Question about "typical" residency day...

[FiveRivers]

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This may have an obvious answer, but I needed this clarified. I was looking at the typical inpatient daily schedule for a program that I am interested in and will rank high. I see that their day for the typical inpatient schedule starts roughly around 7AM getting the sign out from the night team, and with ends with patient care around 4PM. However, the night team does not start up again until 7PM. My question is, generally who covers from 4PM-7PM, or is that split amongst the group? Or is the day team typically there till 7PM anyways (even though the website says 4)? Thanks for any insight.

 

[DrBowtie]

This may have an obvious answer, but I needed this clarified. I was looking at the typical inpatient daily schedule for a program that I am interested in and will rank high. I see that their day for the typical inpatient schedule starts roughly around 7AM getting the sign out from the night team, and with ends with patient care around 4PM. However, the night team does not start up again until 7PM. My question is, generally who covers from 4PM-7PM, or is that split amongst the group? Or is the day team typically there till 7PM anyways (even though the website says 4)? Thanks for any insight.

I suspect there is an on call or late team that the other teams sign out to at 4. That team continues to admit and cross cover until they then sign out all the patients to night float.

 

[deleted116380]

Depends on the program. Mine doesn't allow early signout unless it's a weekend/holiday (1PM). Otherwise one member of each team stays til nightfloat arrives. We just alternate who stays late based on workload and things they need to followup on. Supposedly there used to be a system with early signout, but the cross coverage during the day didn't followup on stuff and dumped it on nightfloat so they changed it. Oh well, it's only a prelim year and I otherwise get a ton of vacation and random days off (outside of wards golden weekends) and more than makes up for it.

 

[FiveRivers]

Thank you for the responses.

So in the scenario that you work 7AM-7PM (12 hours), the max amount of days you could work in a week is 6 (6 X 12= 72 hours) in order to comply with the 80 hour work week.

Does ACGME require one day off/week? Or is that averaged over the month?

 

[mcl]

Does ACGME require one day off/week? Or is that averaged over the month?

One day off per week averaged over 4 weeks, not including vacation time (as in, I can't schedule you for 85 hrs/wk for 3 weeks and say it averages out because you're off the next week).

 

[deleted116380]

Thank you for the responses.

So in the scenario that you work 7AM-7PM (12 hours), the max amount of days you could work in a week is 6 (6 X 12= 72 hours) in order to comply with the 80 hour work week.

Does ACGME require one day off/week? Or is that averaged over the month?

80 hours per week averaged over 4 weeks. We have golden weekends on wards once a block (4 week blocks) so there are times you do up to 14 days of work in a row as you have a black weekend one of the weekends. I've averaged between 11.25-12.25 hrs/day on wards because I like to come in earlier than others (btw 6 and 6:30) and on admitting days you don't always leave when NF shows up. I work quickly so I still signout less than an hour after NF shows up on call unless my resident goes really slow to go over each of my plans and orders.

There are days on wards I leave at 3PM and my co-intern or team resident stays late to allow both interns to leave early.

I work only ~250 shifts all year intern year. 115 days off isn't bad. 🙂

 

[Raryn]

One day off per week averaged over 4 weeks, not including vacation time (as in, I can't schedule you for 85 hrs/wk for 3 weeks and say it averages out because you're off the next week).

And do recall that the day off is defined as any 24 hour period that you are not in the hospital. So if you're on night float and finish at 7am, then start days the next day at 7am, that 24 hour period is a "day off".

I have a friend at a surgery program in the NE that basically switches residents from days to nights and back multiple times a month and that makes up the majority of their days off, at least for interns.

 

[SouthernSurgeon]

And do recall that the day off is defined as any 24 hour period that you are not in the hospital. So if you're on night float and finish at 7am, then start days the next day at 7am, that 24 hour period is a "day off".

I have a friend at a surgery program in the NE that basically switches residents from days to nights and back multiple times a month and that makes up the majority of their days off, at least for interns.

It's known as the DOMA* and is one of the worst parts of the new duty hours. A stupid loophole that the ACGME didn't think about.

*(Day off, my a**)

Edit: The same rule existed in the 2003 duty hours. However programs had enough scheduling flexibility that only the most malignant of programs used it, and those were generally viewed as violating the spirit of the rules if not the letter. Since the 2011 changes and the elimination of overnight call, programs have put it into play much more frequently.

 

[Law2Doc]

Thank you for the responses.

So in the scenario that you work 7AM-7PM (12 hours), the max amount of days you could work in a week is 6 (6 X 12= 72 hours) in order to comply with the 80 hour work week...

Just bear in mind that "on paper" your program will be in compliance. What happens "in reality" could vary. It's not like the Flintstones where you can punch out at the whistle.

