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This is What I Hate

July 14, 2019
by Mark David Siegel

Hi everyone,  

I hate discussing “duty hours.” It’s torture. But the issue is important, so let’s discuss it. Briefly.  

The ACGME limits residents to working 80 hours a week, averaged over a rotation. They also limit overnight shifts to 28-hours and require that trainees have at least one day off a week, again averaged over a rotation. The rules make sense. Eighty-hour workweeks and 28-hours shifts are already long enough, and everyone needs a day off (see Genesis 2:2). 

Cynics claim that some hospitals would, if they could, make residents work even longer hours. The cynics are right; resident labor is cheap. 

That’s why the ACGME monitors programs to ensure the rules are followed, and it’s why we have to show the ACGME that 1) we’re monitoring duty hours and 2) we’re addressing violations when they occur. It’s also why you need to report your duty hours in MedHub every week. When residents don’t report duty hours, the ACGME smells a problem. Which doesn’t bode well for a program.  

We need to hear about all duty hour violations. The ACGME knows that virtually all residencies have violations sometimes, despite working hard to prevent them. They just need to know the issues are being addressed. 

I’ve heard that some residents worry about creating trouble for themselves, or for the program, if they report violations. Don’t worry. No one has ever gotten into trouble for reporting duty hour violations, and the only way a residency can get into trouble is by not caring about them. 

We’ve improved the program a lot because of violation reports. For example, we increased the number of residents on specialty services, like Oncology and Duffy, grew the non-teaching services, and hired more PAs and APRNs. These staffing increases improved education and made workloads manageable. Resident reports made them happen.  

So please, report your hours every week and, if you do exceed duty hour limits, tell us why. Some violations in MedHub are pseudo-violations (aka MedHub mishigas). For example, if you don’t have a day off one week, a pseudo-violation will pop up, but it’s not a real violation if you have two days off the week before or the week after, which keeps the average at one day off per week. If that’s what happened, just explain. If for some reason, you don’t have enough days off, just tell us so we can fix the problem (it shouldn’t happen, but if it does, it’s unintentional; tell us). 

The same holds for 80-hour workweeks and 28-hour shifts. Everyone’s schedule is designed to comply with the rules, but we know residents will sometimes go over. Just explain what happened so we can fix whatever needs fixing. Occasionally, you may decide to stay late to deal with an emergency, for example if a patient codes during sign out. Just use your judgment in those cases, and let us know. 

So please, report your duty hours every week (and spare me the grief of having to remind you). Sometimes we’ll contact you to get more information. More often, we’ll just say thank you for letting us know. It’s the only way we can make sure you’re getting out on time, so you can rest and recharge.  Thanks for helping.  

And with that out of the way, I’m off to the SRC MICU. 

Wishing everyone a lovely Sunday. 

Yours, 

Mark

Submitted by Mark David Siegel on July 15, 2019