I think we all know the answer to that question
But I do think psych (and sometimes Peds) breaks the mold somewhat given they are non-competitive, but on average have pretty humane personality types.
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Calling in sick
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I think we all know the answer to that question
But I do think psych (and sometimes Peds) breaks the mold somewhat given they are non-competitive, but on average have pretty humane personality types.
I think folks who aren't being expected to come in sick think that's the way it should be everywhere and vice versa. That's human nature. But I think folks in certain specialties also can't fully appreciate the coverage issues in other fields. There's a big difference if you are in a big program with once a week call versus a small lean program that's Q3-Q4 where there's not a good backup plan for people not being there because new duty hours make pulls less feasible.
With all due respect, I would categorize the latter programs you describe as bad programs for they do not have the foresight or wherewithal to develop a healthy amount of redundancy in their systems for the inevitable unforeseen circumstance. Instead a culture of toughing-it-out and reactive, sometimes impunitive, measures is the norm so that the status-quo is preserved, however monumentally flawed it is.
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Disagree. The amount of time involved in creating a project is easily much greater than the amount of time you'll get off for going on a trip (I'm easily 60-80 hours into my project, and I haven't even started my data collection). Secondly, sending residents/fellows to present research at a conference is probably the best way to get your name and your program's name out there as a reputable place. If I have to do a little extra call here and there in exchange for getting our residents matched into good places, then that's a pretty even exchange.
Some of the competitive fields have easy hours and easy residencies, so it's not a big deal if someone doesn't come in for the day.
Your definition of "bad program" focuses on things you consider important, but not everyone shares those priorities.. There are plenty of people who are flourishing at these smaller programs and really finding residency pretty painless and enjoyable, except for the rare sick day, and wouldn't trade places with you for anything. having a "healthy redundancy" is a luxury you only get if the powers that be agree to give your hospital funding for more residency slots. It doesn't really have much to do with foresight -- it's not the same people making those decisions. But many of those bigger programs have other issues. The folks I've known who were truly abused during intern year were all at bigger programs. but sure, they had backup if they were truly sick.
My program has 6-7 residents per year, and 50+ clinical faculty. What you say sounds good in principle, but the fact is we are always stretched a little thin. It doesn't mean we are a BAD program. We are in fact a very good program that is exceptionally clinically busy. But if someone is out sick, we all suffer for it. There is no redundancy built into our call system, and I don't see how there could be with so few residents vs patients.
Agreed. We have a large program with many residents as well (as well as many faculty), but every service is very busy. Sure if a resident is sick and has to take time off to stay home and recover, we can manage...but it's not easy.
Here's a great solution: staff can take call if a resident is sick. That sounds doable.
You're so cute.
I've seen it happen too. But it's not in any way the norm and is unlikely to be for a good long time.
How unfortunate.
In fact I will go as far to say that it is poor patient care for a staff to make a hullaballoo about coming in to service the hospital when a resident is sick. In fact, the staff should always be expected to do this. If they do not like it, they can change their job or specialty to fit their more lax perceptions of what it entails to be a physician.
The resistance to change is the fault of both the residents accepting the status quo and the staff wanting to preserve it.
My words may be cute but they're also certainly correct: any program where a resident cannot depend on a staff or another physician to cover their duties in times of unexpected adverse events is a bad program. This may describe a lot of programs, even most, but that doesn't stop them from all being bad.
I gotta believe you are talking about a very different kind of service than some of us. I defy you to fund a program where the attendings come in and do overnight weekend stints in the ICU to let a sick resident go home. We aren't really talking about a few cushy hours in the clinic in the afternoon. And how many residents are going to be comfortable with the repercussions of forcing their attending to come in and cover for them, good program or not. It's not realistic for the labor/call intense fields. By that yardstick I think you would have to label entire specialties as "bad".
Just out of curiosity, what field are you in?
Simple. Staff in good programs won't mind it. Staff in bad programs will. It's fairly easy.
