Vacation Infraction?

[roflcakes887]

I agree with much of what ROFLCAKES has posted. It is good to see a med student who is not a passive wimp. I find the medical profession is filled with many students and residents who are chumps. I have seen program directors say that we (meaning the residents but not the attendings) have to make sure to get all the work done no matter how long it takes and the residents go along with it like they are making a noble sacrifice. Meanwhile the PD is living large and saving money by not having to hire PAs or get more help since the residents are happy to take more and more on without any protest.

Exactly.

It is refreshing to hear an attending physician admit that the current system is build to exploit medical students/residents to get cheap labor out of them under the guise of "education" and "patient safety."

I refuse to be a pushover passive wimp, and if my attendings want to give me a *gasp* pass instead of high pass because I won't let myself be pissed on, then so be it. Medical students and residents let themselves be pissed on, so in some ways, I can't blame the PD/attendings for taking advantage of them. If you're too much of a coward to stand up for yourself, then I guess you deserve to be exploited.

Nonetheless, I go to work to fulfill the contractual obligations agreed to upon between myself and my employer (ie. the hospital, clinic etc...). Nothing more. Nothing less.

I am not here to save the world or mankind, I am here to get my paycheck and fulfill the requirements of my aforementioned contractual agreement. Period.

---

Members don't see this ad.

 

[roflcakes887]

I am a med student and even I know that this is 100% correct. I am shocked at what people are saying here. It is one thing to protest against working hours and pay but another thing to talk about not having a duty to patients. I knew that I would have a fiduciary responsibility to my future patients even as an MS1. How could anyone NOT know this and be in medical school? Why would you GO to medical school if you feel no obligation to patients? What are you going to do, walk out on them when they are suffering and dying? That is shocking and horrible.

Then the hospital/clinic employing me should have no problem if I invoice them for having to stay above and beyond my shift hours to save the above patient's life.

 

[Winged Scapula]

Exactly.

It is refreshing to hear an attending physician admit that the current system is build to exploit medical students/residents to get cheap labor out of them under the guise of "education" and "patient safety."

What you continue to fail to notice is that NONE of the attendings here disagree with the above sentiment.

But because you have latched onto the fact that exPCM has agreed with your deplorable patient care attitude he is somehow the only one who agrees with you about residency being explotative.

 

[SoCuteMD]

Then the hospital/clinic employing me should have no problem if I invoice them for having to stay above and beyond my shift hours to save the above patient's life.

See, here's the thing. The fact that you assume that physicians are employed by hospitals/clinic shows how little you know of the fee/salary structure of physicians. Now, I could be wrong and maybe you've made the decision that you will only work as an employee, but the vast majority of physicians are not directly employed by a hospital or clinic.

I think it's really sad that someone who is a 2nd year at Duke (and therefore in his/her clinical years) has this attitude.

 

[Elfy]

Quote Michael Rack:

Too many doctors today are employees. I have talked too a lot of residents and fellows who are seeking sleep and/or psychiatry careers. It seems that nearly all of them want a guaranteed salary.

I think this is a general problem with psychiatry which as a psychiatry aspirant drives me insane (no pun intended) and which has less to do with salary than with the perceived "easiness" of the field (the mean income for adult psychiatry being still lower than for almost any specialty, I believe). The fact that psychiatry is often suggested as some sort of back-up or dumping ground for the less fortunate (AMG with low steps scores? go into psych! FMG with any steps scores? go into psych! no physical exam skills to speak of? go into psych!) is frightening when one comes to think how little credit is given to a specialty that, after all, focuses on mental health.

Sleep medicine is a whole different ballgame, since it carries with it the promise of higher income (whether fixed or variable), and there seem to be a lot of psychiatry residents who 1. seem to have become interested in sleep studies for monetary reasons and 2. seem to think they will be able to transition from a plain psychiatry residency to a sleep fellowship without a whole lot of co-training in neurology or pulmonology. Here, I guess time will tell. Needless to say, I am fascinated with sleep and dreams but I fear my psychoanalysis background, while it opened an intellectual door, could put me at a net clinical disadvantage.

