On scheduling

[TrumpetDoc]

What's your groups schedule scheme?
Like it?
Is it optimal?

I am finding that our schedule is becoming more and more if a problem.
It wasn't, or at least didn't seem to scare me going in and during residency. But then again, we did not have 3 kids.
The days to nights actually are not the issue. It's the random and variable days of work which are a key problem. This as well as not knowing the schedule any sooner than a month prior and having requests 3 mo ahead of time.
My wife really cannot plan for anything and we are left trying to give away/trade/bribe shifts away every single mo so as to be able to attend kids/family things. My values center on spending time with them.
I wonder if there are groups with a model and staffing to support a fixed days/ blocked days schedule? With predicable weekend coverage etc.
For instance, work day a-d every week and work every other weekend, at some point switch to a swing night schedule etc (or some connotation of such), but be able to accurately predict your work days across the cal.?
I know and knew that days and nights weekends would e a part of our gig, but I had no idea how much my life would change and how much it affects me not being available and stressing my family out. Strange how I/we can work seemingly so few days a mo and yet have the schedule be so F'ed up.

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[pinipig523]

Your post reminds us that our specialty is NOT a lifestyle specialty. Pay attention med students.

My gig has us schedule requests about 1 month ahead. 3 months would be rough.

 

[Daiphon]

My main shops have repeating blocks - one monthly, one quarterly. As of june, I typically know my schedule for the entire coming year.

What makes this work, though, is a handful of people primarily functioning as nocturnalists.

My moonlighting gig is 1-2mos ahead; but it's moonlighting ...

Cheers!
-d

Sent from my DROID BIONIC using Tapatalk

 

[EM_Rebuilder]

We have a requests sheet up about 1-2 months in advance; if you are one of the first three on a particular date, consider it golden.. make plans, you will be off. If you are under those three its a bit more of a crap shoot, but I have been told people tend to still get them off anyways.

Rarely has there been more than three people wanting one day outside of home football games (local big 12 team), and holidays...

We get our schedule about 2 weeks before the month.

I did schedules as a chief resident; no requests and I had them out 2-3 months in advance.

At first, I REALLY hated the way my 'real job' did schedules.. but I found out everyone else loved it, and I soon learned to love it. I have worked near a year now and have had every single day off that I ever requested....

I also remain very flexible to work shifts for other people if something comes up in their life... I have made last minute swaps without issue as well.. I like having some 'in the bank' so if something does come up, I have go to people that owe me a favor...

As far as blocks... we do all 12 hour shifts.. we are foruntate to have full time night people so we only do a two week block of nights just twice a year (about 6-7 shifts each of those blocks). Otherwise, we rarely work more than 4 straight, usually 3 straight. Weekends are fairly equitable at least over a few month period. I seldom work a 'random shift', but it does happen occasionally. I usually have a 5 day or so straight period off without even requesting it.

The key to making a great schedule is living each persons schedule. Whoever makes your schedule should look at or highlight EACH persons name individually and ask themselves... Would I be happy working this?... and if not, change it up..

 

[Cerberus]

The Attendings at my hospital that have either been there a while, work nights exclusively, or have other departmental obligations (i.e. admin) have templated schedules that do not change from week to week. The rest are at the mercy of the scheduler and seem to complain a lot for the same reasons you do.

 

[la gringa]

the schedule is the biggest source of angst most places... where i am, there's a control freak doing the schedule for WAY WAY too many people. i ended up with a horrendous streak from mid april to mid june that honestly made me consider leaving. it was b/c of what Rebuilder mentioned -- he doesn't do that, at least not for everyone. no one could given the amount of people, but that isn't right.

half the battle too is knowing what your docs prioritize and are willing to sacrifice as far as schedule. i'm younger, kidless, and single, so obviously what i want/need is totally different than a single parent, or dad w/ stay at home spouse and 2 kids, or a newlywed, etc etc.

 

[WilcoWorld]

It's important to keep in mind that schedule systems are closed systems, so prioritizing one thing (like circadian rhythm) will force you to compromise another (such as the number of days off you can request).

I know of several other methods, but the following are the ones I have personal experience with:

1) Draft pick method: Everyone has to pick up x weekday-days, y-weekday eves, z-weekday nights, p weekend-days, q weekend eves, r weekend nights. In the spring of year n-1 you make the whole schedule for year n. Everyone picks a number out of a hat (say, 1 through 30 for a 30 person group). In round 1 person 1 picks 30% of his shifts first and you go on down the line to person 30 who goes last. In round 2 person 30 goes first and picks another 30% on back to person 1, in round 3 the order flips again with everyone picking another 30%. Round 4 starts with person 30 picking his last 10% and person 1 ends by picking his last 10% of shifts

This was a great method for personalizing your schedule, but knowing in May 2010 what days you want off in June 2011 is tough.

