You decide to discuss the situation with the fellowship director, who says that he does not “see anything wrong” with the fellow since he is doing a good job of “producing RVUs.” He states that, in his mind, there could not be anything seriously wrong with the fellow because he was still being productive.
You have a short discussion with the fellow about his work performance and his apparent fatigue, but he expresses the concerns that if he were to take any time off from work, then it would mean that the attending radiologists would have to start taking call and that he would be seen as the individual responsible for causing that change. Later that week, when you sit down with the fellow for read out one day, you express your continuing concerns about his welfare but are taken aback when he snaps back by asking, “Don’t you even have any idea how many ACGME rules this place violates?”
Question 2 of 4: Which one of the following is not a duty-hour violation under ACGME rules?
The trainee starts work at 7:00 AM on Monday and then takes overnight call on Monday night. After final readout with the attending radiologist at 7:30–8:30 AM on Tuesday, making callbacks for three cases with discrepant findings to the ICU and ER, and rendering appropriate changes to the radiology reports after clinician notification, the trainee leaves at 9:30 AM but is expected to return at 4:00 PM for evening ultrasound coverage until midnight.
The trainee starts the evening ultrasound coverage at 4:00 PM on Monday and then works until midnight. He then returns for work in interventional radiology (IR) at 7:00 AM on Tuesday and completes his work at 6:00 PM that day.
The trainee starts work at 7:00 AM on Tuesday and then takes overnight call on Tuesday night. After final readout with the attending radiologist at 7:30–8:30 AM on Wednesday, with no callbacks needed for discrepancies, the trainee grabs a cup of coffee to stay awake and then attends grand rounds, given by a guest lecturer, at 9:00 AM.
The trainee works in IR from 7:00 AM to 7:00 PM on Wednesday and then takes overnight call on Wednesday night. After final readout is completed at 8:30 AM on Thursday, the IR attending informs the trainee about a really interesting new IR case just about to start and says he is welcome to participate. All goes smoothly, and the trainee leaves at 2:00 PM.
The trainee works in IR from 7:00 AM to 7:00 PM on Thursday and then takes overnight call on Thursday night. After final readout is completed at 9:00 AM on Friday, the head IR tech calls to ask the fellow to place a PICC line in a patient who is currently in the angiography suite. The trainee is qualified to do it by himself since he has already done over 200 PICC line placements, and the attending interventional radiologist is doing an emergent procedure in the ICU. The fellow completes the procedure in 15 minutes and goes home at 9:30 AM.