Fudging of hours?

[BOHICA-FIGMO]

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Just wondering how many people out there are in programs that tacitly encourage/expect them to fudge their reported hours to stay under the 80 or 88 hour limit? For instance, I've been on duty for 34 hours straight, taking care of patients the whole time, but only logged it as 30. Is this common?

 

[psymed]

I do Q5 calls and work 13-16 hours a day even when I'm not on call. My time sheet says 08:30am to 04:30pm everyday. I filled out my first time sheet honestly and had to redo it. I was told by program that it doesn't work that way in the real world. We log the hours that we are supposed to work not the hours we actually work!

 

[DonStracci]

I'm up against this, possibly. I'm on my way to averaging waaay more than 80 hours this month. When I casually mentioned this to a chief, it was implied that I'm supposed to alter the numbers a little bit.

I'm all for honesty and playing by the rules, but I know that a whistle-blower in an upper class at my hospital ANONYMOUSLY reported hours violations last year, and it definitely was NOT anonymous- she encountered a lot of problems because of it.

I seriously would have to miss a day of work to average out at 80... that's really likely haha. It's laughable to imagine the chief's reaction if I asked for that day 🙂

 

[mercaptovizadeh]

I'm up against this, possibly. I'm on my way to averaging waaay more than 80 hours this month. When I casually mentioned this to a chief, it was implied that I'm supposed to alter the numbers a little bit.

I'm all for honesty and playing by the rules, but I know that a whistle-blower in an upper class at my hospital ANONYMOUSLY reported hours violations last year, and it definitely was NOT anonymous- she encountered a lot of problems because of it.

I seriously would have to miss a day of work to average out at 80... that's really likely haha. It's laughable to imagine the chief's reaction if I asked for that day 🙂

Since "anonymous" is obviously fake during residency, why don't residents who are leaving at least report it after they are out of harm's way? Or do they just not care enough at that point? Would the PD try to track them down and make their post-residency life difficult?

 

[Law2Doc]

Since "anonymous" is obviously fake during residency, why don't residents who are leaving at least report it after they are out of harm's way? Or do they just not care enough at that point? Would the PD try to track them down and make their post-residency life difficult?

Most specialties are very small communities, and you will be going back to your program for recommendations for future jobs and fellowships for years to come. Why would you make waves once you are already done? Plus things rarely seem as bad in retrospect, and many just see the extra hours as something that in the long run probably made them better prepared and trained. Which is why the old guard wasn't particularly in favor of the 80 hour rules. This will only be fixed by junior level whistleblowers willing to martyr themselves for the cause.

 

[Winged Scapula]

As L2D notes, there is still some fear of retribution. Every time you apply to a hospital for privileges, they will request information (at least for the first 5 years out of residency) from your PD about how well you are trained, are you qualified, etc.

Secondly, many residents still feel a sense of duty toward their program and the remaining residents in it. Its a lot like the Stockholm Syndrome, frankly.

And yes, as the years go by, time blurs the experience so it doesn't seem so bad.

 

[Impromptu]

My program is very clear that we are to log our hours honestly. Data do nothing unless they are recorded accurately. During my first year we rotated through several other departments. I had a week with 2 calls and no days off, so I went over hours. I immediately heard from my home-base program about my hours. I wasn't in trouble, rather they just wanted to know what they could do to so that I wasn't going over hours. They had had trouble with that particular rotation in past years, had successfully lobbied to get changes made, and wanted to ensure that it wasn't returning to the old ways (high frequency calls, long winded attendings on rounds, extra work added in because we were guests in that program). The next week I had two days off and only 1 call, so the average was fine.

I am grateful to be in such a great program. They have been very attentive to the residents' needs.

 

[bluealiendoctor]

What some of you ankle grabbers who have been beat down by the system don't seem to understand is that when you fudge your hours..you are only disturbing the whole idea of this 'duty hours' policy ideology. Studies were done that unarguably showed that when residents were worked beyond a certain level of hours..their performance was affected quite negatively. So when those of you who choose to follow the straight and narrow and do your PD's laundry fudge your hours...you are only strengthening the idea that hours worked are still too much and causing errors. They look at the data and say ' Hmmm these residents only worked 80 hours yet have made many more errors than those who worked 65.....I guess we better lower the duty hours some more'. Nobody wants to be the whistle blower, but sometimes you have to show some maturity and dignity and do what the higher powers state as requirements..which is to log your hours honestly. To say you might have to contact the program again in the future prevents you from wanting to say anything is really sad. I certainly wouldn't want some pansy who didn't have the rocks to just log his/her hours honestly. What else will these people fudge? Vital signs? ABG's? Doses? Come on people, grow a pair and step up.

