Fired/dismissed from residency program in 51st week

[Perrotfish]

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't awesome! Congrats!

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[Law2Doc]

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.

Well, having worked on the business side of these things before med school, I have to say that most of the time this has little to do with being greedy, and a lot has to do with hospitals not being particularly viable entities in this day of slow Medicaid/Medicare payments, lots of nonpaying customers and pressure to make up the LOSS with high turnover and volume. Few hospitals are making a ton of money, and those whose clientele are not rich suburbanites have to operate very lean. As for malignant again I suggest that if you are getting good education and a lot of opportunities and folks helping you to your goals, and if you enjoy your teammates and have a blast at work on a daily basis, that's not really malignant. There will always be things on your wish list ( shorter hours, the opportunity to be out sick), but it's still better than being somewhere where the hours are good but you are everyone's whipping boy and the opportunities for fellowship are mediocre and you get no backing from the higher ups.

 

[jdh71]

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.

I send sick people home. Though, I think you should show up and let people know, even if you have a few sick days in your contract.

Where I did residency, you technically had one sick day a month. No one ever used them though, not on the regular. I missed one day in residency because of illness. I did show up to work. On the way into work I almost sh:t myself and when I got there I had a fairly impressive puke and heave session into the trashcan in the locker room. I decided it was ridiculous for me to be there, found my attending and let him know what happened and he sent me home. I think this is generally the best way to approach ambulatory illness in residency.

 

[SouthernSurgeon]

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...

No I can't think of many PDs that would "force" someone to work in that state. But it doesn't usually get back to the PD as the resident "forces" themselves to do it.

We have all heard stories (or seen in person) about residents getting fluid boluses and rounding with IV poles at work, getting zofran from the ICU nurses, taking imodium before going into the OR...

It happens. No one is saying it is smart or good patient care, but that is L2D's only point...it does happen.

 

[VA Hopeful Dr]

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.

I've worked with all of that, minus the puking, on two different occasions this past year. We have sick days, I just didn't want to leave anyone having to cover my patients.

 

[danielmd06]

Congratulations to the OP for successfully navigating this potential problem.

 

[QofQuimica]

This is kind of a tangent to the tangent, but I'm curious: don't all surgery residents have to do off-service rotations, especially as interns? They do at my hospital, and not all of those are 80 hours per week. So, say, if a surgery intern is rotating through the emergency department, do they have additional clinical duties on top of their time in the ED that get them up to working 80 hours per week still? Also, do they have no electives whatsoever, even as PGY5s? I'm just finding it hard to believe that even a surgery resident is averaging 80 hours per week every single week on every single rotation for five straight years.

At my program, someone who is on elective time/easier rotation serves as a "jeopardy resident" who can be called in. The time has to be paid back, which I think is fair.

And because the OP's thread has gotten so horribly derailed, just wanted to say that I, too, am glad that s/he is getting a chance to make things right.

 

[Dr Bartlet]

No I can't think of many PDs that would "force" someone to work in that state. But it doesn't usually get back to the PD as the resident "forces" themselves to do it.

We have all heard stories (or seen in person) about residents getting fluid boluses and rounding with IV poles at work, getting zofran from the ICU nurses, taking imodium before going into the OR...

It happens. No one is saying it is smart or good patient care, but that is L2D's only point...it does happen.

All that does is back up what the other poster said about some residents being show offs. They want to be viewed as martyrs who never miss a day, but when I've seen these things, all I've done is call them attention ******. A nickname well deserved.

 

[Smurfette]

This is kind of a tangent to the tangent, but I'm curious: don't all surgery residents have to do off-service rotations, especially as interns? They do at my hospital, and not all of those are 80 hours per week. So, say, if a surgery intern is rotating through the emergency department, do they have additional clinical duties on top of their time in the ED that get them up to working 80 hours per week still? Also, do they have no electives whatsoever, even as PGY5s? I'm just finding it hard to believe that even a surgery resident is averaging 80 hours per week every single week on every single rotation for five straight years.

At my program, someone who is on elective time/easier rotation serves as a "jeopardy resident" who can be called in. The time has to be paid back, which I think is fair.

And because the OP's thread has gotten so horribly derailed, just wanted to say that I, too, am glad that s/he is getting a chance to make things right.

Few general surgery programs offer electives at any point during residency because the ABS (board) requirements are pretty limiting. Mine did not. There are restrictions as to what rotations can be done in your PGY5 year.

As an intern, my "off-service" months were ENT, ortho and CT surgery. Other co-interns got plastics and urology. No ER rotations or anesthesia rotations in my program.

 

[Winged Scapula]

This is kind of a tangent to the tangent, but I'm curious: don't all surgery residents have to do off-service rotations, especially as interns? They do at my hospital, and not all of those are 80 hours per week. So, say, if a surgery intern is rotating through the emergency department, do they have additional clinical duties on top of their time in the ED that get them up to working 80 hours per week still? Also, do they have no electives whatsoever, even as PGY5s? I'm just finding it hard to believe that even a surgery resident is averaging 80 hours per week every single week on every single rotation for five straight years.

