Surgery training program at MGH is put on probation

By Liz Kowalczyk
Globe Staff / November 17, 2009

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The surgery training program at Massachusetts General Hospital has been put on probation by a national accrediting organization.

The unusual action carries no penalties, but candidates may have second thoughts about applying to a program on probation.

The Accreditation Council for Graduate Medical Education warned the hospital in April that a significant number of junior surgeons were working too many hours and were on the job seven days straight, in violation of patient safety rules.

The organization believes heavy workloads contribute to fatigue-related mistakes, and had given the hospital until Aug. 15 to fix the problem.

Even though the hospital made “enormous changes’’ and is now in “100 percent compliance’’ with the rules, said Dr. Andrew Warshaw, the chief of surgery, the accrediting group told Mass. General last month that it had put the program on probation.

Warshaw said the decision was based on the surgery program’s past performance, a situation that he said could hurt the quality of applicants. “My sincere hope is that [the ACGME] comes back soon [for a follow-up inspection]. This is a very harmful circumstance that is quite unfair at this point,’’ he said.

Warshaw said he had canceled certain clinical rotations, in which residents learn different kinds of surgeries, and educational conferences to reduce their hours, among other measures.

The accreditation council would not comment on its reasons for putting the Mass. General program on probation. But it’s rarely done.

During the 2008-2009 academic year, just 1 percent of 8,734 residency programs were on probation or were warned they could be put on probation.

Surgery residents at Mass. General generally work from 6 a.m. to 6 p.m., plus occasional overnight shifts. Accreditation council rules require residents to have at least 10 hours off between daily shifts and after overnight shifts.

According to a 2007 survey of Mass. General surgery residents, nearly 20 percent said they weren’t always getting a 10-hour break, while another 20 percent reported working more than the 88 hours per week allowed on certain especially difficult rotations.

During a site visit, the council confirmed this problem and found residents on other rotations were violating the 80 hours a week permitted for those programs.