Should I log my real hours?

[Somedaydoc]

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Ok, so I know program directors, etc always say log how many hours you are actually working etc. But I'm an intern and my seniors don't like to lift a finger and keep me past my hours. When I once said "well he consultant isn't responding and I don't want to violate my hours" my senior lost it saying "patient care comes first, you can log your hours etc". But these seniors have said "we can make you look really good in front of the attending or really bad" and if you bring up hours will say "you need to be more efficient" although I'm doing all the admissions I can. Recently I heard of a resident in my program who was dismissed after reports of being "inefficient". I believe that resident took too long to write notes, which I do fairly quickly but still I am afraid that these particular residents might just say the word "inefficient" in my eval and then combined with long hours, if I post them accurately, this may make me look bad. My fellow residents are a mix of American and foreign grads, and I have a feeling the foreign grads don't post accurate hours to stay below the radar. Should I go ahead and post my real hours along with my real evaluations of these residents or just keep my head down, post hours that don't make the program look bad so I can keep my job? Please answer with my best interest in mind, I get scared when these seniors take their claws out.

Thanks

 

[Shikima]

I'd accurately document all hours. Programs won't have a problem to throw you under the bus. Keep a written dialouge of who said what, note dates and times - even if you've paraphrased it.

 

[p30doc]

If you know that you will be in violation of hours in advance ex: going over the 80hr/wk ave or not getting 4 24 hrs periods off in 4 weeks notify your program director so they can try to prevent it. I was in a situation where I saw my violation coming I had in writing(email) my attempts to inform the chief resident of that service and my program director this was going to happen. In the end it was not properly fixed and I logged my real hours. I got a violation but my PD backed me and the residents of that service got a stern reminder that ACGME policies need to be followed. YMMV. If everyone involved is a malignant personality I would think twice about your situation.

 

[Law2Doc]

Nobody is going to advise you to do other than document your hours accurately. And programs generally will abide by what is required of them based on what you document. However if you go over hours, it's not uncommon to start hearing that you must be "inefficient" or how they "don't understand why you are the only one not able to get out on time", etc. It can create a bad reputation for you. And suddenly all those other minor things program usually let slide become the focus if your semi-annual review. The ACGME won't be able to protect you from that. In the end you need to do whatever lets you keep your head down and get through. Having your program shave a couple of hours off of a subsequent week might not be worth the headache.

 

[Shikima]

Nobody is going to advise you to do other than document your hours accurately. And programs generally will abide by what is required of them based on what you document. However if you go over hours, it's not uncommon to start hearing that you must be "inefficient" or how they "don't understand why you are the only one not able to get out on time", etc. It can create a bad reputation for you. And suddenly all those other minor things program usually let slide become the focus if your semi-annual review. The ACGME won't be able to protect you from that. In the end you need to do whatever lets you keep your head down and get through. Having your program shave a couple of hours off of a subsequent week might not be worth the headache.

This rings so true.

 

[Somedaydoc]

Thank you guys, I really do appreciate the advice!

 

[dragonfly99]

You should lie about your hours/fudge them, in the situation that is being described. The risk of your being branded slow/inefficient/crappy, is at least moderately high if you do not. The other person who posted above about having her program director back her about the hours violation sounds like it was some fp or ER resident on an "off service" rotation like surgery or something - this is totally different than being a medicine or fp resident, or a surgical intern, who is running a little over your hours and the senior residents are telling you you should have everything done. They are giving you fair warning that they aren't going to take the work on for you - this could be partially justified (if you ARE slower than other people), or they could be acting malignant, or they are also overworked (if the whole program is just a lot of work and understaffed). Nobody is going to tell you to lie about your hours but sometimes you have to understand what is the subtext, the things that are not being said, but implied. Also, always consider things from the other people's point of view (patients, your senior residents, attendings, etc.). It may seem unfair but SOMEONE has to do the work, and sometimes that someone is you, fairly or unfairly. Of course, if you are working 100 hours a week and it is totally ridiculous, something has got to give at some point, but if it's more like flirting with the 80 hr week or 18 hrs per shift thing, I think you should let it slide, based on the conversations you say you've had with your seniors.

 

[FutureInternist]

I would wait for your review first
Once you have, presumably, good reviews, I would print them all out, so there is no "accidental" deletion of your evals & THEN start logging accurate hours so that the "slow, inefficient" axe cannot be held over your head

 

[Ronin786]

You also mentioned that this is your intern year. I'd try my hardest to keep my head down and get through it, because you won't be there next year (or at least you'll be with another department). 

 

[hrandani]

First rule of residency is that whenever something bad happens, it's always going to somehow be your fault.

Sure, there are a lot of programs that will bend over backwards to help you, but only you can know whether you're in one of those fabled unicorn dream residencies.

I'd never advise someone to lie, but when the only person getting hurt is yourself, the culture of medicine generally expects you to take the fall and not complain.

 

[MadHopsMD]

First rule of residency is that whenever something bad happens, it's always going to somehow be your fault.

