- Joined
- Jul 30, 2009
- Messages
- 205
- Reaction score
- 0
Last edited:
a main reason we were given the number of residents that we have (we recently increased the size of our program by about 50% two years ago) was in order to increase resident staffing of the ICU.
I'm likely missing something here. If those residents are already working max shifts elsewhere how does transferring them to icu save money?1) Strongly agree with the above, that this is way above your pay grade. I'm not sure why the head of the PA group is emailing the chief residents about this. This is a conversation between the director of GME/DIO and the PD/chair of your department.
2) That said, since you are looped into these conversations, I would strongly recommend that you start to inform yourself about the mechanisms of GME funding. Your department expanded 2 years ago - in all likelihood they did NOT receive additional federal funding to do that. GME funding has been capped by Medicare since 1997. Most of the times when departments expand, they have to make a financial argument to the hospital to justify that expansion. Sometimes that comes with Faustian bargains such as increased call/coverage responsibilities to make it worth the hospital's while. A good starting point for understanding these issues is the IOM report on GME funding (pdf free online)...I personally think their arguments for how to fix GME are FUBAR, but the report nicely summarizes how GME funding works.
3) Since you are looped in. Be an advocate for your fellow residents. The hospital wants you to take on this extra call because, regardless of federal funding or not, you (the residents) are the best deal they have. They pay you less than PAs and you work nearly double the hours. Throwing you in the ICU means they save a buttload. It doesn't mean it's in the best interests of your co-residents education.
1) Strongly agree with the above, that this is way above your pay grade. I'm not sure why the head of the PA group is emailing the chief residents about this. This is a conversation between the director of GME/DIO and the PD/chair of your department.
I'm likely missing something here. If those residents are already working max shifts elsewhere how does transferring them to icu save money?
Is the premise that thay work 60 now and will just add a icu shift?
In Medicine/Peds the Chief resident is usually a staff position that you take the year after residency, and they often get involved in staff level discussions, along with the PD.
Odds are they are trying to pull residents from outpatient rotations where they would normally have weekends off. That's how my residency staffed our wards/ICUs on weekends, because my residentcy didn't believe in reducing staffing levels on weekends. That's also why my program's Interns only get two golden weekends in their entire Intern year.
2 golden weekends. No holidays. Only two weeks of vacation, which they assign. Yes, it sucked.Wtf only 2 golden weekends? That is the worst schedule ever. Even in my workhorse program I've had a bunch of golden weekends
2 golden weekends. No holidays. Only two weeks of vacation, which they assign. Yes, it sucked.
You should have 21 days of vacation like everyone else......That is what CMS allows.
2 golden weekends. No holidays. Only two weeks of vacation, which they assign. Yes, it sucked.
Programs vary between 2 and 4 weeks of vacation over the course of the year.You should have 21 days of vacation like everyone else......That is what CMS allows.
I'm going to be a chief in less than 2 months, but if I got an email at any point next year demanding that my residents work more than they already do (and likely changing the structure of rotations because of it), I would most certainly be looping my PD into that discussion. Our PD backs up the Chiefs for just about anything they want to do, but I would feel that I need backup for that type of discussion. We are changing up how everyone's schedule works next year, and there were multiple discussions between the current Chiefs, our PD and aPD, and the rising chiefs about what those changes should entail.In Medicine/Peds the Chief resident is usually a staff position that you take the year after residency, and they often get involved in staff level discussions, along with the PD.
Residency is based on ACGME regulations not CMS. ACGME doesn't mandate any specific amount of vacation, they just say that the individual GME needs to have a written policy about it. My program does 2 weeks of vacation for years 1-4 and 3 for 5-6 (because interviews take up vacation days). But we do get an extra 5 days off at Christmas or New Years that is not an institutional thing, just a benefit privilege that the department gives us on the side.
Programs vary between 2 and 4 weeks of vacation over the course of the year.
