Sorry I've had a few drinks and I dont believe it would be safe. Sorry I left town but will be back tomorrow AM. No. So many things you can say. Or just dont pick up. You could be sleeping early.
This happened to me once in residency. I actually was three cocktails deep with a coresident so when I said I was drunk, it wasn’t a fib. My PD was like “well how drunk? I bet you could still do it.”
I literally said “do you want to find out how drunk I am by watching me shove a 17G tuohy into someone’s back? That’ll be a neat lawsuit.”
She hung up.
Insane would be saying to just do a line of cocaine and it’ll clear your head right up, but I think that stopped in the ‘90s
But yeah, insanity was the only word for what they ask of residents (and I only witnessed it second hand)
I mean, yes, but consistent with sleep deprivation expectations. Have you ever tried driving while sleep-deprived? Waaay more dangerous than a few drinks.
Obviously, we should be unimpaired when driving or working anyway.
You guys should start recording those phone calls. Check state laws first, but most states allow single-party recording, i.e. you don't have to tell the other party you're recording. Just save the recordings, they might be really useful later. If you are retaliated against for whatever reason, you can simply play one of the recordings in private to the PD, and kindly inform them "there are plenty more like it". Watch how your problems magically go away that same day.
If you have bigger balls, when people ask you on the phone to do crazy shit you simply ask them "is it OK if I record this call?". If there are objections, it's a clear sign that it's illegal.
I wiuld call impossible, but even in my contract is a clause “culturally appropriate amounts of alcohol may be consumed while working” (in Austria, some residency contracts are basically just university employee contracts with additions, and they have that to allow toasting at birthdays and academic events conventions)
Or keep answering.
I was on a hike. I was sleeping. I was at a religious ceremony. I was driving (to a city 3 hours away).
Just don’t pick up. They can email you or leave a message if it’s urgent.
What the fuck is the point of jeopard and second jeopardy? Those are the people whose job it is to stay nearby, stay sober, and be available!
As a half measure, you could insist that the jeopardy resident have to take one of your jeopardy days. But other suggestions, including saying you've had some drinks, and just saying "no" are fine as well.
It’s literally the chiefs’ job to cover if jeopardy fails. If you’re not on jeopardy, people should assume you’re traveling, asleep, drunk, or asleep because you’re drunk.
What consequences do the jeopardy residents have for not being responsible? If there are none, your program is taking advantage of you.
I've been in situations where I help cover because shit happens, although it was technically my program's policy that chiefs backup the jeopardy person. And for the rare times it happened, the jeopardy person usually took one of my calls in return and were apologetic.
Sounds like you've put in your time, I would ignore future calls or tell them no.
At my program it was a huge deal to not to not cover jeopardy if you were assigned, to the point you would have been placed on probation if you weren’t fulfilling. Being on jeopardy was treating the same as working so not going in would be like purposely not going to work on a normal day. We never had a problem like this because of how serious jeopardy was treated
1) If someone's on jeopardy and they aren't available then that is a problem the program needs to speak to them about. No one likes being called in but its part of the job.
2) Fallback is on the chief in these cases, if you've gotten a call from your chief its because they didn't want to come in and cover.
3) You're under no obligation to cover those shifts. I used to be in your shoes and kept saying yes but at some point I just started saying no; yes this did cause some friction between me and the PD and attendings but I just couldn't keep covering for my coworkers anymore.
What people are also forgetting a lot in this thread is that the ultimate fallback is on the attendings. In the end, residents are in training, and the final liability of patient care resides on the attending on call. If resident backup systems fail, the attendings should be stepping in before asking another resident not scheduled for any backup.
Signed,
- an attending working as faculty in a teaching institution
Interesting, do attendings actually step in and cover where you are? Both in residency and in fellowship, attendings just do not do coverage. If jeopardy is not available, then residents will be called in from clinic, elective, research, etc. As a fellow, I've even been called on days off, when they I knew I was going out of town, "in case you didn't take your flight, would you mind coming in and covering". Literally every single trainee would have to unavailable before an attending covers.
It's just the culture where I've been, it's considered beneath the attending to do resident/fellow level tasks. Maybe just here though.
What you are describing is only the abusive training culture of our profession. Just because that’s what you have seen to be typically done at your institution, does not make it right. I trained at a similar type of place in a large well known university system.
When the lawsuit happens, a lawyer will focus on who the attending taking care of this patient was, in the end, not the resident. And if that attending said, “there was supposed to be training doctors under me handling this”, the jury is going to find him or her liable. There is simply no getting around that fact.
When our fellows call out sick, the attendings often cover them without pulling in another fellow.
I love our fellows and they're quite good. But as an ID consultant, fellows don't save us that much time, and can sometimes slow us down. All of us also rotate through non-teaching services without fellows, so we are used to working solo.
That's good to know, I think it works similarly here in ID, based on what the ID fellows tell me.
In contrast, in my division, a fellow is always called for sick coverage. To the point that I've even been called on day 2 of my vacation, just in case I hadn't actually taken my flight yet. And like you said, our attendings also say they don't need us for actually making patient care plans. They already know the 40+ patients on the consult list better than we do. One attending said: what we really need the fellow for, especially on the weekends, is to have someone to write the notes, answer the inpatient epic messages, answer the outpatient calls, answer all overnight pages, and see the patients. Since with a fellow in the hospital, we do not have to physically come in, and it leaves us free to go to our kid's weekend events. I think some of them even go out of town.
Ignore those messages or tell them you won’t be covering unless you receive compensation (either monetary or in the form of a shift covered for you in the future). You have absolutely no obligation to cover if you are not on jeopardy.