As Smurfette notes, true "off service" (ie, non-surgical) rotations or electives are not by any means common. There are some programs in which you do rotate through Anesthesia, Ob or EM, but as she states, the ABS requirements are pretty strict in terms of elective time, vacation time, etc. and given the average size of a surgery program as categorical 5 residents/year, many do not allow these off service rotations because of (wo)man power issues.

Electives are not allowed at all during PGY-4 and PGY-5 by ABS. We had a resident that wanted to go to the Royal College during PGY-4 to work with some world famous surgeon; the ABS actually had to approve it because you must be at the main teaching facility for PGY-4 and 5 (not sure what he had to do to get it approved).

Like hers, my "electives" were PRS (PGY-2) and ENT (PGY-3); the only other choice was Uro. My hours on ENT were pretty decent; they somewhat sucked on PRS because we were on Face and Hand call that month.

 

[QofQuimica]

Thanks, Smurfette and WS, good to know. So when you were on your off-service surgical specialty rotations, were you still working 80 hours per week? And if your program had needed you as a jeopardy resident, could they have called you off your subspecialty team? I assume that their residents also had to rotate through gen surg, so what I'm asking is, were you replacing a necessary surg specialty intern/junior that couldn't be spared? If so, then how did you send people home if they were sick, and/or manage FMLA leave and vacation time?

 

[Winged Scapula]

Thanks, Smurfette and WS, good to know. So when you were on your off-service surgical specialty rotations, were you still working 80 hours per week? And if your program had needed you as a jeopardy resident, could they have called you off your subspecialty team? I assume that their residents also had to rotate through gen surg, so what I'm asking is, were you replacing a necessary surg specialty intern/junior that couldn't be spared? If so, then how did you send people home if they were sick, and/or manage FMLA leave and vacation time?

Well my "off service" rotations were before the 80 hr restrictions, so yeah, I did work more than that. In our program, we were still required to take in house trauma call while on off service rotations and of course, we did not go home post-call.

The "off service" residents were all Prelims on GS as PGY-1s (they did not rotate on GS otherwise) so we were not replacing them per se as we were not interns on their service, although I recall their being some rules about when we could be on those services.

Vacation time for our program was scheduled at the beginning of the year; there were months when you couldn't take vacation (June, July, December and right before our ITE). Some rotations would also not allow vacation to be taken - can't recall which those were but in general, you didn't know what your schedule was going to be before putting in vacation request (ie, you just picked the week and the Admin Chief worked the schedule around those requests).

FMLA? I don't know...it wasn't that much of an issue in my program. I'm the only one I know who took it and people were pulled from the lab to take call in my stead.

Sending people home was dependent on the Chief. Some were sympathetic and others were not. But it was not ok to "call in sick"; you had to show up, the Chief had to assess the work flow, see how many people would be available to cover the work/cases, etc. I had some Chiefs/seniors who would send you home routinely but many others would just find an empty bed for you in the call room, start and IV and periodically check on you to see if you felt better. I remember one Christmas Eve when the PGY-4 and I were on trauma call, taking turns in puking in the call room (hi Rob!); short staff, no one else to cover, so we sucked it up. Despite what one poster writes above, this was not about ego, it was about manpower and doing the job you were asked to do. Believe me, I would have much rather been at home those times.

 

[Giemsa]

I remember one Christmas Eve when the PGY-4 and I were on trauma call, taking turns in puking in the call room . . . . Believe me, I would have much rather been at home those times.

Oh, the memories!

When I was a clerk (medical student in Canada) I had the flu, and was on OBGYN. There was this poor woman who has hyperemesis gravidarum her entire pregnancy, and now as in labour.

We took turns heaving our guts up. And nope, they wouldn't let either of us go home

The worst part . . . the WORST part . . . was that every SINGLE f'ing OBGYN attending (as they wandered by looking for coffee or something) asked me if I was pregnant (i.e. assuming morning sickness).

No, you dimwits, I'm infectious!

 

[Winged Scapula]

The worst part . . . the WORST part . . . was that every SINGLE f'ing OBGYN attending (as they wandered by looking for coffee or something) asked me if I was pregnant (i.e. assuming morning sickness).

No, you dimwits, I'm infectious!

Yep, that was par for the course as a female surgical resident. Every comment about feeling nausea was met with the comment, "you're not pregnant are you?"

 

[Smurfette]

Well my "off service" rotations were before the 80 hr restrictions, so yeah, I did work more than that. In our program, we were still required to take in house trauma call while on off service rotations and of course, we did not go home post-call.

The "off service" residents were all Prelims on GS as PGY-1s (they did not rotate on GS otherwise) so we were not replacing them per se as we were not interns on their service, although I recall their being some rules about when we could be on those services.

Vacation time for our program was scheduled at the beginning of the year; there were months when you couldn't take vacation (June, July, December and right before our ITE). Some rotations would also not allow vacation to be taken - can't recall which those were but in general, you didn't know what your schedule was going to be before putting in vacation request (ie, you just picked the week and the Admin Chief worked the schedule around those requests).

FMLA? I don't know...it wasn't that much of an issue in my program. I'm the only one I know who took it and people were pulled from the lab to take call in my stead.