Not all residents are paid by CMS. Many are paid out if hospital funds, medicaid dollars, VA money, etc. Hell, no peds residents get CMS money at all, they have a completely separate funding system.But never more than 21 days.....because that is what CMS mandates is the upper limit, or they withhold money.
These are important points for students to consider that most never realize until they are already residents.
I think if the hospital will get full payment and allow their residents 21 days off, but has a policy which allows LESS than that, it says alot about the type of program you are applying for.
Culture is huge in residency programs. The units/floors need to be covered, the residents need to be in the hospital to learn, but there is a rampant culture of well.....abuse that permeates a lot of programs. This is just one small example of that thing.
Yes, but CMS pays the bills. CMS funded residency spots allocate 21 days of vacation. It is purely a money thing for them. At least that is what our hospital has told us since we were interns. My Med Ed are decent people, they were always about us actually taking vacation. Certain rotations (ICU) don't allow you to take time off, and you can only use so many per rotation, so they always grill into us the need to actually use our vacation time earlier in the year, and not get stuck with 7-8 unused vacation days at the end of the rotation.
ACGME just does the accrediting. Kinda like JACHO does the accrediting, and CMS does the paying. CMS actually pays per resident per month to the facility that actually has that resident. The allocated 21 days per year is their upper limit for full payment (they don't want to pay for people to not be at work...) This is why most programs HATE when you do out rotations, because the money goes with the resident.
Now if a program decides NOT to give you your full 21 days of vacation, that is allowed per ACGME rules, it just makes them D*cks.
What is this vacation thing you guys are discussing?
Back in my day we didnt take days off, we were fortunate to take naps!
But with Rad Onc you had every weekend off!
So I just went through the institutional, common program, and a couple specialty requirements just to see what the ACGME says. While there are clear guidelines stating a maximum of time off for each year, the only other requirement is that your vacation policy should be spelled out in your contract. They are otherwise silent on the subject. (There's also a random clause in the IM requirements that vacation time doesn't count towards your "must have a continuity clinic every X days" but that's mostly unrelated)I don't claim to be all-knowing on this subject. But there are programs that give more than 3 weeks of vacation and I can't find documentation of the rule you state on the internet. I do know of at least one program that gave 4 weeks of vacation; however for interns it kinda sucked because they would randomly assign the vacation as a 4-week block. My friend basically had all of August off but no vacation the rest of her intern year. Therefore I surmise that if such a CMS rule exists limiting reimbursement to 3 weeks, it has nothing to do with what is recommended or allowed. It's just a financial cap. Therefore GME offices are free to make policy based on ACGME requirements. And vacation time can be subject to the needs of the institution/program. I disagree that getting less than 3 weeks makes a program d*cks.
Perhaps we can get @aProgDirector to weight in?
there are many programs out there that don't give 3 weeks of vacation...the minimum was 2 weeks...the max 4 weeks...as it has been said before its program dependent and i would imagine the programs has checked to see if their policies violate any rules.Yes, but CMS pays the bills. CMS funded residency spots allocate 21 days of vacation. It is purely a money thing for them. At least that is what our hospital has told us since we were interns. My Med Ed are decent people, they were always about us actually taking vacation. Certain rotations (ICU) don't allow you to take time off, and you can only use so many per rotation, so they always grill into us the need to actually use our vacation time earlier in the year, and not get stuck with 7-8 unused vacation days at the end of the rotation.
ACGME just does the accrediting. Kinda like JACHO does the accrediting, and CMS does the paying. CMS actually pays per resident per month to the facility that actually has that resident. The allocated 21 days per year is their upper limit for full payment (they don't want to pay for people to not be at work...) This is why most programs HATE when you do out rotations, because the money goes with the resident.
Now if a program decides NOT to give you your full 21 days of vacation, that is allowed per ACGME rules, it just makes them D*cks.
But never more than 21 days.....because that is what CMS mandates is the upper limit, or they withhold money.
These are important points for students to consider that most never realize until they are already residents.
I think if the hospital will get full payment and allow their residents 21 days off, but has a policy which allows LESS than that, it says alot about the type of program you are applying for.
