand if you spent the rotation so sleep deprived you were falling asleep at the wheel then moonlighting is an issue you need to address.
 
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FutureInternist said:
Moonlighting and not having enough sleep can affect pt care.
Sure some folks may not have any manifestations, while others fall asleep on the way home from a shift, so its better to have a blanket rule that protects everyone.

We will perhaps agree to disagree 🙂
Click to expand...

And if he's showing manifestations that would affect his or patients' safety then go ahead and say something. I think majority of us are taking issue with reporting a guy based on third hand info for an administrative issue and not something illegal. Many other places allow moonlighting during the week as long as we stay in ACGME work hour restrictions. He never said he was exceeding work hours (though he could be, don't know) but that he was moonlighting during the week. Maybe like me he found an opportunity that allowed him to moonlight nights but with minimal interruption and thus didn't affect his ability to function during the day. There's been MANY more nights where I was interrupted by my kids where I was exhausted the next day at work.
 
nlax30 said:
And if he's showing manifestations that would affect his or patients' safety then go ahead and say something. I think majority of us are taking issue with reporting a guy based on third hand info for an administrative issue and not something illegal. Many other places allow moonlighting during the week as long as we stay in ACGME work hour restrictions. He never said he was exceeding work hours (though he could be, don't know) but that he was moonlighting during the week. Maybe like me he found an opportunity that allowed him to moonlight nights but with minimal interruption and thus didn't affect his ability to function during the day. There's been MANY more nights where I was interrupted by my kids where I was exhausted the next day at work.
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Exactly.

Plus its Psych. The categorical psych residents at my hospital virtually all moonlight 3rd year on, because actual weekly work hours are 50-60 hrs. You can easily work 1-2 nights a week and still be in a state better than residents in other specialities.
 
Perrotfish said:
Disagree with this. If you think someone is a danger to patients you report them to the administration. If they're a danger to patients they need monitoring to make sure the problem gets and stays resolved, and the program administration is set up to do that in a way that a random coresident isn't. Also if you know they're lying to the PD, and you confront them about it, what are the odds that they don't just start lying to you as well? If its worth doing something at all its worth involving the PD.




Depends entirely on your employer and your contract. Unless you are in the military you are not legally obligated to report someone breaking the rules, but you may or may not be contractually obligated to do so. You never need to report a feeling, and probably don't need to report hearsay, but overhearing a statement from a coresident that they are breaking the moonlighting rules is not a feeling or hearsay. If you have a duty to report in your contract and fail to do so you may be endangering your own career.
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He overheard another resident talk about the resident in question...that is the definition of hearsay.
 
rokshana said:
He overheard another resident talk about the resident in question...that is the definition of hearsay.
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I think I read it differently, I thought he overheard a conversation between two other people but heard it directly from the moonlighting resident. You're right that if he heard it from a different resident then its hearsay.
 
Perrotfish said:
I think I read it differently, I thought he overheard a conversation between two other people but heard it directly from the moonlighting resident. You're right that if he heard it from a different resident then its hearsay.
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I think you did:

twospadz said:
At our program, residents can moonlight with the permission of the program director. My co-resident has been working at a hospital moonlighting. The resident shared with a different resident that he received permission from our program director but is working nights during the week which is forbidden. After finding out this information, what should I do? Should I speak to the program director about this? And what would the consequences if he was caught by our program director? Ive never told on anyone before but I feel this can be detrimental to patient safety.
Click to expand...

The OP finding out the resident in question got permission is definitely 2nd hand. He/she doesn't say how they know that said resident is moonlighting at night so its possible that OP heard that straight from the horse's mouth.

Either way, unless OP was witnessed that resident performing badly they should stay out of it.
 
I am surprised to see the responses here!

Im sure there is a high probability that the offending resident does not make a major mistake (esp Psych). But what if tomorrow, he does make a mistake that could be even remotely attributable to his lack of sleep/attention etc. And that mistake caused a major disability, or worse, in a patient. How would the OP feel about that? In medicine, the stakes are so high, you can't "wait for him to make a mistake and then report".

Second, excessive moonlighting as a resident takes away from thinking, reading, learning and research time and energy. Which could affect the quality of his education and hence patient care in future.

I personally would write an anonymous letter to the resident in question and express your concerns and recommend following the rules. If he still doesn't then you could consider talking to PD, anonymously.
 
this thread should have ended a while ago. You should mind your own business.

/thread
 
deathmerchant said:
I am surprised to see the responses here!

Im sure there is a high probability that the offending resident does not make a major mistake (esp Psych). But what if tomorrow, he does make a mistake that could be even remotely attributable to his lack of sleep/attention etc. And that mistake caused a major disability, or worse, in a patient. How would the OP feel about that? In medicine, the stakes are so high, you can't "wait for him to make a mistake and then report".

Second, excessive moonlighting as a resident takes away from thinking, reading, learning and research time and energy. Which could affect the quality of his education and hence patient care in future.

I personally would write an anonymous letter to the resident in question and express your concerns and recommend following the rules. If he still doesn't then you could consider talking to PD, anonymously.
Click to expand...

In my opinion you're assuming there's "probable cause" to assume that he's going to make a mistake. If he's doing something illegal, drugs, abusing etoh, etc then yea there's probable cause/reasonable suspicion (whatever term you want to use) that he's going to harm someone. This is not illegal. This is something that MANY residents and fellows do around the country and IMHO certainly not something that raises to a level of where I’d assume he’s going to harm someone. Hell, this is going to be all of us as attendings to some degree.... working nights/taking call and expected to work the next day. Whether or not we SHOULD be doing that is a completely different philosophical argument but not something where you have a duty to inform the program that he is going against some arbitrary administrative decision.

I’m sure they also have patient caps, if he’s admits an extra patient or two over his cap would you report that as well?
 
deathmerchant said:
I am surprised to see the responses here!

Im sure there is a high probability that the offending resident does not make a major mistake (esp Psych). But what if tomorrow, he does make a mistake that could be even remotely attributable to his lack of sleep/attention etc. And that mistake caused a major disability, or worse, in a patient. How would the OP feel about that? In medicine, the stakes are so high, you can't "wait for him to make a mistake and then report".

Second, excessive moonlighting as a resident takes away from thinking, reading, learning and research time and energy. Which could affect the quality of his education and hence patient care in future.

I personally would write an anonymous letter to the resident in question and express your concerns and recommend following the rules. If he still doesn't then you could consider talking to PD, anonymously.
Click to expand...
The same could be said of anyone in training, period...yet we don’t keep say, July 1st interns, from seeing pts because they may make a mistake.

Also the OP doesn’t know if the other resident is truly breaking any rules...he hasn’t gotten the information from the moonlighting resident.

At most, he could say something to his chief, but he needs to know that saying something could have blowback...
 
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