Now I'm not saying that residents should take a day off for a cold, but if a resident is sick as hell or some sort of a vomit cannon they should not go into work. No staff worth their salt should feel as if the resident should suffer repercussions for not working when ill and asking the staff to do it. After all, the staff is the lead physician in charge of the care of the patients that the resident usually cares for, and if that resident isn't around then someone's gotta do it. And it is possible in the labor intense fields, if a program and its staff aren't being dicks. And if that means that some fields are bad entirely (which I doubt...I've seen horrible programs in generally "cush" specialties, and reasonable programs in specialties with occasional 1 in 2 call) then so be it.
If a staffperson feels some sort of grudge or animosity towards a resident because said resident was too ill to come to work that day, then that staff is an egotistical ***** who provides poor patient care. It's that simple.
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I have never heard of a medicine or surgery attending dropping everything to spend their Saturday night in the ICU because an intern had the flu. And really can't imagine the intern with the balls enough to call in an attending for this. Changing the term "attending" to "staff" throughout your argument underscores that you aren't talking about fields with the same kind of hierarchy. I don't think it reflects an attending being an "egotistical *****", rather someone who has already paid their dues and graduated from the indignity of staying up all night in the unit on a Saturday night. Sorry but by your definition all programs in these specialties are "bad". And that's really not the case. You simply have an unrealistic perspective for these fields. Now maybe if we were talking about some cushy field with home call where the attending can just hold the pager for the night I would believe you, but working overnight in the Unit again decades after they have "graduated" from such misery, I just don't see it happening, and never have seen it.
I get what you're saying, but that is why the "attending" is paid the big bucks because he\she is ultimately responsible for all the patients under their care. In academics, a resident should cover as much as possible for the learning experience. If that attending or staff wanted a Cush lifestyle and not have to worry about patients at 3 am on a sat night they should either find a place with less calls, more coverage or switch fields.
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Where I'm from, attending and staff are synonymous. Don't make assumptions.
As for your argument, I believe it is you that has the unrealistic perspective on patient care in intense fields. Residency is about learning patient care. It's not about trying to obtain some badge of honor so that you have to do less work later because you "paid your dues". This isn't a unionized millworkers job.
In fact, I would say that the attending is always on call. The residents are the ones who do the grunt work but it is the attending's name that goes on everything, and it is the attending that is ultimately responsible if something goes awry. If I were an attending would I want my H1N1 resident infecting all of my patients just so I could stay home and sleep? Would I want miserable residents working for me? My answer is no. Maybe yours is yes.
This attitude makes clinical medicine into some kind of pyramid scheme, where the people on top don't need to do any actual work to get paid huge amounts of money. Instead they feel entitlement to have those at the bottom work for them under any circumstances, to an extent beyond any learning purpose.
Perhaps your attendings should start selling herbal supplements to their interns as well.
Hey, I didn't make the rules or create this attitude. I'm just saying that, wagy's unique example notwithstanding, this is how things actually play out in 99.9% of the programs out there -- the attendings aren't running in to cover on a Saturday night in the ICU for a sick intern. I don't think it's realistic to label virtually all such residencies as "bad" programs because of it. This is the norm. Bad programs have to be something worse than the norm IMHO, not simply worse than some people's ideal. Some on here are quick with the "bad" program label, but I don't think it's a fair characterization.
Smurfette
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You guys are assuming that every place adheres to a "one service, one attending" model. So idealistic.
To be devil's advocate:
My residency program (surgery) did not work like this. There were multiple surgery services. On any given service, there were multiple attendings with patients at all times. If service A had 24 patients, 12 might be from attending S, 6 from attending T, 4 and 2 each from attendings U and V. Each attending managed only their own patients and each staffed patients with the residents during the day. Residents on Service A may cross cover Service B at night, which might be 8 attendings total (or more). But the attending on call may be a Service C attending. Keep in mind that if an emergency came up with a given patient, their own attending would be contacted, NOT the attending on-call, unless the patient was in the ER and unassigned. If a resident from Service A is sick, what attending covers? Do all 8 attendings on Services A and B come in and cover their own patients? Does the on-call attending from Service C take in-house call covering Service A and B and manage other attending's patients, but not cover his own service as "first call"? Keep in mind the resident is covering multiple services and multiple attendings. Now throw in politics typical in academics where certain attendings may not like each other OR simply have vastly different approaches/subspecialties, etc. etc., and now you have a real mess as to how this could work. Add in the fact that the on-call attending does not get paid (and cannot charge for) to manage another surgeon's post op patients who are in a global surgery period if they are part of the same group. So does this attending then need to get paid by the hospital for "call" (more expensive than a resident) or are they working for free (if so, why should or would an attending agree to this)? It becomes far more complicated than switching the residents around or making residents cover even more patients each overnight to compensate for a missing resident.
