Call for months at a time, is this legal

[billBOB213]

Hey all,

Talking with the other residents at my hospital (ortho, medicine, gen surg, OMFS) they all think our call hours are crazy. When they are on call they get 'post call' breaks where it's illegal to work them for a certain amount of time. I realize general surgery can get lit up overnight and work the whole time. But then they get a 24 hour break.
At my program we go on call for months at a time. We actually get a fair amount of trauma and DFU's that the ED will consult us on, and we are expected to go in for them-during the day or at night, whenever. Obviously we aren't getting called in at 2am everynight, but it's not uncommon where we can get called in multiple times a week in the middle of the night. It seems absurd, as we are then treating patients in clinic and also in the OR operating on patients. I have heard that podiatry is behind the times, not protected by these new law for residents, but wanted to see if I was missing something here.

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[GreenHousePub]

Sounds like you are right on the money. Also with a lot of residencies just being a "do my work for me" instead of an actual educational program.

 

[air bud]

a"do my work for me" instead of an actual educational

THIS

 

[dtrack22]

Hey all,

Talking with the other residents at my hospital (ortho, medicine, gen surg, OMFS) they all think our call hours are crazy. When they are on call they get 'post call' breaks where it's illegal to work them for a certain amount of time. I realize general surgery can get lit up overnight and work the whole time. But then they get a 24 hour break.
At my program we go on call for months at a time. We actually get a fair amount of trauma and DFU's that the ED will consult us on, and we are expected to go in for them-during the day or at night, whenever. Obviously we aren't getting called in at 2am everynight, but it's not uncommon where we can get called in multiple times a week in the middle of the night. It seems absurd, as we are then treating patients in clinic and also in the OR operating on patients. I have heard that podiatry is behind the times, not protected by these new law for residents, but wanted to see if I was missing something here.

I believe technically you are right in that Podiatry doesn't fall under ACGME guidelines...but I'd imagine that CPME has similar work hour restrictions (though someone would have to look that up because I'm not going to).

As far as your call is concerned, the program can do it/get away with it because you are taking home call from the sounds of it. Ortho and Gen surg programs essentially never get to take home call (well the upper may be able to since he/she is often back up). Because they actually get consulted frequently throughout the night, at least at larger academic centers, it makes sense. They have to physically be in the building at all times while on call. Podiatry residents typically do not. They then get post-call schedules where they aren't supposed to work. Your program (just like my old program) doesn't have to give you post-call time off because you aren't taking in house call. So you may be "on call" but the only duty hours you are accumulating are the ones where you are actually treating a patient in the hospital. The Ortho residents have to log duty hours for the entire 12 hours they were on call, which often follows a regular clinic or surgery day which means they have been in the hospital for 24 hours straight.

A month of even house call at a time is really dumb. Having to go in and see every DFU in the ED prior to admission is also dumb. I didn't go many nights of being on call without having to go in, but at least I could tell the ED to admit em and I'd see em in the morning if I wanted to. But you signed up for it so...

 

[acromium]

No it's not. Just like how we see consults without attendings and they still bill for it. Residents are used for cheap labor in clinics, rounds, paperwork/charting, coding, preop work, dictating, post op orders, updating attendings, waiting for consults. Why did I need to round with this attending I've never heard of and write this pts note I've never seen before?

Well at least at my program we are not allowed to log 80 hrs a week, at least one day off after 6 days straight , and can't work after 12pm post call. But it is a level 1 trauma center and we always have someome in house and never do house call.

But I am annoyed at the b. s. consult calls I receive from PAs and nurses. Stable DFU floor consult at 8pm with "cellulitis" that needs to be seen stat, toe pain with no xrays ordered, bedbound ankle soreness. One PA called to remove a jones that was put on too tight..pt sat in ED for 3 hrs with it on, they seriously couldn't just unwrap it until I got there?

I'm only 4 months in

 

[dtrack22]

Why did I need to round with this attending I've never heard of and write this pts note I've never seen before?

But it is a level 1 trauma center and we always have someome in house and never do house call.