Culture is huge in residency programs. The units/floors need to be covered, the residents need to be in the hospital to learn, but there is a rampant culture of well.....abuse that permeates a lot of programs. This is just one small example of that thing.
I don't claim to be all-knowing on this subject. But there are programs that give more than 3 weeks of vacation and I can't find documentation of the rule you state on the internet. I do know of at least one program that gave 4 weeks of vacation; however for interns it kinda sucked because they would randomly assign the vacation as a 4-week block. My friend basically had all of August off but no vacation the rest of her intern year. Therefore I surmise that if such a CMS rule exists limiting reimbursement to 3 weeks, it has nothing to do with what is recommended or allowed. It's just a financial cap. Therefore GME offices are free to make policy based on ACGME requirements. And vacation time can be subject to the needs of the institution/program. I disagree that getting less than 3 weeks makes a program d*cks.
Perhaps we can get @aProgDirector to weight in?
2 golden weekends. No holidays. Only two weeks of vacation, which they assign. Yes, it sucked.
What sucked was the Intern who got one of the two weeks of vacation for his first week of residency.Damn dude that sounds really terrible.
Not all residents are paid by CMS. Many are paid out if hospital funds, medicaid dollars, VA money, etc. Hell, no peds residents get CMS money at all, they have a completely separate funding system.
And do recall that only the weekdays count as vacation. My program gives me 20 days of vacation a year. If I take them in one week chunks, our policy is to avoid work the weekend before and after assuming we can make the call schedule allow for it. So that can be up to 36 actual days of "vacation".
What sucked was the Intern who got one of the two weeks of vacation for his first week of residency.
What sucked was the Intern who got one of the two weeks of vacation for his first week of residency.
That schedule takes a special kind of cruelty to invent
We are given week blocks off in certain rotations. My intern year, they gave me a week in July, a week in August, and a week in January. I was ready to kill someone by the end of the year.
My intern year didn't have any sick days built in. Just used a jeopardy system for coverage.What happens if you take sick days?
What happens if you take sick days?
They're actually great to have around so long as there is an attending to back them up and they're trained in procedures. At a major ICU, they did all of the central/arterial lines and worked 7-5 while attending coverage was available, allowing our attendings and residents to cover more patients and giving the residents more time for learning instead of writing order changes, calling social workers, and doing other scut.I dont think midlevels have any business in an ICU.
My intern year didn't have any sick days built in. Just used a jeopardy system for coverage.
We don't get sick days. If we called out for some reason, we would either miss clinic, or someone would have to cover us. On wards during the day, that usually meant that the other interns split up your patients. At night or in the ED, that meant that the person on call was called in, and you were expected to pay them back. I have two or three people who still owe me shifts...
Did the system in place make you second guess actually taking sick days when you were really sick?
Feels odd to me to create a system whereby taking a sick day penalizes your co residents in a sense that they then automatically have to take an additional shift. Sort of an odd ethical scenario there to have to be involved in when you are feeling sick.
It's pretty much how many small practices are arranged, so even though it sucks in residency, it's kind of reasonable in a smaller program or one in which there isn't enough coverage if someone is out for a day. If you've got, say, five people providing ICU coverage in the community and one of you is sick, somebody has to cover, and usually you'll cover a shift for them to make up for it down the line. Medicine isn't like retail or something where you can just pick up the slack of a person that's out (most of the time). There's work that needs to be done, and someone needs to be there to do it.Did the system in place make you second guess actually taking sick days when you were really sick?
Feels odd to me to create a system whereby taking a sick day penalizes your co residents in a sense that they then automatically have to take an additional shift. Sort of an odd ethical scenario there to have to be involved in when you are feeling sick.
Did the system in place make you second guess actually taking sick days when you were really sick?
Feels odd to me to create a system whereby taking a sick day penalizes your co residents in a sense that they then automatically have to take an additional shift. Sort of an odd ethical scenario there to have to be involved in when you are feeling sick.