Resident work hour violations

[conservative15]

If a resident wants to report work hour violations that are beyond her or his control, then can there be any legal ramifications if the information reported to the ACGME is accurate and supported by official documentation?

On a separate, albeit related question, is it possible to report the violations 2-3 years after graduating from the program, so as to prevent any repercussion while in the program? Put differently, is there a statute of limitations on this?

[conservative15]

Interesting. Over 400 views of this question in under a few days, yet no reply. Does anyone have any thoughts on this? Clearly it must be a topic that many people have on their mind. Can someone address this?

[ROL_2010]

Dude .. suck it up. It's only 5 years. Many before you used to work a lot longer than you are. Took call every other night - 30-36 hour on with 12-18 hours off for months at a time and never complained.

If you don't want to suck it up, then at least talk to your PD before bringing down your whole residency program

[conservative15]

That didn't answer my question, and assumed that I have plans to bypass the due process described by the ACGME's language. I don't see why you made that assumption. Simply, I am trying to gather the facts as I decide how to best approach this.

Incidentally, I have approached the PD and even the office of GME, but the way our program is designed, this still occurs.

As for sucking it up, that is precisely what I intend on doing, hence why I ask about the statute of limitations. Having said that, however, it seems that your solution to this is to throw this under the rug and never discuss it. This is wrong for many reasons, and I cannot imagine that attenings who have a genuine interest in resident education will condone this (as opposed to perhaps attendings who have a misplaced or disingenuine interest in academics who might condone it.) This is precisely why I posted the question for attendings and not on the portion of the forum that seeks replies from residents.

I could be wrong in asking, but is there any chance that you are a resident? Nothing personal!!! I simply ask out of curiosity to see if my assumption is correct.

[BoneDiddly]

I wonder if you log your cases as vigorously as you log your work hours...?

[DoubleRow11]

My "assumption" is that its cowardly and of poor character to wait to report it after you're done so that you don't hose yourself. Instead you'll be hosing all the juniors below you. Congrats.

[conservative15]

DoubleRow: Well, so be it. No need for the congrats. I'm not seeking approval, I'm just looking out for myself. And if you want to be a martyr, then good luck-- these people don't love you. The sooner you learn that none of these people are your friends, and that ortho is a world full of sharks, you'll stop being so concerned about your sense of martyrdom. By the way, how do you define "character" and "cowardly"?

BoneDiddly-- you damn straight I do.

[ROL_2010]

When you're out in practice in the real world, are you going to take the next day off after a call night? Just sayin'

[orthotrauma3]

This is a sad state of the current system in that there're lots of folks who would work their backside off just to get into an ortho residency, and then continue to give up a lot to be the best trained surgeon they could be. And you want to whine about the work restrictions. Seriously man, suck it up and get the best training you can, or let us know all know where you're going to practice so we don't have to worry about a loved one being injured and the on-call orthopod refuses to take care of it because they've worked past their hours.

[ROL_2010]

This is not meant to pile on. I really do wish you the best, but I found this post by you from July 2010 (see below).

So, I'm not really sure if you are waiting to match since you were applying for an away in July 2010, or what you situation is. Anyway, you have started 2 total threads on this site, and both were related to work hours.

I do not intend to offend you, but if you are that concerned about the work hour restrictions, maybe you're looking at the wrong specialty. Nothing is worse than getting 1-2 yrs into residency and then deciding you made the wrong choice.



"While preparing to apply to Hershey for an away rotation, I discovered on their website that they have an unusually large attrition rate. It seems like they lost 3 residents in their chief class, and 2 residents in their PGY-3 class. That accounts for 5 residents total, or 20% of their total resident body.


Does anyone know whats going on there? Why are residents leaving at such a high rate? Is it a malignant program? And how are their residents expected to comply with work hour regulations when they are five residents shy of what they've been approved to train? Surely the other residents are having to pick up the slack to cover a lot of attendings, and the resident morale must suffer from this.


I remember viewing their website last fall and didn't see that they had so many residents leaving. They must have just lost a lot of these residents recently. I'd hate to be a chief resident there right now or in 2 years; these guys will have to take chief call virtually every other night after loosing so many residents in their class. When are they supposed to study for their boards in their chief year?


If anyone has info on what's going on and on addressing my concerns above, I'd appreciate it"

[orthostaff]

This is my first post - but this topic is concerning to me. I have been in practice at a large academic center for the last 3 years and understand the challenges of the work hours - both in following them and in maintaining a high level of training within their framework. First - to answer your question about reporting after the fact a) why would you do that? b) absolutely NOT!. Punishing others will not benefit anyone in the long-run. These are subjects that need to be discussed honestly with your program director and solved before you, your fellow residents and/or the program as a whole is damaged for years to come.
I have found that when a resident is struggling with work hour concerns several things need to be looked at a) how often is this happening and how have the chiefs helped you solve this b) honestly look in the mirror and decide is ortho what you want - frequently those complaining of the hours are unhappy with their program,ortho or classmates and would be unhappy working 40 hours/week. The occasional violation may occur and should not set of alarms ... As a profession we do not work by the hour and need to accept the days/weeks that are at times more consuming than others. Truth be told, as an attending the job only gets more challenging and consuming - increased responsibililty ... however, with this the rewards grow as well. Please speak with your program director or senior resident you connect with and really evaluate why the hours are so concerning. I believe the work hour rules as a whole are good but one must always remember this is a profession and requires dedication and passion for what you do.