2) Limiting each person's number of requests in order to enable circadian scheduling: Each person gets to make a certain number of requests for days off (5 or 6/mo) and the schedule is made with rules such as 48 hours of after a string of overnights, no shifts starting fewer than 12 hours after the last shift, etc. The schedule is generated by a computer according to those constraints.

I think this provides the best balance between sleep needs and social needs. It is my favorite method. People get bothered that they can only make a certain number of requests, but if you allow people to make more than the schedule can't get filled without breaking circadian rules.

3) Prioritize everyone's days off over circadian concerns: My least favorite - it leads to some really crappy turn-arounds. Also, if there isn't a limit to the number of days off requested people will get greedy and request 10 days off in a month and you may get no credit for having limited yourself to 2 requested days off.

Having made schedules before, I think you need to give the scheduler a month from requests to schedule completion - making a good schedule can take a lot of time, and the less time your scheduler puts into it, the crappier the schedule will turn out. I think that getting requests in 2 months ahead of time and getting your schedule back a month later is a nice balance between predicting what you'll need off and planning life around your schedule.

 

[deleted65604]

I've got 5 kids, and I just miss things when I'm scheduled to work. I've been taken advantage of so many times, bending over backwards for other people's needs, that I've become really reluctant to help people out. If things are really important, then you usually know about them a couple of months beforehand. Birthdays can be celebrated another day. Concerts can be video-taped. Presents can be opened 2 days after christmas. Short of a beloved first degree relative's death, I don't see why anyone should be asking me to trade out of a shift.

I don't see why presumably responsible people can't seem to get their s&!# in order on a monthly basis or make the same sacrifices that I feel obligated to.

If you are trying to get out of several shifts a month, I believe that your priorities are screwed up. If your kid is competing in state championship games, I'll try to help out. If you want me to work for you so you can go to his meaningless pre-school graduation, I'm going to be offended that you think your family is more important than mine.

Sorry, sore subject.

 

[la gringa]

Jarabacoa,

you'd be surprised how many non-kid or traditional holiday events are NOT scheduled that far out. think about what you'd do if you weren't married with 5 kids... yeah, rarely scheduled in advance. semi-last minute tix to a pro sport or concert... college and med school alumni events... social group outings... hell, even vacations! it's really hard to get your doc or non-doc friends to commit to a trip far enough out to guarantee you'll get time off a lot of the time. i've gone on a LOT of solo vacations...

i try to help others with THEIR priorities in hopes that they'll help me with MINE. sometimes i just go ahead and come out and say it - hey, i'll help you w/ THIS, but please remember when i need help with THAT. in the end though, you just know who will help and who won't.

 

[TrumpetDoc]

I've got 5 kids, and I just miss things when I'm scheduled to work. I've been taken advantage of so many times, bending over backwards for other people's needs, that I've become really reluctant to help people out. If things are really important, then you usually know about them a couple of months beforehand. Birthdays can be celebrated another day. Concerts can be video-taped. Presents can be opened 2 days after christmas. Short of a beloved first degree relative's death, I don't see why anyone should be asking me to trade out of a shift.

I don't see why presumably responsible people can't seem to get their s&!# in order on a monthly basis or make the same sacrifices that I feel obligated to.

If you are trying to get out of several shifts a month, I believe that your priorities are screwed up. If your kid is competing in state championship games, I'll try to help out. If you want me to work for you so you can go to his meaningless pre-school graduation, I'm going to be offended that you think your family is more important than mine.

Sorry, sore subject.

I feel ya, I was very much the "go to" guy my first year out a far as grabbing shifts for folks... Not anymore. That's helped a little but not much.
I will say, I put in for every known occurrence, but a lot of stuff and opportunities come up too.
Unlike yourself, i find it very hard to miss even the little things that my kids have going on. For me, its what I live for! I understand that we will miss things, holidays and such, but when it becomes a regular thing, thats tough.
When I ask for shift help if I get it it's a bonus.

