Residency Roundup: Duty Hours

I have noticed several reoccurring questions on our LDW facebook group about residency!  LDWblog is a perfect platform to provide answers that will be helpful to current and future resident wives. 

This week there was some questions/concerns about residency work hours and restrictions.  While I'm sure there are differences between how each specialty applies the rules, I wanted to post and dissect the real ACGME 2011 regulations for your guidance and information.
http://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-ComparisonTable2003v2011.pdf

Here are my 'favorites':

-Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities and all moonlighting.   http://www.acgme.org/acgmeweb/Portals/0/PDFs/dh-faqs2011.pdf  for more information in their FAQs.  You get desensitized to the 80 hour weeks!  Its the weeks that push that four week average up that are brutal.  I overheard someone who works for the state department, joyously talking about how much overtime pay they received for working only 52 hours...wouldn't that be something!  The second link to the FAQs has some great followup examples and explanations.  I personally did not expect all the Journal Club, Dissection Lab, Tumor Board type meetings that keep DrH away from home that is not added into the '80-hour work week'. 

-A Review committee may grant exceptions for up to 10% or a maximum of 88 hours to individual programs based on a sound educational rationale. So what programs cannot justify the 88 hours? Although they are suppose to get permission first;)  I know of a program (not ours, I promise) that keeps to the 80 hr average but has 'volunteer shifts' that put the intern hours way above regulations.  

-Residents must be scheduled for a minimum of one day free of duty every week (when averaged over four weeks).  At-home call cannot be assigned on these free days.  Four a month.  Are weekends really two days long??

- Duty periods of PGY1 residents must not exceed 16 hours in duration.  Seemed like a good idea.  But it makes the other PGY years make up for the hours.  PGY2 was not awesome.

-Duty periods of PGY2 residents and above may be scheduled to a maximum of 24 hours of continuous duty in the hospital.  Programs must encourage residents to use alertness management strategies in the context of patient care responsibilities.  Strategic napping, especially after 16 hours of continuous duty and between the hours of 10:00pm and 8:00 am in strongly suggested.  I find this standard a tad humorous... strategic napping...where and when does that fit in? At the computer? On an extra gurney? Haha...who likes to nap when your ridiculously loud pager can and will go off at any minute? 

- It is essential for patient safety and resident education that effective transitions in care occur.  Residents may be allowed to remain on-site in order to accomplish these tasks; however, this period of time must be no longer than an additional four hours.  This is a huge one!  Although, it covers practically any variable that could keep DrH at the hospital, it defines what their real job is: patient care and learning.  They cannot leave after stitching up half an ear, or ditch the last clinic appointment because time is up!


Hopefully, as this year moves along we can focus on the time together and less on time apart!  

Cheers!

Cami

Pain Management Fellowship

We have endured the non-match Pain Management fellowship application/interview process and have accepted a position in Lubbock, TX.  We have done med school and residency here, so I guess we will be here for another 2 years.  The obvious plus side is I don’t have to move or sell my house just yet.  The down side?  The dust and not getting to see another state.

Has anyone else done all their medical studies and training in the same city? Just curious how common this is?

Healthcare Reform

Like many of you, I have heard a lot more this week about Healthcare reform and the government, and how the AMA feels about it. I realize this issue is pretty personal for all of us and will/does affect us in many different ways. It interests me to hear other physician wives opinions on this matter though. Have any of you done research into how this might effect your husband’s specialty? I have been looking over lots of articles in the past couple of days and am discovering that this could have major ramifications for those doctors who enter into Interventional Pain Management—mainly because many of the procedures are voluntary and would most likely not be covered because they might not be considered necessary treatment.
What have you been hearing about your husband’s future in medicine? Are there any parts to the healthcare reform that you truly hope they really work on to come to a better solution for everyone? What concerns you as a doctor’s wife? What concerns you as a citizen?

Let’s try to remember that this is a hard issue to discuss. I encourage you to read over your words before publishing your comment. This discussion is not meant to offend—instead I hope we all can learn from it

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just happy news to share

As I mentioned before Damian will start an infectious disease fellowship in July which means 2 more years before we are done but he had been toying with the idea of doing two additional years of critical care after Infectious Disease, which I supported even though I didn't really like it, because that would have been 4 more years until we were done. Well, last night he told me that he wasn't going to do critical care. so YAY! the end is closer!!!

Decisions, Decisions

I'm wondering what routes your husbands took that ended them up in Med School and what specialties they thought they might want to do before they ultimately deciding what residency they wanted to go into. (some of you are not to residency, but you can tell us what they are considering)

For instance: My husband always wanted to be a doctor. He participated in an organization that took him to the local hospital in high school to learn about medical fields. He got his first job in that same hospital after high school. He went through college earning a BS in Biology and Computer Science (his backup if Med school didn't work out), and got into med school after working for one year as a computer programmer for the state. Upon entering med school he toyed with the idea of becoming a surgeon (heart surgeon was one I remember him talking about) and then we had our son and he decided that was too busy for him. (He really likes his naps and family time). He wanted to do procedures and still be able to be in the surgery room, so he looked into Anesthesia--Pain Management specifically. He is now a PGY-3 in Anesthesia and applying to Interventional Pain programs...and loves it.