[ROL_2010]

When you submit your rank list, you are signing a contract. This contract stipulates the work hours. If your employer is not holding up their end of the contract, requiring you to work more or else face sanctions or firing, they are in breach. Thus, they you are in the right to inform of mistreatment and breach of contract. I enjoy the emotional, moral obligation argument being thrown around here but lets be honest, you are an employee and thus have rights afforded to you by your contract...fight for them.

[conservative15]

ROL_2010:

No worries, you're not piling on on me. There is no way in hell that I'm posting information regarding my concerns about work hour violations on my own account. Doing so could be career suicide, and I thereby wish to maintain anonymity. To that end, I'm using the account of one of the 4th year med students who posted this (sibling of a co-resident, no longer pursuing ortho after a change of heart, so no conflict of interest using the account.)

Having cleared that, I enjoyed your comment regarding the contract being in breach. And when I become an attending, I'll make sure not to be on primary call for 36 hours continually (among the repeated violations I speak of.) If you want to do that and keep going after call when you are "in the real world", then you're the man! It's not what I seek; but hey, at least there are people who do seek this out, such as orthotrauma3. God bless you all.

orthotaff, to address your questions: This is happening enough so that I already had to discuss it with the PD and GME office, and it still occurs (did you read my initial posts carefully?) The violations are egregious enough and occur so frequently, that one look at my call schedule and the ACGME will be on my program like white on rice.

What do people who want to work 40 hrs/week have anything to do with this? How about more like 36 hours of continuous primary call more than once a week, sticking around 2 more hours on those days to tighten up the service before going home, and working over 30 days continually on such a schedule? Have I got anyone's attention now? How can you generalize when you don't have access to the data on the violations I speak of? We emphasis backing that a*# up with evidence so much on ortho, but when it comes to something like this, even an attending is quick to make generalizations without the facts. Occasional violation? Required dedication and passion-- so you're assuming I lack this? Where's the proof that if someone complains about egregious violations, that this must mean that the resident lacks "dedication and passion"? Do you think that because violations occur only occasionally at your academic institution, that this thereby means that it must not occur more so at other institutions? Very assuming, and without even having the facts to assess before making these assumptions. Interesting.

[ROL_2010]

That sounds pretty horrible to me and definitely in violation of ACGME work hours. I would be pissed too if I were in your shoes. Is this an issue for just you or all of the junior residents? I'm not an attending so I don't know if this is the advice you want but these are my ideas:

1.) I would approach your PD, and the director of GME again and let him know your work hour violations and I might even go as far as to state that you will report these violations if the call schedule is not changed.

2.) Go ahead an report these violations to the ACGME, it may result in a site review, it might put your program on probation, or it might do nothing. However, it will very likely get the attention of your PD and GME office and really make them think about changing the call schedule.

3.) Don't break work hours. When the clock strikes noonish post-call sign-out and leave the hospital. No one can threaten you or punish you for following ACGME guidlines...just don't be negligent or directly compromise patient care.

4.) Don't do anything, roll with the unfairness and the long hours and realize that this too will soon be over and you'll finish residency in a few years. Also realize that long hours=more training and experience (unless it's scut!)

5.) Forget all the above and try to change programs (maybe the best idea)

Also, take comfort that you're not alone. Two fellows I worked with this year (one from TX, one from PA) said that their programs didn't adhere to ACGME work hours at all.

[ROL_2010]

This is a sad state of the current system in that there're lots of folks who would work their backside off just to get into an ortho residency, and then continue to give up a lot to be the best trained surgeon they could be. And you want to whine about the work restrictions. Seriously man, suck it up and get the best training you can, or let us know all know where you're going to practice so we don't have to worry about a loved one being injured and the on-call orthopod refuses to take care of it because they've worked past their hours.

Unfortuately, we all know that the OP has little choice in this matter. Best to put your head down, work your ass off, and get through it. Making waves will only make your life worse... and believe me, the programs that support an enviroment like the one you describe damn well know that they have you by the short hairs.

Just a couple points regarding the post above...

1. It's interesting that people equate # of consecutive hrs worked to getting "the best training you can", as if you're learning the secret to orthopaedic surgery during your 40th+ hour of primary call. I'd like to see the data on that.

2. No doctor worth a damn - resident or attending - is going to "refuse" treatment to a patient, as in the scenario that you provide. That's hyperbole. I don't want to make any assumptions regarding the OP's perspective/situation... but, I don't think anybody is really complaining about putting in >80hrs in scenarios where they're actually needed... it's the pervasive mentality of "hey, stay in the hospital and work on X, Y, and Z for the hell of it because when *I* was a resident yada, yada... and if you leave before Xpm, even if your responsibilities are taken care of, you're less of a man".

3. I'm all for paying my dues and paying respect to those who came before me. I truly believe that we are "standing on the shoulders of giants" in this profession. The pioneers of this specialty were/are phenomenal people that did amazing things... and none of us would make it far in this field without our mentors. That said, the argument/mentality that "this is how it's always been done" is asinine, and doesn't fly ANYwhere in "the real world" in ANY context. Times, circumstances, and rules change.

4. As has been said already, the work hour restrictions are bound by the contract, handed down and enforced by the ACGME, and to be adhered to by the programs. Current residents didn't ask for the restrictions or create them. It's not the fault of the current ortho residents that they exist. Yet residents are being treated as if it is their fault. The animosity that I've seen it create between attendings and residents at some programs is unfortunate.