Time Off During Residency Serious/Important Question

[bad virus]

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Hello to everyone,

This is an issue that has been causing me a lot of stress recently and I have come here to find some answers. I am in my last rotation of third year, currently attending a state school. Before I was accepted into the school, I made it clear to my interviewers that as a Muslim male, I would require time off on Friday between the hours of 12:30 and 2:30pm for religious obligations. It is mandatory on me to attend these weekly prayers and I may only miss them for important reasons (i.e. my leaving will cause undue patient harm). I am allowed to miss one or two here or there but not to make a habit out of it. My interviewers told me not to worry. I was accepted to the school on a full tuition merit scholarship. Being that this was my home state and my intention is to stay here, I accepted the offer. I am in no way trying to brag, but using this to clarify my current dilemma. My application was such that I could have attended multiple other schools that are much more prestigious. In the end, I chose home and the fact that I felt that my religion would be accepted here.

Everything went well for the first two years and I only had to miss a maximum of Five Friday prayers. Problems first arose during the start of third year. I was told that my Friday prayer would conflict with my education and patient safety. This was discussed with the office of student affairs and the dean of students and a letter was written that stated I may attend Friday Prayers as long as there were no required block objectives (lectures or exams) during that time. This letter was sent out to all the blocks and I made my effort to remind them of this letter before the blocks began. Every block has allowed me to attend these prayers, despite having lectures during those hours and I only had to miss 2 Friday prayers. This was until my current block. This last block has Friday lectures during my required Friday prayer. Unlike other blocks, I was told that I may not make up these lectures by working extra days or doing extra projects. Usually, I make up for the Friday prayers by working an extra day during the week or doing a journal presentation etc... I was told that residencies will not allow me to practice my religion and that is why I would not be excused to attend Friday prayers during the block.

So after all this round about explanation, here is my question: Will any EM residency programs allow me to have the hours of 12:30pm-2:30pm on Friday’s off in return for extra shifts or any other form of make-up?

I am not the type of student that goes out of his way to break rules or confront/disrespect authority for the fun of it. I have had a stellar record in school which is as follows:

1st and 2nd year: All A’s except for one B.
Step 1: 249
Third Year: Honors in all clerkships thus far (last one pending)
Elected Junior AOA.
2 Research projects and heavy extracurricular/volunteer work.
Top quartile of class.

I am sorry for the long winded question and explanation, but I wrote this much because of how important it is for me to be able to attend Friday prayers and freely practice my religion as long as I am not harming others. Sure I have missed a prayer here or there, but I do not wish to make a habit out of it.

 

[dotcb]

You'd have to discuss this with each individual program. You may encounter some hesitancy because your responsibility for patients goes way up as a resident and subsequently your absence will have much more effect on patient care. In addition, there is much less redundancy in staffing in residency. I know of a few "sabbath residencies" in radiology and IM for orthodox Jews, but I've never heard of this in EM.

 

[EM_Rebuilder]

Religion or not, I think you are best to minimize this to whatever you apply for... or as someone else said, find a very rare residency/specliaty that caters to your lifestyle and go there.

I can tell you that if I was a co-resident of yours and you had to bale on us every Friday for a few hours... You would quickly become a very non-favorite resident. Your colleagues would dislike you and you will probably find some attendings that will dislike you.

Medicine is (rarely) a job with Fridays off.. and its essentially NEVER that in residency.

I am just a lowly EP at a private joint. If I was a PD or such, I would have much reservations about hiring someone that tells me they need to be excused every friday for several hours. Other residents are going to be upset (should the christians get every sunday morning off?), and other attendings are going to be upset when the resident is leaving, etc etc...

You cannot be discriminted against based on religion, but I am not so sure this applies here as the situation you request is extreme.

I feel like my response sounds a bit harsh, but I am just trying to be frank with you... You are obviously very bright based on your scores and maybe you can find what you are looking for..

