Duty hour violation? Please help

[letoilenoire]

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So I am in a low risk specialty for duty hour violations. The residents in my program each have to cover one holiday and we are only on call a few months out of the year. Two people are on call each month. I am on call this month, and the other person on call with me had new years eve as their holiday coverage. They had to cover sat, sun, mon, and today like they were weekend days (see pts at two hospitals). The weekdays are easier as we just cover call at home at night until the morning after we leave work.
There are four weekends in January.Since my coworker already did four days that were like weekends he is convinced for some reason that our weekend like days should be equal. So this means the coworker wants me to cover three of these weekends while they only cover one. Which means starting tomorrow, the 2nd-31st I will have only two days free of duty.I tried explaining that I think this violates the 1 in 7 days off we have to average over a four week period but he brushed it off and continued to tell me it's not fair to him if we split the remaining weekends evenly. (Since these past four days he's worked for the holiday coverage he got assigned were like weekend days).
I don't know, I can see his point of view and usually I would be willing to help, but two days off in 30 days sounds severe to me and not something that I'm going to be happy about. Also, since no one has to approve this schedule (it is up to the two resdients on call per month to split their call) I feel in a hard place to run it by someone asking about duty hours. He is insisting that it is legal and nothing will come of it unless I make a big deal over it. I also tried expressing my concern over working a stretch like that with two days off and he doesn't seem to care since he had to cover four days for the holidays and that's all he keeps saying.
Any advice on how to handle this?

 

[Law2Doc]

So I am in a low risk specialty for duty hour violations. The residents in my program each have to cover one holiday and we are only on call a few months out of the year. Two people are on call each month. I am on call this month, and the other person on call with me had new years eve as their holiday coverage. They had to cover sat, sun, mon, and today like they were weekend days (see pts at two hospitals). The weekdays are easier as we just cover call at home at night until the morning after we leave work.
There are four weekends in January.Since my coworker already did four days that were like weekends he is convinced for some reason that our weekend like days should be equal. So this means the coworker wants me to cover three of these weekends while they only cover one. Which means starting tomorrow, the 2nd-31st I will have only two days free of duty.I tried explaining that I think this violates the 1 in 7 days off we have to average over a four week period but he brushed it off and continued to tell me it's not fair to him if we split the remaining weekends evenly. (Since these past four days he's worked for the holiday coverage he got assigned were like weekend days).
I don't know, I can see his point of view and usually I would be willing to help, but two days off in 30 days sounds severe to me and not something that I'm going to be happy about. Also, since no one has to approves this schedule (it is up to the two resdients on call per month to split their call) I feel in a hard place to run it by someone asking about duty hours. He is insisting that it is legal and nothing will come of it unless I make a big deal over it. I also tried expressing my concern over working a stretch like that with two days off and he doesn't seem to care since he had to cover four days for the holidays and that's all he keeps saying.
Any advice on how to handle this?

It does sound like it's a duty hour violation, and if you really wanted to make a big deal about it, you could raise the point with the PD or worse. That being said, you have to look at the big picture in deciding how wise it is to play whistleblower.

 

[deleted480308]

Weigh this carefully, pyrrhic victories aren't always worth it

 

[Samoa]

Really, it's your fellow resident's victory that's Pyrrhic if your program ends up violating ACGME rules to accommodate his viewpoint on holiday/weekend coverage.

I think you should just say, this puts me in violation of ACGME rules, so we need to get permission from our PD. at which point, either your co-resident will back down, or the PD will say no. Or you'll have to lie. Or your program will get in trouble.

Those are your options. They all have unpleasant repercussions, so pick your poison.

 

[letoilenoire]

Really, it's your fellow resident's victory that's Pyrrhic if your program ends up violating ACGME rules to accommodate his viewpoint on holiday/weekend coverage.

I think you should just say, this puts me in violation of ACGME rules, so we need to get permission from our PD. at which point, either your co-resident will back down, or the PD will say no. Or you'll have to lie. Or your program will get in trouble.

Those are your options. They all have unpleasant repercussions, so pick your poison.