 

[Elfy]

Many of us are fearful about being treated in our old age by residents who worked 56 or fewer hours per week and care more about what time their shift ends than whether or not their patients need them.

This thread, the way the OP started it, seemed to be rather about the pre-hiring / post-hiring potential discrepancies in the length of a stipulated vacation than about the number of weekly work hours. I doubt I would have jumped in a thread that dealt with the weekly hours per se (100, 80, 56 or whatever), since there I don't know exactly where I stand myself.

The OP's question, as I saw it, had less to do with what residency programs do to residents, but rather what happens when a program says one thing to a person before hiring them and does another thing to that person after hiring them. Now, I do understand you clarified OP's discrepancy for him so in this particular case that's a moot point.

I have no idea how it feels to work 56 hours a week in a hospital (have for the past few years worked closer to 80 if you consider dissertation research plus part-time jobs to qualify as work, but again, you don't have to, and perhaps shouldn't, hold it to the same standard as hospital work since it may be as *long and arduous* but does not involve life-and-death decisions). I am not adverse to working hard for not-always-tangible results, and I did not go for the MD or the PhD thinking I am going to emerge as some sort of glorified nine-to-fiver paper pusher. I simply think candidates have the right to know what they sign up for, if nothing else than in order to relinquish the spot in favor of a more dedicated candidate, if you wish.

Speaking of sleep studies though, while I don't know yet whether I would prefer to be treated in my old age by a resident who worked 100, 80 or 56 hours a week while the knowledge base is increasing, what I do know is that I wouldn't want to be treated now, today, by a resident who is so sleep-deprived s/he can't even remember their Step 2 stuff straight.

 

[Winged Scapula]

This thread, the way the OP started it, seemed to be rather about the pre-hiring / post-hiring potential discrepancies in the length of a stipulated vacation than about the number of weekly work hours. I doubt I would have jumped in a thread that dealt with the weekly hours per se (100, 80, 56 or whatever), since there I don't know exactly where I stand myself.

True, but this thread, in the grand SDN tradition, has been highjacked and our friend at Duke and others have made this about how much residents work.

I have no idea how it feels to work 56 hours a week in a hospital (have for the past few years worked closer to 80 if you consider dissertation research plus part-time jobs to qualify as work, but again, you don't have to, and perhaps shouldn't, hold it to the same standard as hospital work since it may be as *long and arduous* but does not involve life-and-death decisions).

Nor do I but there are plenty of people pushing for work hours to be further reduced from where they already are, and 56 hours/week is an oft-repeated number. If programs reduce the work week to 56 hours but extend training by several years, then I will retract my earlier statement about worrying about who's providing my care in my twilight years.

I simply think candidates have the right to know what they sign up for, if nothing else than in order to relinquish the spot in favor of a more dedicated candidate, if you wish.

Absolutely. The problem was that the OP (who hasn't bothered to come back to the thread) didn't understand that 15 days = 3 weeks in residency, so he wasn't lied to. I suppose one could interpret this as the program not being clear because I'm fairly sure that many students would make the same assumption he did. Then again, most students probably don't rank programs based on length of vacation time offered.

Speaking of sleep studies though, while I don't know yet whether I would prefer to be treated in my old age by a resident who worked 100, 80 or 56 hours a week while the knowledge base is increasing, what I do know is that I wouldn't want to be treated now, today, by a resident who is so sleep-deprived s/he can't even remember their Step 2 stuff straight.

To each his own, but given that many many residents are able to work lengthy hours and still function at a high level and that Step 2 stuff is largely not relevant to clinical practice, the point is moot.

Was I safe after working 42 hours straight or being in the hospital for 3 days straight? Absolutely not and I don't wish to return to those days but there is something to be said for treating medicine as more than a job in which you punch a time clock and that the more you do something, the better you get at it.

 

[error404]

I am so, so embarrassed for Duke's name being dragged through the mud on this.