Sure, there are a lot of programs that will bend over backwards to help you, but only you can know whether you're in one of those fabled unicorn dream residencies.

I'd never advise someone to lie, but when the only person getting hurt is yourself, the culture of medicine generally expects you to take the fall and not complain.

Hrandani, You should have this quote as your footer. An awesome quote. 🙂

 

[WentForitandWon]

I feel sorry for your situation. If you are an intern you are aware that the hours restrictions are still relatively new and for many seniors (who never worked under those restrictions) they can seem ridiculous. It can be difficult to listen to interns complain about violating hours when they don't take overnight call and have limited shift schedules as well (16 hours at a time). Especially when you have vivid memories of getting destroyed on call as an intern nobody seemed to care what your hours were. That being said, you are stuck between a rock and a hard place. If you miss report your hours, this can be discovered during RRC visits or by your program director by comparing hours logged to EMR orders entered. Failure to accurately report hours can be grounds for dismissal as it puts the programs accrediation in jeopardy. Unfortunately, you can get hurt by accurately reporting your hours if your seniors get a bunch of **** from the program director for hours violations.

I think the best approach is to send the chief's an email (to create a paper trail) where you say: I have been told to log my hours accurately by the program director, but I don't want to cause a problem with the service. Here are my hours for the last two weeks. I will do whatever you want me to do from this point forward. (then don't complain, EVER).

If this does not work, you should send the program director an email and say you have had some issues with your hours. you are trying to be more efficient with your time, but you worry that you may go over hours. Ask them what they would like you to do in regards to logging hours.

it is hard not to ruffle feathers when you talk about going over your hours, but unfortunately it is a reality of medical training. hopefully your chiefs can understand this, but ultimately you need to remember that willful violation of ACGME policy is more damnable because it puts the program accreditation at risk.

the best way to minimize conflict is to NEVER complain. Couch the issue as an objective problem " here are my hours, what would you like me to do?". Lastly, realize that sometimes you need to go over your hours because staying for a good case can be educational. You are given the opportunity to justify your violations. Don't be afraid to use it.

Good luck

 

[Law2Doc]

I feel sorry for your situation. If you are an intern you are aware that the hours restrictions are still relatively new and for many seniors (who never worked under those restrictions) they can seem ridiculous. It can be difficult to listen to interns complain about violating hours when they don't take overnight call and have limited shift schedules as well (16 hours at a time). Especially when you have vivid memories of getting destroyed on call as an intern nobody seemed to care what your hours were. That being said, you are stuck between a rock and a hard place. If you miss report your hours, this can be discovered during RRC visits or by your program director by comparing hours logged to EMR orders entered. Failure to accurately report hours can be grounds for dismissal as it puts the programs accrediation in jeopardy. Unfortunately, you can get hurt by accurately reporting your hours if your seniors get a bunch of **** from the program director for hours violations.

I think the best approach is to send the chief's an email (to create a paper trail) where you say: I have been told to log my hours accurately by the program director, but I don't want to cause a problem with the service. Here are my hours for the last two weeks. I will do whatever you want me to do from this point forward. (then don't complain, EVER).

If this does not work, you should send the program director an email and say you have had some issues with your hours. you are trying to be more efficient with your time, but you worry that you may go over hours. Ask them what they would like you to do in regards to logging hours.

it is hard not to ruffle feathers when you talk about going over your hours, but unfortunately it is a reality of medical training. hopefully your chiefs can understand this, but ultimately you need to remember that willful violation of ACGME policy is more damnable because it puts the program accreditation at risk.

the best way to minimize conflict is to NEVER complain. Couch the issue as an objective problem " here are my hours, what would you like me to do?". Lastly, realize that sometimes you need to go over your hours because staying for a good case can be educational. You are given the opportunity to justify your violations. Don't be afraid to use it.

Good luck

Most of us have EMR access remotely (some even from their smart phones) -- that doesn't really tell anyone when we are at work. So nobody is ever going to know your hours beyond what you voluntarily report.

Your advice is fine in a perfect world. Sadly few of us live in one. You will create problems for yourself telling your program you are going over hours no matter how nicely you phrase it. They will abide by the rules, but it won't stop the grumblings or keep you under the radar for other things. All PDs and chiefs want happy residents who seem to get all the work done without having to deal with "issues". Again nobody will ever tell anyone not to follow the rules, but if 80 hours was really 82 or 16 hours was really 18 maybe it's just not worth the hassle.

 

[e30ftw]

Logging violations is a good way to start a career in urgent care, assuming you're lucky enough to graduate intern year.

 

[SouthernSurgeon]

The range of answers reflect the varying cultures of individual fields and different programs. Presumably the OP's hours were due quite some time ago at this point.

I'm fortunate to be in a program where we log our hours honestly, and if there are consistent problems with hours on a service we actually try to do something to improve the situation...although the improvement may be worse for everyone in the long run haha - I'd rather be pushing my hours a little bit then have them add an extra resident to our EGS/trauma service (i.e. everyone has to do an extra month).