Thanks everyone. I agree with the above. I pretty much know this would be considered a violation and my program does not encourage breaking duty hours and "hiding" it. So lying or my program getting in trouble aren't options. I'm just going to run the schedule by the chief resident and say "look this is what's going on. I'm trying to help him out since he covered all those days for the holiday but it results in me only having these two days off in that four week period. Can you check if it's a violation because I don't want to get our program in trouble."

If it's not a violation I'll suck it up and do it, but that coresident will not be the same in my eyes. We have our inservice coming up and some of this is obviously due to wanting more time to study on the weekends this month. By doing what he wants I am getting pretty screwed over. If it is a violation well then my dilemma is solved, because I'm not doing anything that is going to get my program in trouble on my part. He will just have to be upset that i'm following the rules.

Also, correct me if I'm wrong in my sentiments but I figure if you are on a holiday call in a month, you should expect to be doing more "weekend" type calls than the person sharing the month with you. You shouldn't expect it to be equal in that case.

 

[dpmd]

The way I understand the 1 in 7 rule is that it applies for a certain 4 week period of time. At my program we have 4 week rotations and that was the 4 week period we used to stay in compliance. For example, if you have the first two weekends of one rotation off and the last two weekends of the next rotation off there is technically a 4 week period of time where you have no day off. Despite having anyone who worked like this logging accurately, it never came up as a violation so my guess is that it is a reasonable way to work things. With that in mind, what are the dates of your rotation? If it is like ours, both holidays are included (rotation ends next week if I remember correctly) so with only two people on for call at a time it would work out for one to work christmas and one to work new year's. If that happened and now they are looking to work less, then they are being a d*ck. If it is calendar months, then your co resident only worked one "extra day" (today) for this rotation and there wouldn't be a way to pay it back anyway (unless you are able to get a weekday off instead of a weekend day, but then you would be the one working an "extra day").

 

[Doctor Bagel]

Thanks everyone. I agree with the above. I pretty much know this would be considered a violation and my program does not encourage breaking duty hours and "hiding" it. So lying or my program getting in trouble aren't options. I'm just going to run the schedule by the chief resident and say "look this is what's going on. I'm trying to help him out since he covered all those days for the holiday but it results in me only having these two days off in that four week period. Can you check if it's a violation because I don't want to get our program in trouble."

If it's not a violation I'll suck it up and do it, but that coresident will not be the same in my eyes. We have our inservice coming up and some of this is obviously due to wanting more time to study on the weekends this month. By doing what he wants I am getting pretty screwed over. If it is a violation well then my dilemma is solved, because I'm not doing anything that is going to get my program in trouble on my part. He will just have to be upset that i'm following the rules.

Also, correct me if I'm wrong in my sentiments but I figure if you are on a holiday call in a month, you should expect to be doing more "weekend" type calls than the person sharing the month with you. You shouldn't expect it to be equal in that case.

Yeah, I'd definitely run this by someone else, and I honestly don't think it's right of this guy to ask you to only get 2 days in a month regardless of how many days he had to cover for holiday coverage. We've all had to do that stuff, so it balances out anyway. The good thing is I don't see how his request would not be a duty hours violation, so I think you're in the clear with your excuse. Honestly, just saying no would be OK, too -- you've got inservice exams coming up, too, and 2 days off in 30 days is a long haul.

 

[Winged Scapula]

If you hadn't told us you were in a "low risk specialty for duty hours violations" I would have assumed by your fellow resident's behavior, that you were in a surgery program.

As DoctorBagel notes, we've all had to do it at some point and felt we were getting screwed, but he needs to suck it up because in the end it all somehow balances out.

I think your best option is to do exactly as you've described: tell him that you don't want the program to get into trouble and take the schedule to the PD and say, "gee I want to help Resident X out, but this looks like it would be a duty hours issue and I don't want us to get in trouble. Can you take a look at it with me/us?"

Your colleague will learn that behaving like this just doesn't help him as you've noted, you will never look at him the same way again and are probably less likely to want to help him, given that he appears to have no qualms in shafting you.