 

[roflcakes887]

I am not sure why people have a hard time understanding that not everyone went to medical school to help people. Some of us went to medical school for good pay, good vacation and job security.

That is beside the point. The point is, physicians should clearly work out with their employers exactly what is expected of them, the hours they are going to work, salary, overtime etc...

I have no responsibility to patients other than what is specifically outlined in my aforementioned contract.

The reason why medicine is losing it's salary, prestige and influence are because of weak physicians who let themselves get pushed around by "the system."

 

[roflcakes887]

What you continue to fail to notice is that NONE of the attendings here disagree with the above sentiment.

But because you have latched onto the fact that exPCM has agreed with your deplorable patient care attitude he is somehow the only one who agrees with you about residency being explotative.

Then since you agree, why not band together with residents and allow residents to work 60 hours a week and provide them with humane working schedules. Why not join with med students/residents and lobby government for changing resident work condition legislation.

Oh, I forgot, your too busy "taking care of patients."

Talk is cheap.

 

[Winged Scapula]

Then since you agree, why not band together with residents and allow residents to work 60 hours a week and provide them with humane working schedules. Why not join with med students/residents and lobby government for changing resident work condition legislation.

Oh, I forgot, your too busy "taking care of patients."

Talk is cheap.

And your insults are cheap shots.

Frankly, its none of your business to what extent I have been involved and continue to be involved in doing JUST what you suggest. My activities in doing such resulted in a lot of complaints about me from my faculty during residency who felt I wasn't dedicated because I questioned the fruitfulness of working a 120 hour week.

However, I do not support a 60 hour work week without significantly lengthening or changing residency training especially in the surgical specialties; something that nearly every resident is opposed to.

But this will be my last word on the topic here as it appears that discussing this with you is also not fruitful.

 

[nancysinatra]

Then since you agree, why not band together with residents and allow residents to work 60 hours a week and provide them with humane working schedules. Why not join with med students/residents and lobby government for changing resident work condition legislation.

Oh, I forgot, your too busy "taking care of patients."

Talk is cheap.

You are actually turning people away from your cause. After encountering your posts in this thread, I now find the idea of EVER "banding together" for any purpose related to work hours to be totally disgusting. And by the way, if you chose medicine for good pay, good vacation, and job security, you are a fool.

If you abandon a patient, there are legal consequences, I do believe. At a minimum you can be professionally banished if you violate your specialty's ethical principles. You don't actually get to choose what your obligations are.

 

[John Deere Gree]

However, I do not support a 60 hour work week without significantly lengthening or changing residency training especially in the surgical specialties; something that nearly every resident is opposed to.

I'm fine with an eighty hour work week. Yeah it sucks, but I would rather be done at the end of three years, instead of extending residency any longer. Going to 60 hours would mean lengthening any residency program.

But this will be my last word on the topic here as it appears that discussing this with you is also not fruitful.

You are Winged Scapula, you can do something to prevent asinine remarks from littering this forum.

 

[NotAProgDirector]

I have no idea why I am posting on this thread, since it seems it's all been said before. But, here goes...

It is refreshing to hear an attending physician admit that the current system is build to exploit medical students/residents to get cheap labor out of them under the guise of "education" and "patient safety."

I think it would be more accurate to state that the current system developed into one which has the tendancy to exploit students and residents. It wasn't designed that way, that I know of. In fact, many changes have been made over the last 20 years which has made residency (and medical school) much less onerous. Some fields are "better" than others in this way.

Can we improve? Absolutely. My personal opinion is that 24+ shifts are really a bad idea, esp if busy and the chance for sleep is minimal. I'm not sure that 60 vs 80 hrs is important -- remembering that if we switch to a 60 hour week either residency will get extended, "easy" months will be sacrificed, or overall experience will be reduced.

I refuse to be a pushover passive wimp, and if my attendings want to give me a *gasp* pass instead of high pass because I won't let myself be pissed on, then so be it.