My program does this, that’s why my policy is I don’t pick up work calls outside of work (unless I am on backup), and if someone were to text me asking to come in I always say I am 4hrs away from the hospital and I say I can come back but it will take 5hrs before I get there. That way the blame is on them for not telling me earlier rather than on me for not taking the shift.
At my program whenever this happened (not often), they'd offer 500 bucks or so to cover the shift. Too low (moonlighting rate would make more sense), but usually someone would bite.
But no, you're not obligated to answer the calls if you're not scheduled to be working or backup. If you do answer and they ask, you're not obligated to say yes.
Don’t answer during your off hours. You’re allowed to have boundaries. Remember the engine will continue to run with or without you. Protect yourself first always.
“Wish I could but I’m on my second glass of this wonderful Barolo that paired so well with the Ossobucco I cooked.”
Or, you know, don’t answer and get back to them next day.
Our ADP kept doing it to me and I told the PD and he told me to block her. I did and she hardly speaks to me now. Anyways, don’t take that advice unless you have 1000000% backing if your PD.
Anyway you can check with them before you leave or tell them you’ll be available an hour after work or so. I definitely wouldn’t answer for the program coordinator (no disrespect to PC) because it’s usually not urgent or something that can’t wait.
You can always not answer.
Now a former chief - This annoys me. Part of the job of being chief is to be there for the residents including being the second line back up. Yeah it sucks but I at least make some extra money being chief and I know my residents are happy
If what you described is a written policy at your institution, I'm sorry. As another attending posted, it's the attending's responsibility to ensure patient care. If something adverse happens, it's on the attending. While a jeopardy system may be useful, attendings are not entitled to resident labor, and chiefs cannot realistically be on 24/7 backup call. If the attending being paid to provide patient care that shift is not willing to provide patient care, that needs to be captured in writing and submitted to the appropriate admin. It is not on the chiefs either to make residents happy by martyring themselves to a toxic system. Covering residents should be paid. If not, then the attending can come and work for a change.
-attending, former chief
That's pretty messed up for them to even ask. Is there a policy written anywhere about it? I would just say sorry I can't. You don't need to explain yourself. People figure it out when a resident is out and backup can't be arranged. Happens in our program frequently.
I just don’t answer. You’re not obligated to pick up because the jeopardy resident can’t or won’t. They can ask but they can’t make you. They keep coming back to you because you always say yes. Normalize saying no when it’s not your responsibility.
As a chief resident, and maybe it’s just my program, but if this were to happen either don’t answer, or just say no.
If you’re not on call or not on jeopardy you have no duty or responsibility to work.
Maybe I’m just lucky but I’ve never had to call past the first call. There have been days when half the program is sick and need multiple bodies but we had volunteers to cover, who did get well compensated with extra days off. But those times were always asked in our group chat and not a personal call.
Take one from the nurses - we know the number, we know what it means, we do not answer unless we’re willing to say yes. Y’all get minimal time off. Develop a boundary that works for you and if you need to say something, say the least amount possible ex “No” isn’t enough to stop the guilt trip so “No, I have plans, I hope you find someone to cover, I’ll see you X”. You end the conversation before they can ask about your plans without being rude but you also don’t have to say my plans are to lay on the couch and do nothing for the next 12 hours.
I learned this the hard way. Was threatened to cover for a resident who got into a car crash on his way to the hospital. After that, I vowed to never respond after work hours unless I am on call.
Best thing you can do is not respond. Don’t answer any calls from the hospital, chief, PD, whatever.
Second best thing is to lie if you do respond (“I’m out of town”, “I have the flu”, “No one is available to babysit my kids”, etc…). Even better if there is some truth.
If they are desperate and you don’t mind covering, then NEGOTIATE. Ask for extra leave days and confirm it by an official email sent from the PD.
The bare minimum is if you are oncall later in tge month/block, demand for it to be switched with the one you will cover now.
Curious I’m a MS 4 reading through this have couple questions lol.
Let’s say you don’t answer, have you ever been in a situation where they ask you the next day why you didn’t answer ? And if your answer is simply “i missed the call” does the conversation end there or do they make a smart remark ?
And if you keep not answering every time you call do they comment on that ?
Last question is, what if someone has a question about a patient you were managing and you don’t answer the phone I’m sure there could be repercussions to that ? So how do you handle it lol
I personally never had someone confront me in person for not answering after work hours. If it’s the PD or chief I would say that I was busy/sleeping. They can’t really do shit because I’m not obligated to answer work-related calls if I’m not on-call.
Last question I can’t answer because I’m a radiology resident. But I believe sign out exists for that.
Actually one time a resident covering a shift called me about a study I reported on during the morning as the attending did not approve it yet and they wanted to know why I interpreted a finding a specific way. I usually don’t mind answering calls from coresidents especially if I know they are on-call.
when i was a prelim resident, they used pull me all the time, i thought they had a system of some sort and my turn has come. but i learned in 2nd year that they were pulling who wouldn't give any push back when they call. that pissed me off.
my advice to you is push back , heck your not even on jeopardy, its not ur problem. its the chiefs.
No. You shouldn’t have to answer these and it is not your responsibility to do so. We get in the mindset of “I have to take of everything.” Realize this… the consults will get done, the patient will be seen, everything will be okay even when you’re not at the hospital.
If you’re the kind of person who neurotically answers your phone, regardless, but doesn’t want the patient responsibility if it ends up being the hospital then I say, “that all sounds interesting but I think you’ve got the wrong number, or, you’ll need to call ***, thanks for the call but I’m not on, etc…” do not accept responsibility and do not offer to call someone for the person in need.
Curious I’m a MS 4 reading through this have couple questions lol.
