The only gray area I have is what to do with the hours where I went home and then catch up on progress notes from there.
Like, especially intern year, it wasn't unusual for me to finish a workday, go home, have dinner, watch some TV, then spend a couple hours to wrap up clinic notes or discharge summaries or whatever. If I were to log those as one continuous shift, which a strict reading of the rules might suggest, I was breaking duty hours pretty much every day I did that. I just ended up logging the hours I was physically in the hospital.
Back to OP's topic and work hours
my program wouldn't go for your above scenario because if they are audited
(yes, let's remember the ACGME can audit the program, and yes, let's think about how they would go about doing that: hint the EHR is hard data on first note/order of day and last note/order of day, and timing of pages can be tracked too, and when ACGME actually gets involved it is because they are beyond the point of taking anyone's word for what hours are)
and the EHR shows that you started notes at 6:00 am and signed your last d/c summary at 10:00 pm, there is really no way to prove you're at home eating pizza for a few hours in between, and if those are the hours putting you over....
Depends on the rules, at my program you could go home and eat that pizza and work on those d/c summaries but by God you better both:
appear to be making hours on paper
appear to be making hours with scrutiny of your EHR & pager sign out
The first paragraph was explicitly explained to me by my program so that's an n=1 not just my speculation
The second part was what the Chief told me off record
I actually do recommend lying about your work hours unless you're going to be caught, you're reaching dangerous levels of fatigue, or it is a systemic issue in which case it needs to be addressed for the benefit of all the patients and residents in the program. Except for yours and patient safety I feel comfortable recommending that because getting your program or your ass canned before attending never helped anyone including the hordes of patients needing to be seen with the looming doctor shortage, barring patient safety issues which I see as the only reason for said canning. The best thing you'll ever do for society is get to attending unless of course patient safety is at stake. So call it the ethics of lesser evils.
You have to ask yourself, are you violating work hours and so is everyone else (and even if there are, are you going to be the squeaky wheel? is this the only weakness of yours or are you adding to a list?), was it bad luck (a few mistimed codes that you can point to when your PD hauls you in for work hour violations), or is it just you? If it's just you I suggest before anyone catches on to your work hour problems that you proactively try to get as fast as your peers (remember the mantra tho of safe fast pleasant in that order)
TLDR:
I time my hours by what others are going to be able to see in the EHR & pager
Work hour violation and discrepancy between logged and hard data are a good way to 1) royally piss off the PD 2) provide ammo for termination for being slow and a liar (OK that's dramatic but going over work hours and having logged hours that do not match EHR under scrutiny will not do anything good for you 99% of the time)
Fake it until you make it (work hours)
safe
FAST pleasant in that order