Be my guest. I think you will find all of those passes will have a negative effect on your career options, but that is your choice. Perhaps instead of bucking the system like this, you should try and change it through more constructive processes?

Nonetheless, I go to work to fulfill the contractual obligations agreed to upon between myself and my employer (ie. the hospital, clinic etc...). Nothing more. Nothing less.

I am not here to save the world or mankind, I am here to get my paycheck and fulfill the requirements of my aforementioned contractual agreement. Period.

You will discover it is not this cut and dry. First, as others have stated, you do have a legal obligation to care for patients. Yes, if your "contract" says you finish after a 12 hour shift, you should sign all of your patients out to the next person. However, if you're the one coming on and someone gives you a crashing patient you really don't know, plus a bunch of other things to do, you'll find out how unpleasant that is. And if a mistake is made in that crashing patient because of your signout, both physicians will be held responsible.

You will also find that your contract will not be as defined as you think. It's unlikely to state how many hours / shifts / etc you need to work.

Also, some have suggested that you might not work for a hospital -- in that case, there is no contract. This is probably the kind of practice you would thrive in -- the more work you do, the more you get paid.

Then the hospital/clinic employing me should have no problem if I invoice them for having to stay above and beyond my shift hours to save the above patient's life.

Tit for tat like this will not go far. In that case, do I charge you for lectures? Morning report? Teaching rounds?

Also, it's unlikely you will be "worth" anything when you start your PGY-1. Everything you do will need to be supervised by someone else. In this kind of crazy world, perhaps you should pay me for the first 4, 6, or 12 months for "training" until you prove that you can do the job without direct supervision. Not that I suggest this is the right thing to do -- but if you're going to treat residency just like a job, then I'm going to treat you just like an employee -- which is not good IMHO.

The problem was that the OP (who hasn't bothered to come back to the thread) didn't understand that 15 days = 3 weeks in residency, so he wasn't lied to.

Just to set the record straight, we give all residents 21 days of vacation = 3 weeks including weekends. All vacations come from elective / outpt blocks, so both weekends are included (unless the vac is the first week of the block, then it depends on what the prior block was, but even in that case the chiefs try to jigger the call schedule to get that weekend off)

Then since you agree, why not band together with residents and allow residents to work 60 hours a week and provide them with humane working schedules. Why not join with med students/residents and lobby government for changing resident work condition legislation.

This is exactly what you should do, if you feel strongly about it. It's going to be hard to decide what "humane" working conditions are, as some will disagree with whatever definition you try to develop. And you might have to accept longer training times as a result.

As a final note, to roflcakes887, I am afraid you may be very unhappy in medicine if this is your true attitude. Yes medicine comes with a nice salary, and is a very stable career, and is relatively economy independent. But, it also comes with significant commitments to patients and colleagues.

Also, you may be much happier in a field which is defined by shifts -- such as ED or Anesthesia. In that case, you might find that the "passes" you get because of your unwillingness to "play the game" may come back to haunt you, as these fields tend to be the competitive ones.

 

[roflcakes887]

Also, you may be much happier in a field which is defined by shifts -- such as ED or Anesthesia. In that case, you might find that the "passes" you get because of your unwillingness to "play the game" may come back to haunt you, as these fields tend to be the competitive ones.

This is definitely good advice and I will take this to heart.

 

[DarthNeurology]

My activities in doing such resulted in a lot of complaints about me from my faculty during residency who felt I wasn't dedicated because I questioned the fruitfulness of working a 120 hour week.

That is interesting that Winged questioned the "fruitfulness" of working the 120 hour week. I think most people feel that 120 hrs/week was too much . . .

In any other profession outside of medicine you could have a civil/non-accusatory discussion about how hours should be regulated. It wouldn't be an issue of someone questioning the training involved, but just a practical matter. "120 is too much, and 20 is obviously not enough so let's find a middle ground."