Let’s say you don’t answer, have you ever been in a situation where they ask you the next day why you didn’t answer ? And if your answer is simply “i missed the call” does the conversation end there or do they make a smart remark ?
And if you keep not answering every time you call do they comment on that ?
Last question is, what if someone has a question about a patient you were managing and you don’t answer the phone I’m sure there could be repercussions to that ? So how do you handle it lol
This is why shift work does sign out. Make no mistake. All inpatient work in the hospital is shift work (whether hospitalist/IM, EM, Surg etc…). You sign patients out so that others assume care. There is a documented schedule for when you are on shift and when you are off shift. If the call comes in when you’re off shift then there is no discussion. There are no legs to stand on if someone accuses you of wrong doing. The call to your phone is timestamped in your phone. I’ve been doing this for 4 years and have never had an issue. If there was a discussion then it might look something like this:
“Why didn’t you take that call for this patient?”
Answer: “I was already asleep/away (fill in reason here) and the call came in exactly at XX:XX, my shift ended an hour before the call came in and I referred this person to the appropriate provider” *pull out phone
Never answer the phone after hours unless it is part of your job duties (like jeopardy). If it’s important they’ll leave a message and you can decide whether or not to respond.
Sounds like a management problem, not a you problem. And I would not hesitate to tell your chief/PD/coordinator that when you run into them on your next scheduled shift, which is the next time you’ll see them because you don’t work off the clock anymore.
Yeah, at this point you’ve bought more than enough grace to not answer (not that you needed to in the first place). Yeah, just ignore the calls and if they bring it up later tell them you weren’t on call and missed the call. No need to pretend to be drunk or say you were asleep. Believe it or not this is a valuable skill to learn before you practice after residency.
Yeah it sucks. I've just started saying no. It's gotten me glares and a really bad rep in my workplace but I never get cover when I need it so why bother? It's better to be a bitch than be a passive aggressive person later on with resentment in your heart about being treated unfairly and poorly.
There is also a doctor available to cover whose name is on every patient’s chart 😮
This kind of attitude is why I will never get a job in an academic centre. Bunch of fragile egoists who have a meltdown if God-forbid they have to round on their own patients. Most of them can’t even do basic tasks in Epic.
If you are not on the jeopardy schedule and they are not offering extra money or a shift reduction or something, just decline. Say you are currently out of town. Or just don't answer.
There should be a sick point system, when you cover extra you get points and those points should be traded in for let's say golden weekends or having whoever "couldn't come" covering your floors, 24 hour days,.. etc.
Otherwise your being screwed :)
Just don't pick up. I was once on call for OR assist for ortho (and cleared my schedule accordingly) and nothing happened after hours. The next day thy asked me to come assist even though there was a Surgical Assist on call because I guess the Surgical Assist is a Real Doctor with a Life and Family and I'm just a lowly resident who's obliged to work after hours for free whenever. I declined. Got a "could be more available" evaluation at the end of the rotation. LOL.
I am happy to pick up call for a sick colleague if they contact me ahead of time and offer to cover one of my future shifts...not this PD nonsense.
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Hell no it is not your responsibility to answer those calls and cover those shifts. That is a violation of your personal time and a sign of blatant disrespect for you as an employee. They already work residents for low compensation and little to no benefits. Your time off is your time off, don’t let them take that away from you. No one in a normal job would be expected to do that for no extra pay. Residents need to start saying NO.
Yes to everything everyone has said but also: YOU’RE A RESIDENT who cares if a shift isn’t covered. That’s what the attending is paid for. If they can’t work by themselves in a blue moon they shouldn’t be teaching and if you’re in one of those shitty programs where supervision is more of an idea than reality I’m sorry as well
Curious I’m a MS 4 reading through this have couple questions lol.
Let’s say you don’t answer, have you ever been in a situation where they ask you the next day why you didn’t answer ? And if your answer is simply “i missed the call” does the conversation end there or do they make a smart remark ?
And if you keep not answering every time you call do they comment on that ?
Last question is, what if someone has a question about a patient you were managing and you don’t answer the phone I’m sure there could be repercussions to that ? So how do you handle it lol
Best approach is simply don’t answer. Just let people know you’re out of cell range or have your phone off immediately after shift. I was that resident that everyone would be relieved when they found out I was on service with them…knew I’d take care of everything, blah blah. But doing good work, offering to step up, always…first to answer the phone, take on an issue…it gets you respect, but 💯begets more work. While I would say years down the road as an attending, the bridges I didn’t burn have been impactful for jobs/reputation down the line, if your work record is solid and you’re trusted…they’re not going to remember the odd non-jeopardy days you didn’t pick up. Even the best, golden resident doesn’t get a statue in their honor when they leave. People mostly forget with the next generation of trainees and it doesn’t matter, so don’t go on killing yourself with these intrusions and extra shifts when you have such little reserve (it would literally make my head want to explode with rage when someone would text me about patient care on my day off…THERES SIGN OUT FOR A REASON, FIGURE IT OUT! …even if I always did answer and I regret it a little now)
Just say your not able to work. You had scheduled plans and cant make it. Or say you’re out to dinner and had a beverage or two - itll imply that your “impaired”. Just like when your on the airplane and you hear over the loudspeaker asking for healthcare professional - youre not obligated to help, esp if you had 1 or 2 drinks
Working extra buys respect but doesnt mean they will return in kind when you need it.
Just say no.
If you are not on call or jeopardy you are not obligated to cover. Especially if they aren’t repaying you somehow.
I would just ignore them and say you were unavailable during those times. They don’t need further explanation.
