Fired/dismissed from residency program in 51st week

[Apollyon]

It's your own fault. You come across as a cold-hearted, nonsensical SOB. And, I just graduated from a general surgery residency. So don't preach to me about cross coverage. We made it work, usually. It's takes a team effort and honesty. Why don't YOU cut the nonsense.

Just be careful - some people on SDN stifle conversation by constantly reporting people if s/he thinks that the TOS has been violated (and that ain't me - I haven't reported a post in any regard in over a year; spam, ads, and everything else I just let fly).

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[wine is good]

Just be careful - some people on SDN stifle conversation by constantly reporting people if s/he thinks that the TOS has been violated (and that ain't me - I haven't reported a post in any regard in over a year; spam, ads, and everything else I just let fly).

You are correct.

 

[Doctor4Life1769]

Incorrect. Because of the decreased hours of interns, it now takes 3 interns to do the work that 2 used to be able to do. Most programs didn't get a 50% increase in GME or hospital funding to make up for this, so they're having to stretch the same number of people over 50% more work hours (at least for interns).

So while the raw numbers you quote are correct, way more interns will be pushing 80 hours every single week and there won't be anybody to pick up the slack.

That said, not allowing sick days is total bullsh**.

It takes a team effort, nonetheless. The others would have to be a tad more efficient when it comes to covering and seeing patients within their hour limits.

Hell. 4th of July week/weekend... A LOT of upper levels are out (taking their vacay this week) and it just meant we all had to pitch in and work harder and more efficiently. Is this fair to dump all this on newly minted interns? No. However, we're still plugging through. The chiefs are also helping out with some scut and are keeping close watch of the hours, too. They will scold interns if they don't follow the new rules, as well.

 

[ShyRem]

Wow. At my program we're not allowed to take vacation in July BECAUSE there are new interns. No vacation allowed in June because the third year folks reserve the vacation that month to move for fellowship or jobs. (we do, however, have sick days allowed, days off for boards, days off for interviews, vacations, and if you're on an elective you might get the holiday off unless you're cross-covering.)

Tells you the variation out there.

 

[Buzz Me]

Wow. At my program we're not allowed to take vacation in July BECAUSE there are new interns. No vacation allowed in June because the third year folks reserve the vacation that month to move for fellowship or jobs. (we do, however, have sick days allowed, days off for boards, days off for interviews, vacations, and if you're on an elective you might get the holiday off unless you're cross-covering.)

Tells you the variation out there.

Agreed. Here the two days you use to take Step 3 count as two of your four days off that month.

We also can't request a vacation week in either June or July. You're only allowed a day off for an interview if you can get the necessary rounding/clinic/cases covered. No "holidays" since we don't really have electives.

 

[Doctor Bagel]

Jeez, you guys are making me love my life. We get sick days (and in fact are actually encouraged to use them) and days off for Step 3 that don't count against our days off in a month. We also have back up call and then jeopardy after that, so there are two layers of coverage in case something happens.

One of my fellow residents called in backup because she saw her cat die. Totally acceptable to everyone. I went to work with a nasty URI one day, and my attending basically sent me home. I actually took another sick day once last year, and my attending (another attending) wrote me an email telling me to take care of myself and that they would cover everything.

Even in our more hard core off service rotations (internal medicine), we're encouraged to use their jeopardy system is we're sick. Maybe the surgery folks here show up even when they're getting an IV infusion.

On another note, wine is good and other peeps, you could just ignore Law2Doc if his authoritarian ideas bug you. Oh wait, you can't because he's a mod. Bummer.

 

[Winged Scapula]

Perhaps it should be noted that at least in my programs, while we had no sick days, if you showed up and were clearly too sick to work, most Chiefs would send you home. So it wasn't totally inhumane.

But I agree with ShyRem and Buzz...never heard of being allowed to take vacation in July. We were not allowed to take time in June, July, December or the week before our ITE.

 

[Apollyon]

Oh wait, you can't because he's a mod. Bummer.

Not anymore - s/he is "emeritus", as you are. Maybe that's why his/her colleagues aren't running en masse to back him/her up.

 

[tkim]

One of my fellow residents called in backup because she saw her cat die.

I'm having trouble with this one. Perhaps it's because I'm a dog guy.

 

[smq123]

Getting kind of heated in here. But if you find someone else's viewpoint so unpalatable that it really irks you to read his/her posts, you can put them on ignore...and that includes emeritus moderators.

One of my fellow residents called in backup because she saw her cat die.

When you say that she "saw her cat die," does that mean she was actually standing there when it was hit by a car/mauled by a raccoon/stoned by some kids who are psychopaths-in-training? Because, yeah, that'd be pretty traumatic.

 

[Law2Doc]

It's your own fault. You come across as a cold-hearted, nonsensical SOB. And, I just graduated from a general surgery residency. So don't preach to me about cross coverage. We made it work, usually. It's takes a team effort and honesty. Why don't YOU cut the nonsense.

