Weekend coverage as residents

[johnbeck]

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Hi Friends,

I was curious how your residencies handle weekend coverage. Ours is as follows:

1. If there are patients for whom treatment needs to occur on the weekend, and they are in the midst of their treatment (i.e. on their 5th out of 19 fractions for breast cancer and need treatment because a machine was down for a few days), the residents cover these.

2. If there is a new consult on a Saturday, Sunday or holiday that needs urgent treatment, then the attending must come in with the resident to staff the consult and initiate treatments.

As residents, when on call, we are coming in most weekends for treatments as a result. The BMT patients can be the most time consuming in that you need to be present for a morning and evening treatment, both of which last an hour.

I'm curious how your weekends are staffed. Are attendings required to be present any time a machine is on? Only for new starts? Thanks in advance.

 

[medgator]

we did the same thing in residency.... only needed an attending to staff consults where we would be sim/Tx'ing over the weekend

 

[ramsesthenice]

We do the same thing. But I would say most weekends we dont treat anyone. We have a pretty busy service averaging about 120 patients on 4 machines plus a CK. Maybe we are just lucky? We work most weekends but most of our weekned work is meeting new consults which can usually wait until Monday for treatment. We have some very senior faculty and as a result when we do treat new patients on the weekend we do a lot of clinical set ups which I think is a great experience as a resident.

 

[deleted18755]

So when you treat on the weekends there isn't an attending in the department (or even in the entire hospital)? It's probably not a patient care issue since I'm sure there is an attending on call, but from what I understand (and I definitely could be wrong) this can in some situations present a serious billing issue . . .

 

[johnbeck]

So when you treat on the weekends there isn't an attending in the department (or even in the entire hospital)? It's probably not a patient care issue since I'm sure there is an attending on call, but from what I understand (and I definitely could be wrong) this can in some situations present a serious billing issue . . .

Yes. There are no radiation oncology attendings present unless a new treatment is being initiated. The residents are asked to man the machines without an attending present on the weekends for ongoing treatment. I have no idea how billing works, I just know that is our policy. I assume this wouldn't be done if there were billing issues... but I could be wrong.

 

[DermViser]

Hi Friends,

I was curious how your residencies handle weekend coverage. Ours is as follows:

1. If there are patients for whom treatment needs to occur on the weekend, and they are in the midst of their treatment (i.e. on their 5th out of 19 fractions for breast cancer and need treatment because a machine was down for a few days), the residents cover these.

2. If there is a new consult on a Saturday, Sunday or holiday that needs urgent treatment, then the attending must come in with the resident to staff the consult and initiate treatments.

As residents, when on call, we are coming in most weekends for treatments as a result. The BMT patients can be the most time consuming in that you need to be present for a morning and evening treatment, both of which last an hour.

I'm curious how your weekends are staffed. Are attendings required to be present any time a machine is on? Only for new starts? Thanks in advance.

Wow, I'm actually shocked that there actually is call for radiation oncology residents, or is it CINO (call-in-name-only)?

 

[stems]

Yes. There are no radiation oncology attendings present unless a new treatment is being initiated. The residents are asked to man the machines without an attending present on the weekends for ongoing treatment. I have no idea how billing works, I just know that is our policy. I assume this wouldn't be done if there were billing issues... but I could be wrong.

That's actually medicare fraud being committed by your faculty.

 

[medgator]

That's actually medicare fraud being committed by your faculty.

Not really. Probably a gray area.

Fraud would be using an np or pa, or just having the therapist treat by themselves

 

[medgator]

Wow, I'm actually shocked that there actually is call for radiation oncology residents, or is it CINO (call-in-name-only)?

There are some rad onc emergencies. Not too often but they do happen. Nonoperable cord compression, brain mets, uncontrolled bleeding from lung or cervix tumors to name a few

 

[Neuronix]

1. If there are patients for whom treatment needs to occur on the weekend, and they are in the midst of their treatment (i.e. on their 5th out of 19 fractions for breast cancer and need treatment because a machine was down for a few days), the residents cover these.

Attendings only cover those here.

2. If there is a new consult on a Saturday, Sunday or holiday that needs urgent treatment, then the attending must come in with the resident to staff the consult and initiate treatments.

Same. Attending is supposed to come in to see any new consults. That is, if a resident sees it, the attending is supposed to come in as well. That doesn't always happen. That said, if you aren't considering a weekend treatment, the consult can wait until Monday morning.

Though if there is a new weekend sim and treat, you are expected to be there and do as much as you can by yourself for learning purposes. It just isn't all that common here--maybe one or two a year per resident.

As residents, when on call, we are coming in most weekends for treatments as a result. The BMT patients can be the most time consuming in that you need to be present for a morning and evening treatment, both of which last an hour.

I'd say I have to come in maybe 1 in 4 weekends on call. Our call is mostly just questions per phone which is really triage (GO TO ER NOW, come to our urgent care facility, wait until Monday, call in meds, etc) and I probably average about one call per day.


The billing rules about residents covering treatments have been discussed about this a few times at our institution. Apparently it is some sort of gray zone. I have some minimal understanding of it, and there is some ambiguous wording to the billing rules that people interpret differently both within academics (attending vs. resident being qualified) and in private practice (does it have to be a rad onc attending present or can a med onc or other physician be in the area).

 

[stems]

Not really. Probably a gray area.

Fraud would be using an np or pa, or just having the therapist treat by themselves

What you're stating is flat out incorrect. Medicare requires attending presence and supervision during treatment. Maybe these institutions attendings want to believe that it's a gray area, but come an audit (or a disgruntled resident) they'll be screwed.

 

[medgator]

're stating is flat out incorrect. Medicare requires attending presence and supervision during treatment. Maybe these institutions attendings want to believe that it's a gray area, but come an audit (or a disgruntled resident) they'll be screwed.

Would love to see a link to that. Medicare supervision requirements afaik require M.D. presence of someone who is knowledgeable And able to furnish assistance when needed. A rad onc resident may be able to fit that bill. Perhaps the requirements are specific to academics.

A med onc or mid level wouldn't fulfill that requirement

 

[stems]

Would love to see a link to that. Medicare supervision requirements afaik require M.D. presence of someone who is knowledgeable And able to furnish assistance when needed. A rad onc resident may be able to fit that bill. Perhaps the requirements are specific to academics.

A med onc or mid level wouldn't fulfill that requirement

Yes I'm talking about a resident who is in-training at said institution. Medicare requires residents to be supervised (unless they're a board eligible PGY-5).

 

[medgator]

Yes I'm talking about a resident who is in-training at said institution. Medicare requires residents to be supervised (unless they're a board eligible PGY-5).

Fyi

https://www.astro.org/Practice-Management/Reimbursement/Medicare/Supervision.aspx