Sending people home was dependent on the Chief. Some were sympathetic and others were not. But it was not ok to "call in sick"; you had to show up, the Chief had to assess the work flow, see how many people would be available to cover the work/cases, etc. I had some Chiefs/seniors who would send you home routinely but many others would just find an empty bed for you in the call room, start and IV and periodically check on you to see if you felt better. I remember one Christmas Eve when the PGY-4 and I were on trauma call, taking turns in puking in the call room (hi Rob!); short staff, no one else to cover, so we sucked it up. Despite what one poster writes above, this was not about ego, it was about manpower and doing the job you were asked to do. Believe me, I would have much rather been at home those times.

Pretty similar in my program, which was post-work hour regulations.

Our off service rotations were q2 home call so yes, it pushed the 80 hour rule. I ended up being in-house all night more than once due to how busy it was. We could NOT pull interns off the off-service rotation for jeopardy call due to political issues that would inferiorate the ortho/ENT/GU/Plastics depts. Those services did not have "extra residents" to begin with.

Jeopardy call did not exist. On the rare occasions when I (as a chief) sent home an ill member of my team, unless my service was slow, I had to ask another chief to "borrow" one of their residents to help us out, and that resident did "double duty" on both services until the ORs were done. Thus, everyone really tried NOT to go home sick cuz they didn't want to burden others to help cover. And some unfortunate soul would be told "you're on call tonight" if the sick person was supposed to be on that night. The sick person then needed to take that person's next scheduled call. But no one just called in sick...you showed up and your chief may or may not send you home, and you may refuse to go home if your service was horrendously busy with multiple disasters (like transplant or vascular). Actively puking from illness generally got sent home. Most other things did not.

There were no back up plans, so when someone was on a scheduled vacation, everyone else on the service (or cross covering services) had more calls and longer hours. So if someone was sick when someone else was on vacation, it became a logistical nightmare within the 80 work week rules to get coverage. I was in a big program (for surgery, that is), but we covered multiple hospitals and thus had limited coverage options. Like WS's program, vacations could not be taken on certain rotations and only one person per call pool could be on vacation at any given time anyhow.

 

[142348]

Pretty similar in my program, which was post-work hour regulations.

Our off service rotations were q2 home call so yes, it pushed the 80 hour rule. I ended up being in-house all night more than once due to how busy it was. We could NOT pull interns off the off-service rotation for jeopardy call due to political issues that would inferiorate the ortho/ENT/GU/Plastics depts. Those services did not have "extra residents" to begin with.

Jeopardy call did not exist. On the rare occasions when I (as a chief) sent home an ill member of my team, unless my service was slow, I had to ask another chief to "borrow" one of their residents to help us out, and that resident did "double duty" on both services until the ORs were done. Thus, everyone really tried NOT to go home sick cuz they didn't want to burden others to help cover. And some unfortunate soul would be told "you're on call tonight" if the sick person was supposed to be on that night. The sick person then needed to take that person's next scheduled call. But no one just called in sick...you showed up and your chief may or may not send you home, and you may refuse to go home if your service was horrendously busy with multiple disasters (like transplant or vascular). Actively puking from illness generally got sent home. Most other things did not.

There were no back up plans, so when someone was on a scheduled vacation, everyone else on the service (or cross covering services) had more calls and longer hours. So if someone was sick when someone else was on vacation, it became a logistical nightmare within the 80 work week rules to get coverage. I was in a big program (for surgery, that is), but we covered multiple hospitals and thus had limited coverage options. Like WS's program, vacations could not be taken on certain rotations and only one person per call pool could be on vacation at any given time anyhow.

Isn't it the PD/chair of the department's job to ensure that coverage can be obatined in a way that allows residents to take vacation/be ill/etc. in a reasonable manner. If 2 residents in your call pool had major life events, what would happen? Would you ask someone to miss a child's birth, a siblings wedding, etc. It seems that programs that are so busy and have no back up plans, are doing a disservice to their residents. These types of programs may not be malignant in the classical definition but by their lack of organization/additional man power they can be to some residents.

 

[deuist]

I'm curious: don't all surgery residents have to do off-service rotations, especially as interns?

Not where I did my internship. Non-categoricals (i.e., me) could take two weeks to do an elective and that was it. The rest of the time was spent in the Dept of Surgery. We did not cover ENT, urology, or ortho.

 

[Doctor4Life1769]

I send sick people home. Though, I think you should show up and let people know, even if you have a few sick days in your contract.

Where I did residency, you technically had one sick day a month. No one ever used them though, not on the regular. I missed one day in residency because of illness. I did show up to work. On the way into work I almost sh:t myself and when I got there I had a fairly impressive puke and heave session into the trashcan in the locker room. I decided it was ridiculous for me to be there, found my attending and let him know what happened and he sent me home. I think this is generally the best way to approach ambulatory illness in residency.

I understand that. Show up if you can, and then go home with permission. That's fine. At least your attending let you go. L2D wouldn't...

I've worked with all of that, minus the puking, on two different occasions this past year. We have sick days, I just didn't want to leave anyone having to cover my patients.

I hope you loved running to the ****ter every time you had the runs... in between seeing pts and fielding pages. Oh wait, you were that guy with the IV pole by your side and immodium in your pocket.

