Ok, so every Wednesday we have Grand Rounds (which I explained on my post 10/24/07.) So I had to go in slightly earlier to pre-round on my patients and then sign them out to one of the other interns so that I could go to Grand Rounds. After 5 1/2 hours, my colleague and I returned to see what was going on in the unit. One of my patients had been discharged (orders written by the senior resident) and the other was leaving the CCU (transfer orders written by the senior resident.) The new Medicine intern joining the service today asked if I would change short call with him and take it tomorrow instead meaning I could leave early today (as in 30 minutes after getting back to the unit after Grand Rounds.) Oh, yes, I would, and did.
Let me explain: in the late 1990's, two NY residents sued the Residency Board stating that too many long hours were leading to patient deaths, resident deaths, and were not conducive to a good learning environment. So several new resident rules were passed: an 80 hour work week maximum, a 30 hour limit to being at the hospital, a mandatory 24 hour period off per week, and a 10 hour limit between shifts.
Suddenly, all of the work force in the hospitals needed to be replaced since residents, per the rules, couldn't work those 48 hour long shifts anymore. Hence, there are now more "mid level" providers such as nurse practitioners and physician's assistants to make up the work force. And, to keep residents within those limits, a lot of residency programs instituted an overnight "float" team. This team takes call Sunday through Thursday in-house from 8 p.m. to 8 a.m. We take "short call" from about 2 p.m. to 8 p.m. admitting and managing our own services until we sign out to the overnight team. On Fridays & Saturdays, we take "long call" working 24 + hours (with a maximum of 30 mind you) so that the Float Team gets their 24 hours off.
As an aside, one of the consequences is that suddenly everyone wanted to go into surgery because most people had been deterred by the long hours. 80 hours is twice the normal person's usual work week, but much better than the 120 - 140 hours which used to be de rigor in surgery. However, the drawback is that programs are having to hire more mid-levels which take away from the residents' learning opportunities, and programs are also finding that residents are not meeting their number of required cases. There's a movement to lengthen the usual 5 year training to 7. The alternative is the combined programs (Vascular surgery, plastic surgery, etc.) which complete a fellowship specialty in 6 years instead of adding another 2 years to the end of general surgery training.
Doesn't matter to me any more since I am now in Emergency Medicine. One of those fields that never had a problem with hours or overworking its residents. However, when we rotate on different services, we get caught up in keeping the mandatory limits on hours.
As for me, I am now taking short call tomorrow, and long call on Friday, so we'll see what admissions I end up getting then.
I tried to think of a good rating system today during my meetings. I couldn't come up with anything. After a day of rounds and short call, we'll see what I can do tomorrow. For now....
CCU Countdown:
Days left until the end of the rotation: 25
Actual number of days I will be working during that time: 22
Number of days until my next 24 hours off: 7
Days left until current painful attending leaves: 4
Number of short call shifts remaining: 4
Number of long call shifts remaining: 3
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