Covering attending tasks

Picoballa

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  1. Fellow [Any Field]
    I am a fellow in an internal medicine subspecialty who works with 3 other fellows and approximately 10 attendings. Our medical system recently switched to a new EMR and, since this time, whenever out on vacation, a physician must be covered by another person.

    Our attendings have decided that the fellows (we have designated the fellow on call) will cover their tasks while they are away. This becomes an issue, particularly over the summer when up to 3 or 4 at a time may be gone for a few days to several weeks.

    I have discussed with our PD and our clinic PD other potential ways to manage these tasks and divvy up responsibility, but it remains ours alone.

    Are any other fellows having such issues? Any suggestions to help manage this problem. Perhaps I just need to suck it up, but for some reason this situation seems inappropriate.

    Thanks for any insight.
     

    IM2GI

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      It is inappropriate and you are getting taken advantage of. Not sure what you can do about it though.

      A real division would have other faculty members cover each other, which is the professional thing to do.
       
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      jdh71

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        I am a fellow in an internal medicine subspecialty who works with 3 other fellows and approximately 10 attendings. Our medical system recently switched to a new EMR and, since this time, whenever out on vacation, a physician must be covered by another person.

        Our attendings have decided that the fellows (we have designated the fellow on call) will cover their tasks while they are away. This becomes an issue, particularly over the summer when up to 3 or 4 at a time may be gone for a few days to several weeks.

        I have discussed with our PD and our clinic PD other potential ways to manage these tasks and divvy up responsibility, but it remains ours alone.

        Are any other fellows having such issues? Any suggestions to help manage this problem. Perhaps I just need to suck it up, but for some reason this situation seems inappropriate.

        Thanks for any insight.

        I agree. This is inappropriate and not part of your training. If they want to start an house moonlighting gig where you guys get paid to cover that is OUTSIDE your fellowship training call and voluntary that would be fine I suppose. What you are describing is NOT ok. At all.

        You have recourses but you need to ask yourself how bad do you want to pursue this.
         

        P Diddy

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          I am a fellow in an internal medicine subspecialty who works with 3 other fellows and approximately 10 attendings. Our medical system recently switched to a new EMR and, since this time, whenever out on vacation, a physician must be covered by another person.

          Our attendings have decided that the fellows (we have designated the fellow on call) will cover their tasks while they are away. This becomes an issue, particularly over the summer when up to 3 or 4 at a time may be gone for a few days to several weeks.

          I have discussed with our PD and our clinic PD other potential ways to manage these tasks and divvy up responsibility, but it remains ours alone.

          Are any other fellows having such issues? Any suggestions to help manage this problem. Perhaps I just need to suck it up, but for some reason this situation seems inappropriate.

          Thanks for any insight.

          This is not illegal, but it is unprofessional. In my cardiology group, when another member is out, the on call cardiology attending covers for them, not the fellows.

          That said, fellows often take outpatient call, particularly in the more foofy specialties like Rheum and Endo, sometimes Pulm. This is likely because the outpatient workload for those specialties is low, so the fellows don't have much to cover, and the attendings went into these specialties with the expectations of a cush lifestyle.

          I don't agree that this is not part of your training. Taking outpatient call while a fellow trains you for taking outpatient call as an attending. How would you learn to triage otherwise?

          However, it sounds like you're being asked to follow up on labs etc that you didn't order. and deal with the most maddening, esoteric minutiae possible: that generated by the EMR. That is unfortunate. It also appears you are being used as cheap labor to cover for multiple attendings because your program and faculty are parsimonious and lazy.

          Buck up, Rheum fellow. You'll be an attending in 3 short years, and never hear from a patient when not in clinic again.

          p diddy
           

          rokshana

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            This is not illegal, but it is unprofessional. In my cardiology group, when another member is out, the on call cardiology attending covers for them, not the fellows.

            That said, fellows often take outpatient call, particularly in the more foofy specialties like Rheum and Endo, sometimes Pulm. This is likely because the outpatient workload for those specialties is low, so the fellows don't have much to cover, and the attendings went into these specialties with the expectations of a cush lifestyle.

            I don't agree that this is not part of your training. Taking outpatient call while a fellow trains you for taking outpatient call as an attending. How would you learn to triage otherwise?

            However, it sounds like you're being asked to follow up on labs etc that you didn't order. and deal with the most maddening, esoteric minutiae possible: that generated by the EMR. That is unfortunate. It also appears you are being used as cheap labor to cover for multiple attendings because your program and faculty are parsimonious and lazy.