PA school?

Does anyone have experience with Physicians Assistant school or know someone who has? Do you know any where to go to get information on it? Perhaps a blog? ;o)

Night Shifts

Melisa posed a question to me:

I have a question for you Leann. ER seems like such a tempting

specialty because it is shift work and there is no call. It seems like

you'd have fewer shifts a month than regular specialties. But I

wonder, if they spend the following day recovering from a night

shift, it is technically like they are gone for a whole day instead of

just a shift, essentially losing double the time from the family. Is

that how it is? Are you glad he is in ER because of the shift work

and no call? Or does it not seem worth it? I know it would be great

to not have call. You can't plan anything. I always assume that if

Brad is on call, he is gone. I'm kind of like Pavlov's dog. I hear a

pager buzz and my heart drops.

I will do my best to answer your quesitons. I'll try to explain some of his residency program, but I have to admit, it is hard to know how to compare crazy ER shifts to being on-call. Brian's program, unlike other residency programs, has them working no call hours at all. He hasn't been on-call since med school.

When he was deciding what specialty he best fit into, he came to the realization that his ADD-ness, and inability to get stressed-out were particularly useful in the ER and in OB. Those were the two he narrowed down to. He LOVED OB. The office visit portion was not his cup of tea, but managing labor/delivery excited him. Having a mix of office/action/surgery was a perfect fit for him. There were 2 major downfalls to OB, though. (We'll leave out the GYN part. We all know that sucks.) The malpractice insurance. He was concerned with the portion of his paycheck that would be deducted to cover malpractice. The second reason was because of the hours.

The ER offered a similar mix of office/action, without such a high insurance rate, and with shift work. However, he would have to let go of the OR, and the rush of delivering a baby.

In the end, it boiled down to office hours + call hours vs shift work.

Shift work won hands down, and we are both glad for the decision that we made.

One thing I love about shift work is knowing when Brian will be coming home. The rotations that he does in other specialties drive me nuts. I dread seeing 'surgery' written on the family calendar, b/c I know that means staying late. With the ER, there is a new set of doctors walking in the door at 6:45. Patients are handed off to the next physician. Brian walks out the door.

There have been a just few times that he has stayed late, maybe 3x a year. The reasons are usually a patient who has labs returning quickly then will be discharged, or a patient who is about to be transferred to another floor and explaining the case would not be worth just staying and managing the patient.

One of our big concerns about the ER was the required night shifts. The night shifts do put a wrinkle in the family routine, but we are learning to adjust. It is getting easier as the boys get older. Nights are hardest on me as I dont sleep well, and have to go into a 'survival mode' of sorts. However, the night shift is the one that allows for the most time spent with the boys.

Here is one of his schedules from a 31 day month. His work schedule is written in black. His home routine in red.

Day Schedule

1--7p-7a

2--off sleep from 8a-3p. awake from 3p-about 2am to stay on night schedule.

3--7p-7a awake @ about 10a. family time until he leaves at 6p.

4-- 7p-7a sleep from 8a-3p. family time from 3-6 when he leaves for work.

5--off sleep from 8a-3p.

6--off attempt to stay in 'night shift mode'

7--off sleep from 2a-about 10a

8--off

9--off

10--7p-7a leave for work at 6p

11--off sleep from 8a-3p, stay up until 2a

12--7p-7a sleep until 10a, leave at 6p

13--7p-7a sleep from 8a-3p, leave at 6

14--7p-7a ditto

15--7p-7a ditto

16--off sleep from 8a-3p, go to bed at normal time

17--off "normal" day schedule

18--7a-7p Leaves for work @ 6a, arrives home @7:30p

19--7a-7p reads 4yr old a story before he goes to sleep

20--7a-7p most often the baby is already asleep.

21--7a-7p Brian does not see the baby on most 'day shift' days. 4 straight days here.

22--off

23--7a-7p and sees the 4yr old only long enough to read him a couple books.

24--off

25--off

26--7a-7p he also does not get to eat a meal with us on day shift days.

27--off

28--off

29--7a-7p

30--7a-7p

31--7a-7p

He keeps reminding me that his residency program is really resident-friendly. His program does not allow their residents to work more than 12 hours in a 24 hour period *in the ER*. And they are not permitted to work more than 24 hours in a row when in other rotations, or when moonlighting.

He does have twice weekly meetings from 7a-9a on monday/wednesday. These meetings are required attendance unless they have a really really good reason for missing. If he has just come off a night shift, he must stay for the meeting. ((these meetings are a thorn in my side, and I think I am most excited about getting rid of them when he graduates. forget about any of the other perks. lol))

His first 2 years, he worked mostly in rotations. They covered every area of the hospital, and a few in a neighboring hospitals. The last 2 years are even/odd--even months in the ER, odd in a rotation.

um... I kinda got off on a rabbit trail there. sorry.

Back to your question. Is the hassle of a night shift/night shift recovery better than being on-call? I don't know. I think the answer would be different for every doctor, every family.

My husband actually preferrs the night shift. He has even dared to call it a 'perfect fit.' He gets to work during the busiest part of the day, and it allows him the most time with our kids. Now, if we could just figure out how the two of us could survive on night shifts without having to enter survival mode.... it would be smooth sailing.