I think the problem is that there is a lot of insecurity in medicine, maybe because of working with patients who might die because of a mistake we might make. I think that malignancy starts when attendings feel that they are doing their best, and if a resident questions this, then the resident must be "wrong" in some way, i.e. not exhibiting the right group spirit, which more and more seems to mean that the attending is always right and that you need to walk on egg shells around the attending.

I think that medical students and residents say things that do make sense a lot of the time. There was a study that showed that a patient's mortality increases one percent each year that a physician is out of training. I think that older attendings feel a need to put residents in their place because the residents have just received an excellent medical education that is up to date. In a perfect world there would be better dialogue between residents and attendings, but again insecurity gets in the way of things.

Medical students and residents are de facto employees at hospitals, without the same respect/protection as normal employees I think. On the worst rotations attendings would use medical students and residents for doing clerical work and rounds were pointless in that the answer to each question was "go look it up" which invariably means that matter is closed.

It is currently and possibly will always be impossible to train an adequate group of attending physicians who also do passable work as educators of their medical students and residents. I believe because an excellent teacher is also humble and must admit when they don't know something and would learn along with the residents and even students. There is no such humbleness in medicine, the only form of teaching that is tolerable to doctors, who by in large are still competing with everybody, is to ask questions in a demeaning way of others, even when the answer is not known.

The medical system in this country will/is suffering due to a lack of good clinical educators, residents won't learn as much and when combined with an 80-hour work week the quality of physicians will decrease to some degree.

What you need to learn to survive in medicine is:

1. Everybody really hates everybody else in the hospital underneath a fascade of cheerfulness. Really, anyone can do something mean to you at any time for any reason, fellow residents, attendings, PDs . . . you just have to mentally prepare yourself and don't buy into any talk that a residency program is a "family" or that attedings are "supportive" of resident education. This means that if you are yelled at out of the blue by a nurse, you won't be horrible distraught/surprised as you realize that everybody really does hate everybody else. . . On one elective I had as a medical student there was an attending who was a "great teacher", and excellent attending, but due to a "personality conflict" was put off the teaching service for a some months. Sounds implausible, but my "everybody hates everybody" rules explains it.

2. Chances are nobody at your institution will teach you what you need to know. Sure, being on the wards is a great educational experience in terms of seeing different types of patients, but at the end of the day, what you learned in "rounds" might not be standard of care or even what is tested on the boards. You have to setup your own covert educational system where you read outside of the hospital to decode/understand what is happening. You might gain a couple of good nuggets or "clinical pearls", but the bulk of your learning is going to be outside reading. Don't expect to soak up knowledge by osmotic pressure. Put another way, don't let medical school interfer with your education.

3. The best way to win is to not play the game. Sure, there is a game to play in hospitals, knowing who to "kiss up" to at the right moment or asking for "feedback" spontaneously during a hard rotation, but really the best way to win this war is not to play by not getting in that position to begin with. Find out which attendings are malignant and just plain figure out how to avoid them, find out which residencies are malignant and avoid them. Really. If you do get stuck into such a situation then you will be the OP of an SDN post entitled "Problems on rotation/in residency/with attending" and these threads never end well.

4. Your gut instinct is worthless. Sure, we all get the patient who turns out to some rare disorder we were sort of worried about, but in the end common things are common, and it is better to workup the patient appropriately then go on a wild goose egg hunt, if they patient doesn't get better then it is time to get more creative. A protocol is worth its weight in gold, and staring at lab values never made any patient well.

5. A rolling stone gathers no moss. It never hurts to run a list again, check up on a patient an extra time, or do some extra reading if you find you have "spare time".

6. Don't hope for much. Invariably if you hope a malignant attending will leave you alone, or hope that a hard rotation will end, or hope that you will figure out what residency you want to do, you will be disappointed. Another hard rotation will follow a hard rotation, a malignant attending will leave a team only to be replaced by an even more malignant attending. Invariably hoping you won't get another admission at night means that you will get not one, but two or three. The best you can "hope" for is to returned relatively unharmed to your home/apartment and be able to return to work the next day.