For community hospital rotations, some guys in private practice (especially surgical specialties) cover multiple hospitals and may be unable to stay in house at one place all night to cover a sick resident if something comes in at one of the other hospitals they are covering, especially if the other hospital (which likely doesn't have residents) pays them to take call AND they can bill for the encounter.
I'm not in academics, btw. Just trying to point out how difficult it is to cover a sick resident. No matter what, somebody still gets screwed over...
To be devil's advocate:
My residency program (surgery) did not work like this. There were multiple surgery services. On any given service, there were multiple attendings with patients at all times. If service A had 24 patients, 12 might be from attending S, 6 from attending T, 4 and 2 each from attendings U and V. Each attending managed only their own patients and each staffed patients with the residents during the day. Residents on Service A may cross cover Service B at night, which might be 8 attendings total (or more). But the attending on call may be a Service C attending. Keep in mind that if an emergency came up with a given patient, their own attending would be contacted, NOT the attending on-call, unless the patient was in the ER and unassigned. If a resident from Service A is sick, what attending covers? Do all 8 attendings on Services A and B come in and cover their own patients? Does the on-call attending from Service C take in-house call covering Service A and B and manage other attending's patients, but not cover his own service as "first call"? Keep in mind the resident is covering multiple services and multiple attendings. Now throw in politics typical in academics where certain attendings may not like each other OR simply have vastly different approaches/subspecialties, etc. etc., and now you have a real mess as to how this could work. Add in the fact that the on-call attending does not get paid (and cannot charge for) to manage another surgeon's post op patients who are in a global surgery period if they are part of the same group. So does this attending then need to get paid by the hospital for "call" (more expensive than a resident) or are they working for free (if so, why should or would an attending agree to this)? It becomes far more complicated than switching the residents around or making residents cover even more patients each overnight to compensate for a missing resident.
For community hospital rotations, some guys in private practice (especially surgical specialties) cover multiple hospitals and may be unable to stay in house at one place all night to cover a sick resident if something comes in at one of the other hospitals they are covering, especially if the other hospital (which likely doesn't have residents) pays them to take call AND they can bill for the encounter.
I'm not in academics, btw. Just trying to point out how difficult it is to cover a sick resident. No matter what, somebody still gets screwed over...
I see from another thread that you are in the Canadian system, not a US residency, which may account for the differences. I have little familiarity with Canadian residency, so I'm not sure you are in a good position to judge which are good or bad residencies in a totally different system. As Smurfette pointed out, frequently attendings in the US aren't "staff", just folks with multiple local hospital privileges. And its not a one attending per intern scenario. And the hierarchy is likely more rigid here than in a socialized system. That likely changes the dynmics.
I thought Substance was from Canada? Canada uses a single-payer model of universal health care not a "socialized system."
Tomato, tomato.
Not exactly true.
Our physicians have comparable incomes to yours. The only difference is that we get raped by income tax a bit more (yours is a more gentle penetration).
Some fields up here do far better than their american counterparts, like family med and pathology. Derm and plastics can still do cosmetics and rake it in like the USA. Ophtho can still pull in 2 mil a year billing the public payor for laser retinal surgery, again just like in the USA. Cards too. Uro too. And so on...
We're not all equally paid and required to "share the wealth" as would be expected in communism.
In fact, given our far less punitive legal system and the significantly lower malpractice premiums, I would even say that it may even be more lucrative to practice medicine in Canada than in some states in the US.
This is a tangent from the discussion. My point is that you are in a very different health system, and perhaps not ideally positioned to evaluate what a "bad" US residency is, given that you arent even in one. This difference perhaps is why you describe attendings as "staff", and why your expectations on them are different.