I was talking about comments to several posters in addition to myself. see eg post 153 in this thread.

 

[Law2Doc]

What are you talking about?

The 80 hour limit is an average over 4 weeks.

As long as you've not gone > 320 hours in that timeframe, you're fine.

Your argument fails in so many ways. Not allowing a genuinely sick resident off and instead forcing them to do scut or take consult pages? Really?

Again, it's not "my argument". I'm telling you how a lot of residencies are actually run. You don't get sick days. They don't have folks to cover you if you are out. Not my argument just the way it works. The 80 hour comment is only a good one it residents in certain programs aren't coming close to to 320 hours each month. In certain specialties they are. If someone is averaging close to the 80 hour mark EVERY week, as certain specialties regularly do, then they can not be asked to pick up another shift. So you compound the problem by playing with duty hours. In the olden days, a person could ramp up his hours to cover for someone else. But if he's already at 80 for the week pretty much every week, he can't. You are acting like there are no residency programs where folks aren't within spitting distance of that 320 hour mark most months. Some are. Some places do things like 6 days in a row of 13 hour night float shifts for a month, and if you can get out of there in 13 hours without a code or something throwing you above x80 hours for the week, you are lucky. Some programs don't have elective time. And we've all seen plenty of stories on SDN of folks faking time cards to stay within the duty hours. It happens. So does no sick days.

 

[142348]

Again, it's not "my argument". I'm telling you how a lot of residencies are actually run. You don't get sick days. They don't have folks to cover you if you are out. Not my argument just the way it works. The 80 hour comment is only a good one it residents in certain programs aren't coming close to to 320 hours each month. In certain specialties they are. If someone is averaging close to the 80 hour mark EVERY week, as certain specialties regularly do, then they can not be asked to pick up another shift. So you compound the problem by playing with duty hours. In the olden days, a person could ramp up his hours to cover for someone else. But if he's already at 80 for the week pretty much every week, he can't. You are acting like there are no residency programs where folks aren't within spitting distance of that 320 hour mark most months. Some are. Some places do things like 6 days in a row of 13 hour night float shifts for a month, and if you can get out of there in 13 hours without a code or something throwing you above x80 hours for the week, you are lucky. Some programs don't have elective time. And we've all seen plenty of stories on SDN of folks faking time cards to stay within the duty hours. It happens. So does no sick days.

You are missing the whole point of why people like myself and others made the comments about you. It's not because you noted some programs don't have sick days, because other did as well. It's comments like the one you made where you implied a sick resident too ill to manage patient care should come in and do scut (consults, pages, etc). Winged Scapula commented that even with no sick days, a chief would let a visibly sick person go home. However, It's comments like the one you made make people say the things they say about you. But you seem to be too obtuse to understand that and keep harping on the 80 hr week. Some of us have been residents longer than you and know how to manage residents work hour schedules better than you with an 80 hour work wk, new intern rules etc.. Are there programs where it's more difficult and maybe near impossible. Sure, I can believe that. But I also believe that any program that is that is on that thin a margin for labor is probably not an ideal program to train in because residents are valued more for their labor than the potential education.

 

[Neuronix]

Not anymore - s/he is "emeritus", as you are. Maybe that's why his/her colleagues aren't running en masse to back him/her up.

I take offense to that statement. We do not run to back each other up on matters of opinion--only on matters of SDN policy. I disagree with other mods with regularity.

FWIW, my internship gives 5 sick days and 3 weeks of vacation. If you have to work a holiday, you get an extra vacation day. For the med students reading this thread--choose your specialty wisely.

 

[Law2Doc]

You are missing the whole point of why people like myself and others made the comments about you. It's not because you noted some programs don't have sick days, because other did as well. It's comments like the one you made where you implied a sick resident too ill to manage patient care should come in and do scut (consults, pages, ...) ...

I am not missing the point at all. Again I didn't say a sick resident should come in and do scut. I said many programs regard this as what you should be doing when you are too sick to do patient care. None of this is my policy. None of this is my doing. It is you and several others on here who are being obtuse and blaming the messenger for the message. I didnt make these policies. Yet they exist at many places. And I suggest they are likely to be more prevalent, not less as duty hours get adjusted and residencies get closer to their cap with man hours. That's what I said. I didn't say it was my opinion that it was a good idea that everyone should suffer through sickness and put in their 80 hours, I said this is the policy at many programs. You dont like it, that's fine, but your beef isn't with me but with that model of program.

 

[Apollyon]

I take offense to that statement. We do not run to back each other up on matters of opinion--only on matters of SDN policy. I disagree with other mods with regularity.

See, though, I was just thinking about this this morning. When I think of the SDN mods that haven't "drunk the Kool-Aid", you're the first one of whom I think. The rest I'll give you by PM.

However, I shall publicly say that Neuronix is one of the good ones. Truly. He is NOT an underhanded player, and I've only see him do the right thing. I'm not saying he's perfect, but I've yet to see a misstep by him.