The bottom line is you have to have some situational awareness and understand the culture of your program. When you have seniors basically threatening to undermine you if you log your real hours, or call you "inefficient" to your PD, and no one else is logging their real hours...well, good luck to you brave soul if you log your real hours. Clearly your program is not going to support that, and honestly the only outcome is that it's going to come back negatively on you.

 

[Neuronix]

My internship worked hard to be in compliance with ACGME work hour regulations. I logged my violations when I was an intern. The ACGME site visited us a few months later. I believe we had a completely citation free review and we were re-accredited for the full length. When I violated work hours, which were all 16 hour shift length violations, I always had a reason (unstable patients) which I logged. The site reviewer told us that they're not looking for 100% compliance, just a culture that promotes compliance. My PD thanked me for logging everything and including reasons for the violations.

At the end of the day, this is simply a program culture issue. Does your program really care to comply with ACGME regulations? If not, you have to keep your head down. We're indentured servants, by the facts that we're burdened by high debt loads, have no other job prospects without a residency, and it's very difficult to switch residencies once you match. There is no whistleblower protection. It's your career on the line. If your program is against you, you can take the high road and report things honestly, but you will likely (hopefully) be finding a new residency in the future, maybe in your current specialty, and possibly having to repeat a year. This is the stark reality.

 

[oldbearprofessor]

Some excellent and honest responses on this thread. The only situation I would like to add is that of a resident in a very large program (e.g. one with 20-50 residents each year and yes they exist in pedi). Sometimes there can be a problem with one or two rotations and the PD doesn't really know about it. I assure you that a series of reports from residents of work hour violations focused on one rotation in a large program will get the PDs attention and might lead to improvements.

 

[Law2Doc]

Some excellent and honest responses on this thread. The only situation I would like to add is that of a resident in a very large program (e.g. one with 20-50 residents each year and yes they exist in pedi). Sometimes there can be a problem with one or two rotations and the PD doesn't really know about it. I assure you that a series of reports from residents of work hour violations focused on one rotation in a large program will get the PDs attention and might lead to improvements.

Yes but as an intern would you really want to bear the label of " inefficient" in hopes that changes might be made to improve life for interns in future years? Playing Norma Rae is nice conceptually but it's not unreasonable to suck it up and keep your head down when the aggravation isn't worth the personal benefit. Everyone needs to decide for themselves whether it makes sense to be "that guy", taking into account the culture and the other things your superiors have been letting slide because the work is all getting done.

 

[deleted497653]

Personally, I log in the hours I was scheduled to work as opposed to the hours and minutes that I was actually there. If the schedule says 6am to 6pm, I log in just that and nothing extra. Part of the reason is that by the time I log in hours, it is usually weeks after the shift and I don't really remember the exact time I left. However, in the beginning of residency, I did log in accurate hours and had gone over my hours during call on a busy service. I got a few emails from our program coordinator asking me to document "who had asked me to stay late". I told her that I had stayed late to wrap up patient care but it seemed like she didn't understand and wrote another email asking more questions. So I went back to the computer and changed my hours so that there were no violations.

I would rather just log the hours scheduled than have to document why I stayed late. It's not worth the extra time and I gain nothing. (Theoretically, future residents may gain something if I "tell the truth" but that is not my focus. My focus is to complete residency and to do so without getting involved in a lot of "politics").

 

[Law2Doc]

Personally, I log in the hours I was scheduled to work as opposed to the hours and minutes that I was actually there. If the schedule says 6am to 6pm, I log in just that and nothing extra. Part of the reason is that by the time I log in hours, it is usually weeks after the shift and I don't really remember the exact time I left. However, in the beginning of residency, I did log in accurate hours and had gone over my hours during call on a busy service. I got a few emails from our program coordinator asking me to document "who had asked me to stay late". I told her that I had stayed late to wrap up patient care but it seemed like she didn't understand and wrote another email asking more questions. So I went back to the computer and changed my hours so that there were no violations.

I would rather just log the hours scheduled than have to document why I stayed late. It's not worth the extra time and I gain nothing. (Theoretically, future residents may gain something if I "tell the truth" but that is not my focus. My focus is to complete residency and to do so without getting involved in a lot of "politics").

I think your experience is common.

 

[Random Anesthesiologist]

I log the hours I am actually in the building. My reason for this is that there is liability attached to it, and if I'm in the building, I can be paged, called, stopped in the hallway by a nurse for clarification, etc. I don't take home call. So to me, being in the building (outside of lecture hours) is working. And I log it. What if something happened (Lord forbid) that brought you in to court, with documents with your name on them, but your hours say you weren't working? Not good for you or the program.

I have never heard of a resident being let go for "inefficiency". Unless they were truly a poor resident. Being at the hospital late doesn't necessarily mean inefficiency.

 

[Random Anesthesiologist]

DP