 

[maceo]

I'm up against this, possibly. I'm on my way to averaging waaay more than 80 hours this month. When I casually mentioned this to a chief, it was implied that I'm supposed to alter the numbers a little bit.

I'm all for honesty and playing by the rules, but I know that a whistle-blower in an upper class at my hospital ANONYMOUSLY reported hours violations last year, and it definitely was NOT anonymous- she encountered a lot of problems because of it.

I seriously would have to miss a day of work to average out at 80... that's really likely haha. It's laughable to imagine the chief's reaction if I asked for that day 🙂

I cant believe there are programs out there that encourage resident to lie about thier hours. And I cant believe there would be retribution. those programs should be reported and SHUT DOWN.

 

[tkim]

What some of you ankle grabbers who have been beat down by the system don't seem to understand is that when you fudge your hours..you are only disturbing the whole idea of this 'duty hours' policy ideology. Studies were done that unarguably showed that when residents were worked beyond a certain level of hours..their performance was affected quite negatively. So when those of you who choose to follow the straight and narrow and do your PD's laundry fudge your hours...you are only strengthening the idea that hours worked are still too much and causing errors. They look at the data and say ' Hmmm these residents only worked 80 hours yet have made many more errors than those who worked 65.....I guess we better lower the duty hours some more'. Nobody wants to be the whistle blower, but sometimes you have to show some maturity and dignity and do what the higher powers state as requirements..which is to log your hours honestly. To say you might have to contact the program again in the future prevents you from wanting to say anything is really sad. I certainly wouldn't want some pansy who didn't have the rocks to just log his/her hours honestly. What else will these people fudge? Vital signs? ABG's? Doses? Come on people, grow a pair and step up.

Bold words. Haven't been in the situation myself, so I'm not sure what I'd do if pressed. Glad you can talk the big talk, though.

 

[Winged Scapula]

Easy to talk big when you've been in residency for 6 weeks and aren't privy to all the possible ramifications or an attending who isn't affected by it.

 

[bluealiendoctor]

Sorry Wing, you're wrong. You have obviously been completely beaten into submission by your superiors and that may be fine for you. These issues pertain to life and not just residency. How you hold your own, defend your own ethics and principles is a process everyone learns in their life. Some people choose to lay down and let footprints paint their face and others chose to reason, explain and yes, sometimes challenge. You have chosen your path and are projecting your anger at any one who chose a different one. No, it isn't easy for me to talk the big talk...it's just hard for you.

 

[Winged Scapula]

Sorry Wing, you're wrong. You have obviously been completely beaten into submission by your superiors and that may be fine for you. These issues pertain to life and not just residency. How you hold your own, defend your own ethics and principles is a process everyone learns in their life. Some people choose to lay down and let footprints paint their face and others chose to reason, explain and yes, sometimes challenge. You have chosen your path and are projecting your anger at any one who chose a different one. No, it isn't easy for me to talk the big talk...it's just hard for you.

Lest you forget blue...I am not in residency, nor do I have "superiors" any more. In addition, if you care to read through all of my posts, I did not necessarily "lay down and let footprints paint my face" during residency. I was routinely chastized for having interests and a life outside of surgery and demanding that my program adhere to their own goals and regulations.

I did advocate that residents pick and choose their battles wisely. Some of what residents perceive as abuse is merely NORMAL working conditions in any work place, not just residency. We have a large contingent of whiners and cry babies who cannot fathom working or responsibility. I was never beaten into submission - I was raised with a good work ethic by a family who honored their commitments.

I am not angry and have no anger to project on anyone else. But thanks for the armchair psych consult.🙄

You have an excellent point though - if you lie about your work hours and still make mistakes, it becomes very easy for the RRC to decide that hours need to be reduced even further. The OP's user name makes me wonder if he/she has a military background and/or is in a military residency. If so, "standing up" to his superiors, can have additional repercussions outside of residency. Choose your path, but most aren't interested in a court martial.