 

[Rendar5]

i won't be as severe as the above person, as there are some residencies where this is doable. Namely residencies that have fewer shifts but more hours. You'd have to let them know that you couldn't do friday day shifts, but perhaps you could make up for it by doing more weekend shifts or night shifts to make up for it. Having very few fridays would be possible in my own residency, but you would pay for it in other ways. But there is no way you can have partial friday shifts. You can't take a break in the middle of a shift as this would cause danger to patients.

However, you will meet resistance from some people/residencies because this puts severe restrictions on schedule makers.

 

[bad virus]

Na, no worries, none of it sounded harsh and I'm a big boy anyway.

Thanks for the advice.

Here is I guess how best I can sum it up. How hard will it be to find a program that will let me avoid one out of 21 shifts in the week in turn for doing more of the unwanted ones (holidays, weekends, nights)? The 1/21 figure is just from our schedule at our school. The ED has three shifts and the Friday day shift will be just one out of the 21. I am not asking to bale out in the middle of that shift, just to be able to have that shift no more than once a month. I know there are off service months where they expect you to work a certain something, I just can't be doing it every single week or more than 2 weeks in a row.

 

[bad virus]

Disclaimer: Wow, I just googled the Sabbath residencies and saw some of the discussions that occurred regarding the topic. So here it goes: This thread is not a us against them thread like the sabbath threads became (total antisemitism). This is just a thread looking for programs which might allow me to avoid one shift out of 21 or one shift out of 14 a week if possible. It does not have to be every week but I don't want to work that shift more than once a month if I have too.

I am totally all for working every single holiday, weekend, and night shift you got.

 

[Apollyon]

dotcb mentioned "sabbath observant" residencies. I saw that in Brooklyn when I was a med student. I was doing my peds sub-I. One resident was sabbath. Another was an Orthodox Jewish guy that wasn't on the sabbath program. His take was that, for his religion, the work of healthcare, and the need to work on the sabbath for the well being of his fellow people, was above the proscriptions laid down by the holy book.

What I am not trying to do is make any value judgments for or against anyone's religious choices. But, what happens in Muslim countries when a fire breaks out during one of the 5 prayer times? Do the firefighters continue to pray, while letting the fire burn? Or what if someone has a medical emergency during prayers? Do the others say "In shah allah", and say that it's God's will that whomever has a seizure or codes during prayers, and, if he lives, he was meant to? What about emergency departments in Saudi Arabia or Bahrain or Dubai? Do they close up during prayers or for Jummah, or do they stop resuscitating people to pray? Do the surgeons upstairs stop in the middle of an open heart? I am not being sarcastic when I ask this. And I am not referring to such things as the Mecca fire at the girls' school in 2002.

If you volunteered to work every Friday night, as long as you had Friday day off, you can see if that will work. However, if you get every Friday off, and also have Friday nights off, then you get quickly into what EM_Rebuilder said.

edit: I was writing when you were.

 

[bad virus]

dotcb mentioned "sabbath observant" residencies. I saw that in Brooklyn when I was a med student. I was doing my peds sub-I. One resident was sabbath. Another was an Orthodox Jewish guy that wasn't on the sabbath program. His take was that, for his religion, the work of healthcare, and the need to work on the sabbath for the well being of his fellow people, was above the proscriptions laid down by the holy book.

What I am not trying to do is make any value judgments for or against anyone's religious choices. But, what happens in Muslim countries when a fire breaks out during one of the 5 prayer times? Do the firefighters continue to pray, while letting the fire burn? Or what if someone has a medical emergency during prayers? Do the others say "In shah allah", and say that it's God's will that whomever has a seizure or codes during prayers, and, if he lives, he was meant to? What about emergency departments in Saudi Arabia or Bahrain or Dubai? Do they close up during prayers or for Jummah, or do they stop resuscitating people to pray? Do the surgeons upstairs stop in the middle of an open heart? I am not being sarcastic when I ask this. And I am not referring to such things as the Mecca fire at the girls' school in 2002.