 

[142348]

I am not missing the point at all. Again I didn't say a sick resident should come in and do scut. I said many programs regard this as what you should be doing when you are too sick to do patient care. None of this is my policy. None of this is my doing. It is you and several others on here who are being obtuse and blaming the messenger for the message. I didnt make these policies. Yet they exist at many places. And I suggest they are likely to be more prevalent, not less as duty hours get adjusted and residencies get closer to their cap with man hours. That's what I said. I didn't say it was my opinion that it was a good idea that everyone should suffer through sickness and put in their 80 hours, I said this is the policy at many programs. You dont like it, that's fine, but your beef isn't with me but with that model of program.

Please refer to your own post #181

"In most cases you can wear a mask or gloves to minimize passing a cold onto patients. But even if that isn't adequate, you could always be in the hospital fielding pages, calling consults, doing dictations, putting in orders, and a host of other non-hands-on tasks. Additionally, in many cases the symptoms of a cold/flu come later, from your immune system, not the bug, meaning you have been passing on the bug throughout the hospital for several days already before you even feel sick. You've already exposed the patients and coworkers you see daily by that point. "

This doesn't sound like you are reiterating policies but discussing your own take on sick days. Maybe you meant it to mean something else but this comes off as your own opinion and certainly not as the messenger for programs.

 

[Law2Doc]

...
This doesn't sound like you are reiterating policies but discussing your own take on sick days. Maybe you meant it to mean something else but this comes off as your own opinion and certainly not as the messenger for programs.

I was reiterating a policy I worked under. I didn't actally express whether this was a good thing, just that this could be done (and in fact in some places is done). And yeah, I think objectively most have to concede that a mask and gloves do minimize germ spread, and that there are non-patient related tasks that exist in the hospital. Thats all you should take away from that post unless you are trying to shoot the messenger. No place did I say it was ideal for folks who were sick to have to come to work, just that it is routine at a lot of places.

 

[Doctor4Life1769]

I was reiterating a policy I worked under. I didn't actally express whether this was a good thing, just that this could be done (and in fact in some places is done). And yeah, I think objectively most have to concede that a mask and gloves do minimize germ spread, and that there are non-patient related tasks that exist in the hospital. Thats all you should take away from that post unless you are trying to shoot the messenger. No place did I say it was ideal for folks who were sick to have to come to work, just that it is routine at a lot of places.

I really think you are back-pedaling now that you've been called out. You're hiding behind the "hospital policy" line. You stated what you stated as a means to justify what a certain program/hospitals are for those who are clearly sick. If you didn't believe it to be a good thing or an ideal thing, you would have stated the policy and left it as such. Instead, you've gone the distance when it comes to backing up malignant policies. Every single time. Then you hide behind the "it's just how it is" line. No, it's not "just how it is" everywhere. Maybe it is at yours. For that, sucks for you for picking a malignant program/specialty or both. When called out on it, you're now saying it's not something you favor. Lies. Then again I'm not surprised, considering the field you left before going into medicine.

I won't comment on the mod squad, it's not worth it anyway.

 

[Law2Doc]

... No, it's not "just how it is" everywhere. Maybe it is at yours. For that, sucks for you for picking a malignant program/specialty or both...

um, I never said this is how it is everywhere. I think everyone in the thread concedes that there are multiple approaches, and that there are some specialties that are more "intense" than others. I indicated that many programs have a no sick day policy, a fact borne out by the good handful of people on here in addition to myself who have worked under such policy.

As for malignant programs, I think malignancy is a totally different and unrelated question. I certainly didn't suggest that I ever worked in a malignant program, although I have worked at a program where there were no sick days. These are not concepts that dovetail. You can be at a very benign program for a given specialty that has very high hours and no sick days. Having to work hard and even show up when sick does not alone make the place malignant. It's not great for the day or two when you are sick, but honestly I have had a blast on other days. I actually know quite a few people who are more miserable than I who work far fewer hours and probably have ample sick and personal days. Malignancy has to do with a culture of hostility and abuse, usually coming down from the higher ups. This is not equivalent to a program where you are respected and liked and people are eager to teach you, but you are expected to be there up to 80 hours per week whether you are healthy or not. I see a big difference.

 

[142348]

um, I never said this is how it is everywhere. I think everyone in the thread concedes that there are multiple approaches, and that there are some specialties that are more "intense" than others. I indicated that many programs have a no sick day policy, a fact borne out by the good handful of people on here in addition to myself who have worked under such policy.

As for malignant programs, I think malignancy is a totally different and unrelated question. I certainly didn't suggest that I ever worked in a malignant program, although I have worked at a program where there were no sick days. These are not concepts that dovetail. You can be at a very benign program for a given specialty that has very high hours and no sick days. Having to work hard and even show up when sick does not alone make the place malignant. It's not great for the day or two when you are sick, but honestly I have had a blast on other days. I actually know quite a few people who are more miserable than I who work far fewer hours and probably have ample sick and personal days. Malignancy has to do with a culture of hostility and abuse, usually coming down from the higher ups. This is not equivalent to a program where you are respected and liked and people are eager to teach you, but you are expected to be there up to 80 hours per week whether you are healthy or not. I see a big difference.

