End of PGY1 year issue

[justadude]

I'm towards the end of my PGY1 year in Prelim Medicine at a community teaching hospital. The contract explicitly states my employment runs through June 23, 2004. I was put on overnight call in the MICU on June 23 to June 24, 2004. I thought this was a simple oversight, but when I brought it to the attention of my chief resident, who in turn asked the program director and graduate medical education office, I was told the following.
(1) I had a "professional obligation" to finish my shift, even if I had no contractual obligation
(2) Technically, I started on the morning of June 24 2003. Thus I could work until the morning of June 24 2004. (come again??)
(3) It was my fault for not putting in a special request to the program to not put me on call for a day on which I am not contractually supposed to work at that hospital. (think of the liability issues involved!)
(4) If I did not work on June 26, it would go into "my permanent record" and it may be difficult in the future to find a good job. (come again?? I never even thought of bailing out. I wanted to work this out, get the proper coverage. I even offered to work q2 for two calls, but I couldn't do that because it wasn't "allowed by ACGME")

It pains me to post this message for a number of reasons. Overall, I have had a good year. This program has its share of problems but what program doesn't. I like a lot of the residents, faculty, staff here. I have never missed ONE day, never been late ONE day during the entire year. I received a letter of commendation for the outstanding job I've done. And yet, I feel that I've been stabbed in the back with the accusations, defensiveness, and insults to my intelligence.

I was willing to suck it up as a favor to the program. But now I feel less inclined. It's one thing to do it as a favor, it's quite another when someone compels you to do it, and says you were wrong to even suggest otherwise.

I am asking for opinions. Should I take this to the ACGME? Should I just chalk this up to life's lessons and move on to my residency (which awaits me at another hosptial)?

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[LaCirujana]

Quit yer bitching and suck it up. It's one call night (out of how many???) and since you're in a medicine program at the moment, you'll (in all probability) go home post-call and be able to move on to your real residency program. Learn not to sweat the small stuff, which this is BTW, otherwise you will go completely f***ing nuts.

 

[Anasazi23]

This is yet another example of the overbearing arrogance of academia and the nearsightedness and personality pathology of academicians. I sympathize with your situation and can only advise that you do the call, as annoying as it is. Leave the ACGME out of it. Better times are ahead for you.

 

[Apollyon]

This is not an uncommon occurrence. What can you do? Insist they pay you. I am confident that, if there was an untoward patient outcome, you would be hit for "working without having a job", and that your willingness to work the shift shows you did it intentionally.

 

[kinetic]

Congratulations, you just realized that programs don't give a crap about residents! I agree with you: it's not a huge deal to accomodate them - it's just that it sucks when they are so unwilling to accomodate YOU (i.e., they are asking you to be better than them). And programs can, will, and do blacklist residents (while residents have no recourse against programs, seeing as they only have "word of mouth" and are usually thought to be just "disgruntled jerks who are being unfair"). That being said, unfortunately, the medical field is extremely non-conducive to whistle-blowers. Even if your concerns are valid, you will still get hammered when the ACGME notifies your program that you were the one who leveled the accusation. It's sort of a small issue to risk your professional career over, so I'd just bite the bullet (and flip them off after you leave).

P.S. I hate the phrase "suck it up". That is a thinly-veiled demand for someone to just accept the crap that is being dealt out to them. Again, why do programs never "suck it up"?

 

[eddieberetta]

I am confident that, if there was an untoward patient outcome, you would be hit for "working without having a job", and that your willingness to work the shift shows you did it intentionally.

If you do decide to work the shift, ask them to write you a letter on hospital letterhead stating that your appointment has been extended to [whatever date/time]. I bet getting them to pay you will not be worth the effort.

Better safe than sorry.

 

[avendesora]

While you are virtually powerless to fight the program on this issue, I always feel like one good turn always deserves another (or the reverse).

I don't know whether you're staying on at this hospital or moving on. BUT, you there are ways you can let people know that the program has a habit of treating their residents this way.

1)Go to scutwork.com and write an anonymous review of the program. People DO read these. Don't trash the place, and I wouldn't get so specific that they can identify you.

