Trauma as an upper level

[eclcell]

I am wondering if you all could comment on how much trauma call you take at your programs as chiefs. We take Q4 trauma call all five years of residency with the exception of about 10-11 subspecialty months. Everyone on call goes to the trauma activations, and the ER trauma consults go to the second year residents. Recently the second year residents have been getting overwelmed so it was decided all consults from the ER would go to the chiefs to be divied out. This is at a big level I trauma center. We stay busy. This sounds good for patient care so we don't have much of a leg to stand on. Most of us feel like that at most programs the chief isn't in house up all night Q4 taking trauma call, but that may be a misperception.

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[Castro Viejo]

I am wondering if you all could comment on how much trauma call you take at your programs as chiefs. We take Q4 trauma call all five years of residency with the exception of about 10-11 subspecialty months. Everyone on call goes to the trauma activations, and the ER trauma consults go to the second year residents. Recently the second year residents have been getting overwelmed so it was decided all consults from the ER would go to the chiefs to be divied out. This is at a big level I trauma center. We stay busy. This sounds good for patient care so we don't have much of a leg to stand on. Most of us feel like that at most programs the chief isn't in house up all night Q4 taking trauma call, but that may be a misperception.

You think you've got it bad, huh?

We're Q3 all five years. ED/house consults get split between the 3s and 4s with one of them on-call overnight Q3. Chiefs are always in-house and come to all traumas.

 

[Celiac Plexus]

q5 in house, go to all traumas, see all consults, cover all services except for peds.

 

[eclcell]

You think you've got it bad, huh?

We're Q3 all five years. ED/house consults get split between the 3s and 4s with one of them on-call overnight Q3. Chiefs are always in-house and come to all traumas.

Does that mean you take Q3 in house call your entire chief year?

 

[jc7721]

You think you've got it bad, huh?

We're Q3 all five years. ED/house consults get split between the 3s and 4s with one of them on-call overnight Q3. Chiefs are always in-house and come to all traumas.

I was thinking about your Q3 in house and was wondering if you go home after 24 hours (I'm guessing not). If you don't, do you lie about your hours?

Q3 is about 10 call shifts a month, and assuming you're at a busy level 1, it's near impossible to leave before 28 or 30 hours. Throw in just 3 or 4 non-call weekdays and you're easily over an 80/wk average. How do you do it if you're not lying?

 

[Castro Viejo]

Does that mean you take Q3 in house call your entire chief year?

Yes. Sucks, huh?

 

[Castro Viejo]

I was thinking about your Q3 in house and was wondering if you go home after 24 hours (I'm guessing not). If you don't, do you lie about your hours?

During the first two thirds of the year I didn't go home after my calls. I usually stayed to TA a case, do an "interesting" case, finish up paperwork, or meet with the medical students. Now in the twilight of my residency, I'm beginning to go home more and more after calls. I'm just too tired sometimes, or maybe it's just the senioritis ("Chiefitis?") setting in... The 4s should be more than capable of doing most of the cases that are routine, although they technically still require an attending surgeon to be scrubbed with them here. The 4s are also dealing with the medical students.

I'll still stay to TA a case if an attending asks... Like this morning for a right colon resection, although I'm coming off post from doing a trauma lap early this morning and I'm tired.

Q3 is about 10 call shifts a month, and assuming you're at a busy level 1, it's near impossible to leave before 28 or 30 hours. Throw in just 3 or 4 non-call weekdays and you're easily over an 80/wk average. How do you do it if you're not lying?

We're not a busy Level 1 Trauma Center. Penetrating/Operative trauma cases are few and far between. I think this year I've only taken about 15-20 cases to the OR for trauma, including the one last night. As a Chief I've never done an ED thoracotomy. This ain't the typical Knife-and-Gun Club Level 1 a la Grady, LAC, or Kings County.

There are loopholes and stuff with the ACGME 80 hour work week rules that programs play with to make things work and stay in compliance. It just works out and our program hasn't been cited for work hours violations in years.

 

[ESU_MD]

our chiefs don't have to cover any trauma. we are on home call and only come in if the trauma attending wants a "chief", or if we feel like the case is worth coming in for- which at this point in my career... is none.

i'd rather sit at home and watch TV than deal with nuisance trauma patients. even a big trauma case is an annoyance, since it often results in another morbidity conference presentation or something.

I feel sorry for the guys who are in house as chiefs, you guys must be fried by now.

 

[opr8n]

trauma is a specific rotation for us, busy level 1 trauma center (15-25 alerts per night)
its all shift work (14h on, 10off) never call

chief 4 does trauma nights and is in hous, they have an R1 and PA to do their scut

chief 5 does trauma days, they have an R1, R3, and PA to do their scut

the trauma ICU is run by a R2 and R3