I disagree with you on this. A program can have components that are malignant and components that aren't. In my opinion, not allowing for sick days definitely makes a program malignant in that component. However, it might still be a great place to learn/train if you can handle that component. When a program is not willing to accept that the physicians in training who work around ill patients all day for 80 hours a week are capable of becoming ill and needing sick days, to me that #1 speaks of a lack of respect for the residents well being, #2 a lack of leadership that would create coverage schedules for sick days. With the ever changing working hours/restrictions, it will be tougher to create schedules. However, programs that are truly invested in their residents as more than simply labor, will find ways to adjust rather than simply eliminating the days, even it means fellows/attendings taking a more active role when residents are ill (this happens now in my department).

 

[Law2Doc]

I disagree with you on this. A program can have components that are malignant and components that aren't. In my opinion, not allowing for sick days definitely makes a program malignant in that component. However, it might still be a great place to learn/train if you can handle that component. When a program is not willing to accept that the physicians in training who work around ill patients all day for 80 hours a week are capable of becoming ill and needing sick days, to me that #1 speaks of a lack of respect for the residents well being, #2 a lack of leadership that would create coverage schedules for sick days. With the ever changing working hours/restrictions, it will be tougher to create schedules. However, programs that are truly invested in their residents as more than simply labor, will find ways to adjust rather than simply eliminating the days, even it means fellows/attendings taking a more active role when residents are ill (this happens now in my department).

I'm going to agree to disagree on this -- we are operating on very different definitions of what constitutes a malignant program. I also think you can have long hours and be expected to be there every day without it necessarily being either a lack of respect or a lack of leadership. There are only so many pieces of the machinery to work with in some programs and this is my point when I suggest that programs are running very lean and don't have the backup you describe. I would agree that if a program had fellows that would theoretically be another potential component that could pick up slack, but not all programs have fellows ( in some specialties most won't). So yeah it would be wonderful if a program had more residents, or fewer hours or some combo of the two but that's not every program. And it doesn't make that program malignant if they like you and give you good feedback and are eager to teach you and help you succeed and you basically enjoy being at work most days. That's not the definition of malignant by anyone's definition. Now I agree that some people will put up with a lot of crap to get to their goals, but I guess my point is that having a blast objectively isn't the same as being abused. It's not like the program is having a no sick day policy because they disrespect residents so much as they simply don't have the staff to offer otherwise. But I think I'd rather have that situation than a program that was only 65 hours per week and 5 sick days a year where I didn't enjoy what I was doing, didn't feel the love, and didn't have the camaraderie. So that's where our definitions of malignancy deviate. In my opinion hours has nothing to do with malignancy, although perhaps it can be a warning sign in some settings.

 

[Neuronix]

But I think I'd rather have that situation than a program that was only 65 hours per week and 5 sick days a year where I didn't enjoy what I was doing

I've never actually heard a name named of this mythical low hours, unhappy program. In addition to the three weeks of vacation, six holidays, and five sick days, my program gives me cheap subsidized housing, two meals a day (and a third on call), and a salary well above the median. I work about 40 hours a week on electives and about 60 on wards. Everyone is super friendly and supportive.

The only time I've heard of a program that was supposedly low hours and turned out to be malignant was when a program lied to applicants (I know of two programs). You know--the old switch-a-roo from what they tell you when you interview (it's so cush here!) to what day to day is like. My point is a lot of decent programs exist, and I think hours is an important part that reflects overall program friendliness.

 

[Doctor4Life1769]

I'm going to agree to disagree on this -- we are operating on very different definitions of what constitutes a malignant program. I also think you can have long hours and be expected to be there every day without it necessarily being either a lack of respect or a lack of leadership. There are only so many pieces of the machinery to work with in some programs and this is my point when I suggest that programs are running very lean and don't have the backup you describe. I would agree that if a program had fellows that would theoretically be another potential component that could pick up slack, but not all programs have fellows ( in some specialties most won't). So yeah it would be wonderful if a program had more residents, or fewer hours or some combo of the two but that's not every program. And it doesn't make that program malignant if they like you and give you good feedback and are eager to teach you and help you succeed and you basically enjoy being at work most days. That's not the definition of malignant by anyone's definition. Now I agree that some people will put up with a lot of crap to get to their goals, but I guess my point is that having a blast objectively isn't the same as being abused. It's not like the program is having a no sick day policy because they disrespect residents so much as they simply don't have the staff to offer otherwise. But I think I'd rather have that situation than a program that was only 65 hours per week and 5 sick days a year where I didn't enjoy what I was doing, didn't feel the love, and didn't have the camaraderie. So that's where our definitions of malignancy deviate. In my opinion hours has nothing to do with malignancy, although perhaps it can be a warning sign in some settings.

