My schedule as an intern

[MirkoCrocop]

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switch to path... my 'intern' schedule:

7am: wake up
715: leave
745-800: arrive
800-1200: read/preview slides/occassional conference
1:200-1:00: eat lunch/read
1:00-5:00: gross/read
5:00 - go home

 

[deleted109597]

I learned that I can round on 12 people in an hour after the first month of internship. That includes the notes.
I always write out the important parts first (before seeing the patient) so that I know what to look for. Nothing pisses off your senior more than not knowing the chest tube output. I would just go back and fill in the values after seeing all the patients on that flow. Wash, rinse, repeat on the 7 other floors.

 

[nykka3]

Ahh... New York nurses. A great bunch of men and women who answered the call to "Dare to Care" and relieve human suffering.

They taught me quite a few things during my five years of training in New York City.

1) I really don't like New York City that much after all.

2) I would've made a damn good phlebotomist.

3) I am a one man IV team.

4) I am a one man MAR checker.

5) I can pilot a patient's bed through the narrow hallways of any hospital expertly and which speaks highly of the years of education I have attained.

6) Fifteen minute breaks every three hours can be combined to make a three hour break in an eight hour shift.

7) LPNs and RNs were a higher form of life than an MD.

8) LPNs and RNs essentially teach MDs everything they'll need to know in clinical medicine.

9) Non physician staff in hospitals are quite vindictive toward the physician staff.

10) When given the chance, attending MD staff will always take the side of the ancillary staff against you, the resident b!tch.

11) The only real utility in paging the resident is for the nurse to document that they have informed you of some highly insignificant thing, so that they can "protect their license."

12) Pages increase in frequency as the clock approaches 7AM, 3PM, and 11PM (shift changes) and remain high for approximately 2 hours following the change of shift.

13) A nurse's signout at the change of shift is much more important than anything an MD has to say about a patient, so you'd better not interrupt all that important clinical decision making.

14) Nursing orders ALWAYS need clarification around the time of your ONLY lecture/conference for the day, and if you don't deal with it when they page you and defer it until the end of lecture, you're going to get a scolding from the Nursing Manager. Then you're really in deep ****.

15) I really, really, really despise unions and I think I became a Republican almost solely because of NYSNA.

I'm not saying it's necessarily better in Chicago, but I inquired as to when a particular nurse in the SICU was going to take her union sanctioned break, and her reply was, "I have too many sick patients to go on break! I'll go on break when my shift ends tonight at 7PM!" It was 11AM when she said this to me. I was shocked and amazed and relieved to a great degree. The nursing staff will draw STAT bloods, routine bloods, and call Rads for studies, EKG, etc. for you.

I'll warn all you out there in SDN land again -- NEW YORK CITY is a great place to live, but it's a terrible place to be a PHYSICIAN and to TRAIN AS A RESIDENT.

I got out. So can you.

Good luck.

Once again thanks for steering me away from NYC programs. I really like NYC but your PM advice was all that I needed to know to make the right decision. I am working hard but enjoying myself in sunny Cali.

 

[Doni2008]

Hi all, I come back.

During the last 2 days I had many new patients with multiple problems and went home very late.

A second year resident in my program has sent complaint about scutwork to the CEO, but he did not send to ACGME.

I am considering to send conditions in my program to ACGME (and whO else please tell me).

Our residents work hard but always being followed up like a criminal, I did not make any serious mistake since I joined this program. But I really hate to be treated like this.

One of our CMRs is very terrible. This guy thinkS that he is a king, he just hangs around to find mistakes of residents and blame and report to PD. When going to cafeteria, he did not get line but enter directly to the place where having food he needs. What a doctor?

After working in this program I realized that residents were trained well regarding knowledge and skills but others like attitude, behavior are very bad: PGY3s are grandiose about their capacity to handle pts, residents become very mean (PGY2+3), some are very aggressive and deny their mistakes (pgy2). I have confronted and also witnessed. There is a big group of residents in the same country in my our program and brought their "wild" culture to this hospital. In the call room they speak in their native language despite I was there.👎UNBELIEVABLE.

 

[Doni2008]

Now I completely understood why this program is 100% IMGs.

