CCM: Common Work Schedules

[mickey85]

What are common work schedules for critical care docs- particularly PICU?

Are they overnight call q4/5? Are they on one week, off the next?

I would appreciate any insight. (I know it no doubt varies based on situations)

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[Stitch]

I can only comment on PICU and my experiences there as a resident, but there's generally been a trend towards shift like work (I assume you're asking about the attending's schedule). Obviously this setup will vary by institution and by the number of people in the group. At my place, there are seven intensivists for our 19 bed unit. They do one week of day shifts (7a-430p), then the night coverages comes in. The night shift varies, but generally they are not on for the whole week. Saturdays tend to be 24 hour shifts.

When you're not on service or covering nights you are off, though our PICU guys do cover the sedation service as well. It's actually a pretty good gig.

Some larger units employ NPs to aid in coverage, though the tendency is still to have an attending physician in house 24/7.

 

[proman]

though the tendency is still to have an attending physician in house 24/7.

I think this is going to be a growing trend in coming years, especially if the new work hour rules go into effect. It's probably best for the patients overall.

Of course, there's one intensivist where I did residency who would be on for 2 weeks, off (non clinical) for 2 weeks. She would be in house for 2 weeks, sleeping in one of the spare rooms in the SICU. That's excessive (and gets smelly).

 

[mickey85]

I can only comment on PICU and my experiences there as a resident, but there's generally been a trend towards shift like work (I assume you're asking about the attending's schedule). Obviously this setup will vary by institution and by the number of people in the group. At my place, there are seven intensivists for our 19 bed unit. They do one week of day shifts (7a-430p), then the night coverages comes in. The night shift varies, but generally they are not on for the whole week. Saturdays tend to be 24 hour shifts.

When you're not on service or covering nights you are off, though our PICU guys do cover the sedation service as well. It's actually a pretty good gig.

Some larger units employ NPs to aid in coverage, though the tendency is still to have an attending physician in house 24/7.

Thanks for all of the info.

How often are the intensivists on and off?

 

[Stitch]

Of course, there's one intensivist where I did residency who would be on for 2 weeks, off (non clinical) for 2 weeks. She would be in house for 2 weeks, sleeping in one of the spare rooms in the SICU. That's excessive (and gets smelly).

Thanks for all of the info.

How often are the intensivists on and off?

It depends. It's not uncommon for my friend to have a full week off at a time followed by a week doing sedation, which ends early and starts late. He also managed to take a full month off to go climb a mountain though he next couple of months were rough making up the time.

 

[emergiQ]

What are common work schedules for critical care docs- particularly PICU?

Are they overnight call q4/5? Are they on one week, off the next?

I would appreciate any insight. (I know it no doubt varies based on situations)

I work clinically about 24 weeks a year in the unit (SICU). So about two weeks out of each calendar month.

When I'm "on" a week, I'm in house call every other night. I round post-call then go home and sign out to another attending who is also on for the week and covers the other nights (we have two attendings per week).

Sure, shift work would be nice (i.e. 12 hours on/12 hours off) but either I would have to work a lot more days (and weeks) or my reimbursement would be laughable.

 

[Bigpoppa]

At my hospital we have four intensivists who cover a 26 bed unit. They work a week of days 7a-7P, then the night relief comes in 7p-7a. Then the guy who worked the previous week of days works a week of nights. The guy who was on nights is off for 2 weeks. And they just rotate around this schedule all year. Great for the pts and doc because even though 2 weeks straight is a pain, you have a full 2 weeks off which a couple of the docs use to moonlight at other hospitals in the area

 

[SurfingDoctor]

The work schedule depends primarily on two things:
1. Community hospital versus academic (or tertiary) hospital
2. How many attendings are employed within the department

For the community hospital settings, it usually is a 2 week on, 2 week off type of deal with overnight coverage varying depending on how many other people are in the practice. Call is usually not in house, but you do have to come in for any issues/admissions and typically have to live within a certain distance to the hospital. Likewise, you function as the resident/NP and attending, thus there is no one to troubleshoot small things for you during the middle of the night. The draw is that the pay is considerably higher.

For the academic settings, smaller programs function more like community hospitals (typically because of faculty number) but there is a buffer to calls because the residents are in house. Call can be at home, but it may be up to 72 hours on weekends. In larger programs, attendings stay in house for 24 hour calls, but typically have a buffer of a resident/NP and a fellow. Thus overnight calls can be limited to new patients and major issues (ie arrests). The frequency of this call varies depending on faculty size but can be from every 4th night to 3 calls per month. Typically, attending service time is no longer than 2 week blocks and may occur 6 to 18 weeks out of the year. The pay is generally less (that is true for all specialities in academic settings for the most part).

By the way, I was speaking in reference to pediatric ICUs.