If you volunteered to work every Friday night, as long as you had Friday day off, you can see if that will work. However, if you get every Friday off, and also have Friday nights off, then you get quickly into what EM_Rebuilder said.

edit: I was writing when you were.

No worries, good questions, I just thought I preemptively answered them in my first post by stating (not working as long as it does not create undue harm). Basically, if it will harm other humans (life/limb) you can't say "woah i can't help ya bud, I got Friday Prayer" That is just silly. what they do in these countries is they have 2 prayers held in the afternoon on friday, so docs and other professionals can pray in shifts. Basically, you can't allow harm to others in exchange for your prayers, so a fire fighter would not stop. They just have better systems to accomodate things over seas for that group since its a majority there. The five prayers take a maximum of 5 minutes each and scattered all throughout the day so it would usually not be an inconvenience to patients. The communities in the US are usually too small to have 2 Friday prayers, or you can't take off during that time. So basically, I am just looking for a list of programs, that are willing to take an extremely hard working future resident and accommodate his Friday day wish in exchange for working every crappy shift you got.
My favorite thing is working Christmas, thanksgiving, easter and other holidays so my friends can take it off. I got nothing better to do on Friday and Saturday nights that I can't do during the week so I never have problems not having those off.

So back to the original question:

Would your shop be able to accomodate my request. It doesn't have to be every Friday Day, but I wouldn't want to work more than one a month in exchange for all the terrible unwanted shifts.

 

[Flopotomist]

I will answer that at my program (Wash U in St Louis) one of my classmates is Orthodox Jewish, and for the most part has been able to trade shifts around so that she can have Friday nights off. Of course it is not perfect, and there are times when she has to work if she is on an off service ,but we do our best to support her. She still works the same number of weekend shifts as anybody else - they are just on Saturday night or Sunday instead of Friday night.

 

[Arcan57]

So back to the original question:

Would your shop be able to accomodate my request. It doesn't have to be every Friday Day, but I wouldn't want to work more than one a month in exchange for all the terrible unwanted shifts.

As an attending it's easily doable, I'm a scheduler and I have one devout Muslim doc that is off every Friday. As a resident, it's going to be more difficult because of the complexity of the schedule. And regardless of what the ED does, off-service rotations are not going to be cool about you checking out on Friday afternoons. I would have a serious talk with your religious advisor, since you are going to be saving life or limb pretty much whenever you are in the hospital. I'll ask my doc what he did during residency next time I see hime.

 

[cofcemt]

I would also look into smaller programs that are not dependent on the residents to run the departments. This would probably allow a bit more shift flexibility. I know SIU was like that when I interviewed there...and there we a couple more, but cant remember them right now.

 

[EMmotherhen]

Having recently had an Orthodox Jew in our program I can relate. Yes, we allowed this person to take Sabbath off but they had to pull extra weekday shifts to compensate the residents who ended up always working weekends. Created some hard feelings among the residents (about always working weekends) but we feel you should try to allow religious expression as long as it doesn't impede patient care or cause grave offense. So only needing two hours one day a week, in comparison, is a piece of cake! I would expect your Program Director to ask you to make them up, either by working an additional two hours another day or by combining all 8 (or 10) hours into an entire additional shift. I remind people that they don't think twice about asking to not work on Easter or Christmas....

 

[Apollyon]

I remind people that they don't think twice about asking to not work on Easter or Christmas....

2/365 vs 52/365 is quite a bit of difference. (This is not to demean the OP - he sounds like he is very willing to take up his share.)

 

[KarlPilkington]

I think the real risk in this type of request would be during the application phase of the process. I'd look at programs with plenty of residents in each class. This would give you more peers to try to swap shifts with. Personally I wouldn't push the issue too much with the program director during the interviews. Its totally valid to try to make room in your schedule for things that are important to you, religion, family..., but I don't think the interview is the time to bring this up. While all programs want content well rounded residents, residency is a job, and what programs are really looking for is people who are going to work hard, and cause minimal disruptions.
My advice would be to show up, work hard early on, and then start asking your classmates and chief residents to help keep this space open in your schedule.

