If you've ever met a medical resident, chances are they were probably very tired.
That's because they're on their feet 60 to 80 hours a week, often working 28 or 36-hour shifts with little to no sleep. As a result of those working conditions, residents suffer from high levels of burnout and exhaustion.
Among other things, that cocktail of health problems makes driving or biking home from the hospital particularly perilous for residents and for the general public. A recent study in the New England Journal of Medicine found that interns who worked more than 24 hours in a shift were 2.3 times more likely to report crashing their car, and 5.9 times more likely to report "nearly" hitting another driver. Not very good!
To address this issue and to mitigate fatigue, the Accreditation Council for Graduate Medical Education (ACGME), which sets the standards for accrediting medical schools, requires schools to offer "safe transportation options for residents who may be too fatigued to safely return home."
The University of Washington offers what it calls an "Emergency/Safe Ride Home Program," but severely fatigued residents are calling the program "a sham."
Sarah Kirsch, a third year internal medicine resident, said she first heard about the program as an intern during orientation week. According to a slideshow delivered during the presentation, "perks" of resident compensation packages included the "Emergency/Safe Ride Home Program."
In her first few months as an intern, Kirsch said she worked 28-hour shifts on the cardiac and medical intensive care units at Harborview, which she described as "probably the most intense rotation we do here."
Kirsch typically bikes to the hospital from her place in Eastlake, but after working four of those shifts, which ran from 7 a.m. to 11 a.m. the following day, biking home in the big city seemed like "a bad idea." Kirsch said she "didn't think twice about calling an Uber" on those days to get a ride home, as her understanding from orientation week was that exhausted residents could just call a ride-hailing service or take a taxi home.
Kirsch ended up submitting four receipts to the graduate office, expecting to be reimbursed for a grand total of $37.11. Two months and multiple follow-up emails later, assistant dean Cindy Hamra denied her request, saying that one of those rides was to a place other than Kirsch's home (she was dropped off at her fiancé's place), and the rest were requested when public transportation was available.
In the e-mail, Hamra also expressed concern about Kirsch's physical endurance, emphasis mine. "If you are experiencing significant fatigue this early in the year, I encourage you to speak with your program about scheduling and to consider connecting with our Wellness Service," Hamra wrote.
Kirsch said she felt Hamra was using "shame language" in her reply, but the response didn't piss her off. "I was just sad that it was a sham program," she said. Hamra used that exact same "shame language" in rejecting a reimbursement request from another resident, who wishes to remain anonymous for fear of retaliation. In that rejection, Hamra also CC'd the resident's program director, which "surprised and embarrassed" the resident.
Neither Hamra nor UW's Housestaff Affairs office has returned requests for comment, but I will update this post when I hear back.
Kirsch hasn't used the program since, and her story has discouraged other co-residents from availing themselves of the mandated service, such as it is.
Alexander Adami, a second year resident in internal medicine who typically bikes or walks to work from First Hill, said he thinks about using the service a lot, especially when he gets off a shift at 3 a.m. and buses running from the UW Medical Center are scarce. But he's heard from others that the program is "a waste of time because they never reimburse you."
Indeed, UW's uses confusing language in its policy. The university initially states that residents "who feel that they are unable to get home safely by walking, public transportation, or driving are encouraged to take advantage of the [Emergency Safe-Ride Home Program]." Later the university contradicts that statement, saying residents will only be reimbursed for rides if they, "walk or use public transportation, and worked longer than expected and beyond when public transportation is available.”
Moreover, Adami points out, the definition of "available" public transportation is unclear. "If you don't get the one bus that goes downtown at 3 a.m., you're stuck until 4:15 or so. And at the end of our shifts, especially in the emergency room, there's always stuff to finish up, so you almost never make it out on time."
"It's not quite as bad if you leave at 10 p.m., but if you’ve been working for a long time, it's probably not the best idea to be sitting there falling asleep on public transit," Adami continued.
Compared to taxi voucher programs at other universities, UW's policy is much more restrictive. Stanford, University of Pennsylvania, University of California - San Francisco, UCLA, the University of Kentucky, George Washington University, and Emory offer residents rides to and from work (so they don't end up financially penalizing doctors for using the program), and don't exclude program hours to periods of the day when public transportation is available.
"This is standard practice at every academic medical center, but especially the ones who have multiple hospitals to cover like UW," Adami said. "We’re an outlier by not providing this kind of coverage."
"And it's not like it’s a million dollar program," Adami added. "If every resident was using this all the time it still would never amount to much. You can make small investments that prevent tragic consequences and really help the people who keep your medical system moving, but evidentially that’s not a priority of UW's."
In response to denials of service from the university, the University of Washington Housestaff Association has essentially been running a shadow program. According to numbers from the union, over the last two years, UW has refused to reimburse six doctors for 21 rides, mostly on the basis of the requests being made during commuter hours. The union has picked up those tabs, plus other rides from residents, totaling over $228.
The university's unwillingness to pay for those rides is somewhat baffling for Kirsch. "UW residents are ridiculously hardworking, compassionate, enthusiastic young people, and we're just disappointed that we work for an institution whose actions do not support us," she said.