Maybe you'll get lucky and he'll read this and see he's being an ******* about it. Perhaps you could leave your laptop open with this page pulled up. 😀

 

[shopsteward]

Has your co-resident been trained in high-pressure sales techniques? He's certainly doing a good job on you.

The main responsibility here is on you to step up to the plate and say "No." The best way to say "No" is to say "No" and not a thing more - it doesn't give the person asking any way to start an argument about the issue without looking like a dick.

In this case, "No" hasn't worked, because you have allowed yourself to be drawn back into the discussion. But you have a clincher to add, which is "If I agreed I would be in violation of my duty hours, and I'm not going to do that." Once you have said that, you need to shut down any further attempts on his part to discuss the issue, by refusing to listen to any further points he may want to make. As long as you keep not agreeing, at some point the time for making the swap will expire and he will have to give up.

Learning to say "No" is an important part of any professional life. If you have a good reason to say no, and someone either doesn't accept it or is rude about it, that is there problem, not yours. Don't allow anyone to make it your problem.

 

[NotAProgDirector]

I am a bit confused by the whole story.

Your co-resident covered for the New Year's holiday. Each resident is assigned one holiday to cover. That's an extra call that everyone needs to take, to make the schedule work. So, this month he'll cover two weekends, plus his extra holiday. Meanwhile, whatever holiday you need to cover, you'll work those days as extra days.

So, I don't see that he should get any additional weekends off this month. His extra holiday shift is just that -- an extra shift, that's split amongst everyone equally.

Or, am I misreading the picture here?

 

[Winged Scapula]

I am a bit confused by the whole story.

Your co-resident covered for the New Year's holiday. Each resident is assigned one holiday to cover. That's an extra call that everyone needs to take, to make the schedule work. So, this month he'll cover two weekends, plus his extra holiday. Meanwhile, whatever holiday you need to cover, you'll work those days as extra days.

So, I don't see that he should get any additional weekends off this month. His extra holiday shift is just that -- an extra shift, that's split amongst everyone equally.

Or, am I misreading the picture here?

No, you're reading it correctly.

The other resident simply wants more time off because he feels he has already done enough call for the month of January. He doesn't see the "big picture" that everyone has to work a holiday at some point in time, and that it all evens out.

 

[letoilenoire]

I am a bit confused by the whole story.

Your co-resident covered for the New Year's holiday. Each resident is assigned one holiday to cover. That's an extra call that everyone needs to take, to make the schedule work. So, this month he'll cover two weekends, plus his extra holiday. Meanwhile, whatever holiday you need to cover, you'll work those days as extra days.

So, I don't see that he should get any additional weekends off this month. His extra holiday shift is just that -- an extra shift, that's split amongst everyone equally.

Or, am I misreading the picture here?

No, you've got it dead on. For example, later this year I have a holiday coverage that will also occur before the month starts, resulting in me doing three "weekend like" days. That month also has four weekends(in addition to my holiday). You can bet your salary that whoever is on that month with me will not be happy if I inform them "since this is what happened to me, you now have to work three weekends this month with only one weekend off. Have fun." Yea right. I wouldn't do that anyway. Because as you all have said the point of covering the holiday is that it's your assignment and for that one month you will end up doing more.I totally missed that when I was discussing it with him. We all end up doing it at some point. He's mad because his holiday ends up being 4 coverage days instead of 3 and he's freaking out thinking everyone is ahead of him studying for inservice. Mind you this person took a 10 day vacation in December as well.

Yep. I'm running this by the chief. And to whoever above asked if this person had been trained in sales, it sure seems like it as I think about it more. I really do need to learn the skill of saying no. It's hard because the program is small and I really don't want to burn bridges working with someone in such close proximity for years to come.

 

[gutonc]

Was the schedule made up in advance for the month by someone else (chief or PD)? If so, that's the schedule and homeboy can suck it and do his damn job or quit. His call.

If you two had to come up with the coverage schedule yourself at the beginning of the month and you somehow agreed to this plan...you can bitch about it all you want but it's your fault and in the grand scheme of things this is probably not worth causing a huge stink over.