 

[la gringa]

I think the real risk in this type of request would be during the application phase of the process. I'd look at programs with plenty of residents in each class. This would give you more peers to try to swap shifts with. Personally I wouldn't push the issue too much with the program director during the interviews. Its totally valid to try to make room in your schedule for things that are important to you, religion, family..., but I don't think the interview is the time to bring this up. While all programs want content well rounded residents, residency is a job, and what programs are really looking for is people who are going to work hard, and cause minimal disruptions.
My advice would be to show up, work hard early on, and then start asking your classmates and chief residents to help keep this space open in your schedule.

agree 100%. there will be times it's not feasible... but you want people to know YOU first and your religion/family/whatever preferences later.

 

[edgesofsanity]

I've got to disagree with some of the sentiments here about not bringing it up during your interview process - this is the one time where you are not beholden to any particular program; trying to arrange for the special exemption once you're locked in to the year long contract could be extremely difficult.

A lot of it I would think depends on how important getting this time off is - you could try to subtly bring it up at the resident dinner/hangout the night before and see if anyone has had a similar experience; but in your case if it's really as important as you seem to state (and kudos to you for that by the way) your best bet is to bring it up to a program director - not as your first question, but one of the later ones.

Recognize that doing this will shoot you in the foot at some residencies. The good news is on paper you come off as an outstanding resident, which should allow you the opportunity to interview at multiple programs - and you will likely need to interview at more than the majority of your classmates to find that match.

If you don't feel comfortable bringing it up at the interview, make sure to interview at the larger residences. The more residents in the program, the more flexibility the schedule makers will have to fill the slots in and abide by your requests. Additionally, if you get one of those shifts there are more people you have to be able to trade in and out of shifts with). Speaking from experience, people trading out of a weekday day shift at our old program had no problems trading out of it.

If you can find a program that will work with you, once you're out of residency you should have no shortage of job opportunities that will acquiesce to your restriction - daytime shifts are relatively easy to fill; and you'll be a sure hire if you offer to pick up every Christmas/Easter/Passover.

Best of luck!

 

[shookwell]

I think that you are obligated to bring this issue up to the residencies early in the process. It would be unreasonable to match somewhere and then tell them that you don't want to work on Fridays.

I think most residencies would be willing to at least say they will work with you on the issue, although I don't think many of them will be willing to guarantee Fridays off, especially on off-service rotations.

 

[Cerberus]

dotcb mentioned "sabbath observant" residencies. I saw that in Brooklyn when I was a med student. I was doing my peds sub-I. One resident was sabbath. Another was an Orthodox Jewish guy that wasn't on the sabbath program. His take was that, for his religion, the work of healthcare, and the need to work on the sabbath for the well being of his fellow people, was above the proscriptions laid down by the holy book.

Regarding "Sabath Observant" residencies, I am at a hospital that has slots for Sabbath observant residents in IM and Peds. EM here does not make any special accomadations for religious Jews (or anyone else). It's expected that as an "Emergency" Medicine resident you will make being seeing sick/dying people regardless of the day hour and will take that into account when choosing a specialty.

As for "just switching shifts" this is also not easy to do. It is difficult to make an EM residents schedule with the duty hours restrictions, it's even harder to change once it's made. I've found that oftentimes a seemingly easy shift change isn't possible because it would violate one of the rules for myself or the other person.

Not trying to discourage you, just letting you know it will be an obstacle.

 

[thorg12]

Im gonna go against the grain and say this might be very easy if the program does the schedule month by month. If your willing to more work more Friday and weekend night shifts you wouldn't be burdening your fellow residents but actually be helping them.