There really isn't much I dislike more than people who abuse sick days.
In my allied health care position prior to med school I worked with so many dead beat sick day abusers it made me want to scream. RNs were often the worst offenders for some reason.
That being said, I would happily cover for people who I knew were really sick and had earned the so-called "street cred". Likewise I would expect the same.
In my allied health care position prior to med school I worked with so many dead beat sick day abusers it made me want to scream. RNs were often the worst offenders for some reason.
That being said, I would happily cover for people who I knew were really sick and had earned the so-called "street cred". Likewise I would expect the same.
I don't think its a tangent. You brought it up to discredit my opinion, so I politely described how you were wrong about your characterization of my country's health system as "socialist"
I'm pretty sure that our systems aren't as different as you may think. Here we have bad programs, as I have described, and good ones as I have also described. Each institution has its own flavor, and some of these are bitter.
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Did they have an allotted number of sick days that they could take each year? Were these paid or unpaid?
They weren't exactly sick days, you earned a certain amount of time per paycheck that could be either sick days or vacation days. I think it was like 0.6 days per paycheck or something like that.
You could accumulate a lot if I remember correctly, the cap may have been like 50 days or something.
Both of those numbers increased the longer you worked there.
They were absolutely paid.
On a similar note, what are people's thoughts on students calling in sick on rotations? Should they contact someone ahead of time to say they're sick or just go in and if the attendings or residents feel they're okay enough to make it through the day, have them stay? I've seen both done and I've seen a variety of responses to each, so I'm curious about others' opinions.
Seriously? If you're sick enough to not be able to learn/work, just call in and let them know, no need to bring in your sickness and get everyone else sick (saw this happen with norovirus on my medicine rotation). It's 1 or 2 days and they depend on us so little, it doesn't even really matter.
I agree with you, and that's usually what I do unless I don't have the contact info to let someone know, in which case I'd show up and let them know how sick I am and then go home. However, some people (especially on electives) seem to be so scared of being seen as lazy or uninterested that they'll show up and just assume someone will tell them to leave if they shouldn't be there. Just wanted to see if that's a common thought process or a few outliers I've happened to come across.
Yep, too many neurotic med students worried about being seen as weak, uninterested, etc. I agree about the whole not sure who to call thing, showing up if possible maybe good. The one time that happened to me I just paged the resident, since there was no way I could even get to the hospital even if I wanted to. Noro is one nasty virus.
Noro is going around the peds wards right now. A couple residents called out sick this week, and yesterday both a student and attending were out with the virus. We're definitely encouraged and expected to call out if we're sick - we just have to pay back the resident who is on sick-call who gets pulled off an elective to cover us.
I'm a student at an American school and we use attending and staff interchangeably. I thought that was the norm, but guess not.
It's not. As Smurfette pointed out above, at many hospitals the attendings can have privileges at multiple hospitals but are not the staff of any. I'm not sure which is the more prevalent model today, but this is hugely common. So to many of us when you say staff, that means the house staff (residents and fellows), hospitalists (if any), and midlevels.
I think med students are a very different story -- there are no coverage issues for a regular rotation, it just means the residents have to present the patients to the attendings themselves, but otherwise it doesn't really change the residents workflow. It's not like the residents were not double-checking everything the med students did anyhow -- it's still their asses on the line. Things actually go faster on rounds if the attendings have less of an audience. So if a med student is really Bona Fide sick, they should call in. Ive definitely sent folks home if they were visibly sick. Med student absences should be a rarity though because in a month long rotation you cant afford to miss too many days. I saw a med student get chewed out pretty significantly by a chief for seeming to abuse sick days. Also the rules are a little different IMHO if you are a sub-I with your own patients; you need to really be badly I'll not to be there -- the threshold is more like that of a resident.
In general you should call the senior. If you can't reach the senior any resident on the team who isnt post-call should do. Leave the attendings out of the mix.
Worst case, call or email the clerkship coordinator who can easily get in touch with the team (if perhaps 2 hours after you were supposed to show up).