 

[Winged Scapula]

...I had to ask another chief to "borrow" one of their residents to help us out, and that resident did "double duty" on both services until the ORs were done. Thus, everyone really tried NOT to go home sick cuz they didn't want to burden others to help cover. And some unfortunate soul would be told "you're on call tonight" if the sick person was supposed to be on that night. The sick person then needed to take that person's next scheduled call. But no one just called in sick...you showed up and your chief may or may not send you home, and you may refuse to go home if your service was horrendously busy with multiple disasters (like transplant or vascular). Actively puking from illness generally got sent home. Most other things did not.

That is how it was done for us as well. A team which was down a resident (either from vacation/illness, etc.) would sometimes "borrow" a resident from a less busy service or on rare occasions, pull someone from the lab.

I had emergency surgery as a PGY-2 on Trauma. This also occurred when another member of the team was out on vacation. I came back to work post-op hour 36 - not bravado, I actually had no pain and felt pretty good, and figured I couldn't let the team down. I underestimated how dehydrated I was and as SICU rounds wore on, as the attending noted, "the nurses are taking more care of you than the patients", so I was sent home. The service pulled residents from the SICU service to cover for me.

It usually evened out over the years - I did an extra month of Trauma to back-up a weak off-service gas intern that the attendings didn't trust; guess you could consider that my pay back for the time I needed coverage.

Isn't it the PD/chair of the department's job to ensure that coverage can be obatined in a way that allows residents to take vacation/be ill/etc. in a reasonable manner. If 2 residents in your call pool had major life events, what would happen? Would you ask someone to miss a child's birth, a siblings wedding, etc. It seems that programs that are so busy and have no back up plans, are doing a disservice to their residents. These types of programs may not be malignant in the classical definition but by their lack of organization/additional man power they can be to some residents.

The department Chair is often not involved in day to day workings of the residency program. We usually tried to work such things out ourselves. But I'm not sure how the residents or even the program are to be blamed if there is a manpower shortage. After all, programs cannot just increase the number of residents wily nily. Our program petitioned ABS/RRC for several years for an increase in the number of categoricals; it was denied even though it was clear that all the residents exceeded the minimum number of cases required by ABS by a significant number and that we needed more. I believe it was finally approved last year.

I'm honestly interested in what back up plans there *could* be. We never closed to trauma, never went on by-pass and there was no cap on admissions or cases. There was just so much work and only so many residents. We all really tried to help each other out, but at the end of the day, you cannot add residents to the roster, you work with what you have.

I hope you loved running to the ****ter every time you had the runs... in between seeing pts and fielding pages. Oh wait, you were that guy with the IV pole by your side and immodium in your pocket.

You seem to be awfully smug and judgemental for someone that's done 1 week of residency. How about supporting your colleagues who may find themselves in a predicament of being ill but not being allowed to go home, or for whom they feel a commitment to their fellow resident colleagues? If you have yet to find yourself in such a situation, count your blessings. Believe me, there are even <gasp> anesthesia programs out there which will require you to work when you're sick. And if you're in a program that allows sick days, please understand that many residents do not. Rather than blaming them, why not be more supportive and sympathetic?

 

[Doctor4Life1769]

I know I'll have to work hard when I'm in anesthesia. Where did that come from? Hell, I'm busting ass my intern year working 78-80 on each surg/med/ICU service. This week was rough, but I learned a lot.

VA Hopeful's reply insinuates there may be a sick day possible but HE took it upon himself to show up despite his illness and work. Upper levels will let you go for stuff like that. That's not helping anyone, and its not going to impress anyone. It's best to take the day off to recover and then come back when better. That's my point.

I find it ironic how many were bashing the OP for his predicament, rather than being supportive of him. Now, you want support for residents who work when they shouldn't?

 

[jdh71]

I understand that. Show up if you can, and then go home with permission. That's fine. At least your attending let you go. L2D wouldn't...

I didn't really give my attending the option. I was going home. I'm not rounding while puking and ****ting myself. I have my dignity. And as much as you hear the surgeons going on and on and on in this thread, you can find a way to cover one resident for one day. You'd think if the fleas can figure out how to do it, the "best" doctors in the hospital should be able to as well

 

[Dr Bartlet]

I didn't really give my attending the option. I was going home. I'm not rounding while puking and ****ting myself. I have my dignity. And as much as you hear the surgeons going on and on and on in this thread, you can find a way to cover one resident for one day. You'd think if the fleas can figure out how to do it, the "best" doctors in the hospital should be able to as well

Hee! Post of the thread right here!

 

[Winged Scapula]

I know I'll have to work hard when I'm in anesthesia. Where did that come from? Hell, I'm busting ass my intern year working 78-80 on each surg/med/ICU service. This week was rough, but I learned a lot.

VA Hopeful's reply insinuates there may be a sick day possible but HE took it upon himself to show up despite his illness and work. Upper levels will let you go for stuff like that. That's not helping anyone, and its not going to impress anyone. It's best to take the day off to recover and then come back when better. That's my point.

I find it ironic how many were bashing the OP for his predicament, rather than being supportive of him. Now, you want support for residents who work when they shouldn't?