 

[Doni2008]

Thank Winged for sending me the link, I read it and now I know violations in my program. Here are some that I collected:

• Residents have to do blood draw because nurses did not do, the chief medical residents make resident responsible for blood draw. Residents are supposed to do blood draw because the hospital trained phlebotomy at the beginning and repeated trainings. Residents have to do fecal occult blood tests. Residents sometimes have to bring blood samples to the labs. Residents sometimes have to collect stool samples, urine samples for tests.
• Residents have less than 7 hours for rest (everyday almost residents come to the hospital at 6:30 am, leave the hospital at 9:00 pm, some residents leave the hospital at midnight, the program is clever to make all residents have to sign in at 7:00 am and sign out at 5:00 pm but in fact residents never leave the hospital at 5:00 pm)
• Residents have to give medications to patients because nurses refuse to do, medications as Metoprolol IV, Diltiazem IV, Dextrose 50% IV, Lasix IV are some medications that residents have to give to patients.
• Residents have 2 months of night float in 1 year.
• Residents sometimes have more than 12 patients, some have to manage15 patients daily.
• Residents on call sometimes receive more than 8 patients, including transfers and new admissions.
• Residents on call on Saturday have to work more than 24 hours continuously (come at 8:00 am for sign in and leave at 10 am, some residents stay until 5:00 pm because too much work, although sign out at 8:00 am of the following day).

 

[Doni2008]

I learned that I can round on 12 people in an hour after the first month of internship. That includes the notes.
I always write out the important parts first (before seeing the patient) so that I know what to look for. Nothing pisses off your senior more than not knowing the chest tube output. I would just go back and fill in the values after seeing all the patients on that flow. Wash, rinse, repeat on the 7 other floors.

In NY too much scutwork, you never finish you job as scheduled. As a resident PGY1, you are supposed to play your role as a RN+ MD+student+PCA+secretory at the same time.

 

[Doni2008]

switch to path... my 'intern' schedule:

7am: wake up
715: leave
745-800: arrive
800-1200: read/preview slides/occassional conference
1:200-1:00: eat lunch/read
1:00-5:00: gross/read
5:00 - go home

I wish I'd be in your program. So wonderful schedule.

 

[Smurfette]

Thank Winged for sending me the link, I read it and now I know violations in my program. Here are some that I collected:

• Residents have to do blood draw because nurses did not do, the chief medical residents make resident responsible for blood draw. Residents are supposed to do blood draw because the hospital trained phlebotomy at the beginning and repeated trainings. Residents have to do fecal occult blood tests. Residents sometimes have to bring blood samples to the labs. Residents sometimes have to collect stool samples, urine samples for tests.
• Residents have less than 7 hours for rest (everyday almost residents come to the hospital at 6:30 am, leave the hospital at 9:00 pm, some residents leave the hospital at midnight, the program is clever to make all residents have to sign in at 7:00 am and sign out at 5:00 pm but in fact residents never leave the hospital at 5:00 pm)
• Residents have to give medications to patients because nurses refuse to do, medications as Metoprolol IV, Diltiazem IV, Dextrose 50% IV, Lasix IV are some medications that residents have to give to patients.
• Residents have 2 months of night float in 1 year.
• Residents sometimes have more than 12 patients, some have to manage15 patients daily.
• Residents on call sometimes receive more than 8 patients, including transfers and new admissions.
• Residents on call on Saturday have to work more than 24 hours continuously (come at 8:00 am for sign in and leave at 10 am, some residents stay until 5:00 pm because too much work, although sign out at 8:00 am of the following day).

Hmm...some of these things are not even remotely ACGME violations, unless I'm missing something. I thought NY only had slightly stricter "hours" rules.
- residents doing blood draws and taking samples to lab. Happens all the time in county hospitals and when phlebotomy just won't be there quick enough. Frustrating for junior residents, but this will not get your program into trouble with the RRC
- some meds are "MD push" by hospital policy. Again, frustrating for junior residents, but hardly anything the ACGME is going to ding a program on.
- 2 months of night float in one year does not violate any ACGME guidelines (We routinely do 2 consecutive months of night float at my program, it's never been an issue).
- Number of patients to manage varies by type of program you're in. In surgical specialties, there are no patient or admission caps.

The hours issues are something that WILL get your program in hot water.

 

[Winged Scapula]

She got those "requirements" from the ACGME IM residency program requirements link I posted on the previous page. http://www.acgme.org/acWebsite/downloads/RRC_progReq/140_im_07012007.pdf

The program director is supposed to be:

ensure that the residency does not place excessive reliance​

on residents for service as opposed to education;

I am not sure that drawing blood, for example, is a violation per se, but rather if the hospital does not have 24 hour phlebo services, it appears to be. We are NOT talking about drawing blood when you need it stat or don't want to wait around for phlebotomy. The OP tells us that the residents ROUTINELY draw blood; this is their job. A very close friend of mine did her residency in NY and all blood, EKGs, and NGT were placed by interns (she told me this today, as a matter of fact, while we were discussing this issue). It is the routine use of residents for these activities which I believe violate the intent of ACGME, if not the requirement.