I don't know about you, but I rotated/interviewed at programs that had their residents working 65/week and 78-80/week, etc. Without fail, hours played a major role in resident happiness. Are you saying that the programs giving 65 and 5 produce unhappy residents compared to those giving 78-80 and 0 sick days?

You sound like the one who's putting up with a lot of crap. Actually, YOU probably are the one creating the crap. Glad I'm not your intern. You'd be so concerned about towing the hospital/program line that you'd ensure that interns work all 16 hours daily since your inefficient self can't get the job done to begin with.

The chiefs and upper levels at my program have definitely come together to ensure us interns get acclimated quickly. Hell, despite the random vacays that some residents have taken, they all understand we (interns) are going to have to deal with that steep learning curve. Plus, the EMR can be a pain to initially get used to. However, I'm finally getting it. I suck at giving sign-outs right now, but they're right there with us to ensure we give all the info needed. Do I feel like a *******? All the time. However, they've been more than supportive of us. They know we're going to be slower than they are. They push us but also help us. They're efficient with what they do with their time. If any of us run out of time, they quickly step in and help us get the work done. Hell, I even try my best to help out a lagging co-intern, but I'm not efficient enough to get their job done too. Of course, I'm getting more better with orders, progress notes, etc. but I'm obviously not at their level at this point. I get the feeling that you and the other upper levels at your program aren't nearly as supportive when it comes to helping others get the job done within the shorter amount of time we all have with the new restrictions. Hence, the need to force genuinely sick residents to come in and do scut. We're all working 78-80 hour weeks. We also get 12 sick days. Of course, no one is going to use it unless they genuinely need to use it.

And the kicker of it all? The specialty I'm rotating through right now is considered to be one of the most malignant specialties out there. With all the support these upper levels/chiefs have been giving us. Who knew.

 

[captaincrunch]

Wow, this conversation has turned pretty combative. I think a lot of Law2Doc's critics are right though. The fact that residency programs operate with a de facto "no sick day" policy is not right. For one, it is dangerous to patients to have a physician who is either incapacitated or contagious. Second, it is damaging to resident well-being and welfare (which makes recruitment difficult). Lastly, it's probably illegal. There are numerous laws that protect the rights of sick employees. Even an unstated "no sick days" policy could be discriminatory. In my state, there are many protections including time off for jury duty, time off to vote (2 hours), time off to attend a child's mandatory school functions (40 hours/year), bonding time with a new child - including fathers (an additional 12 weeks on top of federally mandated time), and so forth. This is all in addition to standard sick leave laws.

I think the attitude that Law2Doc describes comes out of an incredible arrogance in medicine. Programs and residents believe what they do is so important that nobody can be spared. I would like to offer a different viewpoint. I currently attend on a resident team. I sometimes see fewer patients with the resident team than I see by myself as a private hospitalist. Believe me, if a resident is sick, I can absorb the work. A medicine resident is still a trainee; I don't need them to help me with patient care. Don't get me wrong; I appreciate the work they do, but nobody should martyr themselves for their job. Similarly, a surgery attending can operate without a resident. Do you really think the OR tech needs a resident and medical student to help them hand tools to the attending? They don't. There is a walk-on-water mentality that doctors have that I think is misguided. It would be hard to get through training without a little arrogance, but honestly, I think most of my patients would benefit more from a good social worker than from a good doctor.

Another way to look at things: each resident brings with them over $100,000/year in funding from Medicare for their training. It is not as if residency programs are operating without any money. The primary purpose of residency training (and the money that comes with it) is educational. I would argue at any program that cannot function for even a day without one resident is probably short-changing their residents, and using them for free labor instead.

 

[EagerToBeMD]

Forget outdated opinions, there is a job to be done. If you can't do it, then you shouldn't be allowed to.

Taking one day off to tend to a sick child, means you can't do the job? There's a job to be done in police work too. Guess single parents need not apply. There's a job to be done with firefighters too. Guess single parents need not apply. There's a job to be done in being an EMT too. Guess single parents need not apply. There's a job to be done in legal work too. Guess single parents need not apply.

 

[EagerToBeMD]

um, first you don't get sick days in some programs. Period. So your question "what exactly are sick days for..." doesn't make sense. You don't have any at some places.

What programs don't allow for sick days? Name names.

As for the lawsuit suggestion, I agree with you to some extent. You can't be fired for being out sick with an illness which requires medical intervention. But I think that misses the point. The goal in residency isn't merely not to be fired. You need recommendations, good evaluations, the help and respect of your teammates. Residency can be a good or horrible experience based on whether it's a family where everyone has each others backs versus a setting where everyone is for themselves. So you will often find yourself doing things to your own detriment simply to stay off the chiefs or PDs $&@? list, and not to leave your coresidents hanging. Including coming to work sick. So it's part an issue of being sick is not optional, and part an issue of keeping yourself in everyone's good graces.