2)When people ask you about your experience at this place, be honest. Tell them about the good teaching and residents, but do not gloss over these kinds of abuses.

3)When people on this forum ask about the program, speak up, and again be honest.

Buck up, you're almost done and on to what you really want to do! Congrats.

 

[Mirror Form]

what about calling in sick???

 

[Robz]

what about calling in sick???

classic....

but since he has already talked to someone about this date...it might look fishy...

then again..they really couldn't prove that your wern't sick and can't put it in your record as abandonment of a shift.

 

[gilbertfletcher]

I really do feel for your situation. It is a horrible thing to have worked diligently for the entire year, and then be slapped on the face for a simple request that you brought to attention out of a concern that had no hidden agendas. I think the response you got is in and of itself unprofessional and quite frankly childish. They threatened to blacklist you? They're the ones who made the wrongful assumption that you wouldn't show. You have every right to just leave the hospital at the stroke of midnight.

But, to be completely honest with you, you sound like someone who is accustom to intelligent discourse, which is obviously not going to happen where you're at. I agree with the above comment that you should educate the online communities (i.e. scutwork) with truthful, well thought out reviews, and expose the program for what it is.

I think ultimately, just finish the shift, write a review, and let the program fill up with FMGs. You'll get the last laugh.

 

[edfig99]

I would finish the shift, however, you should remind your program that technically, when your contract ends, so does your academic appointment, as well as your malpractice coverage and the hospital is opening itself up to tremendous liability letting someone take care of patients without malpractice or being officially on staff at the hospital. You should also check with the GME office at your institution, since they trump departments. (no need to get the ACGME involved). They need to extend you a one day contract...in writing.


calling in sick is another option i'm sure you can find a doctor to write a note and you won't be obligated to make anything up.

 

[sean wilson]

"finish the shift, write a review, and let the program fill up with FMGs"

This is exactly what I'd do. The punks want to bully you around with the threat of "blackballing" you to the next program. Fight fire with fire, and blackball them with Scutwork. As long as you're fair about your review, which would have to include the good stuff you alluded to as well, you've done the right thing.

People really do look at Scutwork to help decide where to go, so hit them where it hurts.

 

[southerndoc]

I thought this was a simple oversight, but when I brought it to the attention of my chief resident, who in turn asked the program director and graduate medical education office, I was told the following.

If the GME office stated you must finish your shift, then I would finish the shift.

However, I agree with previous posters: kindly remind them that your malpractice coverage will not be in effect after midnight and that they must pay you for any hours past midnight. I would specify the hourly wage since you will technically be out of contract.

 

[pickaname]

They are screwing you. Period. If you called in sick, they can't do anything to you as long as you do it in the way that is outlined in your contract. It will look fishy though. What you need from that residency is only your certificate of intership, which is put out by the GME office, not your program office.
I would just do the damn call and be done with it, then put it up on scutwork. I am going through a situation as well, and I will post it on scutwork.
We all have to remember that if we are residency coordinators in the future, not to be such jerks.

 

[ribsandbbqbeef]

Did you or your chief talk directly to the PD or was it just some power tripping glorified secretary mouthing off?

Perhaps you could approach the PD directly (if your chief was the one who asked for you) and just tell it to him straight: you aren't trying to skip out, you were just wondering how that extended time worked, and request that they put something in writing to extend your malpractic coverage until the next day.

I agree with the others on writing a review on scutwork to let everyone know.

~ribs

 

[Ligament]

I say do the following:
1. Agree to take the shift
2. Contingent that they draw up a WRITTEN contract for that one day
3. They provide you with a letter from their malpractice company that you WILL BE COVERED for that one day
4. They provide you with a letter from the state liscensing board stating that your educational limited liscence will be extended to cover this period
5. They PAY YOU your fee as a moonlighter. Price set by you.

There are a LOT of ways to get screwed in this deal...imagine if somebody dies under your care without malpractice, or even a medical liscense! Both the hospital and you are screwed...

best, Ligament

 

[southerndoc]

I think they will avoid all the trouble by getting someone else to take call if you make as big an issue of it as Ligament suggests (of course, that's the point).