Fake days off

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Perrotfish said:
How many fake days off do you guys average per year? You know, where your day off for the week is really 24 hours to switch to or from night float? I'm just curious how common this is.
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Extremely common. It's why the older system was better than this new fangled night float.
 
Apparently these are called a DOMA, day off my ass. I guessing they're pretty common, and they're entirely lame. Fortunately, my university has decided these are not appropriate, so we don't have them count as our days off.

Aside these certainly not performing the true goal of a day off (relaxation, escape from the hospital), they're problematic in that it's hard to actually get those pure 24 hours off because signouts and whatnot leak into that time.
 
Doctor Bagel said:
Apparently these are called a DOMA, day off my ass. I guessing they're pretty common, and they're entirely lame. Fortunately, my university has decided these are not appropriate, so we don't have them count as our days off.

Aside these certainly not performing the true goal of a day off (relaxation, escape from the hospital), they're problematic in that it's hard to actually get those pure 24 hours off because signouts and whatnot leak into that time.
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Agreed. I would on more than one occassion get calls on back to back Saturdays, and when I complained that would mean me working pretty much 3 weeks straight, the response was oh you don't have to work the Sundays, you can take those off. Really?! I'm sleeping after a 30 hour call, that certainly is not a day off! Or when your day off from ER rotation was after a 7pm to 7am shift. I'm like really?! It's so sad that we are so taken advantage of.
 
We had them all the time in residency. They follow the regulations, and on some services or when we were spread thin it just was the way it was. I actually think it's the breaks of the game, and that's what happens.
 
wagy27 said:
Couldn't disagree more. Its the responsibility of the chiefs and the PDs to realize how useless these "days off" are and to do right by their residents and their well being. Good programs do these things; its easy to say that schedules are tight and that programs are short staffed but thats what attendings and staff are for. Where I trained at, prior to implementing the new rules each program was given the chance to request funds for additional staff (including midlevels) to allow residents to be compliant with the rules.
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Wow, that's amazing. I don't think we got any extra money to deal with the changes, and we certainly didn't get extra coverage from staff or attendings. Fortunately, we found a way to revamp our schedule that worked while keeping most of the burden on 1st and 2nd year residents (we're a front-loaded psychiatry program -- pretty normal in psych). I'd love to train at a program with more money, though. It sounds like it makes everything easier.
 
wagy27 said:
... Where I trained at, prior to implementing the new rules each program was given the chance to request funds for additional staff (including midlevels) to allow residents to be compliant with the rules.
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I am pretty confident that 99.99999% of all programs don't have access to additional funds to supplement residents due to duty hour changes. Its a bad economy and most places are being asked to do more with less. And chiefs have no ability to incorporate attendings or midlevels into scheduling -- they have to provide resident coverage 24/7.
 
DrAwsome said:
Agreed. I would on more than one occassion get calls on back to back Saturdays, and when I complained that would mean me working pretty much 3 weeks straight, the response was oh you don't have to work the Sundays, you can take those off. Really?! I'm sleeping after a 30 hour call, that certainly is not a day off! .
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That was a day off (sometimes after a 36 hour call) when I was a resident, and we were grateful for any we could get.
 
wagy27 said:
I've seen funds used in a couple ways (from most expensive to least)

1) Hire a full time midlevel
2) Use a nocturnist/hospitalist once a week to balance schedule
3) treat it as a moonlighting opportunity to seniors on electives
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All three of these are used at our hospital and many children's hospitals. #3 is used a lot for weekend mornings for senior residents to meet the days off rules. For interns, coverage limitations have led to some use of #1 and #2 (and more than once a week at our place). Amongst the best known children's hospitals, there is considerable competition for top applicants, even in a low competition field like pedi, so doing these things, and talking about it on the "tour", is common.

Or so, I've been led to believe....
 
michaelrack said:
:laugh:

15 years from now, residents will be complaining about 50-60 hour work-weeks, and you can tell them how hard you had it.
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You think there will be any doctors left 15 years from now? 🙂

Anyways, I don't think that's untypical today of residency. 50-60 hours is very typical these days imo, except at super high end places.
 