I understand your point and I agree with it.

But you come across as blaming the victim(s) here. There *are* residents in situations in which they cannot (or feel they cannot) take time off. You and others persist in assuming that those residents are trying to "impress someone". How about being supportive of those residents who honestly fear reprisal for taking time off for illness? I'm not saying the system is right or humane or fair, but it does exist and its not fair to blame our colleagues who are in such situations.

 

[Doctor4Life1769]

I understand your point and I agree with it.

But you come across as blaming the victim(s) here. There *are* residents in situations in which they cannot (or feel they cannot) take time off. You and others persist in assuming that those residents are trying to "impress someone". How about being supportive of those residents who honestly fear reprisal for taking time off for illness? I'm not saying the system is right or humane or fair, but it does exist and its not fair to blame our colleagues who are in such situations.

Again. We are no longer a part of an era where 120 hour weeks are the norm. We are no longer an era where attendings and upper levels gave junior residents stimulants to keep them going. Those that attached IV's to themselves and saw patients were a part of that generation. Not this generation. If you can't have people cover for you, regardless of how tight things may be, that's not a supportive team. I'm not saying take time out for the sniffles. Not at all. Maybe some upper levels can afford to do a little more on the floor. Maybe that junior resident who finished early can stay and help out some rather than make a straight bee-line to the hospital exit. I saw it today, actually. Resident done early. Everyone is swamped. The resident made a quick "peace out b!tches" and left. The upper levels all looked at each other with disgust b/c THEY are staying longer to help make things smoother. This intern 16 hour thing isn't easy. It's especially not easy on us interns. Sure, a lot like to say they love only working 13-16 hour days. BUT, on weekend call days where you're covering 2-4 surgical services and you aren't familiar with all but one of them, and you're trying to see patients, field pages, still do progress notes, do whatever needs to be done for the day, etc... and dealing with acutely ill patients, it's NOT enough time in the day. Trust me, if you want to help out your teammates, you will. Hell, I knew I had plenty of time left before I hit that 80 mark (due to some efficient weekdays) and I ended up staying longer to ensure all the progress notes were done, all the sign-out mini-notes were done, and to help out my co-intern who took over a service from me, before I left. Dumb? Maybe. BUT, I know I'll have the support of my co-interns and upper levels when I need help with something, or if I need some time off due to a major unexpected illness.

 

[Perrotfish]

I'm honestly interested in what back up plans there *could* be. We never closed to trauma, never went on by-pass and there was no cap on admissions or cases. There was just so much work and only so many residents. We all really tried to help each other out, but at the end of the day, you cannot add residents to the roster, you work with what you have.

Why is the only option to cover for a sick resident always another resident? Why can't the attendings have Jepoardy call written into their contracts, so that each surgeon periodically takes sick call for the program? I mean it's not like this is a common occurence. Also the attending could just be compensated financially for the unexpected call rather than having to make the sick resident 'pay back' the time from their sick day.

 

[Doctor4Life1769]

Why is the only option to cover for a sick resident always another resident? Why can't the attendings have Jepoardy call written into their contracts, so that each surgeon periodically takes sick call for the program? I mean it's not like this is a common occurence. Also the attending could just be compensated financially for the unexpected call rather than having to make the sick resident 'pay back' the time from their sick day.

The reason they go into academia is so they can just operate all day and have someone else (residents/med students) round on patients, field pages, deal with bull**** floor work. OK, I'm not totally serious.... but, there is some truth to that. A slight pay-cut (questionable at that) w/o having to do all that ****? Sign me up, if I was surgeon.

 

[Winged Scapula]

Again. We are no longer a part of an era where 120 hour weeks are the norm. We are no longer an era where attendings and upper levels gave junior residents stimulants to keep them going. Those that attached IV's to themselves and saw patients were a part of that generation. Not this generation. If you can't have people cover for you, regardless of how tight things may be, that's not a supportive team. I'm not saying take time out for the sniffles. Not at all. Maybe some upper levels can afford to do a little more on the floor. Maybe that junior resident who finished early can stay and help out some rather than make a straight bee-line to the hospital exit. I saw it today, actually. Resident done early. Everyone is swamped. The resident made a quick "peace out b!tches" and left. The upper levels all looked at each other with disgust b/c THEY are staying longer to help make things smoother. This intern 16 hour thing isn't easy. It's especially not easy on us interns. Sure, a lot like to say they love only working 13-16 hour days. BUT, on weekend call days where you're covering 2-4 surgical services and you aren't familiar with all but one of them, and you're trying to see patients, field pages, still do progress notes, do whatever needs to be done for the day, etc... and dealing with acutely ill patients, it's NOT enough time in the day. Trust me, if you want to help out your teammates, you will. Hell, I knew I had plenty of time left before I hit that 80 mark (due to some efficient weekdays) and I ended up staying longer to ensure all the progress notes were done, all the sign-out mini-notes were done, and to help out my co-intern who took over a service from me, before I left. Dumb? Maybe. BUT, I know I'll have the support of my co-interns and upper levels when I need help with something, or if I need some time off due to a major unexpected illness.

Again, I'm not sure what you are arguing here or why you are trying to educate me on the difficulties of residency.