Service versus Education
1. A sponsoring institution must not place excessive reliance on
residents to meet the service needs of the participating training
sites.​

Inpatient clinical support services must be available on a 24-
hour basis to meet reasonable and expected demands,
including intravenous services, phlebotomy services,
messenger/transporter services, and laboratory and
radiologic information retrieval systems that allow prompt​

access to results.

To this end, the sponsoring institutions and participating sites must
have written policies and procedures, and provide the resources to
ensure the implementation of the following:​

a) Residents must not be required to provide routine​

intravenous, phlebotomy, or messenger/transporter services.

c) Residents must not be assigned more than one and a half
months of night float during any year of training, or more
than four months of night float over the three years of
residency training. Residents must not be assigned to more​

than one month of consecutive night float rotation.

Physicians administering IV medications is not an ACGME violation.

Medicine caps and number of patients per intern are mentioned in the document published by ACGME.

Inpatient Medicine
a) On Inpatient rotations:
(1) A first-year resident must not be assigned more than
five new patients per admitting day; an additional two
patients may be assigned if they are in-house​

transfers from the medical services.

(2) A first-year resident must not be assigned more than
eight new patients in a 48-hour period.​

(3) A first-year resident must not be responsible for the​

ongoing care of more than 12 patients.

Certainly, work hours are an obvious problem at this program.

Duty hours are defined as all clinical and academic activities related
to the program; i.e., patient care (both inpatient and outpatient),
administrative duties relative to patient care, the provision for
transfer of patient care, time spent in-house during call activities,
and scheduled activities such as conferences. Duty hours do not
include reading and preparation time spent away from the duty site.​

1. Duty hours must be limited to 80 hours per week, averaged
over a four-week period, inclusive of all in-house call activities.​

2. Residents must be provided with one day in seven free from
all educational and clinical responsibilities, averaged over a
four-week period, inclusive of call.​

3. Adequate time for rest and personal activities must be
provided. This should consist of a 10-hour time period​

provided between all daily duty periods and after in-house call.

24 hours is not the limit however, NY or not. Residents can work up to 30 hours at a time, although the last 6 hours are supposedly for tying up loose ends, continuity of care; residents are not supposed to be caring for new patients, doing admissions, etc. This requirement is *very* loosely interpreted by programs as to what constitutes continuity.

On-Call Activities
1. In-house call must occur no more frequently than every third
night, averaged over a four-week period.​

a) Internal Medicine residency programs are not allowed to
average in-house call over a four-week period.​

2. Continuous on-site duty, including in-house call, must not
exceed 24 consecutive hours. Residents may remain on duty
for up to six additional hours to participate in didactic
activities, transfer care of patients, conduct outpatient clinics,
and maintain continuity of medical and surgical care.​

3. No new patients may be accepted after 24 hours of continuous
duty.
a) A new patient is defined as any patient to whom the resident
has not previously provided care.​

4. At-home call (or pager call)
a) The frequency of at-home call is not subject to the
every-third-night, or 24+6 limitation. However at homecall
must not be so frequent as to preclude rest and
reasonable personal time for each resident.​

b) Residents taking at-home call must be provided with
one day in seven completely free from all educational
and clinical responsibilities, averaged over a four-week
period.​

c) When residents are called into the hospital from home,
the hours residents spend in-house are counted toward​

the 80-hour limit.

At any rate, please read the source document; they exist for all ACGME specialties. Some of you may find that your programs are violating ACGME rules.

 

[8744]

Hi all, I come back.

During the last 2 days I had many new patients with multiple problems and went home very late.

A second year resident in my program has sent complaint about scutwork to the CEO, but he did not send to ACGME.

I am considering to send conditions in my program to ACGME (and whO else please tell me).

Our residents work hard but always being followed up like a criminal, I did not make any serious mistake since I joined this program. But I really hate to be treated like this.

One of our CMRs is very terrible. This guy thinkS that he is a king, he just hangs around to find mistakes of residents and blame and report to PD. When going to cafeteria, he did not get line but enter directly to the place where having food he needs. What a Monkey doctor?

After working in this program I realized that residents were trained well regarding knowledge and skills but others like attitude, behavior are very bad: PGY3s are grandiose about their capacity to handle pts, residents become very mean (PGY2+3), some are very aggressive and deny their mistakes (pgy2). I have confronted and also witnessed. There is a big group of residents in the same country in my our program and brought their "monkey" culture to this hospital. In the call room they speak in their native language despite I was there.👎UNBELIEVABLE.

"Monkey Culture?"