And I stand by my statement, that the only ones telling the OP to stand up to the "superiors" are you...in residency for 7 weeks now and an attending who hasn't been in residency for years.

 

[Gastrapathy]

Speaking from inside the military system, its actually safer to complain within the system because no single vindictive PD can do you in and work hours complaints are taken incredibly, painfully seriously.

 

[bluealiendoctor]

Well said Wing. I agree with you completely. I was only addressing the original question regarding 'fudging' one's hours. If a program is pressuring you to falsify your duty hours, I think that is wrong....period. However, I do often see how the 'you scratch my back I'll scratch yours' come into play. For example, if a colleague of mine falls ill and I fill in for him/her, or if a really interesting case comes up that an attending is putting in extra hours for education that will require extra work from me, I will go over if I need and will not immediately log that I did so. However, If I'm post call and on my 30th hour and an admission comes in that the silly second year who just started his/her shift doesn't want to do, I refuse to be a scut dog for such unreasonable situations as that. Or if some blow hard wants to give a ridiculous lecture post call that puts me over a 30 hour straight shift....then I sure as heck won't fudge my hours to support such nonsense as that. And yes Winged.....I did forget that you're not a resident..my bad. I absolutely agree with you on the whining though, I just don't support unreasonable tasking just for the sake of 'well, I had to do it' jargon.

 

[Winged Scapula]

Well said Wing. I agree with you completely. I was only addressing the original question regarding 'fudging' one's hours. If a program is pressuring you to falsify your duty hours, I think that is wrong....period.

I don't think anyone disagrees with that, even the most hardcore, old skool attendings. But let's face it, programs are doing that **** and residents are faced with questions about how to handle it (hence this thread).

However, I do often see how the 'you scratch my back I'll scratch yours' come into play. For example, if a colleague of mine falls ill and I fill in for him/her, or if a really interesting case comes up that an attending is putting in extra hours for education that will require extra work from me, I will go over if I need and will not immediately log that I did so. However, If I'm post call and on my 30th hour and an admission comes in that the silly second year who just started his/her shift doesn't want to do, I refuse to be a scut dog for such unreasonable situations as that. Or if some blow hard wants to give a ridiculous lecture post call that puts me over a 30 hour straight shift....then I sure as heck won't fudge my hours to support such nonsense as that.

And that's the proper attitude, IMHO, to have. Regardless of the rules or whether you are at hour 30, if there is real work to be done or something unusual happens, you should be allowed to exceed work hours. The ACGME rules don't allow for that after hour 30, probably because of the potential for residents and programs to abuse it. If staying 1 hour to stabilize a patient is ok, is 3 hours ok to finish clinic? Where do you draw the line?

And yes Winged.....I did forget that you're not a resident..my bad.

You're behind the times...its been 2+ years since I left fellowship and have been in practice. 😀

I absolutely agree with you on the whining though, I just don't support unreasonable tasking just for the sake of 'well, I had to do it' jargon.

Nor was I supporting that either. I don't think its excusable to propulgate bad practices just because the generation before did them. There are *some* good reasons for some practices but everyone has to play within the rules, even if they don't like them.

The problem is, as the OP has noted, what do you do when your program wants you to falsify your work hour logs? Its easy to say, "don't do it", but what if you're a marginal candidate in a competitive specialty? What if you fear the program will close? These are REAL fears faced by residents every day in these programs.

 

[AznTrojan]

i never fudged my hours even though i worked more than 80+ hours per week on some rotations as in intern.. i got dirty looks from my chief resident.. but i didn't really care since it was only a prelim medicine year.. 😀

in the end.. due to all my hard work.. they actually tried to recruit me into internal medicine..

 

[Groove]

I don't think I would ever need to fudge my hours in my residency program... but if I did... I'd fudge them and would definitely NOT report a violation. It's just too risky to make those kinds of waves. I'm not saying that's the right thing to do, but I look at it this way... plenty of physicians have gone before me working much worse hours and made it through alive. I'm just not the whistleblower type.

 

[chael]

at my program, we were told that all the detailed logging we do is for internal use only. the only thing the ACGME sees are the surveys that are done every year.

we definitely had situations where residents who logged their hours honestly were called into the PD's room and told to "be more efficient". There were also problems on one particular service where people were flat out told to alter their hours.

for myself, my log sheet says the same thing for every day, but its just because i'm too lazy to keep track of my hours, so I'll do them all at the end of the month.