 

[Arcan57]

I do the scheduling at my shop and have a deadline of the 20th 2 months prior for requests for that month. In theory this would allow me to get the schedule out to people with a month lead-time so if they needed to make swaps, etc they'd have time available. In practice, half my docs work at other shops and I may have 10-30 shifts not covered until 10-14 days into the prior month (ie 2-3 week notice). I schedule manually because 3-4 of my fulltime docs have either 10+ schedule requests or have specific schedules (2 1-week blocks advancing from day to night, only early morning or late overnight shifts, starting on Wednesday overnight and advancing backwards to a Sunday early am shift) that Tangiers won't accomodate. I try to give them at least two shifts off after an overnight, and am usually successful (maybe one quick transition a month I don't pick up myself). It's difficult to do block scheduling because none of the docs regularly works more than 14 shifts (most are 10-12) and we're understaffed so I currently prioritize getting them days off vs. a clean circadian rhythm.

 

[Hercules]

As a chief resident, I did all our scheduling by hand and arrived at a group who had one doc who did the scheduling by hand. She retired last year and now we use shiftadmin and are very happy with it (I have no financial interests).

It's kind of nice because each person can weight the things that are most important to them (block nights together, always have Friday off when your weekend is off, circadian scheduling, always work Saturday and Sunday together, etc). We also each get 6 high priority, 4 medium priority, and unlimited low priorty requests. The algorithm then generates a schedule that violates as few rules as possible. Different rules are given different weights so it can decide when they are at odds. Low priority requests are weighted so low that you can have it as long as it doesn't cause any other rules to get violated. It generates reports so everyone can see they're not getting screwed (as a former scheduler i can say that docs always think they're getting screwed on schedules). I also like that you can put in requests from anywhere and download your schedule into google calendars. In short we have enjoyed switching over to computer scheduling, and a good program can address a lot of the scheduling woes detailed above.

 

[la gringa]

my shop uses Tangier too... anyone know if it lets you do what Hercules mentioned? my prior shop used ShiftAdmin, but not with that fancy of a request function!

 

[Hercules]

Shiftadmin is pretty flexible and can be as simple or complex as your group wants it to be (I'm sure other scheduling software is similar). You have to put in the time on the front end to make it work and figure out what's important to your group. We had some terrible schedules at first (for a few months we didn't designate which days were weekends, so it wasn't tracking them and some people got hosed) before we really sat down with the company and fixed it up for our group.

 

[Cerberus]

As a chief resident, I did all our scheduling by hand and arrived at a group who had one doc who did the scheduling by hand. She retired last year and now we use shiftadmin and are very happy with it (I have no financial interests).

It's kind of nice because each person can weight the things that are most important to them (block nights together, always have Friday off when your weekend is off, circadian scheduling, always work Saturday and Sunday together, etc). We also each get 6 high priority, 4 medium priority, and unlimited low priorty requests. The algorithm then generates a schedule that violates as few rules as possible. Different rules are given different weights so it can decide when they are at odds. Low priority requests are weighted so low that you can have it as long as it doesn't cause any other rules to get violated. It generates reports so everyone can see they're not getting screwed (as a former scheduler i can say that docs always think they're getting screwed on schedules). I also like that you can put in requests from anywhere and download your schedule into google calendars. In short we have enjoyed switching over to computer scheduling, and a good program can address a lot of the scheduling woes detailed above.

I looked into ShiftAdmin after seeing it at SAEM. I was pretty impressed. If there was any chance of getting my program to pay for it, i'd switch in a heart beat (doing it by hand is a pita).

 

[la gringa]

Hercules,
are you at the hospital that just got hit w/ the big lawsuit? my parents live off Moffat Rd... i visit from time to time, but i really prefer the mid-atlantic/upper southeast.

 

[Tiger26]

I looked into ShiftAdmin after seeing it at SAEM. I was pretty impressed. If there was any chance of getting my program to pay for it, i'd switch in a heart beat (doing it by hand is a pita).

we're just about to do a 2 month trial with them--i was also very impressed after SAEM

 

[Cerberus]

we're just about to do a 2 month trial with them--i was also very impressed after SAEM

It looks great but i think we'd have a hard time convincing the department to pay 12x what they pay for amion. Have you dicsussed the cost with your admin yet?

 

[Hercules]

Our group pays for it--it's $20/physician per month. For your trial, make sure your group sits down and really puts in the time on the front end. Some groups send their docs a survey and make them rank a fees things in order or preference so they can assign their weights. That seems to work really well in giving each person what they want.