 

[bad virus]

Thank you guys for all your candid responses, they were quite helpful. I know it's going to shoot me in the foot at many programs, but to be honest I'd much rather bring it before hand during the interview than cause conflict later on. Also thank you to all the people that pm'd me; you know who you are.

Do you guys really think I would be shooting down my chances at a competitive program like King's county or Maricopa? I don't drink or party, so Friday/Saturday night and weekend shifts are my favorite down in the ED. Also nights in general are more preferred in my book compared to days.

Also thank you for not turning this into an anti-Islamic/Semetic thread (Godwin's law), I always appreciate the civility displayed by the EM forum.

Take care guys, I can't wait to be your colleague.

 

[bad virus]

As an attending it's easily doable, I'm a scheduler and I have one devout Muslim doc that is off every Friday. I'll ask my doc what he did during residency next time I see hime.

Oops

 

[ensuii]

Hi Arcan, did you ever get around to asking the doc what he did? Also to the genetelman that mentioned SIU, where is that?

Last but not least guys, with my stats and my request, approximately how many interviews would you guys recommend?

I make a little bit of money from working in the radiology department and also tutoring the basic sciences, and thus have saved up about $6,000 for the interview season. I have yet to take out loans and I want to avoid doing so if I can. My family of 10, makes less than $20,000 a year and a lot of my earned money goes to help my father, so i don't want to spend excessively if I can avoid this. I'd much rather be able to purchase my grandmother's Parkinson's medications than spending it on hotels and airfare. Plus I have 6 younger brothers I have to help take care of with my mom and dad. All your advice is very helpful and is greatly appreciated.

Thank you again and take care.

Many props go to you.

 

[bad virus]

Many props go to you.

Holy crap, I just realized I totally made a fool of myself by blurting out a total sob story. I truly apologize for this. I didn't post it to get any sympathy or anything of that nature. I just wanted to give you guys a real image of what I am working with so I could get some serious answers. Again sorry for the total sissy fest.

Thanks again for all the candid advice guys and take care.

 

[dotcb]

It's a rare but reasonable request. Start with a disclaimer, then offer what you're willing to do, then make a request. There is no question you will have to be willing to compromise, meet them halfway. and occasionally work some of these Fridays (example: internship). Don't let let that keep you from having your eye on the prize - great training as an EM doc.

If your request was that you wanted to attend your kid's hockey practice every Friday, they would say no. Fortunately, religious practice is different. That said, everyone makes a lot of sacrifices in residency.

At my residency the mantra was "no one gets special treatment" - you could do whatever you want, but you had to arrange all of your coverage. They likely would've put you on the same schedule as everyone else and allowed you to do any trading you want.

 

[Apollyon]

Holy crap, I just realized I totally made a fool of myself by blurting out a total sob story. I truly apologize for this. I didn't post it to get any sympathy or anything of that nature. I just wanted to give you guys a real image of what I am working with so I could get some serious answers. Again sorry for the total sissy fest.

Thanks again for all the candid advice guys and take care.

I like this kid. I hope he sticks around.

 

[8654Marine]

Dude, you seem honest and upfront.

Show the residencies how important this is but also stress the balance that is necessary between religious freedom and patient duty. Don't let this be a surprise to anyone.

From what you'd describe, I'd be glad to work with you. Welcome to the club.

 

[gman33]

I have mixed feelings about this type of request.
I am not a religious person and that colors my opinion.
I do appreciate how important this request is to the OP, but I don't think the reason matters. I'm against giving a resident a different schedule for religious reasons.
I'm not at all against the OP getting the "normal' schedule and then trying to swap out.
He seems very reasonable and more than willing to do his share.
I doubt he had have a hard time swapping a friday afternoon shift for a friday night.

I just don't like the idea of someone getting "special" treatment.
It's not fair to people who don't make these requests and have to pick up the slack.

