Don't you think they need to build some safeguards into the system to ensure that residents in a program that is decertified CAN transfer smoothly into another program. (Kind of a whistle blowers thing) The program could even be required to pay the costs of transferring the affected residents and their families to another program - and other programs should be required (or somehow encouraged) to accept them. Requiring the 'in-violation program' to pay any costs could be part of the penalty for being out of compliance.
We had a discussion here about this situation.
Our conclusions were that instead of penalizing the residents, fines of $50,000 to $100,000 per infraction should be leveled at the Hospital itself with fines of $10,000 to $50,000 being levelled at the Program Directors. By hitting THEM in the wallet, you know for damn sure they are going to abide by the rules and make sure no one works longer than is allowed.
In this case, its the residents who report and then get walloped by having their training interrupted and in some cases, ended. Not good incentive to report, if you ask me. Why call someone and say “Hey they are screwing us on hours here, come shut them down so I am unemployed.” Talk about catch 22.
I have a question about this whole 80 hour thing. I would like to know why has it taken this long to be implemented? It seems so obvious that working all those hours in a sleep deprived state cannot be good for patient care. Also for those that are MD’s how much “scut work” do you do? I’m just curious 
Thanks
Cathy
I still think it's also ridiculous that 80 hours (double most workers' work week) is considered appropriate. I am at the same time listening to the arguments where I live (Switzerland) about following the 55 hours per week limit just imposed here on junior doctors (=residents) hours. I think I heard that in France they are trying to limit the hours to closer to 40.
I so rarely end up on the same side of debates on this forum with MD/PhD slave that I want to jump in and say that I agree with him. While I share Nat’s concern for the folks in the program, I also think that Hopkins can quickly correct the situation and not cause an impact for these residents. However, it is clear that without serious pressure, they will not correct the situation.
Being inside one of these big smug institutions is a constant reminder of the need for these kinds of regulatory actions. Places like Hopkins and Yale and… certain other places in Boston… are very satisfied with themselves. They like to congratulate themselves a lot about how important they are and what a good job they do. There are a lot of pronouncements about how this is the “best” this and the “best” that. Sometimes only strong (metaphorical) kicks to the head can shake this complacency. I think the residents will end up OK. But the question is whether places that are very satisfied with themselves (and are the prime offenders in creating the culture of overwork) will fall into line. This is such an important question that strong action is required.
joe
Joe Wright wrote:
| QUOTE |
| I so rarely end up on the same side of debates on this forum with MD/PhD slave that I want to jump in and say that I agree with him. While I share Nat’s concern for the folks in the program, I also think that Hopkins can quickly correct the situation and not cause an impact for these residents. However, it is clear that without serious pressure, they will not correct the situation. |
I was trying to come up with some answer and this pretty much sums up what I was thinking. Thank you.
Hi there,
I don’t want anyone to feel as if there are “sides” to this problem. There are no sides and no “winners” here. The reality is that the 80-hour work week averaged over a month was instituted by the RRC without much thought as to the “how” this would be carried out. My program (not a top one ) has constantly attempted to comply with the regs by trying different options. Every resident here pitched in and helped our program meet the requirments of the new regs and still keep our good training. We had six months to try several different approaches to meeting the hourly requirements are we are still making adjustments to meet the regs. Our schedules change monthly and sometimes daily.
A large problem is that WE the residents are the policemen of these regs. We DO scrub out of cases in the middle and we DO leave when we are at the 80-hour max. Still, there are plenty of things that are out of your control as a resident. Fortunately, we have an excellent department chair and program director who backs us 100% and have gone the extra mile to make sure that we are in compliance. Right now, our program is under review for accreditation by the RRC and I hope that everything will come out OK. We are one of the earlier programs to be reviewed so we are hoping that everything works out. If we lose accreditation, the clinical PGY-4s will be not be able to sit for boards. This is a tough route since all of them are actually in their sixth year of post graduate training.
There are NO provisions in these regs for transition. This was a huge problem that was not addressed at the time that the regs were under consideration. The regs have been most successfully addressed by the non-surgical specialties but not all, as the Hopkins Internal Medicine program illustrates, have been able comply.
You can sit in your residency interviews and listen to all of the program directors and chairmen say that they are “attempting” to comply or “are in compliance” with all of the RRC regs but implementation is another thing and staying in compliance is another matter. If the implementation and compliance is not happening, you may find yourself in the position of not being in an accredited program. The rules under which you will work are changing day by day and they are not under your control.
Natalie
| QUOTE |
| I still think it's also ridiculous that 80 hours (double most workers' work week) is considered appropriate. I am at the same time listening to the arguments where I live (Switzerland) about following the 55 hours per week limit just imposed here on junior doctors (=residents) hours. I think I heard that in France they are trying to limit the hours to closer to 40. |
Laramisa--
I completely agree!
| QUOTE |
| Being inside one of these big smug institutions is a constant reminder of the need for these kinds of regulatory actions. Places like Hopkins and Yale and... certain other places in Boston... are very satisfied with themselves. They like to congratulate themselves a lot about how important they are and what a good job they do. There are a lot of pronouncements about how this is the "best" this and the "best" that. |
Joe-- unfortunately, I don't think it's necessary to be on the inside of one of those institutions to be aware of the smugness. I can see it just looking at certain medical school websites. I don't think it's confined to certain schools in the Boston area, either.
I too really sympathize with those residents who are caught in limbo. But I think the regulations are necessary, and so are punitive measures for institutions that ignore them. Didn't residents, as a group, have some say in _making_ the new rules? If not, shouldn't they? I don't mean to sound naive, but the conflicts of interest here sound so outlandish as to be ridiculous. Talk about shooting the messenger.
| QUOTE (joewright @ Sep 4 2003, 08:40 AM) |
| I so rarely end up on the same side of debates on this forum with MD/PhD slave that I want to jump in and say that I agree with him. While I share Nat's concern for the folks in the program, I also think that Hopkins can quickly correct the situation and not cause an impact for these residents. However, it is clear that without serious pressure, they will not correct the situation. |
Well, I usually agree with MD/PhD slave and not just because he's given me great advice about pursuing the MD/PhD
. However, I also agree that the residents shouldn't have to suffer becasue of the violations of the institution. What I'd like to know is why can't they suspend the IM program AFTER this last class of residents "graduates" and then not be allowed to take any new IM residents for a specified period of time?