Right, because you're ruined for life if you take a sick day as opposed to getting IV fluids for rounds. That goes back to my other point -- doctors are H Y P O C R I T E S, and that includes you for defending such practices.

 

[EagerToBeMD]

Not every program has "jeopardy" (I've only ever seen that system in Medicine and Peds, thus far). And many only have sick days for catastrophic events, not the usual "head cold" ailments. If you can't function at work, that's one thing - but if every resident that just wasn't feeling well got to take off from work, the remaining residents wouldn't be sufficient for substitute coverage.

The question isn't about head colds. The question is about a resident who needs an IV to get through the day. I have an extremely hard time believing these residents don't have sick days for such things.

 

[Winged Scapula]

What programs don't allow for sick days? Name names.

Penn State General Surgery

 

[EagerToBeMD]

We have no sick days. You can take disability or FMLA, but there are no built in sick days. We do have an emergency coverage plan, but you pay back any time you call in.

So they don't call it a sick day, but technically, you do have a mechanism in place in case a resident needs IV infusions and can't come in. Fair enough. I've never heard of a place, in any field, not having sick days, honestly. People get seriously sick. It's a fact of life. Do you really expect a resident to come in while he/she is projectile vomiting?

 

[EagerToBeMD]

In most cases you can wear a mask or gloves to minimize passing a cold onto patients. But even if that isn't adequate, you could always be in the hospital fielding pages, calling consults, doing dictations, putting in orders, and a host of other non-hands-on tasks. Additionally, in many cases the symptoms of a cold/flu come later, from your immune system, not the bug, meaning you have been passing on the bug throughout the hospital for several days already before you even feel sick. You've already exposed the patients and coworkers you see daily by that point.

This would be unbelievable if it wasn't so laughable.

 

[EagerToBeMD]

also, there have been a rash of " I hope you never become chief"/ "you should never be a manager" type comments on multiple threads on SDN lately. They are almost inevitably made to folks with rather extensive manager/employer experience. I'm not sure why this sentiment is appearing so frequently lately, but I'd say it's a variation of Burnett's law to some extent. Let's cool it with this kind of nonsense.

In this case I think you are trying to blame me for how certain specialties are and always have been run. You want to ignore the fact that at least five other posters jumped on here and indicated their programs run the exact same way. If a place doesn't have the man hours to allow sick days, the greatest chief in the history of the program is still going to not allow sick days.

Sounds more like you're being blamed for the attitudes that you continue to foster. Several in this thread have come out to say they don't have sick days, but they don't defend the policy as you so enthusiastically do.

 

[EagerToBeMD]

Jeez, you guys are making me love my life. We get sick days (and in fact are actually encouraged to use them) and days off for Step 3 that don't count against our days off in a month. We also have back up call and then jeopardy after that, so there are two layers of coverage in case something happens.

One of my fellow residents called in backup because she saw her cat die. Totally acceptable to everyone. I went to work with a nasty URI one day, and my attending basically sent me home. I actually took another sick day once last year, and my attending (another attending) wrote me an email telling me to take care of myself and that they would cover everything.

Even in our more hard core off service rotations (internal medicine), we're encouraged to use their jeopardy system is we're sick. Maybe the surgery folks here show up even when they're getting an IV infusion.

On another note, wine is good and other peeps, you could just ignore Law2Doc if his authoritarian ideas bug you. Oh wait, you can't because he's a mod. Bummer.

Please do everyone a favor and tell us what program you're at. I have a feeling it'll be really competitive in the coming years

 

[Doctor4Life1769]

Penn State General Surgery

Not surprised. I wouldn't want to live in Hershey, anyway.

 

[EagerToBeMD]

Penn State General Surgery

Thank you. Keep naming names. I think all med students should know which programs don't allow sick days.

 

[Doctor4Life1769]

Thank you. Keep naming names. I think all med students should know which programs don't allow sick days.

I'd like to know where L2D is a resident, just so my friends nor sibling apply there.

 

[Winged Scapula]

Not surprised. I wouldn't want to live in Hershey, anyway.

To each his own. Its a lovely town and a beautiful medical center.

And as yet another reminder to the users: disagreeing with another user is not reason to insult them or cast aspersions on their character. Please refrain from making personal comments about each other when disagreeing.

 

[attey]

So just to update:

After some support from a few attendings and graduating upper levels the department and I reached an agreement for remediation. My advanced program has been amazingly understanding. Barring any "disruptive behavior" I should start at my advanced program within the next month.

Thanks to those in this thread who left constructive comments.

 

[JelloBrain]

So just to update:

After some support from a few attendings and graduating upper levels the department and I reached an agreement for remediation. My advanced program has been amazingly understanding. Barring any "disruptive behavior" I should start at my advanced program within the next month.

Thanks to those in this thread who left constructive comments.

Great to hear that. Hope you take this second chance extremely seriously and do really well, whatever you do and wherever you do it. Also any time in your career you see a junior colleague getting into a similar situation, do take them under your wing and guide them through it so their career doesn't get ruined.