 

[8744]

Thank Winged for sending me the link, I read it and now I know violations in my program. Here are some that I collected:

• Residents have to do blood draw because nurses did not do, the chief medical residents make resident responsible for blood draw. Residents are supposed to do blood draw because the hospital trained phlebotomy at the beginning and repeated trainings. Residents have to do fecal occult blood tests. Residents sometimes have to bring blood samples to the labs. Residents sometimes have to collect stool samples, urine samples for tests.
• Residents have less than 7 hours for rest (everyday almost residents come to the hospital at 6:30 am, leave the hospital at 9:00 pm, some residents leave the hospital at midnight, the program is clever to make all residents have to sign in at 7:00 am and sign out at 5:00 pm but in fact residents never leave the hospital at 5:00 pm)
• Residents have to give medications to patients because nurses refuse to do, medications as Metoprolol IV, Diltiazem IV, Dextrose 50% IV, Lasix IV are some medications that residents have to give to patients.
• Residents have 2 months of night float in 1 year.
• Residents sometimes have more than 12 patients, some have to manage15 patients daily.
• Residents on call sometimes receive more than 8 patients, including transfers and new admissions.
• Residents on call on Saturday have to work more than 24 hours continuously (come at 8:00 am for sign in and leave at 10 am, some residents stay until 5:00 pm because too much work, although sign out at 8:00 am of the following day).

You only have 12 patients and you stay in the hospital 18 hours a day to manage them? Dude, I had 12 ICU patients on my census and could handle all of their problems in a solid eight-hour day. I mean, even most ICU patients are meta-stable and many just sit there doing nothing in particular. You need to work on your efficiency...and you need to learn to cut some corners on the paperwork.

And 8 admission is nothing. It's hard when you're brand new of course but in a little while you will see that one chest pain rule out is pretty much like another.

 

[Winged Scapula]

You only have 12 patients and you stay in the hospital 18 hours a day to manage them? Dude, I had 12 ICU patients on my census and could handle all of their problems in a solid eight-hour day. I mean, even most ICU patients are meta-stable and many just sit there doing nothing in particular. You need to work on your efficiency...and you need to learn to cut some corners on the paperwork.

And 8 admission is nothing. It's hard when you're brand new of course but in a little while you will see that one chest pain rule out is pretty much like another.

While I agree that inefficiency is a big problem for the OP, you also have to take into account that she is doing all the blood draws, administering medications, placing Foleys and NGT, and spending what appears to be over 4 hours a day in non-patient care activities (morning sign out, morning report, noon conference and evening signout), so its not really fair to compare that to what most of us experience (ie, having ancillary staff who actually do the work they are hired for).

 

[BlondeDocteur]

My sympathies are with the OP.... though I have to say I'd rather not think what the obvious implications of "monkey doctor" and "monkey culture" are.

 

[Castro Viejo]

My sympathies are with the OP.... though I have to say I'd rather not think what the obvious implications of "monkey doctor" and "monkey culture" are.

Hmmm... Perhaps it's because I'm ******ed, but I have no friggin' clue what's implied by "Monkey Doctor" or "Monkey Culture."

I mean, I really hope that's not what was implied or else this conversation has really taken a turn for the worse.

Please enlighten me.

 

[lowbudget]

While I agree that inefficiency is a big problem for the OP, you also have to take into account that she is doing all the blood draws, administering medications, placing Foleys and NGT, and spending what appears to be over 4 hours a day in non-patient care activities (morning sign out, morning report, noon conference and evening signout), so its not really fair to compare that to what most of us experience (ie, having ancillary staff who actually do the work they are hired for).

... And writing 2 page progress notes on established non-ICU patients.

This place sounds like my worst nightmare and it's stuff that novels and TV show are made of...

 

[BlondeDocteur]

CV: I bet you dollars to donuts that your worst fears are *exactly* what's implied. Western European culture ain't the only racist one, you know.

 

[lowbudget]

Now I completely understood why this program is 100% IMGs.

I know that there are some IMGs who are happy to have a chance to train and eventually practice medicine after trying so hard to get in.

And I hate to fuel to what already sounds like a bad situation, but...

In the US, you have rights. And there are rules that have been set up for your protection. And if you don't stand up and be part of the solution, you will quickly become part of the problem when you become PGY-2 and PGY-3. Because at that point, there's no way out except to defend that flawed system that you have survived for your own survival. You will recruit a bunch of IMG's who will work hard for the abuse. You will pride yourself in surviving PGY-1. And soon, you too will become King or Queen. And when your PGY-1's complain, you will do everything you can to suppress/oppress them to defend yourself. And so, the vicious cycle continues.

If you don't do something about the abuse, you may soon enough become one of the people that you hate so much.

 

[Doni2008]

"Monkey Culture?"

Sorry for using a new word here, I heard this word when I studied at Kaplan center. Monkey here implies " a person has behavior like a person living in wild forest and does not know how to behave in modern society".