7. Ignore when people are being mean to you. As we all know that everybody hates everybody else in the hospital, you will get a lot of random meaness headed your way. If a bully know that he/she is getting a rise out of you, then it will continue no doubt, pretending to have a lower I.Q. than you do and not "understand" when someone is being mean to you goes a long way. Being nice and logical to an attending that reamed you out will go a long way to not making you a target anymore.

8. Don't eat hospital food. Hospital food has been specially engineered by biomolecular chiefs to drain the pleasure out of eating while making you paradoxically more hungry at the same time. Probably because the people running the cafeteria hate everybody else in the hospital (Rule 1) and want to make people's day less pleasurable. If you can, take prepared food to heat and eat at the hospital, this will restore some of the lost enjoyment out of your life. If you look at a hospital cafeteria's menu you would think that people enjoy eating bland mash potatoes with every meal, stewed vegtables that have been frozen for the last 10 months and lathered with butter, and eat chicken drowning in its own vomit. Please, why hasn't hospital food changed since the 1950s? Go to a deli, buy some turkey/pastrami and real cheese and some good sourdough and make yourself a real sandwich to bring to the hospital that won't poison you like the greasy fries and onion rings they sell at the cafeteria will. Even the cafeteria fruit is "poisoned" to some extent in that it is usually mal-shaped for some reason, half unripened, and waxed with the same stuff they use on the floors.

 

[Winged Scapula]

That is interesting that Winged questioned the "fruitfulness" of working the 120 hour week. I think most people feel that 120 hrs/week was too much . . .

You'd be suprised then at how many people thought, and still think, it was necessary to work that much to be a good surgeon. It was clear to me that a lot of that time was not spent doing educational tasks but rather waiting for the Chief resident to get out of the OR to round, waiting for the Chief to come back to hospital from dinner to round, waiting for CT scans to be done so you didn't sign that out to someone, etc. If the 120 hours had been filled with learning, it would have been a different story. Not sure why you think my reaction was interesting...

 

[dragonfly99]

I agree with WingedScap
when I was a clinical medical student, the 80 hour work week was about to be put in place, and MANY of the surgeons were insisting it would cripple surgical education. I think the 80/week was a good thing, b/c it forced surgical programs to streamline the education and spend less time on scut and "waiting to round" as she describes. 120/week is just too much...it doesn't allow enough time for sleeping and reading/studying, much less any kind of social life. I don't support 56 hrs/week.

I agree with the faculty on here...if a person wants shift work, better sign up for ER or anesthesiology. Even then, don't think you are always going to punch out @ exactly the end of your shift.

 

[SoCuteMD]

Also, you may be much happier in a field which is defined by shifts -- such as ED or Anesthesia. In that case, you might find that the "passes" you get because of your unwillingness to "play the game" may come back to haunt you, as these fields tend to be the competitive ones.

Honestly, aPD, please do not direct this person in the direction of EM. I really really really don't want to have to take signout from this person. I can imagine it. It's 9 PM in a single coverage ED. Signout consists of: "This one needs a central line, that patient needs to be admitted, there's a cardiac arrest about 5 minutes out, this patient needs emergent dialysis (sorry, I didn't get a chance to call renal, you'll have to do that), and there are 27 in the waiting room. I'm outie!"

 

[Doodledog]

There was a study that showed that a patient's mortality increases one percent each year that a physician is out of training.

Do you happen to have the reference for that study? I think it is only fair that I should let my patients know that my presence as their doctor has increased their mortality risk by over 20% due to my years post-training. But, I'd like to see the 95% CI around the value first and see how they handled the covariates.

 

[michaelrack]

Exactly.


Nonetheless, I go to work to fulfill the contractual obligations agreed to upon between myself and my employer (ie. the hospital, clinic etc...). Nothing more. Nothing less.

I am not here to save the world or mankind, I am here to get my paycheck and fulfill the requirements of my aforementioned contractual agreement. Period.

Just remember, getting a paycheck during residency and passing a residency rotation are not the same thing.