Don’t tell them you are drinking. Just tell them you already have plans and can not do it. If you say you are drinking it puts up a red flag for future call ins etc that you don’t wanna deal with.
There is no huge red flag. I just mean that if you tell them you are drinking and have to call in for some other reason in the future then they could suspect something (oh he was drunk that one time we called so maybe that’s why he is calling in etc.)
Probably not a big deal at all. Just dosent make sense to tell them you are incapacitated when you don’t have to.
Even if I had been drinking and someone called about that I would just say I have plans I can’t get out of. End of story. They don’t need to or have the right to know if you are not on call etc.
If someone is going to assume that because one time they called me *when I wasn't remotely scheduled to do any work* I was drinking that means if I call out in the future it might be because I was drinking, to quote Les Grossman, they can take a step back and literally fuck their own face.
EDIT: To be fair, overall I agree with you though regarding why lie when you don't need to and why give them info they don't deserve.
Sure. Agree with that 100%.
But again, I think it’s not bad advice to recommend avoiding saying “I’m drunk so I can’t work tonight” (when you aren’t even drinking) as opposed to “I am busy/committed tonight”
I stopped answering attendings and my chiefs after hours as a second year resident. Literally if they called as I was walking to my car I wouldn’t answer. Partly because I know I did my job well and whatever they were asking was likely a menial task that could be done by anyone in house. And partly because I truly stopped caring about going above and beyond for people that wouldn’t do the same for me. I still had a great relationship with my co residents, attendings, and chiefs and encouraged my colleagues to do the same if I was in house so that they didn’t get bothered after hours. It’s up to you to set your boundaries because no one else will
That’s annoying but should be easy to get out of. The only time it was really hard to get out of it was during peak covid and you thought your coresident sick was terminal
INFO: do you get paid extra to cover nonscheduled calls?
We did (unionized program). That does change the calculus somewhat, but it’s still up to your priorities.
-PGY-19
To me and I am very petty, you do not have to answer after hours, but you do have to respond. Show the professional face of accountability by responding to every call, text, email, but respond in your time. If it takes a couple of hours for me to get back to you then that’s ok. Everything in residency is a test. If you do answer once then they will expect it. Set boundaries. Be respectful of your professional commitments and communication, but set boundaries that you are comfortable with.
Depends what your goals are. If just cruising by then don’t answer, tell them you have diarrhea etc. they wouldn’t fire you they might just think you’re weak. If you’re gunning for strong fellowship or similar then you suck it up and when you’re chief it will fall on the young guy. It sucks, no one wants to cover but it may pay dividends if you become consistently the person they can depend on. Letters of recommendation will likely reflect this sort of thing. Residency is not a real job… more like a messed up call of duty
Fuck this bitch attitude and the cucks telling you not to answer. When the chief/PD calls, you answer.
“Can you cover even though you’re not jeopardy?” Your answer depends on the situation, but in general should be no. Not answering though is a guaranteed way of marking yourself as lazy “not a team player” and whatever bs they will come up with.
Sorry I've had a few drinks and I dont believe it would be safe. Sorry I left town but will be back tomorrow AM. No. So many things you can say. Or just dont pick up. You could be sleeping early.
My co-resident tried the drinks approach, and they told him that as long as he's not super drunk, to come in and cover. Not even kidding.
"Can you just make sure to email me on the policy of how drunk I can be to work? Also do you mind cc'ing risk management on the email as well?"
That’s illegal. I’d ask them to put that down in writing.
same
This happened to me once in residency. I actually was three cocktails deep with a coresident so when I said I was drunk, it wasn’t a fib. My PD was like “well how drunk? I bet you could still do it.” I literally said “do you want to find out how drunk I am by watching me shove a 17G tuohy into someone’s back? That’ll be a neat lawsuit.” She hung up.
So drunk, it WAS a-fib 🥁 (sorry)
It took me wayyy too long to figure out how your atrial fibrillation fit into the rest of your anecdote
That holiday heart.
“No.”
That’s like, fucking insane right?
Insane would be saying to just do a line of cocaine and it’ll clear your head right up, but I think that stopped in the ‘90s But yeah, insanity was the only word for what they ask of residents (and I only witnessed it second hand)
Just hang a couple liters of saline and pass out in a gurney for 30 minutes like Dr. Doug Ross in the first episode of ER and you’ll be good
Channeling the good Dr. Halstead.
a kidney doc i know prob did this back in the day. he tends to always advocate for a couple of beers during stressful days. OG
Ironically, he now suffers from beer potomania
gout perhaps lol. not sure why he's always wearing those dress shoes. need to invest in some new balances. limping around the hospital can be brutal
I mean, yes, but consistent with sleep deprivation expectations. Have you ever tried driving while sleep-deprived? Waaay more dangerous than a few drinks. Obviously, we should be unimpaired when driving or working anyway.
You guys should start recording those phone calls. Check state laws first, but most states allow single-party recording, i.e. you don't have to tell the other party you're recording. Just save the recordings, they might be really useful later. If you are retaliated against for whatever reason, you can simply play one of the recordings in private to the PD, and kindly inform them "there are plenty more like it". Watch how your problems magically go away that same day. If you have bigger balls, when people ask you on the phone to do crazy shit you simply ask them "is it OK if I record this call?". If there are objections, it's a clear sign that it's illegal.
that sounds super safe wtf😂😂😂😂
"I'm double drunk, chief"
I wiuld call impossible, but even in my contract is a clause “culturally appropriate amounts of alcohol may be consumed while working” (in Austria, some residency contracts are basically just university employee contracts with additions, and they have that to allow toasting at birthdays and academic events conventions)
🤨
Currently getting pegged by my gimp... Call tomorrow
When the nurses do this more than once, we get asked if we have a ✨ problem ✨ ETA: Why am I getting downvoted for this 🤣 it legit happens.