Yes, times have changed and the expectations of residents have changed.

You seem intent on insisting that everyone currently exists in a supportive environment. Wouldn't that be wonderful? But let's be realistic. There are current residents above posting that they do not exist in that fantasy world. So why are they being blamed for coming in to work when they are sick, when it is the only recourse they know for fear of reprisal?

I am very pleased that you find yourself in a supportive environment but can you not recognize that not everyone is? I'm honestly not trying to be argumentative here, but the sense I get from your posts is that you do not.

 

[Winged Scapula]

Why is the only option to cover for a sick resident always another resident? Why can't the attendings have Jepoardy call written into their contracts, so that each surgeon periodically takes sick call for the program? I mean it's not like this is a common occurence. Also the attending could just be compensated financially for the unexpected call rather than having to make the sick resident 'pay back' the time from their sick day.

While it sounds like a good idea, what academic hospital (who often operate at a loss), is going to pay their physicians *more* when they can get cheap labour from the residents?

Besides, who wants the attendings to be taking day to day calls about minutiae or for things that aren't in their specialty (harkens back to the time we had all the surgical subspecialists taking emergency gen surg call. It was a nightmare trying to teach them how to do a lap appy or the modern management of diverticulitis)? The nurses aren't going to call them, they'll just call an upper level or save all their BS calls for the next morning. During the 1 day a year the surgery residents take the ITE, attendings take the call. Nurses routinely will not call except for dire emergencies and will just stack up their calls for after the exam. I'd bet the same would happen if your plan was implemented (not that the attendings and hospitals would agree to it anyway).

The reason they go into academia is so they can just operate all day and have someone else (residents/med students) round on patients, field pages, deal with bull**** floor work. OK, I'm not totally serious.... but, there is some truth to that. A slight pay-cut (questionable at that) w/o having to do all that ****? Sign me up, if I was surgeon.

Yep. Some of those prima donnas insist they cannot operate alone and throw a fit when they get calls from nurses.

But to be honest, the pay differential for all but the upper echelon between academic surgeons and PP *is* pretty significant. The ACGME prints a report which shows the average academic salaries across the country and I can tell you, its a lot lower than my friends and I make. But I have to deal with the BS myself.

 

[dragonfly99]

The surgical services, when they rely only on residents, really are understaffed relative to specialties like medicine or peds (in general). One solution to this has been to hire a PA and/or NP to take charge of some of the floor work....

 

[wine thief]

I didn't have sick days as a resident. We had 4 weeks of vacation, if you needed a sick day, personal day, interviews, it came out of that. I think we also had a conference week for ca2 and 3. At one point the attendings didn't have sick days either, or at least they couldn't use them until their vacation was exhausted.

 

[142348]

The department Chair is often not involved in day to day workings of the residency program. We usually tried to work such things out ourselves. But I'm not sure how the residents or even the program are to be blamed if there is a manpower shortage. After all, programs cannot just increase the number of residents wily nily. Our program petitioned ABS/RRC for several years for an increase in the number of categoricals; it was denied even though it was clear that all the residents exceeded the minimum number of cases required by ABS by a significant number and that we needed more. I believe it was finally approved last year.

I'm honestly interested in what back up plans there *could* be. We never closed to trauma, never went on by-pass and there was no cap on admissions or cases. There was just so much work and only so many residents. We all really tried to help each other out, but at the end of the day, you cannot add residents to the roster, you work with what you have.

I have been involved to some degree with our hospital's integration of the new work hours as well as adapting to changing resident numbers. These are two things that have been commonly done with multiple programs including surgery and medicine:

1) Increase the complement of PA's/NP to help- An expensive proposition and one which usually requires chairman discussion and approval

2) Getting rid of some previously covered attendings/services to reduce the required number of "floor/rounding residents", and changing some services to consult only, rather than consult/rounding. Once again, the PD can manage this but often due to the delicate nature of hospital politics and the who's covered and who's not issues, the chairman gets involved to smooth things out.

 

[VA Hopeful Dr]

I hope you loved running to the ****ter every time you had the runs... in between seeing pts and fielding pages. Oh wait, you were that guy with the IV pole by your side and immodium in your pocket.

You don't have to be a jackass just because you didn't like what I said.

I was giving you my perspective, that's all. I didn't want to leave my patients to someone else. No attending forced me to be there, there would have been little problem had I asked to leave. It was my own choice to do as I did, I didn't want my work to be shifted onto someone else. I wasn't trying to be a martyr or anything like that.

 

[thesauce]

OP's great news has really taken a back seat to the "sick days controversy"

Congrats OP! Good luck in your advanced program!

 

[deuist]

Those that attached IV's to themselves and saw patients were a part of that generation. Not this generation.

I'm part of this generation. My last IV was three weeks ago.

I saw it today, actually. Resident done early. Everyone is swamped. The resident made a quick "peace out b!tches" and left. The upper levels all looked at each other with disgust b/c THEY are staying longer to help make things smoother.

Unless his senior told him to leave, that was a bad move on his part. There will come a time when he's swamped and needs help and people are going to peace out as a pay back.