DrAwsome said:
You think there will be any doctors left 15 years from now? 🙂

Anyways, I don't think that's untypical today of residency. 50-60 hours is very typical these days imo, except at super high end places.
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I don't know anyone doing 50-60. At least not in intern year.
 
gutonc said:
And yet...they're still bitching about it. Which was michaelrack's point.
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I honestly think that if they are going to squeeze us this much, then we should have normal, regular working hours. If nurses work 40 hours, then so should we. I think it's insane to ask someone to work 100 hours, even 80.
 
Perrotfish said:
I don't know anyone doing 50-60. At least not in intern year.
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Really? Maybe they are at high volume, small residencies. With nighfloat, most people are working 7am to 4-5pm typically. What kind of schedules are you seeing?
 
DrAwsome said:
Really? Maybe they are at high volume, small residencies. With nighfloat, most people are working 7am to 4-5pm typically. What kind of schedules are you seeing?
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I rotated through 5 peds programs. They're all 7 to 7 6 days a week on inpatient. Outpatient varied a lot more but the one I'm at is about 10 hours a day 6 days a week. (Every other weekend covers the inpatient night float). 10 hour day shift might mean slightly fewer hours (keeping in mind you now have a 14 hour per day week of night float) but with didactics you only really have 8 hours to advance care. That is a very low volume program.
 
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DrAwsome said:
Really? Maybe they are at high volume, small residencies. With nighfloat, most people are working 7am to 4-5pm typically.
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How would that work? Night float comes in at 4pm and leaves at 7am? 😕

Usually they're 12-hour "shifts" (I cringe at that word). 7am - 7pm for the day interns, 7pm-7am for the night float interns.
 
Buzz Me said:
How would that work? Night float comes in at 4pm and leaves at 7am? 😕

Usually they're 12-hour "shifts" (I cringe at that word). 7am - 7pm for the day interns, 7pm-7am for the night float interns.
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And 6 days a week. I doubt many residents here are only working 50 hours/week. We work more than that in psychiatry, and I'm pretty sure most other people work more than us.
 
Buzz Me said:
How would that work? Night float comes in at 4pm and leaves at 7am? 😕

Usually they're 12-hour "shifts" (I cringe at that word). 7am - 7pm for the day interns, 7pm-7am for the night float interns.
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Sorry, I guess my post was a little unclear. Of course during nightfloat hours are longer (where I was at the hours were 8pm to 7am btw, not 4pm to 7am). But I meant on non-night float weeks, most interns and seniors worked 7am to 4pm.
 
michaelrack said:
It is insane; I occasionally worked 100+ hour weeks in IM residency. It crushed me. It's one of the reasons I am slightly cynical today.
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Agreed. There were things during my internship that I was very much set on not doing, like working an unhealthy amount of hours. For example, after call, leaving as soon as I finished rounding (the whole idea of sticking until noon conf. was just absurd to me), etc. Same during weekends-as soon as I had taken care of all my patients, I signed out to on call person, I did not stay midday or whatever. I always did my fair share of the work, but I never thought it was ok to work an insane amount of hours like that. I think it is not just grueling and unhealthy, but it is very ironic for us to tell patients about getting enough sleep, etc. while we are sleep deprived and exhausted. It is also terrible for patient care to be that exhausted. No thanks.
 
Doctor Bagel said:
And 6 days a week. I doubt many residents here are only working 50 hours/week. We work more than that in psychiatry, and I'm pretty sure most other people work more than us.
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Doctor Bagel, what are your hours like in psych? Well this is what I have seen/experienced, maybe it does not reflect what others are experiencing currently in their programs.
 
Perrotfish said:
I don't know anyone doing 50-60. At least not in intern year.
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I think the derm residents here probably work that much (almost certainly <60), but they don't start derm until PGY-2, so they (probably) did work more as interns as well.
 