One idea for the OP is to look at programs that don't work on a fixed schedule.
Some programs work on a progressive schedule where you work like 2 days, 2 evenings, 2 nights and then repeat. It's harder to swap on this schedule.
Other programs just make up the schedule each month.
It would be much easier for you to get what you want on this type of schedule.

As long as you are willing to work the occasional Friday afternoon, you should be alright in residency. It will probably be worse during intern year as you will have more off-service months and at times this request will be harder to make work.

Good luck in your search. You seem to have the right attitude about the request you are making.

One other note and interview expenses. I limited myself to a geographic area (due to family reasons). All the programs were within driving distance. I applied to some that weren't, but ended up declining those interviews. I stayed at a couple hotels, but by luck those programs paid for the hotel. I could have driven up in the morning to those programs if I really wanted to. My only expenses were the actual application fees, gas, tolls and 1 new suit. If you are lucky enough to live in an area that has a bunch of programs you can limit your expenses.

 

[Disinence2]

Keep in mind that throughout residence you do lots of off service rotations. Some of which you could probably easily get off, but others like ICU and Trauma you would likely be very difficulty. Plus its often not even your program doing the scheduling for other rotations..

 

[pinipig523]

Hello to everyone,

This is an issue that has been causing me a lot of stress recently and I have come here to find some answers. I am in my last rotation of third year, currently attending a state school. Before I was accepted into the school, I made it clear to my interviewers that as a Muslim male, I would require time off on Friday between the hours of 12:30 and 2:30pm for religious obligations. It is mandatory on me to attend these weekly prayers and I may only miss them for important reasons (i.e. my leaving will cause undue patient harm). I am allowed to miss one or two here or there but not to make a habit out of it. My interviewers told me not to worry. I was accepted to the school on a full tuition merit scholarship. Being that this was my home state and my intention is to stay here, I accepted the offer. I am in no way trying to brag, but using this to clarify my current dilemma. My application was such that I could have attended multiple other schools that are much more prestigious. In the end, I chose home and the fact that I felt that my religion would be accepted here.

Everything went well for the first two years and I only had to miss a maximum of Five Friday prayers. Problems first arose during the start of third year. I was told that my Friday prayer would conflict with my education and patient safety. This was discussed with the office of student affairs and the dean of students and a letter was written that stated I may attend Friday Prayers as long as there were no required block objectives (lectures or exams) during that time. This letter was sent out to all the blocks and I made my effort to remind them of this letter before the blocks began. Every block has allowed me to attend these prayers, despite having lectures during those hours and I only had to miss 2 Friday prayers. This was until my current block. This last block has Friday lectures during my required Friday prayer. Unlike other blocks, I was told that I may not make up these lectures by working extra days or doing extra projects. Usually, I make up for the Friday prayers by working an extra day during the week or doing a journal presentation etc... I was told that residencies will not allow me to practice my religion and that is why I would not be excused to attend Friday prayers during the block.

So after all this round about explanation, here is my question: Will any EM residency programs allow me to have the hours of 12:30pm-2:30pm on Friday’s off in return for extra shifts or any other form of make-up?

I am not the type of student that goes out of his way to break rules or confront/disrespect authority for the fun of it. I have had a stellar record in school which is as follows:

1st and 2nd year: All A’s except for one B.
Step 1: 249
Third Year: Honors in all clerkships thus far (last one pending)
Elected Junior AOA.
2 Research projects and heavy extracurricular/volunteer work.
Top quartile of class.

I am sorry for the long winded question and explanation, but I wrote this much because of how important it is for me to be able to attend Friday prayers and freely practice my religion as long as I am not harming others. Sure I have missed a prayer here or there, but I do not wish to make a habit out of it.

Here's what I can tell you. At Cook County EM - we are very happy to oblige to people's religious backgrounds. We have someone just like you in our program and he gets every friday blocked off for prayer time.

So I'm sure other programs will accommodate your schedule as well.

Not a problem.

 

[AmoryBlaine]

There are 3 issues here.