If it's somewhere in the middle there (the schedule was made up by someone else and your "colleague" is pressuring you into cover one of his weekends because it's "not fair") then it's definitely time to bring it to the chief and/or PD. (Also...refer to "homeboy can suck it" as above.)

 

[NotAProgDirector]

There is usually someone like this in every program.

There's no reason for you to cover one of their weekends because they are on for the holiday.

If you really want to take the high road, you can offer to swap a weekend -- you'll work three this month, and they will work one of your weekends in the future. If you go that route, one big piece of advice -- choose which weekend it will be right now. Don't leave it as "some weekend in the future to be determined". You'll discover that they will never pay you back -- it will always be inconvenient, there's something else I need to do, etc.

 

[Doctor Bagel]

I really do need to learn the skill of saying no. It's hard because the program is small and I really don't want to burn bridges working with someone in such close proximity for years to come.

My guess is that this person has tried to pull stuff like this on other people before, so I wouldn't worry too much about what other people in the program think about you.

 

[shopsteward]

I really do need to learn the skill of saying no. It's hard because the program is small and I really don't want to burn bridges working with someone in such close proximity for years to come.

I strongly suspect that you are wrong in thinking that by saying no you might be burning bridges. Your fellow resident is very probably the kind of man who, once he hears "no", will just move straight on to the next favour he wants someone to do for him.

At a guess, he hits on every woman (and/or man, not to be heteronormative about it) he comes across and doesn't mind all the ones who say no because enough will say yes.

 

[cheruka]

I strongly suspect that you are wrong in thinking that by saying no you might be burning bridges. Your fellow resident is very probably the kind of man who, once he hears "no", will just move straight on to the next favour he wants someone to do for him.

At a guess, he hits on every woman (and/or man, not to be heteronormative about it) he comes across and doesn't mind all the ones who say no because enough will say yes.

I am not a resident yet, but this is really funny. I do know people like this do exist 😀

 

[letoilenoire]

So I told the chief about the situation and she agreed that it is part of the other resident's holiday coverage and I'm not responsible to make it even. So I did bring it up to my coresident that I'm not comfortable with only two days off from Jan2-Feb2. He kinda flipped out on me. Made a lot of passive aggressive insults towards me. For example, "oh fine if you really need to make a big deal out of one day." "Oh well I'll do it because I can do it and not complain, if you do it you'll go into work complaining about not studying because you were working" . I told him we should talk with the chief resident because I didn't like the way our conversation went and he said "I refuse to talk about this anymore. Nothing the chief says is going to change the way I feel." He also brought up the fact that I took vacation near the end of december and used it to study so I should be more willing to help him. He also refused to split one of the middle weekends, telling me he would do whatever day he wanted since he was COMPROMISING FOR ME.
I'm disappointed. I am happy I stood up for myself but honestly it wasn't likely worth it for one day. On the other hand I did explain to my chief that I thought the schedule as it was was going to break duty hours so the chief said it will be looked into and also brought to my co-residents attention if it was. That way if it's not even legal he shouldn't hold a grudge. Guess that bridge is unfortunately burned. Who acts like this?

 

[Winged Scapula]

So I told the chief about the situation and she agreed that it is part of the other resident's holiday coverage and I'm not responsible to make it even. So I did bring it up to my coresident that I'm not comfortable with only two days off from Jan2-Feb2. He kinda flipped out on me. Made a lot of passive aggressive insults towards me. For example, "oh fine if you really need to make a big deal out of one day." "Oh well I'll do it because I can do it and not complain, if you do it you'll go into work complaining about not studying because you were working" . I told him we should talk with the chief resident because I didn't like the way our conversation went and he said "I refuse to talk about this anymore. Nothing the chief says is going to change the way I feel." He also brought up the fact that I took vacation near the end of december and used it to study so I should be more willing to help him. He also refused to split one of the middle weekends, telling me he would do whatever day he wanted since he was COMPROMISING FOR ME.
I'm disappointed. I am happy I stood up for myself but honestly it wasn't likely worth it for one day. On the other hand I did explain to my chief that I thought the schedule as it was was going to break duty hours so the chief said it will be looked into and also brought to my co-residents attention if it was. That way if it's not even legal he shouldn't hold a grudge. Guess that bridge is unfortunately burned. Who acts like this?

