Resident Duty Hours - Jeopardy Question

[LatinDoctor]

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[whoknows2012]

" 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 inhouse clinical and educational activities, clinical work done from home, and all moonlighting." This is per ACGME.

I am wondering if you have to cover a co-resident due to jeopardy, does this coverage goes into account to your duty hours? I have to cover someone and I will exceed my duty hours but my program told me that Jeopardy doesn't count. Is this true?

Thanks

So with your jeopardy coverage you will be working more than 320h for the month?

 

[ortnakas]

I think jeopardy counts (at my program if you get called in for backup you are supposed to get another future day off).

 

[whoknows2012]

Yes, and I would only have 3 free days in the month (Per ACGME: "Residents must be scheduled for a minimum of one day in seven free of clinical work and required education, when averaged over four weeks"). But I want to know if it is true what my program is telling me (that jeopardy coverage does not count?)

I’m not defending the program so I don’t want it to come off that way. But given this is in the future, how do you know you’re going to violate duty hours?

regarding the gist of your question re; whether or not jeopardy is included, or course it’s included! There’s not some special caveat in the acgme rules about jeopardy or sick call coverage. Now that being said is it possible that their take is that being on jeopardy wouldn’t violate the average of 80h/wk? Also during covid there were some guidelines passed (not sure if they’re still in place) about allowing >80/wk

 

[rokshana]

" 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 inhouse clinical and educational activities, clinical work done from home, and all moonlighting." This is per ACGME.

I am wondering if you have to cover a co-resident due to jeopardy, does this coverage goes into account to your duty hours? I have to cover someone and I will exceed my duty hours but my program told me that Jeopardy doesn't count. Is this true?

Thanks

Jeopardy counts

 

[gutonc]

Yes, and I would only have 3 free days in the month (Per ACGME: "Residents must be scheduled for a minimum of one day in seven free of clinical work and required education, when averaged over four weeks"). But I want to know if it is true what my program is telling me (that jeopardy coverage does not count?)

Yes, it counts. But the 4 days off/4 weeks is a rolling average. So while you may not get 4 days off this month, you'll probably revert to the mean over the next 4 weeks.

This is going to come of as a "in my day...uphill both ways in the snow...get off my lawn" kind of statement but...my first month as an intern was in the MICU. My very first day of internship was a day off. I then worked 13 straight days (we still did Q4 overnight call), followed by a day off, 5 days in a row, another day off, then another 10 days in a row (managed 3 overnight calls in that stretch), then a "golden weekend" before moving on to wards night float for 2 weeks

It sucks. You'll survive.

 

[whoknows2012]

Because this month I have 4 days off, and I have been already told that I have to cover one of those days since I am on jeopardy that day, hence - I will be only having 3 days off in the whole month and that is a duty hour violation. I expressed this to my program and they told me that jeopardy coverage doesn´t count towards duty hours violation, which it didn´t make any sense to me and that is why I asked. Also, this has been happening very frequently, that many of us violate duty hours when we have to cover for jeopardy. I already contacted ACGME by the way, they told me that all residents MUST have 4 days off per month WITHOUT being in jeopardy. Now there is a covid outbreak in my program so there is a lot of coverage - it is a big issue. I have not heard of those guidelines you are mentioning about allowing >80/wk

Ok so this is a different question. It’s not about 80h/wk then it’s about 1 day off per week. That’s a very clear recommendation about 4 days off in a 4 week period. If you’re not getting that then it’s a clear violation, with one major caveat; it’s not one month in isolation. It’s averaged so you can’t just take one month at a time. It means at any single time point the preceding 4 weeks you’ve averaged 1 day off per wk which this doesn’t clearly violate as described

 

[aafisahar]

Because this month I have 4 days off, and I have been already told that I have to cover one of those days since I am on jeopardy that day, hence - I will be only having 3 days off in the whole month and that is a duty hour violation. I expressed this to my program and they told me that jeopardy coverage doesn´t count towards duty hours violation, which it didn´t make any sense to me and that is why I asked. Also, this has been happening very frequently, that many of us violate duty hours when we have to cover for jeopardy. I already contacted ACGME by the way, they told me that all residents MUST have 4 days off per month WITHOUT being in jeopardy. Now there is a covid outbreak in my program so there is a lot of coverage - it is a big issue. I have not heard of those guidelines you are mentioning about allowing >80/wk

Is this really the hill you want to die on?

Sack up, cover your fellow residents and move on.

 

[chessknt]

Because this month I have 4 days off, and I have been already told that I have to cover one of those days since I am on jeopardy that day, hence - I will be only having 3 days off in the whole month and that is a duty hour violation. I expressed this to my program and they told me that jeopardy coverage doesn´t count towards duty hours violation, which it didn´t make any sense to me and that is why I asked. Also, this has been happening very frequently, that many of us violate duty hours when we have to cover for jeopardy. I already contacted ACGME by the way, they told me that all residents MUST have 4 days off per month WITHOUT being in jeopardy. Now there is a covid outbreak in my program so there is a lot of coverage - it is a big issue. I have not heard of those guidelines you are mentioning about allowing >80/wk

Im not sure what you were lead to believe but if you file a formal complaint with the ACGME there is a nonzero chance this action you will get destroyed by your program leadership for the enormous headache you will cause. Not to mention you are shooting yourself in the foot because if the program comes under suspension or worse as a result that is your future on the line too.