 

[Top Gun]

This may have an obvious answer, but I needed this clarified. I was looking at the typical inpatient daily schedule for a program that I am interested in and will rank high. I see that their day for the typical inpatient schedule starts roughly around 7AM getting the sign out from the night team, and with ends with patient care around 4PM. However, the night team does not start up again until 7PM. My question is, generally who covers from 4PM-7PM, or is that split amongst the group? Or is the day team typically there till 7PM anyways (even though the website says 4)? Thanks for any insight.

I graduated from a program that had a similar schedule. Generally, 4-8 PM was short call. Whoever was scheduled to be on call would cover during that time.

 

[deleted116380]

And do recall that the day off is defined as any 24 hour period that you are not in the hospital. So if you're on night float and finish at 7am, then start days the next day at 7am, that 24 hour period is a "day off".

I have a friend at a surgery program in the NE that basically switches residents from days to nights and back multiple times a month and that makes up the majority of their days off, at least for interns.

That sucks for them. My nightfloat block of 4 weeks had 14 shifts so I only worked half the nights and never had that problem with needing days off. The only time where we had nights and days the same block is ICU. My program doesn't count it as a day off if you were in the hospital at some point during that day for a shift. Because of the night ICU shifts overlaping 2 days each, we each wound up working 22 shifts of 28 days, but were physically in the hospital for 24 days and had 4 days (12AM to 11:59PM) completely off. Guess my program is different.

 

[shan564]

Every program is different, and within an institution, every service is different.

When I'm on internal medicine, I can sign out as early as 3pm on weekdays to a dedicated cross-cover resident, who is there until midnight. After midnight, cross coverage goes to the night float, who comes in at 8pm and starts working on admissions until he/she takes over cross coverage at midnight. On weekends, you sign out to the on-call team whenever you're done with your work (sometimes as early as 10-11am), and the on-call person signs out to the night float. When you're on call (q4), you can leave as early as 8pm (which is when the night float comes in), but you'd have to get lucky to be done that early. Typically, I'd expect to work 16 hrs on a call day, 12-13 hrs on a post-call day, 10-11 hrs on a short call day (day after post-call, when you inherit one patient admitted by the night float), and 8-9 hrs on the pre-call day. You have one day off per week on average, so if there's a bad week in which you have two call days and two post-call days, you'd expect to work 75-80 hours.

When I'm on psych (aka home), I can sign out to the on-call resident whenever I'm done. Sometimes people finish early if it's a particularly slow day, sometimes people finish late. Call is q5, and at 9pm, the on-call resident signs out to the night float.

So in both of those situations, there's somebody who covers in the evenings so that you don't have to stay until the night float shows up.

If your "typical" day is 7am-4pm, you probably also have an occasional "atypical" call day in which you receive signout from the other teams and cover the floor until the night float comes in. The main task on call days is to admit new patients, but you'll also have to cover other people's patients.

 

[Elisabeth Kate]

I have a friend at a surgery program in the NE that basically switches residents from days to nights and back multiple times a month and that makes up the majority of their days off, at least for interns.

That's just terrible.

 

[neusu]

This may have an obvious answer, but I needed this clarified. I was looking at the typical inpatient daily schedule for a program that I am interested in and will rank high. I see that their day for the typical inpatient schedule starts roughly around 7AM getting the sign out from the night team, and with ends with patient care around 4PM. However, the night team does not start up again until 7PM. My question is, generally who covers from 4PM-7PM, or is that split amongst the group? Or is the day team typically there till 7PM anyways (even though the website says 4)? Thanks for any insight.

What field is this? Generally, there is some sort of short call or flex resident. In the former, someone stays until 7 (or 8 or 9) for signout, and the latter, someone comes in later (e.g. noon) to provide overlap. When does the night team leave?

 

[neusu]

One day off per week averaged over 4 weeks, not including vacation time (as in, I can't schedule you for 85 hrs/wk for 3 weeks and say it averages out because you're off the next week).

IIRC, this is not true.

 

[Raryn]

IIRC, this is not true.

It's absolutely true. At least in Medicine.

 

[neusu]

It's absolutely true. At least in Medicine.

Good for you guys. I was trying to reference the ACGME rules website, but for some reason it's fubar. In any case, my recollection of the rules, is that you count your duty hours over 4-weeks, regardless of the experience during those weeks. Similarily, you could not be on call any more frequent than q3, on average, for four weeks. Also, required a day off, on average, over those four weeks. So in any case, in surgery, if your vacation was upcoming, you were on for q2 for 2 weeks to account for your absence. To add insult to injury, 4 of our vacation days counted as days off..

