program director reading residents' emai

[Doctor Bagel]

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There is no way they were logging things accurately and the PD didn't notice that Mr X never seemed to be on call, while Ms Y hit 80 hours each month. More likely they were either logging in the hours they would have worked before the sale, or it was the kind of place where everybody simply gives in timecards that add up to some number under 80, because if you don't, you get asked to redo it. Either way, that's fraud number one. Fraud number two is the representation the PD is making to ACGME each year regarding what their training consists of and how many hours people are spending in the ICU, etc.
So the PD really had no choice but to shut this down once s/he found out about it.

As far as the PD reading an email seems Orwellian, I think folks in residency don't have a good sense of what it's like to work in the private sector. Your bosses can read emails you send on their facility's computer network. They also have significant rights over email and web usage you do while on company time. That's the norm out there.

But you're making the assumption that a lot of call selling was going on, or that some people were selling a lot of calls, and some people were picking up a lot of extra calls. It might simply be that instead of sending out an email, saying hey, I've got family in town, can someone switch a call for me x night, the culture at their program, is to say, hey, I'll pay you $100 bucks for taking my call on x night. It's possible that each resident sold maybe one to two calls a year, in which case, the PD might not notice even if they were truthfully logging their calls. It sounds like the op only sold one call.

Certainly if some residents were selling all of their calls, you would think they'd have to be lying on timesheets for no one to notice. But lying on your timesheets is a pretty big deal saying you did work you didn't do is a pretty big deal, and I'm having trouble seeing a whole group of residents going along with that.

So we need more information from the op to clarify this one. I just disagree that it's obvious that they must be lying on their timesheets because I can imagine lots of scenarios where the call schedule is only slightly modified, and on one notices.

 

[Law2Doc]

"But lying on your timesheets is a pretty big deal saying you did work you didn't do is a pretty big deal, and I'm having trouble seeing a whole group of residents going along with that. "

Well, there are plenty of threads on SDN of folks submitting time cards which say what the PD wants to see or being asked to redo them, so I don't know if this is even more of a stretch. Especially if money is involved.

 

[BobA]

Just for the record, Psych call can be very difficult. A large portion of ED visits (1/8 http://pn.psychiatryonline.org/content/45/16/1.2.full ) are psych. Also, psych ED visits take a very long time to complete as the patient may not be reliable which requires getting collateral. If they need admission, they might sit in the ED for days waiting for a bed somewhere because psych facilities are often full. Also, it's emotionally draining to deal with crisis after crisis, the whole time having the ED breathing down your neck to get the patient out of there.

 

[Doctor Bagel]

Just for the record, Psych call can be very difficult. A large portion of ED visits (1/8 http://pn.psychiatryonline.org/content/45/16/1.2.full ) are psych. Also, psych ED visits take a very long time to complete as the patient may not be reliable which requires getting collateral. If they need admission, they might sit in the ED for days waiting for a bed somewhere because psych facilities are often full. Also, it's emotionally draining to deal with crisis after crisis, the whole time having the ED breathing down your neck to get the patient out of there.

👍 Unfortunately, entirely too true. And at my institution, we don't have caps like those lazy peds and medicine people do, so we admit or see consults until we're done. I think these people dissing psych call haven't done much in the way of psych call. We psych people send the med students home pretty early, so they don't get the greatest perspective on how crappy our calls can be.

Just editing to add that I don't actually think peds and medicine people are lazy. I have had psych calls that have been harder than medicine calls, though. If you're getting paged all night, call sucks, even if you're getting paged to go see psych patients.

 

[Mattchiavelli]

"But lying on your timesheets is a pretty big deal saying you did work you didn't do is a pretty big deal, and I'm having trouble seeing a whole group of residents going along with that. "

Well, there are plenty of threads on SDN of folks submitting time cards which say what the PD wants to see or being asked to redo them, so I don't know if this is even more of a stretch. Especially if money is involved.

This is interesting in that usually it's lying to say you didn't do work that you did do

 

[Law2Doc]

This is interesting in that usually it's lying to say you didn't do work that you did do

It can be lying in either direction. But yeah, a few residencies discussed on here apparently make clear that they want residents to put an imaginary cap on their time sheets. It's no less lying if you say you worked 80 hours when you actually worked 90 versus 70. Either way you are falsifying records. But right, there are few other instances in life where you are expected to lie and say you aren't as hard working as you really are.

 

[Doctor Bagel]

It can be lying in either direction. But yeah, a few residencies discussed on here apparently make clear that they want residents to put an imaginary cap on their time sheets. It's no less lying if you say you worked 80 hours when you actually worked 90 versus 70. Either way you are falsifying records. But right, there are few other instances in life where you are expected to lie and say you aren't as hard working as you really are.

It's questionable how common that is as well, and in those circumstances, it seems like people have their admin folks breathing down on them strongly encouraging them to change their hours logs. In the op's situation, lying would happen without encouragement from the administration, so to me, it seems a little less likely. Although, it's true, lying is lying, and you could say that they were lying in this situation for the same motivations as the being who underreport lie in hopes of protecting their jobs.

Either way, though, we don't know that they lied on their timesheets, and I still don't think it's reasonable to make the assumption that they did either.

 

[Law2Doc]

...
Either way, though, we don't know that they lied on their timesheets, and I still don't think it's reasonable to make the assumption that they did either.

Either the residents lied, or there was some misrepresentation by the program to the ACGME -- it's hard to see how this could be allowed to happen otherwise. There's a lot more oversight of programs than folks acknowledge, which is why programs care so much about these duty hour logs. I still find it easier to buy that the folks who actually benefitted were the ones who fudged.