Spoiled children, that's who.

Seriously, I'm sorry it didn't go as well as you expected but you did the right thing. Had you let this one go, he would have continued to take advantage. He has no right to dictate the call schedule.

 

[P Diddy]

So I told the chief about the situation and she agreed that it is part of the other resident's holiday coverage and I'm not responsible to make it even. So I did bring it up to my coresident that I'm not comfortable with only two days off from Jan2-Feb2. He kinda flipped out on me. Made a lot of passive aggressive insults towards me. For example, "oh fine if you really need to make a big deal out of one day." "Oh well I'll do it because I can do it and not complain, if you do it you'll go into work complaining about not studying because you were working" . I told him we should talk with the chief resident because I didn't like the way our conversation went and he said "I refuse to talk about this anymore. Nothing the chief says is going to change the way I feel." He also brought up the fact that I took vacation near the end of december and used it to study so I should be more willing to help him. He also refused to split one of the middle weekends, telling me he would do whatever day he wanted since he was COMPROMISING FOR ME.
I'm disappointed. I am happy I stood up for myself but honestly it wasn't likely worth it for one day. On the other hand I did explain to my chief that I thought the schedule as it was was going to break duty hours so the chief said it will be looked into and also brought to my co-residents attention if it was. That way if it's not even legal he shouldn't hold a grudge. Guess that bridge is unfortunately burned. Who acts like this?

Stop being a baby. You did the right thing, no need to pule and whine about it. If you are so averse to confrontation and its repercussions, you should have done the extra weekend and continued as the doormat of your residency.

p diddy

 

[GoSpursGo]

So I told the chief about the situation and she agreed that it is part of the other resident's holiday coverage and I'm not responsible to make it even. So I did bring it up to my coresident that I'm not comfortable with only two days off from Jan2-Feb2. He kinda flipped out on me. Made a lot of passive aggressive insults towards me. For example, "oh fine if you really need to make a big deal out of one day." "Oh well I'll do it because I can do it and not complain, if you do it you'll go into work complaining about not studying because you were working" . I told him we should talk with the chief resident because I didn't like the way our conversation went and he said "I refuse to talk about this anymore. Nothing the chief says is going to change the way I feel." He also brought up the fact that I took vacation near the end of december and used it to study so I should be more willing to help him. He also refused to split one of the middle weekends, telling me he would do whatever day he wanted since he was COMPROMISING FOR ME.
I'm disappointed. I am happy I stood up for myself but honestly it wasn't likely worth it for one day. On the other hand I did explain to my chief that I thought the schedule as it was was going to break duty hours so the chief said it will be looked into and also brought to my co-residents attention if it was. That way if it's not even legal he shouldn't hold a grudge. Guess that bridge is unfortunately burned. Who acts like this?

As others have said, there's no reason to feel sorry about it. He was trying to make you feel bad to steal an extra weekend off, which he had no business doing--this was his turn, you'll have yours later, and anyone who tries to justify getting extra time off on this basis is either a ***** for not understanding this simple and obvious concept, or a sleazeball. You're better off with that bridge being burned, as it's clear he was only going to try and use it to get whatever he could out of you without giving you anything in return.

 

[VMSmith]

Who acts like this?

Someone who is used to people doing what he wants them to do. That's not really going to work for him anymore.

Good for you for standing up to him. Don't let him make you feel bad about it - you're not the one who burned that bridge. I'm sure he's going to burn many more bridges before he's done with residency, if he even finishes.

 

[dpmd]

Did you agree to work two and a half weekends instead of the three he wanted? You also never addressed the questions I brought up about the rotation dates and how it affects what he is asking for.

