Residents covering for mid level providers?

[marauderette]

Hi,

Is it normal for residents to get denied vacation days because they have to cover for mid level providers? I am the only resident at my site in December and I was only granted the 23rd and 24th off. We get every other weekend off, so I have the 25th and 26th off, too. My co-resident got her preceptor to sign her form 6 days after I submitted mine and she was granted the 24th-31st off because her rotation is not resident-dependent. My program director stated that they were being more than fair and that I had to consider “coverage.” I thought residents only had to schedule vacations around each other, not around mid levels, too.

Is this appropriate?

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[Crayola227]

Hi,

Is it normal for residents to get denied vacation days because they have to cover for mid level providers? I am the only resident at my site in December and I was only granted the 23rd and 24th off. We get every other weekend off, so I have the 25th and 26th off, too. My co-resident got her preceptor to sign her form 6 days after I submitted mine and she was granted the 24th-31st off because her rotation is not resident-dependent. My program director stated that they were being more than fair and that I had to consider “coverage.” I thought residents only had to schedule vacations around each other, not around mid levels, too.

Is this appropriate?

It is what it is.

There's rarely anything to be gained by comparing schedules with someone else in residency, except for maybe bitterness. I hate to tell you it sounds like you were given a fair reason, but I also don't really understand what it has to do with mid-levels.

And resident vacations have to be scheduled around any number of factors, not just one another

 

[calvnandhobbs68]

Hi,

Is it normal for residents to get denied vacation days because they have to cover for mid level providers? I am the only resident at my site in December and I was only granted the 23rd and 24th off. We get every other weekend off, so I have the 25th and 26th off, too. My co-resident got her preceptor to sign her form 6 days after I submitted mine and she was granted the 24th-31st off because her rotation is not resident-dependent. My program director stated that they were being more than fair and that I had to consider “coverage.” I thought residents only had to schedule vacations around each other, not around mid levels, too.

Is this appropriate?

Resident vacations are scheduled around whatever your program says it's scheduled around as long as it meets ACGME minimum requirements.
I agree with Crayola, there's little to be gained from comparing schedules to other residents, especially around things like days off and vacation.

 

[robellis]

Hi,

Is it normal for residents to get denied vacation days because they have to cover for mid level providers? I am the only resident at my site in December and I was only granted the 23rd and 24th off. We get every other weekend off, so I have the 25th and 26th off, too. My co-resident got her preceptor to sign her form 6 days after I submitted mine and she was granted the 24th-31st off because her rotation is not resident-dependent. My program director stated that they were being more than fair and that I had to consider “coverage.” I thought residents only had to schedule vacations around each other, not around mid levels, too.

Is this appropriate?

Your program could make you work literally every single day of your life and if you complain they could find a reason to fire you…be grateful that’s not happening..and keep your head down and graduate, they have all the power and you have none, complaining about vacation is the least of your worries and should not be discussed unless you like being unemployed with a lot of debt

 

[tr]

Honestly 4 consecutive days off that include Xmas eve and day (assuming you celebrate it) are a real windfall in a resident schedule. I'd be celebrating that.
There are a lot of things that suck about residency, this is one of them, but probably not the hill to die on IMO.

 

[hallowmann]

So to give you an idea of how it could be worse, I'll describe how vacations work in my own residency. First off, requests for vacations, conferences, or off time must be made 8 weeks in advance, but ideally are made 12 weeks in advance. We do not get every other weekend off, and it's rare that we know which weekends we have off as the call schedule tends to come out only 1-2 months in advance. We are restricted on when we can take vacations based on the type of rotation we are on (certain rotations are simply not vacation eligible), who else is on the rotation (if there are less than usual residents on the rotation that block), and who else has also taken/requested vacation then.

Also, it's rare to have whole holidays off here. In fact I've worked every Thanksgiving for the last 4 yrs, despite requesting that to be my off holiday every year (outpatient year - the only one I was actually slated to get off - I was pulled due to the COVID surge...).

I tell you this not to say, "in my day, we walked to school in 2 ft of snow, uphill both ways", but rather to explain that it's variable when you can get off in residency, and honestly you have very little control over it. Try your best, push when it's worth it, but understand that ultimately you are coming from a position of incredible weakness.