 

[shopsteward]

Thanks for the update, it's always good to hear outcomes, especially good ones. Good luck.

 

[dragonfly99]

So just to update:

After some support from a few attendings and graduating upper levels the department and I reached an agreement for remediation. My advanced program has been amazingly understanding. Barring any "disruptive behavior" I should start at my advanced program within the next month.

Thanks to those in this thread who left constructive comments.

That's so great
Glad you were able to come out of it all right. Hope things continue to go better for you.

As far as the "sick days" thing, I think a lot of it comes down to both specialty and specific programs. Also, what the policies are "on paper" is not the only thing that is important. You still have to work w/your colleagues every day for 1-7 years, so if you are the one who is frequently gone and other people have to cover for you, that may not go over well regardless of what the "law" or "program policies" technically are.

My medicine program technically did allow sick days (not sure how many...I think it might have been 5/year). People generally did not take them, because socially it would be bad. We worked really hard as it was (for a medicine program) and there weren't a lot of people to cover, so people wouldn't take sick days for things other than something really serious (i.e. having fever, being in the hospital, vomiting from food poisoning, etc.). A couple of the derm prelim residents were known to more frequently take sick days, but believe me it was noticed. If someone really had gotten into a car accident, put on bed rest for pregnancy, etc. (both of these happened to I think 1 person total while I was in the program) they would just end up out for a few weeks on medical leave, and we dealt with what we had to deal with to make it work. Most of the people w/kids had either a spouse staying at home or in laws to help w/the kids. If you have kids they will get sick from time to time, but given our program was pretty busy and most people didn't have kids yet, having to cover for people out w/a sick kid would have created some problems. I doubt anyone would be ballistic if it happened once, especially if it wasn't ICU that someone was pulled to cover for, but definitely it would be seen as poor planning, and taking advantage of others, if it happened frequently. However, I could see situations where someone was in say, community resident program in psych or fp, where someone being out several days/year would have gone over O.K. A lot of this comes back to what specialty, and what type of program, you decide to go into.

 

[a winner is you]

No problems with sick days in radiology, we cover for each other. An upper level went on maternity leave for 2 months and she got covered for with no problems.

 

[SouthernSurgeon]

A lot of this comes back to what specialty, and what type of program, you decide to go into.

Agreed. Anecdotally this is extremely common in surgical programs. Mine is no exception and I don't think we are at all malignant.

But the general expectation is (regardless of what our contract technically says about sick days) - that if you are planning on not coming to work you basically should be sick enough to require hospitalization yourself.

 

[EagerToBeMD]

So just to update:

After some support from a few attendings and graduating upper levels the department and I reached an agreement for remediation. My advanced program has been amazingly understanding. Barring any "disruptive behavior" I should start at my advanced program within the next month.

Thanks to those in this thread who left constructive comments.

Glad to hear that! Congratulations!

As far as the "sick days" thing, I think a lot of it comes down to both specialty and specific programs. Also, what the policies are "on paper" is not the only thing that is important. You still have to work w/your colleagues every day for 1-7 years, so if you are the one who is frequently gone and other people have to cover for you, that may not go over well regardless of what the "law" or "program policies" technically are.

No one said anything about frequently. But let me ask you something, say someone had the stomach flu. They were projectile vomiting and had diarrhea. More than that, everytime they stood up, they were nauseated and dizzy. This is a person who never misses a day. Maybe he missed one day a year and a half ago, but since then has been there every day he's supposed to be. So they decided to use a sick day on this particular day. Would you hold it against them or would you, as a physician, understand?

But the general expectation is (regardless of what our contract technically says about sick days) - that if you are planning on not coming to work you basically should be sick enough to require hospitalization yourself.

Same question as above.

 

[dragonfly99]

No. I almost took a sick day once b/c I got food poisoning. I was puking on my post call day/day off. And I almost didn't come in, but luckily the night before I started feeling better, and felt good enough to walk around and do some work the next day, so I went to work. However, I think the threshold for "calling in sick" as an intern or resident is generally much higher than versus any other job(s) I've ever done. Or at least it was at my medicine program. And it's not necessarily a matter of people "holding it against you" (or at least not totally that). It's honestly more an issue of there being a lot of work to be done. Again, if you don't do your work, or can't, then someone else has to do so. In specialties where there are a lot of inpatients to round on, write notes on, operate on, etc., that can be a big deal. It's not a matter of people trying to be malignant, necessarily.

 

[witchbaby]

In other words, those in medical training (clinical years of med school and most residencies ) should be able to devote their full attention to their training. I don't think a single parent of a young child should be in medical training. Their parent status before and after medical training makes no diffference to me.

Come on guys, get it together, if you're entering residency partner-less (or partnered without backup backup childcare) just put your kids in cryo for a few years. . . everything will be cooler when they wake up, they'll always look young, and they'll thank you for it.