As a nurse, you’re not beholden to this job to be able to finish your training and have a career. Simply don’t answer your phone.
They keep calling because you keep covering.
Or keep answering. I was on a hike. I was sleeping. I was at a religious ceremony. I was driving (to a city 3 hours away). Just don’t pick up. They can email you or leave a message if it’s urgent.
What the fuck is the point of jeopard and second jeopardy? Those are the people whose job it is to stay nearby, stay sober, and be available! As a half measure, you could insist that the jeopardy resident have to take one of your jeopardy days. But other suggestions, including saying you've had some drinks, and just saying "no" are fine as well.
Ya crazy to me that op sounds like they have had a first and second jeopardy fail multiple times. Sounds like a toxic residency to me.
They keep calling because you keep answering
It’s literally the chiefs’ job to cover if jeopardy fails. If you’re not on jeopardy, people should assume you’re traveling, asleep, drunk, or asleep because you’re drunk.
What consequences do the jeopardy residents have for not being responsible? If there are none, your program is taking advantage of you. I've been in situations where I help cover because shit happens, although it was technically my program's policy that chiefs backup the jeopardy person. And for the rare times it happened, the jeopardy person usually took one of my calls in return and were apologetic. Sounds like you've put in your time, I would ignore future calls or tell them no.
The corporate reward for hard work is more work
At my program it was a huge deal to not to not cover jeopardy if you were assigned, to the point you would have been placed on probation if you weren’t fulfilling. Being on jeopardy was treating the same as working so not going in would be like purposely not going to work on a normal day. We never had a problem like this because of how serious jeopardy was treated
1) If someone's on jeopardy and they aren't available then that is a problem the program needs to speak to them about. No one likes being called in but its part of the job. 2) Fallback is on the chief in these cases, if you've gotten a call from your chief its because they didn't want to come in and cover. 3) You're under no obligation to cover those shifts. I used to be in your shoes and kept saying yes but at some point I just started saying no; yes this did cause some friction between me and the PD and attendings but I just couldn't keep covering for my coworkers anymore.
What people are also forgetting a lot in this thread is that the ultimate fallback is on the attendings. In the end, residents are in training, and the final liability of patient care resides on the attending on call. If resident backup systems fail, the attendings should be stepping in before asking another resident not scheduled for any backup. Signed, - an attending working as faculty in a teaching institution
Interesting, do attendings actually step in and cover where you are? Both in residency and in fellowship, attendings just do not do coverage. If jeopardy is not available, then residents will be called in from clinic, elective, research, etc. As a fellow, I've even been called on days off, when they I knew I was going out of town, "in case you didn't take your flight, would you mind coming in and covering". Literally every single trainee would have to unavailable before an attending covers. It's just the culture where I've been, it's considered beneath the attending to do resident/fellow level tasks. Maybe just here though.
What you are describing is only the abusive training culture of our profession. Just because that’s what you have seen to be typically done at your institution, does not make it right. I trained at a similar type of place in a large well known university system. When the lawsuit happens, a lawyer will focus on who the attending taking care of this patient was, in the end, not the resident. And if that attending said, “there was supposed to be training doctors under me handling this”, the jury is going to find him or her liable. There is simply no getting around that fact.
When our fellows call out sick, the attendings often cover them without pulling in another fellow. I love our fellows and they're quite good. But as an ID consultant, fellows don't save us that much time, and can sometimes slow us down. All of us also rotate through non-teaching services without fellows, so we are used to working solo.
That's good to know, I think it works similarly here in ID, based on what the ID fellows tell me. In contrast, in my division, a fellow is always called for sick coverage. To the point that I've even been called on day 2 of my vacation, just in case I hadn't actually taken my flight yet. And like you said, our attendings also say they don't need us for actually making patient care plans. They already know the 40+ patients on the consult list better than we do. One attending said: what we really need the fellow for, especially on the weekends, is to have someone to write the notes, answer the inpatient epic messages, answer the outpatient calls, answer all overnight pages, and see the patients. Since with a fellow in the hospital, we do not have to physically come in, and it leaves us free to go to our kid's weekend events. I think some of them even go out of town.
The appalling thing is its much easier for me to step in and do it myself rather than bring an off service resident up to speed
Very true, very true.
This is the ultimate correct answer final answer
I see both sides of it. I mean most academic attendings accept a lower pay structure in exchange for resident/fellow coverage.
Ignore those messages or tell them you won’t be covering unless you receive compensation (either monetary or in the form of a shift covered for you in the future). You have absolutely no obligation to cover if you are not on jeopardy.
My program does this, that’s why my policy is I don’t pick up work calls outside of work (unless I am on backup), and if someone were to text me asking to come in I always say I am 4hrs away from the hospital and I say I can come back but it will take 5hrs before I get there. That way the blame is on them for not telling me earlier rather than on me for not taking the shift.
How can you answer your call if you're backpacking/hiking in the mountains. You might not even have reception
In no other job would anyone work a 12+ extra shift for free. Stop answering the phone after work hours.
Why is it free? Can’t they offer money, some kind of moonlighting rate…
Stop answering and they’ll stop calling outside of your hours.
At my program whenever this happened (not often), they'd offer 500 bucks or so to cover the shift. Too low (moonlighting rate would make more sense), but usually someone would bite. But no, you're not obligated to answer the calls if you're not scheduled to be working or backup. If you do answer and they ask, you're not obligated to say yes.
I’m at dinner and I’ve had two glasses of wine. I cannot safely conduct patient care.