            Buck up, Rheum fellow. You'll be an attending in 3 short years, and never hear from a patient when not in clinic again.

            p diddy
            speaking as a fellow in your so called "foofy" subspecialty…. no we do not cover the attendings tasks…the attendings do their own tasks…as a the fellow on call we do handle the clinic calls after hours so if there is an issue a patient of the clinic has that has to be taken care of urgently the fellow on call does it…but following up on labs and the minutiae of output practice is done by the person who ordered them and if they are on vacation where there is no internet (because with an EMR you can access the tasks from anywhere) the person (attending to attending or fellow to fellow) asked to cover.

            and jeez….could you be more of a douche?…as if cards is all that...
             

            P Diddy

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              speaking as a fellow in your so called "foofy" subspecialty…. no we do not cover the attendings tasks…the attendings do their own tasks…as a the fellow on call we do handle the clinic calls after hours so if there is an issue a patient of the clinic has that has to be taken care of urgently the fellow on call does it…but following up on labs and the minutiae of output practice is done by the person who ordered them and if they are on vacation where there is no internet (because with an EMR you can access the tasks from anywhere) the person (attending to attending or fellow to fellow) asked to cover.

              and jeez….could you be more of a douche?…as if cards is all that...

              But that is exactly what I am talking about. You are covering an attending task, the after hour clinic call. We cover our own in my cardiology practice rather than scutting out our fellows. I imagine you will be scutting your fellows out too if you ever make it into academics? Foofy indeed.

              p diddy
               

              rokshana

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                But that is exactly what I am talking about. You are covering an attending task, the after hour clinic call. We cover our own in my cardiology practice rather than scutting out our fellows. I imagine you will be scutting your fellows out too if you ever make it into academics? Foofy indeed.

                p diddy

                so you're trying to tell me that if a CLINIC patient is having chest pains and calls the cardiology clinic off hours line at midnight, an ATTENDING is answering that call instead of a fellow? riiiight…..maybe you community cardiology groups have do that since you have no fellows, but i seriously doubt a cardiology attending at a fellowship program is taking those calls in the middle of the night.
                 

                jdh71

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                  This is not illegal, but it is unprofessional. In my cardiology group, when another member is out, the on call cardiology attending covers for them, not the fellows.

                  That said, fellows often take outpatient call, particularly in the more foofy specialties like Rheum and Endo, sometimes Pulm. This is likely because the outpatient workload for those specialties is low, so the fellows don't have much to cover, and the attendings went into these specialties with the expectations of a cush lifestyle.

                  I don't agree that this is not part of your training. Taking outpatient call while a fellow trains you for taking outpatient call as an attending. How would you learn to triage otherwise?

                  However, it sounds like you're being asked to follow up on labs etc that you didn't order. and deal with the most maddening, esoteric minutiae possible: that generated by the EMR. That is unfortunate. It also appears you are being used as cheap labor to cover for multiple attendings because your program and faculty are parsimonious and lazy.

                  Buck up, Rheum fellow. You'll be an attending in 3 short years, and never hear from a patient when not in clinic again.

                  p diddy

                  Taking call within your specialty IS part of training. Covering GENERAL medicine call as a fellow when an general medicine attending is gone is NOT part of training, and that was the issue here.
                   
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                  P Diddy

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                    so you're trying to tell me that if a CLINIC patient is having chest pains and calls the cardiology clinic off hours line at midnight, an ATTENDING is answering that call instead of a fellow? riiiight…..maybe you community cardiology groups have do that since you have no fellows, but i seriously doubt a cardiology attending at a fellowship program is taking those calls in the middle of the night.

                    Believe it, sister. I am on call for my clinic patients every night (who knows them better?), and when I'm out of town the inpatient attending takes the calls. I am at an academic center with fellows.

                    Your program is weak.

                    p diddy
                     

                    P Diddy

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                      Taking call within your specialty IS part of training. Covering GENERAL medicine call as a fellow when an general medicine attending is gone is NOT part of training, and that was the issue here.

                      I agree with your first sentence. Have I misinterpreted the OP's complaint? It seemed to me s/he was complaining about taking calls for his/her attendings in the same subspecialty.

                      p diddy
                       

                      jdh71

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                        I agree with your first sentence. Have I misinterpreted the OP's complaint? It seemed to me s/he was complaining about taking calls for his/her attendings in the same subspecialty.

                        p diddy

                        It appears one of us did and it could have been me. We'll see if OP come back and clarifies.

