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Almost There

April 28, 2019
by Mark David Siegel

Hi everyone, 

We’re almost there. Thanks to your candor and creativity, we’re closing in on a better system for overnight call. We won’t satisfy everyone- particularly those opposed to any call and those opposed to adding night rotations- but we’re fast approaching a system that will significantly improve wellness and education. 

Here are the highlights: 

  1. Inasmuch as possible, we’ll limit rotations with q4 overnight call to two weeks in length. This year we implemented a similar limit for interns in the MICU and it helped a lot. Scheduling challenges may preclude limiting all call rotations to two weeks, but we’ll try to do this as much as we can.
  2. On Fitkin, with the help of the hospitalists, we’ll continue the system implemented several weeks ago, which stops admissions to the resident from 3-6 AM. This system should give residents a chance to rest.  Preliminary feedback has been quite positive.
  3. We will likely end most 28-hour call in the MICU. To do this we will move a resident into a night rotation and eliminate the day float. Day teams would take only occasional calls to cover nights off. The new night rotation would be offered to both PGY2s and PGY3s, and we expect it will be clinically and educationally fantastic. Residents would work one-on-one with our exceptional MICU night attendings, admitting patients, perfecting ultrasound skills, and performing procedures. To the extent that nights are staffed by PGY2s, some PGY3s will be assigned to day teams. Residents with strong preferences for days vs. nights can tell the rising Chiefs, who will take preferences into account when making next year’s schedule. 
  4. We will be able to implement these changes without decreasing elective time or pulling residents to cover nights.
  5. Other plans and negotiations are ongoing, particularly efforts to improve call on Oncology and at the VA. We will follow up on these plans as soon as we can.

So, to summarize, we should have less overnight call next year, and the remaining call rotations will be shorter in duration. We will make these changes without compromising electives or pulling residents to cover nights. Most importantly, these changes should improve education and resident wellbeing while keeping our patients safe. 

Decisions aren’t final yet, so now’s the time to share your thoughts. Let me know what you think, and please respond to the survey the Chiefs sent out yesterday. A special shout-out to the overnight call working group and all those who have shared their opinions and ideas along the way- your input has been priceless.  

With that, I’m on my way to the MICU to join my on-call team,

Mark 

PS: Please vote for this year’s graduation award winners: 

https://yalesurvey.ca1.qualtrics.com/jfe/form/SV_5cZWZCIABatM8Sx  

Honor your colleagues, teachers, and staff! The deadline is April 30th! 

MDS

Submitted by Mark David Siegel on April 28, 2019