 

[3dtp]

This has all been interesting but...

Getting back to the OP's concerns: Misrepresentation of fact by a program during the "courting" session.

Having seen/experienced a potential "employer" lie in an attempt to induce a person to join a firm/enter a residency first hand on several occasions, I think this is a very serious concern to which we should all pay heed.

For the programs (apd please feel free to comment!):
Programs that lie about working conditions, educational attributes, procedure experiences leave time, elective time make every single program suspect and every single program director potentially look bad. It casts medicine and medical education in an extremely bad light and demonstrates to incoming trainee/employees that deceit, guile and craft are the rule of the day and if you can get away with it, so much the better you will succeed in your chosen vocation.

I cannot for the life of me see how this benefits ethical caring and conscientious patient care. The side tracks of this thread have amply demonstrated this attitude.

For the residents:
Each program has certain attributes that will appeal to residents/candidates and others that will be anathema. Given the unfortunate fact of the NRMP and its deathgrip on the process, coupled with the extreme inability to readily change programs even for bone fide reasons, a resident will be placed in a program/job which will entrap him for the next 3-7 years. Why in the good green earth would a program want to deliberately mislead and deceive a resident who will be decidedly unhappy with working conditions? There may be others who would thrive in the exact same conditions that would have led one candidate away. Clearly, again drawing on the breadth of opinions expressed on this thread, there is something that floats everyone' boat and conversely sinks everyone's boat too.

Concerning the deception in the OP's post: Vacation time inflated to further attract residents/candidates.

Sample contracts are sample contracts. This requirement was mandated because programs were playing very fast and loose with reality and the problem was significantly widespread. The clever programs then moved much of the objectionable content from the contracts to the "Handbook." Out of sight, out of mind.

Frieda made several changes in response to widespread abuse of published/advertised vacation times: The way it worked was like this.

Program A published 15 days of vacation time on Frieda. Program A informed applicants that the vacation time could only be used on outpatient elective months which did not include call/weekends, thus restricting time to 2 or 3 months. Along comes the contract which had a clause that said vacation time had to be used in a minimum of one week blocks. What was unsaid was the clause in the handbook that defined (incorporated into the contract by reference) the vacation week block as 7 days, regardless of whether the rotation actually worked the weekend or not.

Program defined the vacation by this policy as 15 days / 7 days = 2 weeks. Two bad about the missing day.

This among other abuses caused Frieda to change its policy to insist that programs now report vacation time available in weeks, which it defined as 7 day intervals.

This abuse was carried out in other ways such as misleading call scheduling and misrepresentations. In the pre-80 days this type of activity was rampant.

Unfortunately, these types of abuses tarnish all programs, including those who do play by the rules and make an honest effort to be clear on their policies.

As to what to do about it, the reality is given the indentured servant mentality of the medical residency, the smartest thing to do is bite your tongue, keep quiet about it, get the piece of paper from the program, put some good silk sutures in your tongue until you finish residency, then after you have a license, job, etc, let the whole darn world know what a donkey's backside place you came from. Loud, clear and anonymously. Out the bastards. You will be doing the entire residency system a service.

Unfortunately, this is not practical since they can always hurt you more. So, in retrospect, grin, bear it, and hope you like the taste of raw tongue.

Reality is, I don't know what can be done. ACGME works for them, NRMP works for them well you get the picture. If the RRCs were to grow some coconuts and seriously sanction institutions in a meaningful manner that wouldn't harm residents this would be a good start. I mean if the ACGME/RRCs were empowered to investigate/make findings/penalize a hospital for this, say perhaps a fine equal to about 5x the extra labor a hospital squeezed out, and probation for a repeat offense to be initiated right before the next interview season, perhaps we could keep these people a bit more honest.

Sadly, in the real world, an employer lies to you in a material way, you can always wait until you have another job offer in your pocket, and walk out the door the day before the brief/proposal/sales offer is due and smile on your way to the next job. In residency, you cannot.