Monday, January 12, 2004


Young Doctors Working Too Many Hours

Apparently the intern who reported Johns Hopkins to the ACGME has been having a rough go of it.....

Madsen, meanwhile, suffered a common whistle-blower's fate. "People I worked with, people I knew very well, would not look at me, would not talk to me," he said. He left the program and eventually wound up at Ohio State University Medical Center where he says he is happy.

What made him angriest, he said, was Johns Hopkins' "blatant disregard" for the new regulations. He said the hospital made no schedule changes even as the new rules deadline loomed last summer. "They said, 'Hey, we're Hopkins. We're going to do anything we want.'"

And apparently other programs are attempting to "cook the books":

Justine Wood, a spokesman for the union Committee for Residents and Interns, said a common story he hears is residents are told "more or less explicitly" to falsify time sheets.........A resident in Philadelphia, who asked not to be identified for fear of the retaliation, said she worked a 34-hour shift last week because she didn't want to dump work on her colleagues.

Some are less than impressed with the ability of the ACGME to straighten things out, as seen in this
testimony before the Massachusetts legislature last month:

Why is the ACGME ill-equipped to enforce work hour regulations?

First, the ACGME can only enforce its regulations by withdrawing a program's accreditation. Residents, in order to qualify for licensing exams and continue their professional development, must graduate from an accredited training program. Few residents are willing to report work hour violations to the ACGME if it means that their program might lose its accreditation as a result.

Second, the ACGME does not provide adequate whistleblower protections for those who report violations. The ACGME will not accept anonymous complaints. Instances where residents' names have been disclosed, leading to hostile work environments for those individuals, have led many residents to believe that the ACGME is not able to guarantee confidentiality.

Third, the ACGME conducts pre-arranged site visits approximately every 3.7 years, allowing programs to maintain an appearance of compliance. Residents have been asked to lie to ACGME investigators regarding the number of hours they work. One resident reported anonymously that he was not even able to see his time sheet to ensure that his hours were logged appropriately. By contrast, New York State enforces its separate work hour limits by contracting with an independent peer-review organization that conducts repeated, unannounced site visits.

Finally, although graduate medical education is funded through the Medicare program, the ACGME is not accountable to the public. They do not disclose the details of why a program has had their accreditation withheld. Patients who receive their medical care from residents have no way to know if they have been placed at risk of medical error by an institution that forces its residents to work to the point of fatigue.
Overall, the ACGME is not able to provide adequate enforcement of work hour regulations because, as stated by the New York Times, the ACGME "faces an inherent conflict of interest. Its board is dominated by the trade associations for hospitals, doctors, and medical schools, all of which benefit from the cheap labor provided by medical residents."

The much reported violations of Hopkins and Yale have been resolved without much pain, so a whistleblower may ask "Why bother?"

My thoughts on the issue may be found on7/2/03, 7/3/03, and 8/23/03.

For more insight check out HoursWatch.
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