                        I think taking the first call pulmonary pages for the outpatients for the division while in training was good for my training.
                         
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                        rokshana

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                          Believe it, sister. I am on call for my clinic patients every night (who knows them better?), and when I'm out of town the inpatient attending takes the calls. I am at an academic center with fellows.

                          Your program is weak.

                          p diddy
                          i guess we will have to agree to disagree…personally i think a program that doesn't give the fellow the responsibility of handling those 1st calls for emergencies is ultimately doing their fellows a disservice by coddling them…now they have to learn that kind of stuff when they are a alone as an attending, not when they HAVE an attending to act as a safety net…

                          and you still are a bit douchy to think cards is the end all and be all and to show such disrespect for other subspecialties...
                           
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                          IM2GI

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                            Maybe I misunderstood.

                            We take all of the after hours clinic phone calls when on call, and that seems like a reasonable expectation for your training.

                            We do not deal with business hours issues for attendings that are off for the week, they assign those tasks to other attendings.
                             

                            rokshana

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                              Maybe I misunderstood.

                              We take all of the after hours clinic phone calls when on call, and that seems like a reasonable expectation for your training.

                              We do not deal with business hours issues for attendings that are off for the week, they assign those tasks to other attendings.
                              exactly…i guess p diddy would consider GI to be one of those "foofy" fellowships as well….
                               
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                              P Diddy

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                                It appears one of us did and it could have been me. We'll see if OP come back and clarifies.

                                I think taking the first call pulmonary pages for the outpatients for the division while in training was good for my training.

                                As I wrote above ('I don't agree that this is not part of your training. Taking outpatient call while a fellow trains you for taking outpatient call as an attending. How would you learn to triage otherwise?'), I do think fellows should take outpatient call in their own subspecialty. The question is how much. In our hospital, there are a lot of cardiologists. If the fellows were taking outpatient calls for all the cardiologists, they would be up all night, every night, in addition to performing echoes, seeing consults, reading EKGs. It would not be fair.

                                In addition, it's a better patient care experience for someone who knows the patient to take the call (or at least someone in the subspecialty). Thus EP fellows take call for the EP group, transplant for transplant patients, etc.

                                To me it makes more sense for the general fellows to cover on call issues for all of the fellows' patients; that's more manageable. The fellows get calls for some of the attendings' patients anyway because the operators are incompetent, or the patients don't remember the clinic number and ask for the on call cardiology fellow.

                                p diddy
                                 

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                                  I think this depends on the nature of your continuity clinic. If you have your own separate clinic, then this is an ACGME violation (this is what the survey calls service). If, however, you work in that clinic and these could reasonably be considered teaching patients, you haven't got a leg to stand on.


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                                  Orange Man

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                                    I am a fellow in an internal medicine subspecialty who works with 3 other fellows and approximately 10 attendings. Our medical system recently switched to a new EMR and, since this time, whenever out on vacation, a physician must be covered by another person.

                                    Our attendings have decided that the fellows (we have designated the fellow on call) will cover their tasks while they are away. This becomes an issue, particularly over the summer when up to 3 or 4 at a time may be gone for a few days to several weeks.

                                    I have discussed with our PD and our clinic PD other potential ways to manage these tasks and divvy up responsibility, but it remains ours alone.

                                    Are any other fellows having such issues? Any suggestions to help manage this problem. Perhaps I just need to suck it up, but for some reason this situation seems inappropriate.

                                    Thanks for any insight.
                                    It's an abuse of power if they are all doing it. Attendings should cover for each other, or they should reciprocate for fellows. When you fill out your ACGME annual survey, make a big point of this and ask all your classmates to also. If there is a multiple choice section that indicates "excessive use of fellows for service", all of you should check it. If this happens, it triggers an automatic audit from the ACGME. You tried to play nice, you were professional, and it was ignored. The ACGME audit will make it stop.
                                     

                                    P Diddy

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                                      It's an abuse of power if they are all doing it. Attendings should cover for each other, or they should reciprocate for fellows. When you fill out your ACGME annual survey, make a big point of this and ask all your classmates to also. If there is a multiple choice section that indicates "excessive use of fellows for service", all of you should check it. If this happens, it triggers an automatic audit from the ACGME. You tried to play nice, you were professional, and it was ignored. The ACGME audit will make it stop.

                                      You have far too much faith in the ACGME and their ability to make anything stop. It is far more likely that the fellows will suffer if they follow your naive suggestion.

                                      p diddy
                                       
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