This intern 16 hour thing isn't easy. It's especially not easy on us interns.

It sure wasn't easy when we were working 30 hour shifts, either. Just saying.

The reason they go into academia is so they can just operate all day and have someone else (residents/med students) round on patients, field pages, deal with bull**** floor work. OK, I'm not totally serious.... but, there is some truth to that. A slight pay-cut (questionable at that) w/o having to do all that ****? Sign me up, if I was surgeon.

If you have a password to Careers in Medicine, take a look around the salary tables. You'll see that across the board, academics makes less than private practice.

Hell, I'm busting ass my intern year working 78-80 on each surg/med/ICU service.

You're covering medicine, surgery, and ICU all in the same week? You must be a super intern.

 

[Doctor4Life1769]

Again, I'm not sure what you are arguing here or why you are trying to educate me on the difficulties of residency.

Yes, times have changed and the expectations of residents have changed.

You seem intent on insisting that everyone currently exists in a supportive environment. Wouldn't that be wonderful? But let's be realistic. There are current residents above posting that they do not exist in that fantasy world. So why are they being blamed for coming in to work when they are sick, when it is the only recourse they know for fear of reprisal?

I am very pleased that you find yourself in a supportive environment but can you not recognize that not everyone is? I'm honestly not trying to be argumentative here, but the sense I get from your posts is that you do not.

I get that there are malignant or unsupportive environments. The point of all that was that everyone should be supportive of their own colleagues where said colleague (if needed to) should be able to take the day off without putting everyone else in a hole and without fear of reprisal. If you want to make it work, you can. Missing one day is not going to hurt anyone, and the rest of the team can make proper accommodations for coverage, if you really want to help out a colleague. If everyone pitched in to take a few extra patients, it wouldn't hurt anyone. However, I do know there are programs out there where people are only looking out for numero uno... medicine requires teamwork. I'm also glad I'm in a great environment. I like where I am. Also, not arguing here, just making a point, like everyone else.

I think Dragonfly mentioned the use of PA's to help with floor work. I will agree. My hospital uses PA's. They are an immense help because they know their stuff. Especially on those days where all the upper levels on my service are in the OR and it's just them and me. They know exactly what the attending likes and they teach me the ins/outs of stuff, and so it makes things real efficient. However, I understand they get paid quite well, and hospitals strapped on cash may not be able to afford them. That's a shame.

 

[Doctor4Life1769]

I'm part of this generation. My last IV was three weeks ago.

great?

Unless his senior told him to leave, that was a bad move on his part. There will come a time when he's swamped and needs help and people are going to peace out as a pay back.

Agreed, bad move.

It sure wasn't easy when we were working 30 hour shifts, either. Just saying.

Nice to know. Yesterday was insane. Every 10 mins we had a Cat 1 trauma come in. So, I get your point.

If you have a password to Careers in Medicine, take a look around the salary tables. You'll see that across the board, academics makes less than private practice.

With the lack of call, taking care of ancillary stuff, and just practicing your specialty bread/butter with some zebras, you shouldn't make a whole lot more. I did know of some "upper echelon" surgeons making a well over a mill. But, WS already made that distinction.

You're covering medicine, surgery, and ICU all in the same week? You must be a super intern.

No. I've seen my schedule already. It's tight, hours-wise, for those specialty 3 blocks (I have 3 surg, 3 med, and 2 ICU months). Surgery and Medicine do have pts in the ICU, so we do cover those patients when they are in our respective service, as well.

 

[ilovepath]

With CIM, do they have private practice data? I only see academics. Can someone guide me if theres a compare/contrast?

 

[Doctor Bagel]

Just jumping in to congratulate attey on fighting the good fight and prevailing. I'm sure I don't have to tell you this, but for your remediation, keep your head down and don't disagree with anyone about anything. Only a few more weeks.

As for the backup issue, it seems like the surgery people have the worst time of it. I guess that makes sense since surgery programs are all pretty small, and you generally always have several levels of residents on call at one time. That's definitely a tough situation without lots of good options. In defense of the residents who are scared of calling in sick, I have a friend who did a prelim surgery year -- she called in sick once and did face retaliation from a chief because of it. I guess it happens. I'm personally not up for that, so I'm glad I didn't feel any strong call to operate.

 

[Dr Bartlet]

I understand your point and I agree with it.

But you come across as blaming the victim(s) here. There *are* residents in situations in which they cannot (or feel they cannot) take time off. You and others persist in assuming that those residents are trying to "impress someone". How about being supportive of those residents who honestly fear reprisal for taking time off for illness? I'm not saying the system is right or humane or fair, but it does exist and its not fair to blame our colleagues who are in such situations.

I'll tell you why. Because these individuals help perpetuate the myth that the powers that be have a God-given right to treat residents this way. Until all residents have enough balls to say when I'm running a fever of 103 and puking all over the place, I'm taking the day off, residency programs will think they have a right to run slave operations. Sorry, they get no sympathy from me.

 

[Winged Scapula]

I'll tell you why. Because these individuals help perpetuate the myth that the powers that be have a God-given right to treat residents this way. Until all residents have enough balls to say when I'm running a fever of 103 and puking all over the place, I'm taking the day off, residency programs will think they have a right to run slave operations. Sorry, they get no sympathy from me.