DrAwsome said:
Sorry, I guess my post was a little unclear. Of course during nightfloat hours are longer (where I was at the hours were 8pm to 7am btw, not 4pm to 7am). But I meant on non-night float weeks, most interns and seniors worked 7am to 4pm.
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I think this is where the confusion lies. If night float is showing up at 7 or 8 pm...how are the day people leaving at 4??
 
EM intern. We work 200hr a month, ten hour shifts, have a circadian schedule and have conference once per week. I really only have three overnights this month. Its great! seniors work less than 40/wk and all of them moonlight like crazy. Short of Derm, there is simply no better lifestyle residency.
 
DrAwsome said:
Sorry, I guess my post was a little unclear. Of course during nightfloat hours are longer (where I was at the hours were 8pm to 7am btw, not 4pm to 7am). But I meant on non-night float weeks, most interns and seniors worked 7am to 4pm.
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So who covers the gap? Staff? Mid levels? Intern short call?

I like the short call system, btw. It only work with multiple interns on a service, but it gives everyone a chance to see the sun most days of the week.
 
On our q3 day call schedule (gen surg), the DOMA is quite frequent. At some hospitals, if your pre-call day falls on a weekend, it is a legitimate 24 hours off when extra bodies aren't needed to cover cases and you can sleep in that day. But if your call day falls on a weekend or you need to round on a Saturday/Sunday, the DOMA awaits you.

And you can forget about a golden weekend (at least until 4th or 5th year).
 
DrAwsome said:
Doctor Bagel, what are your hours like in psych? Well this is what I have seen/experienced, maybe it does not reflect what others are experiencing currently in their programs.
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In our first two years, we generally average about 60 hours a week. My 3rd year hourly average will be closer to 40, not including writing notes at home. I know there certainly are 40 hour/week all 4 years programs out there in psych, though -- I'm just not at one of them.
 
this happened very very infrequently at the place I did my prelim and doesn't happen to my knowledge in my advanced program. We had NF that started at 6 or 7 but the gap was managed by a short call team for crosscover with nurses made to understand that time period was to be used for things that were emergencies or required urgent eval and not "my patient hasn't had a BM in 30 hours so I NEED COLACE!!!!" Surprisingly the extra handoff didn't kill every patient in the hospital like some would make you believe because it forced the primary team to actually make a good signout sheet and actually do a good job documenting their assessment and plan every day.

I wouldn't call programs that do DOMAes malignant, but they're not exactly being very considerate of the resident's life and function. I had a friend with a prelim program that did that but then they also acted like she was the worst person on the planet for taking a week off to get life saving thoracic surgery.... so they were definitely malignant.
 
Perrotfish said:
So who covers the gap? Staff? Mid levels? Intern short call?

I like the short call system, btw. It only work with multiple interns on a service, but it gives everyone a chance to see the sun most days of the week.
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Yes, that's how it worked where I did internship. Roughly once a week, interns took short call until 8pmish or so. Otherwise, 7am to 4pm, if something went wrong/late admission maybe 5ish or so, and once a week like I said short call until 8pm. Of course night float was 6days a week, about 12 hours, but that was just a few weeks out of the year. Otherwise normal schedule as stated above.

I liked the short call system as well, if everyone does their job well, it lets most people, even interns! have a pretty normal life most days out of the week, and lets nightfloat be more human, particularly if you are covering 7/8-7 am or so. Sure it sucks for a few weeks, but it is sooo much better than the 36 hour call-that is just freaking brutal.
 
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Mattchiavelli said:
...Surprisingly the extra handoff didn't kill every patient in the hospital like some would make you believe ...
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no that's not a fair way to characterize the argument. Errors are going to be rare under every system. The argument is that OVER TIME, more errors creep in with additional handouts. It's not a question of "killing every patient" it's an issue of having a few more errors slip through the cracks thanks to another round of handouts than under the old system. There are ongoing studies that preliminarily seem to confirm this, anyone who has played "telephone" as a small child knows this, and the fact that reduced call hours combined with additional handoffs hasn't resulted in a noticeable decrease in error rate seems to support this.

even under the worst handoff system, the percentage of patients doctors are "killing" is hopefully going to be negligible. But not zero. The question is, do more handoffs raise the error rate from 1% to 1.5%, not whether you go from everyone surviving one day to the wards resembling the killing fields the next.
 