I'm surprised everybody finds it so hard to get in touch with their teams though. I would swap phone #s with everybody on the team at the beginning of the rotation. Also, what hospital doesn't have a paging operator? Can't you just call them and have them page the resident (or frankly, anybody who has a pager) for you?
Yeah, exactly. There really isn't a good reason why you wouldn't be able to get ahold of SOMEONE on the team.
Actually, it's sometimes difficult when on EM rotations because you don't necessarily know who's on that day. Unless you are super prepared and hunt down the schedules of the residents/attendings. Also, can't page in our hospital because EM doesn't have pagers.
But, then again, just call the hospital switchboard and ask them to connect you to the ED secretary/unit operator/nurses station.
Interesting thread. There are days I feel I could never complete any residency in the USA (I'm 2 years away from finishing neurosurgery residency in Canada). Seriously, post-op day 1 residents expected to round? WHAT?! No thanks. Guess we're weak on the other side of the border...
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I'm in a Neurosurgery program in the States and that wouldn't happen. We're a resident-run service so arrangements would be made by the chief to cover that resident so that they could recover from surgery. It would be harder to cover if the sick resident were also a chief on another service, but not impossible if phone calls were made. Life happens. The (one) time I came to work sick my chiefs/seniors sent me home because they didn't want to catch what I got.
At some of the more malignant programs I rotated at, I did see residents struggle to work (floor work) while they should have been home in bed.I'm in a Neurosurgery program in the States and that wouldn't happen. We're a resident-run service so arrangements would be made by the chief to cover that resident so that they could recover from surgery. It would be harder to cover if the sick resident were also a chief on another service, but not impossible if phone calls were made. Life happens. The (one) time I came to work sick my chiefs/seniors sent me home because they didn't want to catch what I got.
I saw a surgery resident round on POD#0. Albeit it was from a finger surgery and they had had a digital block.
Now, that I could definitely see...he/she would be kept around for the LOLs. "Hey, could you go do...oh wait, no you can't."
I can't see anyone in our program wanting to stay home with that, but obviously the OR would be a problem. Seeing consults, though? They'd probably just stick around to do that and then get sent home as soon as another resident was free from the OR to take care of loose ends.
Since I assume I am/was the resident whose experience rounding on POD #1 is being talked about above, let me clarify:
1) this was a busy trauma service, with one team member already out on vacation
2) this was before work hour restrictions
3) this was a program that didn't especially adhere to #2 when they came around although they tried (there was just too much work, not enough residents and no midlevels)
4) I wasn't told I had to come in, but no one suggested that I stay home either. No one was surprised when I came in, which is where I got the impression that it was expected. I had certainly seen the reaction when residents (interns usually) called in sick.
5) frankly, I didn't have much pain, but the dehydration/nausea coupled with being upright for several hours got the best of me -- I didn't expect that, so figured since I wasn't feeling too bad, why not come to work? That was how I was raised and is more of a function of my personality, than the program, IMHO.
Not defending the program but I did what I felt was right in the situation (ie, busy service with already low team member census) and would do it again if I had to. Fortunately, this is a specific situation, at a specific time and place and may not be relevant to most residency experiences.
1) this was a busy trauma service, with one team member already out on vacation
2) this was before work hour restrictions
3) this was a program that didn't especially adhere to #2 when they came around although they tried (there was just too much work, not enough residents and no midlevels)
4) I wasn't told I had to come in, but no one suggested that I stay home either. No one was surprised when I came in, which is where I got the impression that it was expected. I had certainly seen the reaction when residents (interns usually) called in sick.
5) frankly, I didn't have much pain, but the dehydration/nausea coupled with being upright for several hours got the best of me -- I didn't expect that, so figured since I wasn't feeling too bad, why not come to work? That was how I was raised and is more of a function of my personality, than the program, IMHO.
Not defending the program but I did what I felt was right in the situation (ie, busy service with already low team member census) and would do it again if I had to. Fortunately, this is a specific situation, at a specific time and place and may not be relevant to most residency experiences.
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It's only happened once or twice, but the student had been sick the day before, so when she called in to say she couldn't make it, it was pretty believable. I didn't hold it against her.
As far as Im concerned.. Either one is REALLY sick or its "comic relief "