Fair enough; I can understand that POV.

I happen to think most people are sheepish when it comes to self-preservation and will avoid something they fear will result in reprisal.

 

[ShyRem]

There are some folks who will go home for any little thing. There are others who will stay even if their limb is falling off.

I have had fellow residents go home because they felt "a little fevery and tired". It made the rest of us pick up their slack. I had another resident call in sick because her pet died. Literally. That day I rounded on 14 very very ill patients by myself with the attending and handled all admissions (senior resident was in clinic). I was pretty pissed off about it 'cuz I got totally shafted.

To be fair, I was sent home as a med student because apparently I looked like death warmed over. I went home and was in bed for literally 3 days. I have very little recollection of that time. Guess I needed it. As a resident, I was on my ICU month and got laryngitis. Bad laryngitis. As in was barely squeaking. I felt ok.... but not a sound came out of my mouth even though I felt I was screaming. They assigned me a med student to do all my talking and gave me a pad of paper for messages. Two days later voice came back. Never missed a day of work (and good thing - we were busy busy busy - would have been grossly unfair to the team).

If you are truly ill, then by all means I think you should be allowed, even encouraged, to go home. But a little fever? Pet die? Really? Take some tylenol, put some kleenex in your pocket and get to work.

 

[justaregularmed]

There are some folks who will go home for any little thing. There are others who will stay even if their limb is falling off.

I have had fellow residents go home because they felt "a little fevery and tired". It made the rest of us pick up their slack. I had another resident call in sick because her pet died. Literally. That day I rounded on 14 very very ill patients by myself with the attending and handled all admissions (senior resident was in clinic). I was pretty pissed off about it 'cuz I got totally shafted.

To be fair, I was sent home as a med student because apparently I looked like death warmed over. I went home and was in bed for literally 3 days. I have very little recollection of that time. Guess I needed it. As a resident, I was on my ICU month and got laryngitis. Bad laryngitis. As in was barely squeaking. I felt ok.... but not a sound came out of my mouth even though I felt I was screaming. They assigned me a med student to do all my talking and gave me a pad of paper for messages. Two days later voice came back. Never missed a day of work (and good thing - we were busy busy busy - would have been grossly unfair to the team).

If you are truly ill, then by all means I think you should be allowed, even encouraged, to go home. But a little fever? Pet die? Really? Take some tylenol, put some kleenex in your pocket and get to work.

Still blows my mind people think this way. Running a little fever, sure come into work and run yourself into the ground so you get more sick. Then keep coming and be less productive for a few days, sure go for it. Or you could have just stayed home a half day and got better....

Then again I guess nobody can be trusted these days to actually "be sick"... Managers if you cant trust your employees to use good judgement is one thing, otherwise its just asinine.

Might as well let people come to work after drinking or remove duty hour limits entirely while you are at it.

 

[tkim]

Pet die? Really? Take some tylenol, put some kleenex in your pocket and get to work.

I agree with the sentiment, but obviously you were never close to a pet.

 

[dragonfly99]

You know, I don't have pets because
a) I don't feel I can afford one right now
and
b) I don't have time to properly take care of one.
I know people are totally attached to their pets, but I totally don't think that it would have flown @my residency program to not show up b/c a pet died. I know it sucks big time, but it would not have been cool to leave your fellow intern or resident to round on a bunch of ICU patients because you felt emotionally crappy. Again, I know people love their pets, but it's not your parent or your sibling or some other human being. If there are actual human beings who are hospitalized and in critical care and who need your services, do you actually think it's OK to stay home crying about your cat?
I bet I'm going to get flamed for this post big time....

 

[Dr Bartlet]

As a resident, I was on my ICU month and got laryngitis. Bad laryngitis. As in was barely squeaking. I felt ok.... but not a sound came out of my mouth even though I felt I was screaming. They assigned me a med student to do all my talking and gave me a pad of paper for messages. Two days later voice came back. Never missed a day of work (and good thing - we were busy busy busy - would have been grossly unfair to the team)

The bolded part is why it's laughable that you'd pat yourself on the back for coming to work. Of course having laryngitis isn't an excuse to miss work!

 

[Dr Bartlet]

If there are actual human beings who are hospitalized and in critical care and who need your services, do you actually think it's OK to stay home crying about your cat?

Why is it hard to believe that some people regard their pets as family? People become attached to their pets and when a pet dies (especially suddenly), it's hard for some to just sweep their emotions under the rug and slip into "doctor mode" because his/her colleagues are too insensitive to understand.

 

[Doctor4Life1769]

The bolded part is why it's laughable that you'd pat yourself on the back for coming to work. Of course having laryngitis isn't an excuse to miss work!

Agreed. It's now a pissing contest to see which resident is the most hard-core, of which, ShyRem lost that one... especially to VA Hopeful and another poster who rolled thru rounds with an IV!

 

[J-Rad]

OP: congrats on your success. I wish you well.

Since the remainder of the thread has merely become an opportunity to perpetuate personal bickering and nastiness and as we've spent a bunch of pages arguing over the same points barely related to the OP, this thread has come to an end.