 

[Doni2008]

While I agree that inefficiency is a big problem for the OP, you also have to take into account that she is doing all the blood draws, administering medications, placing Foleys and NGT, and spending what appears to be over 4 hours a day in non-patient care activities (morning sign out, morning report, noon conference and evening signout), so its not really fair to compare that to what most of us experience (ie, having ancillary staff who actually do the work they are hired for).

It seems to me that only past/current residents in NY boroughs and Winged understand the situation we are suffering.

I often go home at 9-10 pm, but around 1/3 of PGY1s in my program go home after 10pm.

If I did not have scutwork and long round, I'd finish my duties at 3pm.

Today I have to do blood transfusions for 2 patients, give medications to pt 5x (3x diltiazem iv, 2x lasix iv), draw blood for 6 pt, do EKG for 1 pt, put NGT then order Xray then go to radiology department to borrow XR and read, many other interuptions I cannot remember.

For the blood transfusion, you must be present to check with nurse, then they ask you to connect lines, then start transfusion. Some nice nurses they may tell you that they stay there for 15 minutes to monitor pt, some go away and you have to stay there to monitor pt.

Imagine how to to draw blood: this really take long time although I am now a skilled phlebotomist (other residents also skilled phlebotomists), I am almost successful at 1st try despite difficult vein access.

1. Order in the computer (test name, type, freq, number... you have to select options)
2. Print labels, this may take take because too many orders, you have to roll down to select test and correct time. Then press print.
3. Go to work room to select equipments (alcohol cotton, vacutainers, butterfly, gauze, tape, vacuum, bag..)
4. Draw blood and stick labels.

If they prepare erything for me, I need only 1-3 minute for blood draw, but here I have to do everything.

 

[Doni2008]

I know that there are some IMGs who are happy to have a chance to train and eventually practice medicine after trying so hard to get in.

And I hate to fuel to what already sounds like a bad situation, but...

In the US, you have rights. And there are rules that have been set up for your protection. And if you don't stand up and be part of the solution, you will quickly become part of the problem when you become PGY-2 and PGY-3. Because at that point, there's no way out except to defend that flawed system that you have survived for your own survival. You will recruit a bunch of IMG's who will work hard for the abuse. You will pride yourself in surviving PGY-1. And soon, you too will become King or Queen. And when your PGY-1's complain, you will do everything you can to suppress/oppress them to defend yourself. And so, the vicious cycle continues.

If you don't do something about the abuse, you may soon enough become one of the people that you hate so much.

The issue here is that I do not like to be closely followed as a criminal and blamed for any small mistakes (e.g late, pending, missed work) . They did not understand and empathize us.

I can stand the hard work but as I said I hate to be treated like this. If you have not ever worked as a resident in NY boroughs, you never understand completely the situation.

 

[Doni2008]

Think and compare:
In my program:

There's a cardiology fellow who did residency in a famous program in Boston but he does not know how to make a heplock. he was surprised when he saw I did.

A GI fellow, residency at a university program in Virginia but she did not know how to make heplock.

Both of them asked me why I had to do these wraps.

They never do it in their program.

 

[3dtp]

Since she states that her program uses morning report and afternoon sign-out as the times in/out, I suspect they don't care one bit that they/she are lying about work hours.

It's not just in NY!

This is the fallacy of the NYHC and Bell Commission. The hospitals still violate the hours, but everyone thinks that because these forms exist and are filled out, that they don't

...
I suspect, as I've stated above, that if the OP were to complain that she was being asked to forge this form with inaccurate work hour claims, that she would be told that she was the problem, that if she worked harder or were more efficient, she would get the work done in the time allotted. That's how these programs roll.

Also true elsewhere. We had a group of us keep track of the hours on duty in little red spiral notepads. Among 6 interns, the average was 109 hours, the median was 108 hours the minimum was 91 hours, the max was 116 hours. The rules were, the clock started when you did the first patient related activity of the "shift" and stopped when you did the last patient activity of the "shift." We intercompared "good" and "efficient" residents with "not so good" or "bad" residents and found in 4 months time, no significant differences between residents. This was brought to the attention of the program and the response was, we were the problem, and specifically, I, the statistician, was the root cause of resident unrest. We got the message.

 

[lowbudget]

This is a classic "whistleblower's" case that comes up in ethics class or legal studies class.

If you report the abuse, you risk getting punished.

If you don't report the abuse, you continue to get punished.

The ideal situation is the hospital or residency has a person who is NOT involved in supervising you or evaluating you, someone who is impartial, that will take your complaint seriously without getting you in trouble. These are usually an ombudsman who will maintain your anonymity.