You shouldn't have phrased it that you weren't comfortable with only having two days off. You should have stated you couldn't do it the way he wanted because it would violate duty hours unless you got weekdays off instead. Then both of you could have gone to the chief together (who then would have told your co-resident to suck it up). Doesn't sound like you actually stood up for yourself as much as you made it sound like he was justified in what he was asking for but you just couldn't handle it.

 

[shopsteward]

Seems to me that the other resident has now gone further than just making a cheeky request for a favour and is tipping over into being a bully.

OP: you don't have listen to this stuff, so if your co-resident starts in on you, just say that and walk away. Now you know how he operates, try to shut down any conversation along these lines before it even starts.

Also,, be aware that bullies work by first creating a previously non-existing weakness and then exploiting it. Everything he has said is about guilt-tripping you into thinking you are in the wrong on this, so that he will have the upper hand in any future negotiations between you. Don't let him - you are in the right. He is very likely to try to same tactics on you again at some point, so I am afraid you need to be aware of that, and not let yourself get drawn into it.

 

[45408]

Sounds to me like he was being a jerk and was trying to get more days off than he deserved. Now he's just being passive-aggressive, bordering on straight-up aggressive. There is NO reason for you to feel bad or to take those shifts for him. We all have to work some holidays. It would have been perfectly fair to tell him, "I'm working two weekends, and you're working two weekends, because that's how we always do it. You had to work this holiday, and I had to work x&y holiday."

 

[Perrotfish]

He also brought up the fact that I took vacation near the end of december and used it to study so I should be more willing to help him. He also refused to split one of the middle weekends, telling me he would do whatever day he wanted since he was COMPROMISING FOR ME.

In addition to agreeing with the above posts, I would probably go back to the chief for this as well. Don't let this guy bully you into anything. If he's too immature to split the shifts fairly then let the chief know and have him/her assign your days off.

 

[Samoa]

After reading how your fellow resident responded, it's clear he thought you were an easy target, and was trying to take advantage of you. And he's not entirely wrong. You ARE an easy target. Still, you partly stood up for yourself, and that's better than nothing. You'd have done better not even to concede that his schedule was unfair--which is what you've done by saying 'I'm uncomfortable..." rather than "I think this would be a duty hour violation for me..." The former implies that you can be persuaded (or bullied) while the second is a matter of fact-finding, and he knows as well as you do that the facts are in your favor.

 

[dantt]

1

 

[Cali2]

I would say holiday coverage doesn't count at all as far as splitting up weekends and your co-resident is unreasonable if he pushes you on this.

Presumably you are covering someone else on holiday time off another time and this will all even out.

But as others have said, if this is a small program, be sure that getting those two days off back (that I think you're being cheated out of here) is worth the bad blood a big dispute over this would bring. Plus, with such a small program, I'm sure you'll have a chance at some point to make similar claim in your favor while working with this same co-resident.

Edit: posted before reaching end of thread. Glad you took this to the chief. Your co-resident needs to grow up.

 

[Dral]

Holiday coverage sucks. We all have to do it at some point. The person needs to suck it up.

 

[mimelim]

Holiday coverage sucks. We all have to do it at some point. The person needs to suck it up.

I worked Christmas and New Years this year. I know we are short handed, but if this happens again next year I'm going to be pretty pissed.

 

[cpants]

Sounds like you handled it pretty well. Generally your seniors/chiefs can pretty much dictate your schedule, but the ACGME rules are set in stone. You must have 4 calendar days off in 28, period. If you aren't assigned four days off, it's your responsibility to make sure that happens, and if it doesn't you are going to get at least half of the blame when the hammer falls...which it will.

If it were me, I think I would just tell him that the schedule doesn't comply with ACGME rules, and that he better fix it. If he refuses, tell him you are bringing it to the PD if he doesn't. Every PD in the country would have your back if you brought that to them, and believe me this guy knows that. Lying about your duty hours on a noncompliant schedule is a horrible idea. This stuff gets audited by ACGME, and if you get caught lying, you will have a lot more to worry about then a pissed senior.

 

[Bobblehead]

Look on the bright side, you'll never be asked to be a peer reviewer for his clinical performance in the future and after residency you'll never hear from him again.