 

[splik]

I think it depends on whether the mid level helps provide coverage for residents. If their presence makes your lives easier, and allows for you to take vacation etc then you cant complain about also helping to cover for them. If not, then I think it is outrageous but there is nothing you can do about it. I almost never deny residents their requested vacation requests but if it does coincide with vacation of our NP (and our NP makes the residents' lives and work schedule much much eaiser) and faculty etc, I do point that out and the residents can decide whether they are okay with that (it will mean the other resident will have more work to do) or to reschedule.

 

[marauderette]

Resident vacations are scheduled around whatever your program says it's scheduled around as long as it meets ACGME minimum requirements.
I agree with Crayola, there's little to be gained from comparing schedules to other residents, especially around things like days off and vacation.

That would be fine. It just would have been nice to know from the beginning that we had to schedule our vacay days around PA/RN vacation days. I won’t fight for it, I just hadn’t heard of this before. Still sucks to be the only resident in the program who doesn’t get a Christmas vacation. Like the first poster said, it is what it is.

 

[Sushirolls]

The only way this power dynamic can ever change is uncoupling the residency as a 4 year program and truly more modular.

I.e. do intern year here, then they tick you off, interview, move and to another place, same thing, get better contract for year 3-4 at final better third institution. To implement this sort of change is highly unlikely.

 

[comp1]

The NP thing is a red herring, could just as easily be another resident. There's a service need...therefore you're scheduled.

 

[marauderette]

I think it depends on whether the mid level helps provide coverage for residents. If their presence makes your lives easier, and allows for you to take vacation etc then you cant complain about also helping to cover for them. If not, then I think it is outrageous but there is nothing you can do about it. I almost never deny residents their requested vacation requests but if it does coincide with vacation of our NP (and our NP makes the residents' lives and work schedule much much eaiser) and faculty etc, I do point that out and the residents can decide whether they are okay with that (it will mean the other resident will have more work to do) or to reschedule.

Thank you for your kind reply. The midlevels have never provided coverage for a resident. We are the first class in this program, so if we get sick or something, the PAs just do all the work like they always did. Residents have filled the mid level’s shoes at least 4x total, but they were just pulled out of rotations and their days off weren’t affected. I’m the first resident to ever get my schedule affected by someone else’s vacation days. Since our schedules weren’t actually related like that before, I was just surprised. Plus it sucks to be alone during Christmas vacations. Nothing can be done, but thank you for being sympathetic

 

[PikminOC]

Hi,

Is it normal for residents to get denied vacation days because they have to cover for mid level providers? I am the only resident at my site in December and I was only granted the 23rd and 24th off. We get every other weekend off, so I have the 25th and 26th off, too. My co-resident got her preceptor to sign her form 6 days after I submitted mine and she was granted the 24th-31st off because her rotation is not resident-dependent. My program director stated that they were being more than fair and that I had to consider “coverage.” I thought residents only had to schedule vacations around each other, not around mid levels, too.

Is this appropriate?

You get alot of days off. Be thankful.

 

[marauderette]

Also, it's rare to have whole holidays off here. In fact I've worked every Thanksgiving for the last 4 yrs, despite requesting that to be my off holiday every year (outpatient year - the only one I was actually slated to get off - I was pulled due to the COVID surge...).

I tell you this not to say, "in my day, we walked to school in 2 ft of snow, uphill both ways", but rather to explain that it's variable when you can get off in residency, and honestly you have very little control over it. Try your best, push when it's worth it, but understand that ultimately you are coming from a position of incredible weakness.

It’s not that rare anymore in Psychiatry residencies. I have friends in at least 10 different programs, all of them have weekends and holidays off except when on call.

Also, I understand that it’s variable when residents can get vacations. I know other residencies schedule vacations in blocks and they don’t have much say. This program doesn’t have that though. For 80% of the program, it wasn’t variable whether they could take Christmas vacations or not. Just me. Doomed from the start because I have inpatient psychiatry in December.

I know I can’t do anything about it. I just needed to know if this was normal. Thank you for your response.

 

[Merovinge]

It’s not that rare anymore in Psychiatry residencies. I have friends in at least 10 different programs, all of them have weekends and holidays off except when on call.

Also, I understand that it’s variable when residents can get vacations. I know other residencies schedule vacations in blocks and they don’t have much say. This program doesn’t have that though. For 80% of the program, it wasn’t variable whether they could take Christmas vacations or not. Just me. Doomed from the start because I have inpatient psychiatry in December.

I know I can’t do anything about it. I just needed to know if this was normal. Thank you for your response.