There was a case a few years ago where an EM resident from Johns Hopkins reported some abuses which triggered an investigation and placed their residency program on probation. It made national headlines and this resident's identity was leaked out and he received a lot of backlash. (You might be able to google it or do a search in this forum...)

On the other hand, it's not like the abuses are a secret. Everyone knows, but no one talks about it. And one day, some patient will get hurt. And it'll trigger an investigation, and they'll find all these violations... that's what happened at MLK/Drew/Harbor and the entire hospital was shut down. All the residents had to find new jobs...

It's a bad situation to be in. I'm so sorry for you.

 

[MirkoCrocop]

LOL@monkey culture

and

LOL@all y'all who got up in arms about a stupid phrase

 

[Trifling Jester]

If you're writing notes after the attending has already written his note for the day, then just write "agree with above" and sign next to his name.

Sincerely,
The Trifling Jester

 

[Doni2008]

This is a classic "whistleblower's" case that comes up in ethics class or legal studies class.

If you report the abuse, you risk getting punished.

If you don't report the abuse, you continue to get punished.

Yes, true


On the other hand, it's not like the abuses are a secret. Everyone knows, but no one talks about it --->absolutely right

Thanks.

 

[Doni2008]

SORRY FOR USING A SENTITIVE WORD.

I did not have any idea of discrimination when using it (actually I am a victim of discrimination), I just wanted to describe some people with bad behaviors in a short way.

First time I heard it in the kitchen room in Kaplan center, I studied there and people (IMGs) there told me. I did not understand and they explained to me.

They also told me NY is the option if I could not get a position (rank at bottom) but I accepted prematch.

 

[3dtp]

This is a classic "whistleblower's" case that comes up in ethics class or legal studies class.

If you report the abuse, you risk getting punished.

If you don't report the abuse, you continue to get punished.

The ideal situation is the hospital or residency has a person who is NOT involved in supervising you or evaluating you, someone who is impartial, that will take your complaint seriously without getting you in trouble. These are usually an ombudsman who will maintain your anonymity.

There was a case a few years ago where an EM resident from Johns Hopkins reported some abuses which triggered an investigation and placed their residency program on probation. It made national headlines and this resident's identity was leaked out and he received a lot of backlash. (You might be able to google it or do a search in this forum...)

On the other hand, it's not like the abuses are a secret. Everyone knows, but no one talks about it. And one day, some patient will get hurt. And it'll trigger an investigation, and they'll find all these violations... that's what happened at MLK/Drew/Harbor and the entire hospital was shut down. All the residents had to find new jobs...

It's a bad situation to be in. I'm so sorry for you.

lowbudget, you have identified the crux of the problem. In an earlier post, you identified the rules and laws that protect residents and my impression was you were naive. It is clear from this post that you do understand the situation.

Unfortunately, the only way to enforce a law or right on those who do not wish to obey the rule, is to either beat them senseless until they submit, which our society frowns upon and will end a career, or to take appropriate legal action, which the hospitals have been until very recently in most states, quite successful in getting themselves protected from under the guise of "educational institution and prerogatives" and "peer review," and thus will also likely end a career. It is becoming increasingly apparent that there is much sham peer review, retribution and retaliation in the resident education process, but the protections are thin, timeconsuming and extremely costly.

Many programs will not, as a matter of policy take a resident who has, justly or not been dismissed from another program, nor will many consider a resident who has resigned from a program under duress. This gives a program director/hospital administration incredible control.

Which brings to mind a question. How many residents have been subject to potentially career ending retaliation or know someone in their program?

 

[edmadison]

I've been pondering this whole situation since it was posted. I do agree with the issues about whistleblowing and retaliation. If this treatment (both of the residents and the patients) is so bad and so illegal, it's the prefect story for the press. I would think that the Village Voice might be interested it. They do some pretty good investigative journalism and they will be a heck of a lot more discrete than the RRC.

Ed

 

[Doni2008]

lowbudget, you have identified the crux of the problem. In an earlier post, you identified the rules and laws that protect residents and my impression was you were naive. It is clear from this post that you do understand the situation.

Unfortunately, the only way to enforce a law or right on those who do not wish to obey the rule, is to either beat them senseless until they submit, which our society frowns upon and will end a career, or to take appropriate legal action, which the hospitals have been until very recently in most states, quite successful in getting themselves protected from under the guise of "educational institution and prerogatives" and "peer review," and thus will also likely end a career. It is becoming increasingly apparent that there is much sham peer review, retribution and retaliation in the resident education process, but the protections are thin, timeconsuming and extremely costly.

Many programs will not, as a matter of policy take a resident who has, justly or not been dismissed from another program, nor will many consider a resident who has resigned from a program under duress. This gives a program director/hospital administration incredible control.

Which brings to mind a question. How many residents have been subject to potentially career ending retaliation or know someone in their program?