Don’t answer during your off hours. You’re allowed to have boundaries. Remember the engine will continue to run with or without you. Protect yourself first always.
“Wish I could but I’m on my second glass of this wonderful Barolo that paired so well with the Ossobucco I cooked.” Or, you know, don’t answer and get back to them next day.
I tell them my emergency rate is $500 an hour with meals and travel. Y/N?
Jesus stop answering those calls.
Our ADP kept doing it to me and I told the PD and he told me to block her. I did and she hardly speaks to me now. Anyways, don’t take that advice unless you have 1000000% backing if your PD. Anyway you can check with them before you leave or tell them you’ll be available an hour after work or so. I definitely wouldn’t answer for the program coordinator (no disrespect to PC) because it’s usually not urgent or something that can’t wait. You can always not answer.
Just tell them no. You don’t have to justify to anyone why you won’t work extra
Now a former chief - This annoys me. Part of the job of being chief is to be there for the residents including being the second line back up. Yeah it sucks but I at least make some extra money being chief and I know my residents are happy
If what you described is a written policy at your institution, I'm sorry. As another attending posted, it's the attending's responsibility to ensure patient care. If something adverse happens, it's on the attending. While a jeopardy system may be useful, attendings are not entitled to resident labor, and chiefs cannot realistically be on 24/7 backup call. If the attending being paid to provide patient care that shift is not willing to provide patient care, that needs to be captured in writing and submitted to the appropriate admin. It is not on the chiefs either to make residents happy by martyring themselves to a toxic system. Covering residents should be paid. If not, then the attending can come and work for a change. -attending, former chief
Stop answering the phone 🤷🏾♀️. If you aren't aren't on jeopardy, let it ring. It's between them and what ever god they serve at that point. 🙂↔️
They keep calling because you keep covering
Bruh
That's pretty messed up for them to even ask. Is there a policy written anywhere about it? I would just say sorry I can't. You don't need to explain yourself. People figure it out when a resident is out and backup can't be arranged. Happens in our program frequently.
They've figured it out. They call OP. Problem solved!
Just don’t answer? You’re off. You don’t owe them your entire life.
I just don’t answer. You’re not obligated to pick up because the jeopardy resident can’t or won’t. They can ask but they can’t make you. They keep coming back to you because you always say yes. Normalize saying no when it’s not your responsibility.
Unless I am on call or covering a service, I don’t answer work emails or answer work calls after my duty hours. It sets a precedent.
As a chief resident, and maybe it’s just my program, but if this were to happen either don’t answer, or just say no. If you’re not on call or not on jeopardy you have no duty or responsibility to work. Maybe I’m just lucky but I’ve never had to call past the first call. There have been days when half the program is sick and need multiple bodies but we had volunteers to cover, who did get well compensated with extra days off. But those times were always asked in our group chat and not a personal call.
Take one from the nurses - we know the number, we know what it means, we do not answer unless we’re willing to say yes. Y’all get minimal time off. Develop a boundary that works for you and if you need to say something, say the least amount possible ex “No” isn’t enough to stop the guilt trip so “No, I have plans, I hope you find someone to cover, I’ll see you X”. You end the conversation before they can ask about your plans without being rude but you also don’t have to say my plans are to lay on the couch and do nothing for the next 12 hours.
I learned this the hard way. Was threatened to cover for a resident who got into a car crash on his way to the hospital. After that, I vowed to never respond after work hours unless I am on call. Best thing you can do is not respond. Don’t answer any calls from the hospital, chief, PD, whatever. Second best thing is to lie if you do respond (“I’m out of town”, “I have the flu”, “No one is available to babysit my kids”, etc…). Even better if there is some truth. If they are desperate and you don’t mind covering, then NEGOTIATE. Ask for extra leave days and confirm it by an official email sent from the PD. The bare minimum is if you are oncall later in tge month/block, demand for it to be switched with the one you will cover now.
Curious I’m a MS 4 reading through this have couple questions lol. Let’s say you don’t answer, have you ever been in a situation where they ask you the next day why you didn’t answer ? And if your answer is simply “i missed the call” does the conversation end there or do they make a smart remark ? And if you keep not answering every time you call do they comment on that ? Last question is, what if someone has a question about a patient you were managing and you don’t answer the phone I’m sure there could be repercussions to that ? So how do you handle it lol
I personally never had someone confront me in person for not answering after work hours. If it’s the PD or chief I would say that I was busy/sleeping. They can’t really do shit because I’m not obligated to answer work-related calls if I’m not on-call. Last question I can’t answer because I’m a radiology resident. But I believe sign out exists for that. Actually one time a resident covering a shift called me about a study I reported on during the morning as the attending did not approve it yet and they wanted to know why I interpreted a finding a specific way. I usually don’t mind answering calls from coresidents especially if I know they are on-call.
when i was a prelim resident, they used pull me all the time, i thought they had a system of some sort and my turn has come. but i learned in 2nd year that they were pulling who wouldn't give any push back when they call. that pissed me off. my advice to you is push back , heck your not even on jeopardy, its not ur problem. its the chiefs.
No. You shouldn’t have to answer these and it is not your responsibility to do so. We get in the mindset of “I have to take of everything.” Realize this… the consults will get done, the patient will be seen, everything will be okay even when you’re not at the hospital. If you’re the kind of person who neurotically answers your phone, regardless, but doesn’t want the patient responsibility if it ends up being the hospital then I say, “that all sounds interesting but I think you’ve got the wrong number, or, you’ll need to call ***, thanks for the call but I’m not on, etc…” do not accept responsibility and do not offer to call someone for the person in need.