La gringa, indeed I am. Thankfully our group isn't involved, but the hospital looks like it will take a hit even after the appeal.

 

[Cerberus]

Our group pays for it--it's $20/physician per month. For your trial, make sure your group sits down and really puts in the time on the front end. Some groups send their docs a survey and make them rank a fees things in order or preference so they can assign their weights. That seems to work really well in giving each person what they want.

La gringa, indeed I am. Thankfully our group isn't involved, but the hospital looks like it will take a hit even after the appeal.

I believe it's slightly cheaper for residents (if I remember correctly, it was 10-15$ per resident/month). Unfortunately, at least for residents, >500$/mo would be a hard sell when it's something Chief's do for free. If I was out in practice, especially if I ended up the scheduler (which I'd probably prefer to see every borderline personality with vaginal bleeding that comes to the ER for the rest of my life than do right now), I'd advocate purchasing it

 

[Apollyon]

(which I'd probably prefer to see every borderline personality with vaginal bleeding that comes to the ER for the rest of my life than do right now), I'd advocate purchasing it

Scheduling as an attending is a different deal, and, depending on your group, you might get paid for it. As an attending scheduler, it's just business, and you can be draconian, and no one has anyone to whom they can appeal, so prima donnas don't get to bitch. You say "these are the rules", and that's it. Everyone is bound by contract as to how many hours they get, and, as it isn't time-limited and gradated by year (that is, everyone is on par), and is "evergreen", it is easier because no one gets preference. If there IS preference, it is one-tiered via age/seniority (like less nights) or committed nocturnists (more nights, so first choice). Whereas you're flat-rate in residency, out of training, you don't work, you don't get paid, and, if you're on the schedule and don't show up, you're fired.

Again, 80/20 (or 90/10), but, because there's no end in sight, people have to be more judicious about their bitching (because, complain too much, and that person complaining doesn't get their contract renewed, and doesn't make partner, etc.). The key is setting a date in stone for last requests and sticking to it. If you bend even once, you have to bend every time. You can't even grant 20 minutes, because then, everyone takes it. Then 2 hours. Then 6 hours. Then the next day.

 

[Cerberus]

Scheduling as an attending is a different deal, and, depending on your group, you might get paid for it. As an attending scheduler, it's just business, and you can be draconian, and no one has anyone to whom they can appeal, so prima donnas don't get to bitch. You say "these are the rules", and that's it. Everyone is bound by contract as to how many hours they get, and, as it isn't time-limited and gradated by year (that is, everyone is on par), and is "evergreen", it is easier because no one gets preference. If there IS preference, it is one-tiered via age/seniority (like less nights) or committed nocturnists (more nights, so first choice). Whereas you're flat-rate in residency, out of training, you don't work, you don't get paid, and, if you're on the schedule and don't show up, you're fired.

Again, 80/20 (or 90/10), but, because there's no end in sight, people have to be more judicious about their bitching (because, complain too much, and that person complaining doesn't get their contract renewed, and doesn't make partner, etc.). The key is setting a date in stone for last requests and sticking to it. If you bend even once, you have to bend every time. You can't even grant 20 minutes, because then, everyone takes it. Then 2 hours. Then 6 hours. Then the next day.

Agree with everything you've said, still don't know if I'd want to do the schedule again.

 

[EBKame]

FYI, there is a bulk discount for ShiftAdmin. I'm a current chief and we were "forced" to move from manual scheduling to shiftadmin because it made the price cheaper for our large attending group. I'd like to hear more about the putting work in on the front end to make it work out well. What kind of work are we talking about exactly?

 

[Hercules]

FYI, there is a bulk discount for ShiftAdmin. I'm a current chief and we were "forced" to move from manual scheduling to shiftadmin because it made the price cheaper for our large attending group. I'd like to hear more about the putting work in on the front end to make it work out well. What kind of work are we talking about exactly?

I assure you that being forced will turn out to be a blessing. The big thing is remembering that it's just a computer algorithm. You have to weight everything in order of importance to enable it to make good decisions. The first few scheduled it generates will probably be terrible, but just discuss them with the shiftadmin support team and they'll tell you what to change to get what you want. I'm guessing that the residents will not be allowed to individualize their schedules all that much.

 

[Jack is Back]

Your post reminds us that our specialty is NOT a lifestyle specialty. Pay attention med students.

My gig has us schedule requests about 1 month ahead. 3 months would be rough.

Some surgeons don't even know they have kids, let alone getting a chance to attend their school functions.

It's all relative.