I went to a pretty accommodating program, but there is no way the majority of inpatient residents could all take off from the 24th-2nd each year, it's just not feasible for programs no matter how "resident independent" any claim to be.

You've given up a lot to be a doctor, this is one more thing along the way, it is completely worth it and enjoy your 4 days off .

 

[hallowmann]

It’s not that rare anymore in Psychiatry residencies. I have friends in at least 10 different programs, all of them have weekends and holidays off except when on call.

Also, I understand that it’s variable when residents can get vacations. I know other residencies schedule vacations in blocks and they don’t have much say. This program doesn’t have that though. For 80% of the program, it wasn’t variable whether they could take Christmas vacations or not. Just me. Doomed from the start because I have inpatient psychiatry in December.

I know I can’t do anything about it. I just needed to know if this was normal. Thank you for your response.

To clarify, I'm still in training. It is rare here, still. Part of my point is that it's highly variable program to program and we are at the whim of our residency programs from the day we match to the day we leave.

 

[PikminOC]

As an attending in pp, I don't take any days off. 7 days a week including holidays.

 

[PikminOC]

As an attending in pp, I don't take any days off. 7 days a week including holidays.

Don't work don't get paid.

 

[robellis]

Don't work don't get paid.

You literally go in to work 7 days a week or do you mean you’re always on call for your patients?

 

[PikminOC]

You literally go in to work 7 days a week or do you mean you’re always on call for your patients?

I see people 7 days a week.

 

[robellis]

I see people 7 days a week.

How much do you make..

 

[Crayola227]

The real point is that the responsibility and inconvenient time demands never end in this line of work. There will always be moments when being an attending physician creeps into your evening, weekend, holiday, to some extent, for like 95% of all physicians. This shouldn't be unexpected.

As for residency, the way I looked at it was like being deployed overseas in military. Just assume they literally own your ass for x number of years at all times. Don't feel entitled to your time off, especially holidays and weekends, just write them off, and just enjoy it when it happens. This approach will prevent you from running afoul the program or other residents, at least when it comes to scheduling.

Once you're an attending you'll have a little bit more power to push back on the unavoidable encroachment.

 

[PikminOC]

How much do you make..

As much as I want.

 

[robellis]

As much as I want.

So you can make 30 million per year if you want?

 

[PikminOC]

So you can make 30 million per year if you want?

Why r u on probation status?

 

[robellis]

Why r u on probation status?

I think because I laughed at someone’s post as a joke and they found it offensive..why are you so afraid to share your ballpark income? For example I work 5 days a week and take call once a week and 1/4 weekends and make about 400k per year…if you’re working 7 days a week I seriously hope you’re making like 700k+ for that because that sounds nuts

 

[sloop]

I agree that you should tread carefully, but I will also say that I’m not sure that residents have no power in all situations.

As a senior resident, there were definitely things that I basically flat out refused to do, but I think I explained these problems to my PD in a tactful way. These were things like being asked to do extra CAP call in order to help fix staffing problems in the CAP fellowship at the time. This issue also partly resulted from the CAP program knowingly ****ing up the scheduling of my rotations with them, despite my having warned them that it would create the issue they later ran into. I basically told my PD that this problem was the CAP fellowship’s fault because they did not listen to my warning and accept my alternative rotation schedule that would have prevented the problem, that this was an issue they needed to figure out on their own, and that I would not be taking the extra calls. Part of why I had the confidence to do this was that the program was so resident-dependent and paid attendings so poorly that, if they fired residents, they would seriously struggle to adequately staff the hospital. Because of how poorly they paid attendings, they would not be able to get attending to do resident work, and there were already just enough residents to adequately staff all of the services. I was pretty confident that they wouldn’t fire anybody for anything other than true and blatant misconduct.

I say this only to say that I think if you have a decent PD, you are a well-regarded senior resident with a reputation for generally pulling more than your fair share to help out, and your hospital is highly resident dependent, you can sometimes leverage those things to get out of the more egregiously unfair things you might be asked to do.

Back to your question, though: yes it is somewhat normal to have restrictions on your vacation based on a midlevel’s absence. At my residency, there were some services that had midlevels on them. Invariably, though, if you looked into the history of these services, they used to be staffed by residents before they decided to hire the midlevels. Hiring the midlevels freed up time for residents to do electives or have track time, or whatever. This was why, when the midlevels were out, residents covered the service—that was the de facto standard prior to when the midlevels came in. I don’t necessarily think that is unusual or unfair, and I would not raise a stink about it. You have to pick your battles, and this seems like a dumb hill to die on.

