Resident duty hours in the emergency department

[PolandSpring21]

I was trying to find information about resident duty hours specifically in the emergency department since we are trying to improve scheduling our program. Google searches haven't yielded me all that much information. Residents are limited to 12 hour shifts seeing patient in the ED with an equivalent time off between shifts. Is there limit to how long residents may stay after that shift when writing notes and does the equivalent time off after a shift begin at the time notes and other on shift duties are completed? Residents are limited to 60 hours per week seeing patients in the ED, is that averaged over four weeks? Any additional information or links are much appreciated.

---

Members don't see this ad.

 

[BoardingDoc]

I was trying to find information about resident duty hours specifically in the emergency department since we are trying to improve scheduling our program. Google searches haven't yielded me all that much information. Residents are limited to 12 hour shifts seeing patient in the ED with an equivalent time off between shifts. Is there limit to how long residents may stay after that shift when writing notes and does the equivalent time off after a shift begin at the time notes and other on shift duties are completed? Residents are limited to 60 hours per week seeing patients in the ED, is that averaged over four weeks? Any additional information or links are much appreciated.

60 hrs/wk averaged over 4 weeks. Staying after counts towards your duty hours. Doesn't count towards the required break between shifts.

This info is literally in the second result if you Google "emergency medicine resident duty hours"

Link

 

[gamerEMdoc]

Yeah, any time you have a question about any ACGME rules, obviously you go to the ACGME program requirements. But the FAQs actually spell out some answers to a ton of common questions to clarify a lot of the requirements. It's a good go to when questions arise around duty hours or really any of the ACGME requirements if you can't find it clearly spelled out in the actual requirements.

 

[Groove]

Man, talk about swaddling the babies these days. I was talking to a recruiter for our local EM residency program and he told me they never work past 3a.m. the entire length of their residency program. So, they go 3 years without EVER doing an overnight. LOL, what horrible prep for the real world. No wonder our new grad hires are the most vocal about being "exhausted" with only 1 day off in between work days. (Working 117 hours/mo). Or how the sky is falling when they have to work 3 overnights in a row. No offense to the new grads who are NOT like this as I realize I'm not speaking for everyone. Why don't we just make it 40 hour work weeks and extend residency to 6 years?

 

[dadaddadaBATMAN]

Man, talk about swaddling the babies these days. I was talking to a recruiter for our local EM residency program and he told me they never work past 3a.m. the entire length of their residency program. So, they go 3 years without EVER doing an overnight. LOL, what horrible prep for the real world. No wonder our new grad hires are the most vocal about being "exhausted" with only 1 day off in between work days. (Working 117 hours/mo). Or how the sky is falling when they have to work 3 overnights in a row. No offense to the new grads who are NOT like this as I realize I'm not speaking for everyone. Why don't we just make it 40 hour work weeks and extend residency to 6 years?

I don't think 60 hours a week in the ed averaged over 4 weeks is exactly swaddling the babes, I would consider that a moderately difficult schedule. You could do 2x12s and 4x10s with one extra day off after a week of nights and meet that schedule requirement.

Individual program culture matters more than ACGME rules.

Intern year at my program worked out to about 75-80 hrs a week if you included documentation. We met duty hours on paper, and though there were no negative consequences for reporting your duty hours accurately I don't think it would have changed anything except your paperwork burden. ED months interns year were considerably harder than ICU months for me throughout residency, even taking into account 28 hr calls in 2nd/3rd year.

Our second and third year were much easier (50-60 hrs) and I think I learned a lot more. Partly that was because I saw more patients, but mostly it was because I had the time and motivation to read, follow up on patients, and I was a better resident when I was at work.

If you're the guy who makes the schedule people are always going to b*tch. Ask them sometime who they would like you to screw over to make their perfect schedule.