Thanks.

Update news: somebody has made anonymous complains to the CEO of the corporation. They had a meeting with CMRs and said that they will investigate if our orders will be done or not.

But these issues happened in this hospital for years so I guess it's hard to change.

There is a shortage of nurses nationally and hospitals in NY boroughs have difficulty to find RN employees. RNs know hospitals need them so these issues happened.

 

[Doni2008]

I've been pondering this whole situation since it was posted. I do agree with the issues about whistleblowing and retaliation. If this treatment (both of the residents and the patients) is so bad and so illegal, it's the prefect story for the press. I would think that the Village Voice might be interested it. They do some pretty good investigative journalism and they will be a heck of a lot more discrete than the RRC.

Ed

Thanks,

It's a good idea to consider the press first if residents make complaints. But as I said when investigation in progress, no one is willing to be a witness, particularly IMGs

 

[dragonfly99]

doni,
you should really, really reconsider reporting this.
They can ruin any chance of you having a career as a physician in the US.

Some of the things you mention are quite common in residency programs and would not be counted as an RRC violation. My top 20 or 30 in the country internal medicine program we had 30 hour on call shifts...they are allowed to do this (keep you until noon or 1 pm postcall) since the work hours rules allow for 24 hrs + 6 more for "educational activities". In our case most of the last 6 hrs was educational...rounds with attending, writing notes on patients, morning report, etc. What they are not supposed to do is to give you more admissions after 24 hrs on call. We also had to do some blood draws, doing ECG's, etc. BUT it was not often or at every one of our teaching hospitals...it certainly can be time consuming. Also, your daily work hours are definitely excessive.

Having more than 12 patients for an intern is also not that uncommon...again, my very well known and well thought of medicine program had that going on as well on certain rotations...they got around it by trying to say that some of the patients were not ours...we had 1 intern and 1 resident per team so they would say patients #13-16 or 17 belonged to the resident...but we would still get all the calls from nurses, etc. for that patient. I have on occasion taken 8 patients/day or more than 5 on a call night...however, most programs at least try to hit the target/obey the work hours and cap on number of patients/shift.

I really, really do not think you will get anywhere positive by trying to make a bad program good. My advice would be finish out your year, then don't sign another contract there. You can consider trying to switch to a different residency program...if you are willing to go to the South or Midwest, to some smaller town or city, I am sure you could find a nicer internal medicine or family practice residency...maybe even a different specialty like physical medicine/rehab or neurology, etc. My advice is do not spend your energy on this (trying to make things "right") at your current residency program. Your program director and the hospital have almost all the power in this situation, and you have none.

You might have a slight chance of getting somewhere with getting the nurses to carry out your orders. However, it is common in many many hospitals that a resident would have to give certain drugs (IV metoprolol, IV diltiazem, etc.). That is because a patient can become acutely hypotensive or bradycardic from these meds. IV Lasix - to require an MD to give it is stupid...people don't get hypotensive from that - what is the medical reason for you to have to give it, vs. the nurse. I also think the nurses should be able to give red cell transfusions...they routinely do at my hospital. In fact, they have a lot of "nursing pride" and would be offended if someone suggested they couldn't do these things.

Don't think the RRC gives a crap about you because they don't. And I guarantee you that your program director will make sure you don't get another residency position if you report the program to the RRC. I don't think there is anonymous reporting...and at any rate it's not that hard for them to figure out who did it if your program only has 10 interns or something.

 

[jennyboo]

Some of the things you mention are quite common in residency programs and would not be counted as an RRC violation. My top 20 or 30 in the country internal medicine program we had 30 hour on call shifts...they are allowed to do this (keep you until noon or 1 pm postcall) since the work hours rules allow for 24 hrs + 6 more for "educational activities". In our case most of the last 6 hrs was educational...rounds with attending, writing notes on patients, morning report, etc. What they are not supposed to do is to give you more admissions after 24 hrs on call. We also had to do some blood draws, doing ECG's, etc. BUT it was not often or at every one of our teaching hospitals...it certainly can be time consuming. Also, your daily work hours are definitely excessive.

Having more than 12 patients for an intern is also not that uncommon...again, my very well known and well thought of medicine program had that going on as well on certain rotations...they got around it by trying to say that some of the patients were not ours...we had 1 intern and 1 resident per team so they would say patients #13-16 or 17 belonged to the resident...but we would still get all the calls from nurses, etc. for that patient. I have on occasion taken 8 patients/day or more than 5 on a call night...however, most programs at least try to hit the target/obey the work hours and cap on number of patients/shift.