 

[Raryn]

Good for you guys. I was trying to reference the ACGME rules website, but for some reason it's fubar. In any case, my recollection of the rules, is that you count your duty hours over 4-weeks, regardless of the experience during those weeks. Similarily, you could not be on call any more frequent than q3, on average, for four weeks. Also, required a day off, on average, over those four weeks. So in any case, in surgery, if your vacation was upcoming, you were on for q2 for 2 weeks to account for your absence. To add insult to injury, 4 of our vacation days counted as days off..

Averaging must occur by rotation. This is done over one of the following: a four-week
period; a one-month period (28-31 days); or the period of the rotation if it is shorter than
four weeks. When rotations are shorter than four weeks in length, averaging must be
made over these shorter assignments. This avoids heavy and light assignments being
combined to achieve compliance.

If a resident takes vacation or other leave, the ACGME requires that vacation or leave
days be omitted from the numerator and the denominator for calculating duty hours, call
frequency or days off (i.e., if a resident is on vacation for one week, the hours for that
rotation should be averaged over the remaining three weeks). The requirements do not
permit a “rolling” average, because this may mask compliance problems by averaging
across high and low duty hour rotations. The rotation with the greatest hours and
frequency of call must comply with the common duty hour requirements.

https://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-faqs2011.pdf

Applies to every program in every specialty accredited by the ACGME. Your program was pretty explicitly violating.

 

[Winged Scapula]

Good for you guys. I was trying to reference the ACGME rules website, but for some reason it's fubar. In any case, my recollection of the rules, is that you count your duty hours over 4-weeks, regardless of the experience during those weeks. Similarily, you could not be on call any more frequent than q3, on average, for four weeks. Also, required a day off, on average, over those four weeks. So in any case, in surgery, if your vacation was upcoming, you were on for q2 for 2 weeks to account for your absence. To add insult to injury, 4 of our vacation days counted as days off..

That is absolutely a violation of the ACGME and RRC rules (see page 11).

 

[Winged Scapula]

Oh, and this is NOT a new rule, having been in existence in all iterations of the duty hours regulations since 2003 (and perhaps before as I recall hearing about it when I was a resident before then).

Neurosurgery programs ( and some others) have exceptions, where permitted, to extend average work hours to 88 per week, but no exceptions have been granted for vacation or the averaging of work hours, days off per week.

Neusu, your program is in clear violation as Raryn notes.

 

[neusu]

Averaging must occur by rotation. This is done over one of the following: a four-week
period; a one-month period (28-31 days); or the period of the rotation if it is shorter than
four weeks. When rotations are shorter than four weeks in length, averaging must be
made over these shorter assignments. This avoids heavy and light assignments being
combined to achieve compliance.

If a resident takes vacation or other leave, the ACGME requires that vacation or leave
days be omitted from the numerator and the denominator for calculating duty hours, call
frequency or days off (i.e., if a resident is on vacation for one week, the hours for that
rotation should be averaged over the remaining three weeks). The requirements do not
permit a “rolling” average, because this may mask compliance problems by averaging
across high and low duty hour rotations. The rotation with the greatest hours and
frequency of call must comply with the common duty hour requirements.

https://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-faqs2011.pdf

Applies to every program in every specialty accredited by the ACGME. Your program was pretty explicitly violating.

Very interesting. Wish I knew about this before.. So do the 4 days off per 4-weeks count as your vacation or not?

 

[neusu]

Oh, and this is NOT a new rule, having been in existence in all iterations of the duty hours regulations since 2003 (and perhaps before as I recall hearing about it when I was a resident before then).

Neusu, your program is in clear violation as Raryn notes.

WAS, it was lol..

 

[Winged Scapula]

Very interesting. Wish I knew about this before.. So do the 4 days off per 4-weeks count as your vacation or not?

No. Again, the ACMGE and RRC are explicit.

Your "one day off per week" may not be used as vacation time.

 

[Winged Scapula]

WAS, it was lol..

Glad to hear that.

 

[neusu]

Glad to hear that.

We are 100% within compliance now.

I just laugh at the ? or **** I had to deal with as "it's within the rules" which obviously doesn't compare to what the old timers had to go through..

But please, understand that these boards are a very young population, I may be the last semblence of a resident that you old timers beat the **** out of who was trained the way it was.

 

[Winged Scapula]

We are 100% within compliance now.

I just laugh at the ? or **** I had to deal with as "it's within the rules" which obviously doesn't compare to what the old timers had to go through..

But please, understand that these boards are a very young population, I may be the last semblence of a resident that you old timers beat the **** out of who was trained the way it was.

LOL...who you calling "old timer"?