Calculating ICU time in residency

[Skeeks]

Ok question for the masses:

When you are on night call as PGY 2+ do you routinely cover the ICU during your shift? If so how involved are you? Do you round, admit and transfer or just follow up on labs, orders etc from day teams and mostly cover non-ICU teams?

I am entering my last year of residency and recently received my final year schedule (Hurrah!). I noticed I have been scheduled for a lot of ICU time, 4 weeks of which is a "night float" shift at one of our affiliated hospitals where you literally work in the ICU the entire time, report to an ICU attending, transfer to ICU, respond to codes and rapid responses and take consults/admits from the ED into the unit. This 4 weeks with the other 8 weeks of day "ICU" shifts would put me over the ACGME max amount of time of 6 months allowed during my residency training. When I calculated the total number of rotations I have completed plus this new schedule I will have completed 7 months of total ICU time. When I brought this up to my chief who schedules this he looked into it and the answer he got from faculty was that this night float is not counted as ICU time. That seems really weird to me given that this entire rotation is completed inside the ICU. Yes, I also cover the regular hospital wards floors as well but that is a tiny fraction of the time spent during this rotation and it is not unusual for residents on this rotation to need to intubate or perform other procedures. I am all for good learning experiences but I am not going into ICU so I dont want or need all this extra time.
I took the question to my PD who word-for-word said this night float shift "never has been, nor ever will be considered an ICU rotation". Now, I can be a good soldier and get through this year. It's not the worst thing I have been asked to do and I am honestly not one to complain (despite me venting to strangers on a website forum ) but it definitely seems pretty shady to me.
Am I being overly sensitive and whiney? I really try not to be, I am not one to make a big deal out of anything. On the contrary, I am very much the type to just keep my head down and deal with it which is probably what I will end up doing anyway but I guess I just wanted to vent a little and ask if anyone has been in a similar situation? Am I being "part of the problem" by just dealing with it without saying anything?
Does anyone know what constitutes a rotation being considered an "ICU" rotation by the ACGME? I looked up the guidelines and it only mentions they are rotations located in a critical care units or cardiac intensive care units so it seems pretty clear that my program's PD is in the wrong here. But what do I know? I'm just a resident.

Anyway, hope everyone is well and taking good care of themselves.

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[chessknt]

You already got the answer from your PD. Going after this any further is just going to put a target on you so just soldier through. You arent going to be disqualified from board certification for doing the night float because the ACGME depends on your PD telling them that you qualify, they dont audit your schedule and investigate what each rotation is to make SUPER SURE that you are really qualified. You could report your program to the ACGME and see how that goes if you have a burning desire to make your life a living hell.

 

[Skeeks]

You already got the answer from your PD. Going after this any further is just going to put a target on you so just soldier through. You arent going to be disqualified from board certification for doing the night float because the ACGME depends on your PD telling them that you qualify, they dont audit your schedule and investigate what each rotation is to make SUPER SURE that you are really qualified. You could report your program to the ACGME and see how that goes if you have a burning desire to make your life a living hell.

Yeah, once upon a time as a starry-eyed intern I would have made an argument about it being my responsibility to "change" the culture. Im no longer an intern. My experience, exploitation and exhaustion knows that you're right. I have no desire to burn my program with an ACGME report that will likely hurt me more than it will affect them.
ACGME, NBME, LCME all of them are about as useful as a razor-blade to the eye.

 

[chessknt]

Yeah, once upon a time as a starry-eyed intern I would have made an argument about it being my responsibility to "change" the culture. Im no longer an intern. My experience, exploitation and exhaustion knows that you're right. I have no desire to burn my program with an ACGME report that will likely hurt me more than it will affect them.
ACGME, NBME, LCME all of them are about as useful as a razor-blade to the eye.

Almost done man, head down power through keep quiet and don't look back when you're out.

 

[rokshana]

Who is the attending for your night float? The icu attending or a gim attending?
Is the rotation listed as night float and checks off your NF requirements?

 

[HemeOncHopeful19]

Am I being overly sensitive and whiney? I really try not to be, I am not one to make a big deal out of anything. On the contrary, I am very much the type to just keep my head down and deal with it

No offense but this statement is completely at odds with “well I emailed my chief and didn’t like the answer so I escalated it directly to the PD and didn’t like the answer so now I’m escalating it to SDN in hopes of rule-lawyering my way out of this.”

 

[stayinalive]

You are nearing the finish line. Put your head down and put on blinders and wrap it up. Nothing good will come from you escalating this. You hold no power.

 

[Kaustikos]

Who is the attending for your night float? The icu attending or a gim attending?
Is the rotation listed as night float and checks off your NF requirements?

If it's anything like my residency; our night float was ICU/CCU, Rapids, Codes but it's a night float. And I know this isn't the only hospital that does this.
Ultimately, though, a couple extra weeks of ICU may not be the best...you really want to destroy a relationship with your PD? Because you may have to come back and ask for a letter of reference from the PD in the future. Not exactly a good message complaining about a couple extra weeks of work.

 

[DrMetal]

I am all for good learning experiences but I am not going into ICU so I dont want or need all this extra time.

If you plan on doing inpatient medicine of any kind, or a subspec that can be inpatient intensive (Cards, GI, Nephro), then having more ICU time can actually be a good thing. You see more pathology and learn better the innerworkings of the entire hospital (not just the unit).

As said above, don't be stupid and try to fight it. Just get 'er done, blink and it'll be time to graduate.