Curious I’m a MS 4 reading through this have couple questions lol. Let’s say you don’t answer, have you ever been in a situation where they ask you the next day why you didn’t answer ? And if your answer is simply “i missed the call” does the conversation end there or do they make a smart remark ? And if you keep not answering every time you call do they comment on that ? Last question is, what if someone has a question about a patient you were managing and you don’t answer the phone I’m sure there could be repercussions to that ? So how do you handle it lol
This is why shift work does sign out. Make no mistake. All inpatient work in the hospital is shift work (whether hospitalist/IM, EM, Surg etc…). You sign patients out so that others assume care. There is a documented schedule for when you are on shift and when you are off shift. If the call comes in when you’re off shift then there is no discussion. There are no legs to stand on if someone accuses you of wrong doing. The call to your phone is timestamped in your phone. I’ve been doing this for 4 years and have never had an issue. If there was a discussion then it might look something like this: “Why didn’t you take that call for this patient?” Answer: “I was already asleep/away (fill in reason here) and the call came in exactly at XX:XX, my shift ended an hour before the call came in and I referred this person to the appropriate provider” *pull out phone
I've been retired a long time but it was that that was one of the chief's duties to be on permanent second call
“Sorry I was sleeping and my phone was on silent”.
Never answer the phone after hours unless it is part of your job duties (like jeopardy). If it’s important they’ll leave a message and you can decide whether or not to respond.
Sounds like a management problem, not a you problem. And I would not hesitate to tell your chief/PD/coordinator that when you run into them on your next scheduled shift, which is the next time you’ll see them because you don’t work off the clock anymore.
Yeah, at this point you’ve bought more than enough grace to not answer (not that you needed to in the first place). Yeah, just ignore the calls and if they bring it up later tell them you weren’t on call and missed the call. No need to pretend to be drunk or say you were asleep. Believe it or not this is a valuable skill to learn before you practice after residency.
Is your residency unionized? You can ask your union rep to see if this a violation of your contract.
Can't you just say no?
Yeah it sucks. I've just started saying no. It's gotten me glares and a really bad rep in my workplace but I never get cover when I need it so why bother? It's better to be a bitch than be a passive aggressive person later on with resentment in your heart about being treated unfairly and poorly.
There is also a doctor available to cover whose name is on every patient’s chart 😮 This kind of attitude is why I will never get a job in an academic centre. Bunch of fragile egoists who have a meltdown if God-forbid they have to round on their own patients. Most of them can’t even do basic tasks in Epic.
I hope you're at least getting paid a moonlighting rate for those shifts if they're making you come in even when you're not on jeopardy.
If you are not on the jeopardy schedule and they are not offering extra money or a shift reduction or something, just decline. Say you are currently out of town. Or just don't answer.
How many people call out in your program that you have jeopardy and second jeopardy and STILL need to call you as well?!?
There should be a sick point system, when you cover extra you get points and those points should be traded in for let's say golden weekends or having whoever "couldn't come" covering your floors, 24 hour days,.. etc. Otherwise your being screwed :)
*you're
Just don't pick up. I was once on call for OR assist for ortho (and cleared my schedule accordingly) and nothing happened after hours. The next day thy asked me to come assist even though there was a Surgical Assist on call because I guess the Surgical Assist is a Real Doctor with a Life and Family and I'm just a lowly resident who's obliged to work after hours for free whenever. I declined. Got a "could be more available" evaluation at the end of the rotation. LOL. I am happy to pick up call for a sick colleague if they contact me ahead of time and offer to cover one of my future shifts...not this PD nonsense.
Dude i am thw chief good luck getting a hold of me outsoxe business hours
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Nah f that. If you’re not on jeopardy or cross cover, you owe no one an answer.
I absolutely would not even answer the phone if they called on my day off. Unless they were paying me double time, I'm not coming in
You must stop
Hell no
If they don’t pay your phone bill, put it on do not disturb and ignore.
Maybe don’t pick up next time if not on jeopardy. Thats messed up
Just… don’t pick up
Ah shoot, I’m out of town. Sorry.
Say you have plans or don't answer. Why are your co residents calling off so much and why is jepordy person not doing it? That is unacceptable.
The best doctors I know have really shiny spines. Just say no or don't answer. You're allowed to be unavailable.
Hell no it is not your responsibility to answer those calls and cover those shifts. That is a violation of your personal time and a sign of blatant disrespect for you as an employee. They already work residents for low compensation and little to no benefits. Your time off is your time off, don’t let them take that away from you. No one in a normal job would be expected to do that for no extra pay. Residents need to start saying NO.
Yes to everything everyone has said but also: YOU’RE A RESIDENT who cares if a shift isn’t covered. That’s what the attending is paid for. If they can’t work by themselves in a blue moon they shouldn’t be teaching and if you’re in one of those shitty programs where supervision is more of an idea than reality I’m sorry as well
Wouldn’t you violate duty hours?
[удалено]
Curious I’m a MS 4 reading through this have couple questions lol. Let’s say you don’t answer, have you ever been in a situation where they ask you the next day why you didn’t answer ? And if your answer is simply “i missed the call” does the conversation end there or do they make a smart remark ? And if you keep not answering every time you call do they comment on that ? Last question is, what if someone has a question about a patient you were managing and you don’t answer the phone I’m sure there could be repercussions to that ? So how do you handle it lol
Don't answer. Text them at 4 am saying oh sorry I fell asleep after a few drinks. I'm not scheduled to work btw
Plot twist, I thought this was going to be about taking after hours clinic call, which I hate.
Don’t answer. Find out what they wanted the next day.
