(To my non-medical readers: FYBIGMR ("F$%! You, Buddy, I Got My Residency!") is the party where medical students either celebrate getting the residencies they wanted or drown their sorrows over a disappointing placement. I also think it's an apt summary of the attitude that develops over years of dehumanizing training.)
Over the weekend, I talked to a couple of junior residents in my husband's program. These guys are PGY2, so they'll do their entire residencies under the new regulations. But both reported being treated like shit, working 100-hour weeks, and not learning very much during the preliminary/transitional year. The prevailing attitude was that "they won't be here next year, so let's squeeze them for all they're worth."
Neither of them made a report to the ACGME, figuring that it was an exercise in futility. Maybe it would have been, but then again, maybe not. Transitional residents may not be around long enough to see the smackdown, but it's still worth initiating. Why let yourself be treated like shit for an entire year? Why not help the transitionals who come after you?
I understand the reluctance of categorical residents (especially foreign medical grads) to risk shutting down their own programs by reporting violations. As much as residency sucks, having your program shut down after your first year would suck too. Remember, though, that while you may not want to report violations, somebody else with less to lose might. For example, an ER resident may rotate through a SICU that's run by surgeons who don't give a damn about the regulations. That ER resident probably won't give a damn if the surgical residencies get sanctioned by the ACGME. Or a fed-up resident in his last year may want to stick it to the rat-bastard attending who's been making his life hell for years. If the hospital is due for an ACGME visit anyway, one squeaky wheel might get all of GME investigated.
It's been more than a year since the regulations went into effect; some hospitals have made improvements, but there are are plenty out there that won't react unless their feet are held to the fire. The good news is that an ACGME site visit is sometimes enough to rein in egregious abuses. Sadly, though, variants of FYBIGMR may end up pitting residents against each other. ("F$%! You, Buddy, I'm Out of Here," and "F$%! You, Buddy, This Ain't My Department.") That's the last thing people need in such a stressful environment. It'll be years before the kinks are worked out. I keep telling myself "Progress, not perfection," but I'm impatient by nature, especially when people I care about are getting shafted.