 

[Mass Effect]

That would be fine. It just would have been nice to know from the beginning that we had to schedule our vacay days around PA/RN vacation days. I won’t fight for it, I just hadn’t heard of this before. Still sucks to be the only resident in the program who doesn’t get a Christmas vacation. Like the first poster said, it is what it is.

The problem is you're thinking about it wrong. You're thinking it's a 1:1 thing where you can't take vacay because you're covering for a midlevel. That isn't the case. You're covering for the SERVICE. That's different.

Say there are three psych teams on your inpatient unit with a total of 30 beds. Each team has 10 beds to cover and each team is made up of an attending, midlevel, and resident.

Team 1 = attending, midlevel, and resident are all working the whole week
Team 2 = attending and midlevel are there, but resident is out
Team 3 = attending is there, but midlevel is out. The program wants someone there besides just the attending, so you're scheduled

So you're not scheduled because you're covering the midlevel. You're scheduled because the service can't have two people out at once. It could just as easily have been another resident who's out.

 

[Mass Effect]

I think because I laughed at someone’s post as a joke and they found it offensive..why are you so afraid to share your ballpark income? For example I work 5 days a week and take call once a week and 1/4 weekends and make about 400k per year…if you’re working 7 days a week I seriously hope you’re making like 700k+ for that because that sounds nuts

I don't think we should assume that he's saying he works 7 standard days a week. He might be one of those who sees one patient every Saturday for therapy, two patients every Sunday for therapy, then does an 8 am - noon schedule Monday - Friday.

I have a friend in PP right now who has a Saturday and a Sunday morning slot available only for emergencies, then works 3-4 hours every evening M-F. She prefers to leave the day open and sees patients something 4 - 8 pm. But technically if she fills the weekend slots, that's 7 days a week and only 20 - 25 hours.

 

[Mass Effect]

For 80% of the program, it wasn’t variable whether they could take Christmas vacations or not. Just me. Doomed from the start because I have inpatient psychiatry in December.

You think this is bad, just wait til you hit the medicine wards.

 

[calvinhobbes]

Hi,

Is it normal for residents to get denied vacation days because they have to cover for mid level providers? I am the only resident at my site in December and I was only granted the 23rd and 24th off. We get every other weekend off, so I have the 25th and 26th off, too. My co-resident got her preceptor to sign her form 6 days after I submitted mine and she was granted the 24th-31st off because her rotation is not resident-dependent. My program director stated that they were being more than fair and that I had to consider “coverage.” I thought residents only had to schedule vacations around each other, not around mid levels, too.

Is this appropriate?

This is against ACGME policy. Residents cannot and should not have anything to do with midlevels. Complain to ACGME, anonymously, and see how fast things change in your program (they will.).

 

[comp1]

This is against ACGME policy. Residents cannot and should not have anything to do with midlevels. Complain to ACGME, anonymously, and see how fast things change in your program (they will.).

This is not against ACGME policy. The OP is not supervising NPs, being supervised by NPs or really having anything to do with NPs. It is a resident upset about seeing patients on days when the NP isn't even there. The ACGME has nothing regarding this and the NP thing is a red herring to get everyone's hackles up.

 

[robellis]

As much as I want.

So are you gonna clarify if you work full 7 days a week/how much you make to help those younger attendings understand their worth

 

[Candidate2017]

I see people 7 days a week.

I also see people 7 days a week. Matter of fact, I see people right now as I'm typing this. But I only see patients certain days of the week.

 

[PikminOC]

I don't think we should assume that he's saying he works 7 standard days a week. He might be one of those who sees one patient every Saturday for therapy, two patients every Sunday for therapy, then does an 8 am - noon schedule Monday - Friday.

I have a friend in PP right now who has a Saturday and a Sunday morning slot available only for emergencies, then works 3-4 hours every evening M-F. She prefers to leave the day open and sees patients something 4 - 8 pm. But technically if she fills the weekend slots, that's 7 days a week and only 20 - 25 hours.

I work more than full time during the week and then weekends. Like I said no money if I don't work.

 

[robellis]

I work more than full time during the week and then weekends. Like I said no money if I don't work.

Do you make less than 700k?

 

[PikminOC]

Do you make less than 700k?