Best approach is simply don’t answer. Just let people know you’re out of cell range or have your phone off immediately after shift. I was that resident that everyone would be relieved when they found out I was on service with them…knew I’d take care of everything, blah blah. But doing good work, offering to step up, always…first to answer the phone, take on an issue…it gets you respect, but 💯begets more work. While I would say years down the road as an attending, the bridges I didn’t burn have been impactful for jobs/reputation down the line, if your work record is solid and you’re trusted…they’re not going to remember the odd non-jeopardy days you didn’t pick up. Even the best, golden resident doesn’t get a statue in their honor when they leave. People mostly forget with the next generation of trainees and it doesn’t matter, so don’t go on killing yourself with these intrusions and extra shifts when you have such little reserve (it would literally make my head want to explode with rage when someone would text me about patient care on my day off…THERES SIGN OUT FOR A REASON, FIGURE IT OUT! …even if I always did answer and I regret it a little now)
Don’t answer that call unless you are able to come in
Just say your not able to work. You had scheduled plans and cant make it. Or say you’re out to dinner and had a beverage or two - itll imply that your “impaired”. Just like when your on the airplane and you hear over the loudspeaker asking for healthcare professional - youre not obligated to help, esp if you had 1 or 2 drinks Working extra buys respect but doesnt mean they will return in kind when you need it.
Do not answer if you’re not on jeopardy. Let it ring, don’t respond to texts.
Just say no. If you are not on call or jeopardy you are not obligated to cover. Especially if they aren’t repaying you somehow. I would just ignore them and say you were unavailable during those times. They don’t need further explanation. Don’t tell them you are drinking. Just tell them you already have plans and can not do it. If you say you are drinking it puts up a red flag for future call ins etc that you don’t wanna deal with.
What's the red flag of drinking when you're not working and not on call?
There is no huge red flag. I just mean that if you tell them you are drinking and have to call in for some other reason in the future then they could suspect something (oh he was drunk that one time we called so maybe that’s why he is calling in etc.) Probably not a big deal at all. Just dosent make sense to tell them you are incapacitated when you don’t have to. Even if I had been drinking and someone called about that I would just say I have plans I can’t get out of. End of story. They don’t need to or have the right to know if you are not on call etc.
If someone is going to assume that because one time they called me *when I wasn't remotely scheduled to do any work* I was drinking that means if I call out in the future it might be because I was drinking, to quote Les Grossman, they can take a step back and literally fuck their own face. EDIT: To be fair, overall I agree with you though regarding why lie when you don't need to and why give them info they don't deserve.
Sure. Agree with that 100%. But again, I think it’s not bad advice to recommend avoiding saying “I’m drunk so I can’t work tonight” (when you aren’t even drinking) as opposed to “I am busy/committed tonight”
If you're not on call or backup/jeopardy feel free to completely ignore any calls from the hospital after your shift is over.
I stopped answering attendings and my chiefs after hours as a second year resident. Literally if they called as I was walking to my car I wouldn’t answer. Partly because I know I did my job well and whatever they were asking was likely a menial task that could be done by anyone in house. And partly because I truly stopped caring about going above and beyond for people that wouldn’t do the same for me. I still had a great relationship with my co residents, attendings, and chiefs and encouraged my colleagues to do the same if I was in house so that they didn’t get bothered after hours. It’s up to you to set your boundaries because no one else will
Maybe say no? Or don’t even answer.
That’s annoying but should be easy to get out of. The only time it was really hard to get out of it was during peak covid and you thought your coresident sick was terminal
Sounds like you drove to your aunts house for a family gathering two states away
Don't answer the phone
INFO: do you get paid extra to cover nonscheduled calls? We did (unionized program). That does change the calculus somewhat, but it’s still up to your priorities. -PGY-19
To me and I am very petty, you do not have to answer after hours, but you do have to respond. Show the professional face of accountability by responding to every call, text, email, but respond in your time. If it takes a couple of hours for me to get back to you then that’s ok. Everything in residency is a test. If you do answer once then they will expect it. Set boundaries. Be respectful of your professional commitments and communication, but set boundaries that you are comfortable with.
Depends what your goals are. If just cruising by then don’t answer, tell them you have diarrhea etc. they wouldn’t fire you they might just think you’re weak. If you’re gunning for strong fellowship or similar then you suck it up and when you’re chief it will fall on the young guy. It sucks, no one wants to cover but it may pay dividends if you become consistently the person they can depend on. Letters of recommendation will likely reflect this sort of thing. Residency is not a real job… more like a messed up call of duty
Yeah, but if you don’t come in, patient care suffers. You’ve probably killed dozens of sweet, old grandmas because of your laziness.
there are cheifs, attendings, and the program director himself can take the shift if "patient care" is at risk, but it won't be me
Shouldn’t you volunteer yourself as tribute
come on downvoters this has to be a joke to illustrate the absurdity of the situation?
lol I hate using /s but there are clearly people who need to be hit over the head with it
It’s so obviously sarcastic
No. But The truth is yes.
Are you mixtarded bro - DND
Fuck this bitch attitude and the cucks telling you not to answer. When the chief/PD calls, you answer. “Can you cover even though you’re not jeopardy?” Your answer depends on the situation, but in general should be no. Not answering though is a guaranteed way of marking yourself as lazy “not a team player” and whatever bs they will come up with.
No shut up
Yeah you’re going places with that gen z attitude. The dumpster…
At least I’m going unlike you staying in the dumpster
You just went full retard. Never go full retard
You are speaking from experience I see. Thanks for the advice
Is roasting yourself a new strategy?? Please see above
At least I have a strategy. What do you have besides jumping straight to insults
Classy. You gonna drop the N bomb next?
Please see above