The age of violating the 80 hour limit is rapidly fading. Programs that do this will get caught, and will lose accreditation.
Hey, there itchy butt! Cite your evidence. And I don't buy the ACGME's propaganda. I think you may be a bit naive, which is not necessarily a bad thing, at least compared to an old jaded resident. But do keep your eyes open and watch your back. Your program may be very good, as is mine, but there are others who are not.
The age of violating the 80 hour rule is a function of the malignancy of the program, how closely they are being watched and the desire of the program to follow the rules, v. the hospital's desire to make money. No desire = half hearted to no effort to follow the 80 hour rules.
There are an increased number of programs that ARE following the rules. But there remain many, many programs that are not and will not until they are up for RRC reviews or they get caught, if they get caught. Will the site visitor review charts and compare them against resident duty hours? How, this is an incredibly labor intensive thing to do. Further, if you report 14 hours on, 10 hours off, which 14 were you actually on? I don't think looking at charts for times of orders or PN/H&Ps will validate a report. Besides, you remember which patients you admitted, rounded, did procedures on, delivered on August 23, 2005? Any consolidated record of that in your hospital?
You make a blanket statement "Lots of people like to talk about how hard the year is, and to claim that they violate hours all the time...not usually true....especially when you here things like "we don't keep track".
Programs who willfully violate the rules do so with full knowledge of the tracking documents.
IF one is in such a program and if one is honest in reporting rules violations, the conversation between the resident in question and the chief or PD might go something like this:
"John, we've noticed in your hours reporting that you are not as efficient as you could be which is causing you to work more than 30 hours on duty to get your work done. Perhaps we need to put you on probation so you can learn to be more efficient. Of course you know if you do get put on probation, it will mean repeating your intern year, so why don't you 'learn' to be a bit more efficient and work just the 24+6 and make sure that you are efficient enough to get your 10 hours off and 1 in 7. IF you can do that, we'll all be happy."
John of course talks to Sean who says, yeah, I work 96-100 hours but the sheets say 80 because I've heard they do that.
This type of coersion is not uncommon as was recently reported by a research group at Harvard who prospectively followed med students through residency. This study of 2700 interns and residents, sponsored by the Brigham and Womens IRB, reported last fall that there was widespread substantial underreporting of hours as recently as July-August 2006.
While there are many programs that are grudgingly coming into compliance, there remain many, many more who are not and will lie to cover their tracks. In this day and age, there remain attending faculty who disagree with the work hour rules and all of the accumulated military and civilian research over the past century that demonstrate humans can do without adequate interval sleep any more than they can do without adequate interval nutrition and bodily waste disposal. To me this is incredible. As an FAA aeromedical examiner, a significan portion of the flight surgeon's training sessions are devoted to cockpit fatigue and sleep deprivation in evaluating pilot errors. This, folks, is not rocket science.
Writing down your hours on a form that goes to the program director who can then individually meet with the problem residents and suggest it is an individual problem and not an institution problem with a clear threat that if you report honestly again, you'll be booted from the program will certainly clear up any resident misunderstanding on how to appropriately report hours.
I'd very much like to believe what you say, but where bucks and the hospital bottom line are at stake, there will always be some that will push the limits.
Choose your programs verrry carefully boys and girls.