1. Is your request unreasonable? No. I actually think far less problematic than an Orthodox Jew who wants every Friday NIGHT off. Especially if you are genuinely willing to pull more crappy shifts then there's no issue. This willingness does have to be generous though.

2. Will this affect your residency search? Yeah, honestly it will. Schedules are complex and having a fixed obstruction in the schedule makes it all the more difficult. I think you have to be upfront about this desire and I would do that with the PD only at interviews/away rotations, see what they think. Some places will hear this and think that you are at risk of being a needy resident. You sound like a reasonable dude and I think you can understand their concern.

3. I think a far better question for you is "is this going to work out when I join a group?" I think it probably will, but it would be interesting to see if you could talk to some devout Muslims who were working in EM.


One piece of advice (from a senior resident) would be to really be flexible with this. There just aren't that many really observant, devout religious people in medicine; you will be part of a tiny minority. If you do become the guy who whines when he is given what is otherwise a pretty nice shift (day/afternoon) you will be met with nothing but consternation and eye rolling.

I though most religions agrreed that pretty much the rules did not apply to doctors on duty i.e. no one expected fasting on call. Does Islam not allow for this?

 

[Janders]

Just random attending opinion here:
(1) As a resident in the ED, I think your request is reasonable and shouldn't be terribly hard to work around for your program. You could just work Friday evening instead of day every time you are scheduled for that... most of your classmates would love it. I am sure some programs might not like it, but I think many/most would be willing to work with you.
(2) Once you are in practice... I think most groups would be more than willing to give you Friday day off if you worked an extra weekend or overnight everyone month, or some minor such thing.
(3) The problem. When you are off-service (which is easily 1/2 of intern year, and 1/3 of subsequent years) you might not EVER get friday afternoon off. Is this acceptable? ICU months are tightly scheduled. When you are surgical services they need you taking floor call then. etc etc. If you are OK with these prayers often being missed, I think you'll be fine.

 

[Khaos]

You will need to find a residency that either works 12 hours and will allow you to only work nights of Fridays or a residency that works 8 to 9 hour shifts. My residency worked 9 hour shifts and thus on Friday hours were 7 to 4, 3 to 12, 11 to 8. This gave an hour overlap. There is no doubt in my mind that if one of our residents needed to be out by say 2, any of our residents would've come in early to relieve him (with the understanding it would be paid back later). This also meant that there were also a lot of us easily willing to switch shifts or change the schedule to accommodate. The 8 and 9 hour schedule would give you 2 shifts that you could swap with. We had a single parent that had his child two weeks out of the month and we all agreed to accommodate this either day shifts or night shifts for him during that time. It can be done, you need to ask while you are interviewing, but it is going to be a very touchy subject and has to be brought up properly. One of the best places to get a feel for how people will react with this question is the dinner before the interview. If the residents basically balk at the idea of it, it doesn't matter what the attendings say.

As for the off service stuff. First off, we always had 2nd or third years over us or another resident on at the times between noon and 2:30. I can't remember any off service where I couldn't easily have someone else look after my patients during that time. I do know that during rounds it would sometime run over and go past 2 pm...but if you needed to be somewhere or you were post call we rounded on your patients first to get you out. There was once in the ICU when I knew that in the morning after my call we had a very slow attending that would take forever to round. I told the fellow that we should round on my patients first because my 30 hours would be up at 11:30am. He said to me "we'll try." Well, they didn't round on my patients first and when 11:30 came around I handed him my notes and told him to have a nice afternoon while I slept. The attending asked if I had reached 30 hours, I said yes and he said to get some sleep. The next day they rounded on the post call person's patients first. They let me get by with this because I worked hard and I did almost all of the procedures (central lines, art lines, intubations, etc...) since the IM guys didn't want to do any of it and didn't want to wait for surgery or anesthesia.

It can be done but you will need an understanding bunch of residents and attendings willing to work with you. It will be difficult to find this. I wish you the best of luck.