This is a once in a lifetime pandemic, everyone has to put in more than normal. Hopefully your leadership is making the attendings work more too but even if they arent this is unfortunately the job right now for the IM field.

 

[Bobblehead]

Based on the OP's post history, creating problems for his residency program isn't going to leave him with a whole lot of options. And it wouldn't be very hard to identify him based the post history either.

You can always put your foot down, file a complaint with the ACGME and insist that despite the covid outbreak that work hours need to be observed. Perhaps this will engender some positive outcome where others in the department find ways to spread the load out some more going into this winter where cases are likely going to spike all over the country.

However, it appears you also need to complete an additional 2 years beyond the current year at your current institution. What do you think your chances are of successfully making it through those years based on your background and match history?

 

[NotAProgDirector]

The OP is correct that being called in for Jeopardy/Backup coverage counts for duty hours just like any other work.

The 4 days off per month is usually assessed "per block" -- if your residency program uses blocks for scheduling, you must get 1 day off per week averaged over the block. It's not a true "running average" although many programs try to meet that standard also.

However -- if there is a declared GME emergency due to COVID, then all duty hour rules are suspended.

 

[whoknows2012]

The OP is correct that being called in for Jeopardy/Backup coverage counts for duty hours just like any other work.

The 4 days off per month is usually assessed "per block" -- if your residency program uses blocks for scheduling, you must get 1 day off per week averaged over the block. It's not a true "running average" although many programs try to meet that standard also.

However -- if there is a declared GME emergency due to COVID, then all duty hour rules are suspended.

It’s pretty awful that the op states this is specifically due to covid outbreak within program (and thus depending on the specific details, gme allows rules to be suspended as I too mentioned above). To the op, you really should suck it up sorry to be blunt

 

[michaelrack]

Yes, it counts. But the 4 days off/4 weeks is a rolling average. So while you may not get 4 days off this month, you'll probably revert to the mean over the next 4 weeks.

This is going to come of as a "in my day...uphill both ways in the snow...get off my lawn" kind of statement but...


It sucks. You'll survive.

In my day we only got 2 days off per month, and there was no 80 hour limit

 

[Kaustikos]

The OP is correct that being called in for Jeopardy/Backup coverage counts for duty hours just like any other work.

The 4 days off per month is usually assessed "per block" -- if your residency program uses blocks for scheduling, you must get 1 day off per week averaged over the block. It's not a true "running average" although many programs try to meet that standard also.

However -- if there is a declared GME emergency due to COVID, then all duty hour rules are suspended.

Thank you!
OP, no disrespect, but you have to pick your battles. This isn't normal and you're not the only one who's had to deal with this. My March/April/May months were constant hours. The days off I couldn't remember, the hours I stayed late I don't even know. You're going to have to just keep your head down and power through. Sucks but it's the reality. This isn't the time/place to argue about personal days; we're all making sacrifices.

 

[gutonc]

In my day we only got 2 days off per month, and there was no 80 hour limit

Did you have to run to codes uphill both ways in the snow?

 

[HemeOncHopeful19]

Am I the only person that thinks maybe 9 months into a pandemic it should be a reasonable expectation for a department to have some plan in place for a COVID outbreak that isn’t “use an emergency declaration to have the residents violate duty hours”?

Maybe I’m just soft and not the grumpy old man my wife seems to think I am.

 

[AussieAg]

Did you have to run to codes uphill both ways in the snow?

While giving instructions in Morse Code.

 

[michaelrack]

Did you have to run to codes uphill both ways in the snow?

no, just run up stairs because the elevators were too slow🙂

 

[Instatewaiter]

Am I the only person that thinks maybe 9 months into a pandemic it should be a reasonable expectation for a department to have some plan in place for a COVID outbreak that isn’t “use an emergency declaration to have the residents violate duty hours”?

Maybe I’m just soft and not the grumpy old man my wife seems to think I am.

Kinda.

For my hospital we have had a bunch of people get infected and we created 3 new icu's basically out of thin air all at the same time. No matter the plan you have in place, you can't plan for everything.

Op needs to stop complaining during a global pandemic and do his damn job .

 

[Kaustikos]

Kinda.

For my hospital we have had a bunch of people get infected and we created 3 new icu's basically out of thin air all at the same time. No matter the plan you have in place, you can't plan for everything.

Op needs to stop complaining during a global pandemic and do his damn job .

Me too.
Some hospitals had so many people intubated/icu they were managed on floors...
Fun times

 

[HemeOncHopeful19]

Kinda.

For my hospital we have had a bunch of people get infected and we created 3 new icu's basically out of thin air all at the same time. No matter the plan you have in place, you can't plan for everything.

Op needs to stop complaining during a global pandemic and do his damn job .

I could get behind that if OP’s Hospital is in that sort of situation, but we don’t know that. I’d be curious to know how many attendings are also working with 3 days off in a month, in my experience the answer is not many if at all.

As someone who used to make resident schedules, I think it’s equally likely someone screwed up the schedule and are just taking the lazy way out and trying not to have to fix it. The fact that his leadership tells him that Jeopardy doesn’t count toward duty hours is pretty telling IMO, I mean it’s literally their job to know that stuff and they either don’t know the rules or straight up lied to OP.

I do agree though that OP really has no recourse here and will ultimately have to work if that’s what his program tells him. I would also delete the crap out of this thread if I were them.