 

[jw3600]

Man, talk about swaddling the babies these days. I was talking to a recruiter for our local EM residency program and he told me they never work past 3a.m. the entire length of their residency program. So, they go 3 years without EVER doing an overnight. LOL, what horrible prep for the real world. No wonder our new grad hires are the most vocal about being "exhausted" with only 1 day off in between work days. (Working 117 hours/mo). Or how the sky is falling when they have to work 3 overnights in a row. No offense to the new grads who are NOT like this as I realize I'm not speaking for everyone. Why don't we just make it 40 hour work weeks and extend residency to 6 years?

That’s insanely abnormal. I know dozens of em residents across the country. We work a **** ton of nights.

 

[GeneralVeers]

We used to do 14 shifts per month in residency. 7 days in a row with 7 off. Half day shift half night shift and all 12 hours.

 

[jw3600]

We used to do 14 shifts per month in residency. 7 days in a row with 7 off. Half day shift half night shift and all 12 hours.

Wait are you serious? That’s a cake walk....
18-19 12s/month is normal for EM interns.

 

[PolandSpring21]

60 hrs/wk averaged over 4 weeks. Staying after counts towards your duty hours. Doesn't count towards the required break between shifts.

This info is literally in the second result if you Google "emergency medicine resident duty hours"

Link

From the ACGME program requirements document it says "a resident must not work more than 60 scheduled hours per week seeing patient in the emergency department and no more than 72 total hours per week." I haven't been able to find anything about it being averaged over four weeks. Where as it explicitly states the 80 hour limit is averaged over 4 weeks. So I was hoping to find it written out some where. I also didn't find it in the EM FAQ.

 

[Lexdiamondz]

Wait are you serious? That’s a cake walk....
18-19 12s/month is normal for EM interns.

Eh I disagree.

I could do 18-20 12s as long as they're broken up into 3-5 shift stretches. 7 on 7 off just sounds like hell - I'd spend the first 2 days off recovering from the previous week and the last 3 days dreading the oncoming week

 

[jw3600]

Eh I disagree.

I could do 18-20 12s as long as they're broken up into 3-5 shift stretches. 7 on 7 off just sounds like hell - I'd spend the first 2 days off recovering from the previous week and the last 3 days dreading the oncoming week

Total hours is far more important than structure. I agree I’d rather have staggered than 7 in a row but I’d much rather have 40 hours a week than 50 hours a week. That’s a no brainer.

 

[GeneralVeers]

7 on was hell....7 off was great. Doing 7 12-hour night shifts definitely prepared us for difficult attending schedules though.

 

[gamerEMdoc]

You aren't allowed to average your days off for EM months. For EM, you have to have one 24 hr period off a week and you have to have no more than 60 scheduled hours of clinical work in a week period. The 60/72 rule (#3 below) is confusing and the FAQ doesn't explain it. I assume what it means is that the 60 is the max average per week over 4 weeks, but any individual week you can't go over 72. 80 is the cap for all activities (shifts plus education/moonlighting). You must have one 24 hr period completely off a week. This is not an average and is supposed to be free of all duties including conference.

Here are the four basic work hour tenants copied straight from the guidelines:

Clinical and educational work hours must be limited to no more than
80 hours per week, averaged over a four-week period, inclusive of all
in-house clinical and educational activities, clinical work done from
home, and all moonlighting.

Residents must be scheduled for a minimum of one day in
seven free of clinical work and required education (when
averaged over four weeks). At-home call cannot be assigned
on these free days

A resident must not work more than 60 scheduled hours
per week seeing patients in the emergency department,
and no more than 72 total hours per week.

Emergency medicine residents must have a minimum of
one day (24-hour period) free per each seven-day period.
This cannot be averaged over a four-week period.

 

[Cingene2020]

The 60 per week in ED shifts is not averaged per week AFAIK.

 

[gamerEMdoc]

The 60 per week in ED shifts is not averaged per week AFAIK.

I‘m not certain this is correct, the ACGME doesn’t clearly explain this. The one day off in 7 is the only thing that is explicitly stated that can’t be averaged. I think it would be smart for programs not to exceed 60 in any given week, but I’m not certain that its a violation if they do go over in one week but the average is less than 60.