Stable DFU floor consult at 8pm with "cellulitis" that needs to be seen stat, toe pain with no xrays ordered, bedbound ankle soreness. One PA called to remove a jones that was put on too tight..

sounds like a s****y residency

 

[hypermobility]

No it's not. Just like how we see consults without attendings and they still bill for it. Residents are used for cheap labor in clinics, rounds, paperwork/charting, coding, preop work, dictating, post op orders, updating attendings, waiting for consults. Why did I need to round with this attending I've never heard of and write this pts note I've never seen before?

Well at least at my program we are not allowed to log 80 hrs a week, at least one day off after 6 days straight , and can't work after 12pm post call. But it is a level 1 trauma center and we always have someome in house and never do house call.

But I am annoyed at the b. s. consult calls I receive from PAs and nurses. Stable DFU floor consult at 8pm with "cellulitis" that needs to be seen stat, toe pain with no xrays ordered, bedbound ankle soreness. One PA called to remove a jones that was put on too tight..pt sat in ED for 3 hrs with it on, they seriously couldn't just unwrap it until I got there?

I'm only 4 months in

You know there's a way to fix this. Tell these folks you will commit to see the patient when the adequate workup has been completed.

 

[ExperiencedDPM]

No it's not. Just like how we see consults without attendings and they still bill for it. Residents are used for cheap labor in clinics, rounds, paperwork/charting, coding, preop work, dictating, post op orders, updating attendings, waiting for consults. Why did I need to round with this attending I've never heard of and write this pts note I've never seen before?

Well at least at my program we are not allowed to log 80 hrs a week, at least one day off after 6 days straight , and can't work after 12pm post call. But it is a level 1 trauma center and we always have someome in house and never do house call.

But I am annoyed at the b. s. consult calls I receive from PAs and nurses. Stable DFU floor consult at 8pm with "cellulitis" that needs to be seen stat, toe pain with no xrays ordered, bedbound ankle soreness. One PA called to remove a jones that was put on too tight..pt sat in ED for 3 hrs with it on, they seriously couldn't just unwrap it until I got there?

I'm only 4 months in

As I’m sure you are aware, any attending who bills for any services completed by the resident while the attending isn’t present is FRAUD. I’m well aware that it’s done all the time, but it still pisses me off that residents are being used to generate money for these greedy a-holes.

 

[Pronation]

You know there's a way to fix this. Tell these folks you will commit to see the patient when the adequate workup has been completed.

That’s a great way to end up on your residency director’s poo list after they get wind you are spouting off at consulting folks.

 

[hypermobility]

That’s a great way to end up on your residency director’s poo list after they get wind you are spouting off at consulting folks.

There’s a huge difference between “spouting off” and making sure simple measures have been completed prior to seeing a consult.

 

[DYK343]

May or may not be legal.
But the more you do the better trained you are.
Get in good with the ER docs and hospitalists.
Be as helpful as possible. Even if it's "petty" stuff.
I put quite a few splints on for the PAs in the ER.
I hated it. But they also called me all the time for good cases instead of ortho.
Its 3 years that you can never do again.....

 

[CutsWithFury]

Hey all,

Talking with the other residents at my hospital (ortho, medicine, gen surg, OMFS) they all think our call hours are crazy. When they are on call they get 'post call' breaks where it's illegal to work them for a certain amount of time. I realize general surgery can get lit up overnight and work the whole time. But then they get a 24 hour break.
At my program we go on call for months at a time. We actually get a fair amount of trauma and DFU's that the ED will consult us on, and we are expected to go in for them-during the day or at night, whenever. Obviously we aren't getting called in at 2am everynight, but it's not uncommon where we can get called in multiple times a week in the middle of the night. It seems absurd, as we are then treating patients in clinic and also in the OR operating on patients. I have heard that podiatry is behind the times, not protected by these new law for residents, but wanted to see if I was missing something here.

Stop crying. You asked for this when you decided to go into podiatry. LEARN...

Residency is only 3 years. See and do as much as you physically can. It will make you a better surgeon and podiatrist

 

[malleolusman]

Truth. Buck up.