While I cannot advise you as to whether you should report the program or not, dragonfly did make some good points. It is actually very hard for most programs to be found to truly violate resident work hour regulations. In order for the program to be in violation, an average must be calculated for ALL the residents over an entire month for a specific rotation, then all the months for the entire YEAR are averaged together.

So if you regularly go "over the work hour limit" while some of your colleagues do not, the program is not in violation.

In addition, many residents at many IM programs go "over the work hour limit" in July and August. However, at the end of the year in May and June when the same residents are more experienced, they may be well under the work hour limit. The resident work hour regulations can catch a program that is flagrantly overworked. However, most residencies are just moderately overworked with some people regularly going over hours, others hovering at or below the limits -- and with hours getting shorter the further away you get from July and August when everyone is new.

In summary, while you think you may be in violation of work hour regulations in July and August, this may not continue for the rest of the year (ask your senior residents). In addition, the work hour regulations only do residents a favor when ALL the residents are over hours. If you are simply a slower resident, the work hour regulations don't help you at all -- the program is still compliant, it's just that the rules do not help slow residents at programs that otherwise meet work hour regulations.

 

[Drawing Dead]

Ahh... New York nurses. A great bunch of men and women who answered the call to "Dare to Care" and relieve human suffering.

They taught me quite a few things during my five years of training in New York City.

1) I really don't like New York City that much after all.

2) I would've made a damn good phlebotomist.

3) I am a one man IV team.

4) I am a one man MAR checker.

5) I can pilot a patient's bed through the narrow hallways of any hospital expertly and which speaks highly of the years of education I have attained.

6) Fifteen minute breaks every three hours can be combined to make a three hour break in an eight hour shift.

7) LPNs and RNs were a higher form of life than an MD.

8) LPNs and RNs essentially teach MDs everything they'll need to know in clinical medicine.

9) Non physician staff in hospitals are quite vindictive toward the physician staff.

10) When given the chance, attending MD staff will always take the side of the ancillary staff against you, the resident b!tch.

11) The only real utility in paging the resident is for the nurse to document that they have informed you of some highly insignificant thing, so that they can "protect their license."

12) Pages increase in frequency as the clock approaches 7AM, 3PM, and 11PM (shift changes) and remain high for approximately 2 hours following the change of shift.

13) A nurse's signout at the change of shift is much more important than anything an MD has to say about a patient, so you'd better not interrupt all that important clinical decision making.

14) Nursing orders ALWAYS need clarification around the time of your ONLY lecture/conference for the day, and if you don't deal with it when they page you and defer it until the end of lecture, you're going to get a scolding from the Nursing Manager. Then you're really in deep ****.

15) I really, really, really despise unions and I think I became a Republican almost solely because of NYSNA.

I'm not saying it's necessarily better in Chicago, but I inquired as to when a particular nurse in the SICU was going to take her union sanctioned break, and her reply was, "I have too many sick patients to go on break! I'll go on break when my shift ends tonight at 7PM!" It was 11AM when she said this to me. I was shocked and amazed and relieved to a great degree. The nursing staff will draw STAT bloods, routine bloods, and call Rads for studies, EKG, etc. for you.

I'll warn all you out there in SDN land again -- NEW YORK CITY is a great place to live, but it's a terrible place to be a PHYSICIAN and to TRAIN AS A RESIDENT.

I got out. So can you.

Good luck.

I know you posted this over a week ago, but had to comment.

I too made the NYC to Chicago transition (not by choice, but by fate of the match). At first I was apprehesive about leaving my family and friends behind, but wow is it so much of a better environment here. All these stories in NYC remind me of the place in the Bronx that passed on me, and how the nurses have it in their UNION contract to no have to do blood draws because of the high HIV rate in the area. Now, you still do have some issues with lazy and vindictive staff, but not as much, probably because there is no union, or not a strong one. And, to boot, I think Chicago is a cleaner and friendlier city than NYC (with less traffic, even if true Chicagoens piss and moan about it all the time.) Just waiting to see what winter is like...

 

[Doni2008]

I know you posted this over a week ago, but had to comment.

I too made the NYC to Chicago transition (not by choice, but by fate of the match). At first I was apprehesive about leaving my family and friends behind, but wow is it so much of a better environment here. All these stories in NYC remind me of the place in the Bronx that passed on me, and how the nurses have it in their UNION contract to no have to do blood draws because of the high HIV rate in the area. Now, you still do have some issues with lazy and vindictive staff, but not as much, probably because there is no union, or not a strong one. And, to boot, I think Chicago is a cleaner and friendlier city than NYC (with less traffic, even if true Chicagoens piss and moan about it all the time.) Just waiting to see what winter is like...

Thanks.

I had limited money so I applied few programs. I did not apply in Chicago, CT, PA, NJ. What a big mistake?