As for 'sick days"

Do I think people should be absent from work due to a child's illness? Generally, no. Have I graciously covered for colleagues who had a sick kid and a partner but for some reason the partner wasn't able to manage the illness/ER visit on their own - absolutely. Would I want them to do the same for me if I had a kid? Yes. Would I be at the bedside of my parent, sibling, or even (certain) aunt/uncle/cousins if they had a serious illness, and expecting one of my colleagues to graciously cover for me? Absolutely. Our families put up with our long work hours, intense focus on the job (which may occasionally translate into neglect of focus on them), and dedication to patient care (often rather than doing something with them.) The least we can do (as a group of doctors) is to ensure that when they really need us - when they are ill - we will be there for them, and someone will be take care of our patients for us.

I never took a sick day in residency, though I was fortunate to be at a program with a backup call system. I was ill enough to do it once, but it would have required a use of the pull schedule, and I only had five patients and a super supportive staff, so I was in and out in a few hours. I was pulled all three years to cover other people, and in my final year of residency to cover interns more than once. I frequently thought these were "Bogus" reasons for me to be there, but I did the work without complaining (much). I voluntarily spent a week and a half on a service I hated covering for a resident who was physically well but clearly incapable of devoting adequate attention to the patients at the time. Why? Because, really it is about the patients. If someone is too sick to provide adequate patient care, OR if they're worried about their sick kid (Mom, sibling, spouse) and going to be distracted from patient care, they shouldn't be at the hospital. Even when it's something we think we could 'work through' we have to trust our colleagues to know when they aren't able to do the job adequately, and cover for them when they can't. If it becomes clear that the system is being abused we call foul (or "unprofessionalism!") and determine whether the person is just really not interested in working generally (maybe shouldn't be a doctor/in their current field) or is abusing their colleagues and then should be made to repay the time during their vacation.

This is from a medicine perspective, where there are elective / outpatient months and backup call. In the surgical specialties, I think the above is still true (if someone is ill and can't do the job adequately, they shouldn't be responsible for patients) but I recognize there is much much less lee way to give people time off. Therefore, there must be an even stronger community of trust between colleagues that if someone needs a day off they really NEED it and you figure it out, but everyone tries extra hard not to need one.

 

[Law2Doc]

... But let me ask you something, say someone had the stomach flu. They were projectile vomiting and had diarrhea. More than that, everytime they stood up, they were nauseated and dizzy. This is a person who never misses a day. Maybe he missed one day a year and a half ago, but since then has been there every day he's supposed to be. So they decided to use a sick day on this particular day. Would you hold it against them or would you, as a physician, understand?...

If you really want the answer, in the programs that firmly don't allow sick days, you are still expected to show up even with a stomach flu.

 

[chocomorsel]

So just to update:

After some support from a few attendings and graduating upper levels the department and I reached an agreement for remediation. My advanced program has been amazingly understanding. Barring any "disruptive behavior" I should start at my advanced program within the next month.

Thanks to those in this thread who left constructive comments.

Well, congratulations. You apparently fought a good fight and glad you didn't just sit by and let it happen. Good you had support from people that matter. Let's see wat L2D has to say about this one. Oh wait he/she was the last one to post before me. Hope it was congratulatory one.

Oh hell not even a "good for you" from our L2D. He/she responded to something else on the post. Surprise surprise.

 

[Doctor4Life1769]

If you really want the answer, in the programs that firmly don't allow sick days, you are still expected to show up even with a stomach flu.

I'd like to hear of a PD/upper level that forced someone to work while puking, having the runs, feverish, and dehydrated. Keep digging yourself a hole...

Anyways, congrats to the OP. Glad it worked out for you.

 

[Perrotfish]

I'm going to agree to disagree on this -- we are operating on very different definitions of what constitutes a malignant program. I also think you can have long hours and be expected to be there every day without it necessarily being either a lack of respect or a lack of leadership. There are only so many pieces of the machinery to work with in some programs and this is my point when I suggest that programs are running very lean and don't have the backup you describe. I would agree that if a program had fellows that would theoretically be another potential component that could pick up slack, but not all programs have fellows ( in some specialties most won't). So yeah it would be wonderful if a program had more residents, or fewer hours or some combo of the two but that's not every program. And it doesn't make that program malignant if they like you and give you good feedback and are eager to teach you and help you succeed and you basically enjoy being at work most days. That's not the definition of malignant by anyone's definition.

To be honest that would still meet my definition. I feel like when it comes to residency programs you tend to act as though their poor/malicious planning is an immutable fact of nature rather than something we have a right to take offense at. When a residency program is running with no back up (attendings or fellows), and the residents are scheduled in such a way that they can't even take a day off when they catch the plague, that's something the hospital could fix if it wanted to. It's not hard to hire more help, and it's definitely not hard to just accept fewer patients. The issue is just the hospital being greedy: they want to increase their revenues (big census lists) while minimizing their costs (few attendings, cheap residents) to maximize their profits. I think doing that to the residents so that you can make a few extra dollars is a perfectly legitimate definition of malignant, however high the quality of the feedback or the teaching.