RENO, Nev. (MyNews4.com & KRNV) -- This News 4 investigation into a sick day policy affects anyone who enters a hospital. That's because when you are treated at the hospital, you are often seen by a resident physician completing his or her training.
News 4 learned local resident physicians were reporting to work sleep-deprived and sick, sometimes vomiting all night before work, yet still caring for patients, potentially exposing patients to illness or medical errors. It all could have been avoided by the supervising medical school with a change of policy.
By the time young doctors enter a residency program- they've already invested at least eight years of schooling and hundreds of thousands of dollars into their education. That's a lot to put on the line, which is why resident physicians we spoke to declined an on-camera interview and opted to share their story in writing instead.
A resident writes: "A few times I’d go to work after being up all night vomiting, fever/chills/night sweats, take a bunch of medicine, and hope I wouldn't puke at work."
Residents in the school of Internal Medicine at the University of Nevada train at Renown Regional Medical Center and the local V-A hospital. They complete medical records, order lab tests, and are directly involved with patient care.
The resident adds, " It's definitely concerning that sick doctors are taking care of patients. It's difficult to think straight when you're tired."
The reason for going to work sick or tired, they cite: a punitive "playback" sick policy imposed only on Reno internal medicine residents that started last June.
Residents who took their earned paid sick day, would owe a sick day, and pay it back by working an extra shift. They worried if they spoke-up the school would retaliate.
The problem with a pay-back sick policy: residents work a demanding schedule as mandated by the accreditation council of graduate medical education, or ACGME.. That sick "pay back" day would go on top of their already grueling schedule.
"The essential rotation can vary anywhere from 50 hours up to 70 hours roughly on average. And the non-essential rotation- roughly 35 to 45 hours a week, " says Chief Resident, Dr. Drin Chow. Chow stepped in to speak on behalf of the program, after Associate Residency Director, Dr. Omar Canaday, cancelled. We're told because of a scheduling issue. Chow says resident rotations are difficult.
Even with the long hours, the school must follow ACGME bylaws that require:
- Duty hours must be limited to 80 hours per week, averaged over a four week period, inclusive of all in house call activities and all moonlighting.
- Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks).
- PGY-1 residents should have 10 hours, and must have eight hours, free of duty between scheduled duty periods. Intermediate level residents should have 10 hours free of duty, and must have eight hours between scheduled duty periods. They must have at least 14 hours free of duty after 24
hours of in house duty.
“When residents are (sic) asked this past year to pay back their sick days we usually do it when they're on a non-essential rotation, usually 35 to 45 hours a week,” says Dr. Chow.
That's not the story News 4 heard from residents, who say the make-up shift was often times not equal, and more demanding and could be scheduled on a day off in their rotation.
Chow says the school is not aware of any accreditation violations. Residents were concerned pay-back sick policy would.
ACGME mandates the program director be sensitive to any signs that residents are not mentally and physically able to perform duties and promote patient safety.
Residents e-mailed complaints to the school and tell News 4 they never got a response from the school, until we started asking questions. We filed a public information request to see those complaints, but we were told there is no record of them.
Chow says he is unaware of any specific concerns, and their human resources department may have the complaints.
Again, those residents tell us the school did not respond to their concerns until we began our investigation, but Chow insists the administration learned of complaints a few months ago through multiple channels.
He says the residents’ concerns prompted the school to change the policy, “Upon advisement of human resources, the legal department, and the overall governing body of our program administration, they've all been in agreement of getting rid of that policy the revision of our sick day policy.”
The residents were informed that the sick day policy will be changed. The school of medicine says the new policy will be effective starting July 1st.