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michaelrack said:
It is insane; I occasionally worked 100+ hour weeks in IM residency. It crushed me. It's one of the reasons I am slightly cynical today.
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My residency program wasn't terribly compliant with hours and I worked 80-95 hours a week for many, MANY months. Now, in fellowship, I average around 90-95 hours a week.
 
TheProwler said:
I think the derm residents here probably work that much (almost certainly <60), but they don't start derm until PGY-2, so they (probably) did work more as interns as well.
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All of the top 10 cush TYs (in the country) average <60 hours/week even on medicine floors. I've been working 45-50/wk so far during my intern year. When you include half a year of electives and cush ambu and ER months, it's probably closer to 20 hours/week averaged over the entire year.
 
Dumb said:
All of the top 10 cush TYs (in the country) average <60 hours/week even on medicine floors. I've been working 45-50/wk so far during my intern year. When you include half a year of electives and cush ambu and ER months, it's probably closer to 20 hours/week averaged over the entire year.
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Yep. even for prelim programs like the one I went to, some electives were very light, no weekends/call, some days off during the week, etc so definitely agree with you on that. Not all interns are working their butts off.
 
I'm in the ICU right now and all of my 4 days off this month are DOMA's. FML
 
Dumb said:
All of the top 10 cush TYs (in the country) average <60 hours/week even on medicine floors. I've been working 45-50/wk so far during my intern year. When you include half a year of electives and cush ambu and ER months, it's probably closer to 20 hours/week averaged over the entire year.
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Yeah some of the super cush ones may be that low in hours. Mine is probably 60ish on ward months and 20-30 on the half year of electives, it has probably the best salary/benefits of any TY though.
 
arielred said:
I'm in the ICU right now and all of my 4 days off this month are DOMA's. FML
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How is that even possible? These only should happen when you switch from days to nights. Did they really make you alternate between days and nights for 4 weeks?
 
My schedule in the icu this month isn't awesome but I have two full days off, three fake days off, and only have to round on three other days; I'm guessing I'll average just below 60 a week.
 
Perrotfish said:
How is that even possible? These only should happen when you switch from days to nights. Did they really make you alternate between days and nights for 4 weeks?
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I alternate between q3 cross cover and q5 admit overnight. The time off before the night shifts are considered my days off.
 
Perrotfish said:
That's horrible
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Agreed. DOMA'S are completely out of line imo. The whole point of a day off is ruined by a DOMA, and does not allow the resident to get some much needed rest. This is why a union is needed.
 
DrAwsome said:
Agreed. DOMA'S are completely out of line imo. The whole point of a day off is ruined by a DOMA, and does not allow the resident to get some much needed rest. This is why a union is needed.
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Well they suck in general, but more than two in a month shows a complete lack of consideration. Even if your coverage is so thin that you need to count coming onto and off of nights as a day off, there is no earthly reason you can't arrange the schedule so that resident only switches once and still at least has two real days off.
 
Perrotfish said:
Well they suck in general, but more than two in a month shows a complete lack of consideration. Even if your coverage is so thin that you need to count coming onto and off of nights as a day off, there is no earthly reason you can't arrange the schedule so that resident only switches once and still at least has two real days off.
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Agreed. This is also the time when upper levels should step in and actually do some work.
 
DrAwsome said:
Agreed. This is also the time when upper levels should step in and actually do some work.
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Yeah the upper levels discussed it amongst themselves on our first day and they decided they were okay with it the way it was. Of course no one asked what the interns thought.
 
arielred said:
Yeah the upper levels discussed it amongst themselves on our first day and they decided they were okay with it the way it was. Of course no one asked what the interns thought.
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Ha! that's not what I meant actually. I meant to say that that's when the upper levels should be like oh we are violating rules and as decent human beings we should let the interns have a break.
 
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