Why does it matter?

 

[robellis]

Why does it matter?

Because we’re curious I don’t know anyone that works 7 days a week so I’m interested to see how much that brings in

 

[GoSpursGo]

This whole recent discussion about attendings working 7 days a week and making however much money... doesn't seem relevant to trainees or the question asked. Let's try to keep this thread on topic please.

Hi,

Is it normal for residents to get denied vacation days because they have to cover for mid level providers? I am the only resident at my site in December and I was only granted the 23rd and 24th off. We get every other weekend off, so I have the 25th and 26th off, too. My co-resident got her preceptor to sign her form 6 days after I submitted mine and she was granted the 24th-31st off because her rotation is not resident-dependent. My program director stated that they were being more than fair and that I had to consider “coverage.” I thought residents only had to schedule vacations around each other, not around mid levels, too.

Is this appropriate?

OP I think you've gotten some good responses from others within the field, but I'll just give you one outside perspective. It may seem like they have used a resident to "cover" a midlevel, but that's not really what happened here. On any given day, they schedule x resident shifts and y midlevel shifts. In this case, they decided x=1 and y=0. So that shift was ALWAYS a resident shift, at least now that they have a residency program.

Now, I will say that if your program doesn't let you know in advance that additional days are blocked from vacation requests, and they don't come up with a plan to fairly divide holiday coverage... that displays a level of administrative incompetence. So again, I do feel for you--it's not illegal, but a more functional program could easily have found a more equitable solution.

I actually find your report that residents are pulled off rotations to cover for midlevels to be much more concerning. Not familiar enough to know if it's truly an ACGME violation, but to me residents providing sick call coverage for midlevels should be unacceptable except in truly exceptional circumstances.

 

[FlowRate]

Just for some additional perspective. 3/4 years of residency we had to express vacation preferences for the following entire year of residency three months before starting that year. It wasn't completely impossible to swap if needed but was not easy and was dependent on who's on service with you at the same time.

 

[sloop]

Just for some additional perspective. 3/4 years of residency we had to express vacation preferences for the following entire year of residency three months before starting that year. It wasn't completely impossible to swap if needed but was not easy and was dependent on who's on service with you at the same time.

This was my experience for all 4 years of residency, as well.

I think that a lot of this winds up depending on whether your hospital is resident-dependent or not. Where I went to med school, residents were often able to take vacation whenever they wanted with minimal notice. Part of the reason for this was that even ED rotations were not strictly resident dependent. I was rotating in a psych ED when one of the residents was there. He went on vacation and the attending just did all the work. This could never have happened where I trained. The main reason we always had to request vacation the year prior was that most services could not afford to lose a resident and you basically had to take vacation during one of the few less demanding rotations. In order to give you any flexibility at all over when you took vacation, they would literally rearrange your entire schedule to try to make a less demanding rotation coincide with the time you said you would want to take off.

Also, during intern year, we could only have Christmas or New Years off, not both. You got to request which one you wanted, but that didn’t even mean you would get it.

 

[Stagg737]

Somewhat similar to the above, my program assigns vacation for interns (to prevent requests occurring on IM or neuro rotations) and then allows us to request vacation PGY-2-whatever, but requests must be at least 60 days in advance or they aren't considered. You can request specific weeks off coming into intern year, but may or may not get it depending on how the IM scheduling works out.

All holidays are considered "call". So you may not have to work many holidays (usually in senior years), but then the entire service has to be covered (academic inpt, academic ED/consults, VA inpt/ED/consults) and when you're the one on call it sucks extra.

 

[Mass Effect]

This is against ACGME policy. Residents cannot and should not have anything to do with midlevels. Complain to ACGME, anonymously, and see how fast things change in your program (they will.).

Which ACGME policy forbids the situation the OP is in?

 

[Crayola227]

Which ACGME policy forbids the situation the OP is in?

It's true that it's in writing that "scut" work or being supervised by midlevels, such that the educational experience is compromised, is forbidden by ACGME policy. That's the only place to my knowledge that resident protection vis a vis midlevel is mentioned.

But I have no idea what that would have to do with complaining about the scheduling of vacation. They don't care how much your schedule sucks as long as it follows the work hour rules.

 

[calvinhobbes]

Ah yes, I stand corrected. Thank you for pointing that out! I was always under the assumption that midlevels could not be in charge of, or alter a schedule, (or that a resident could not be shuffled around b/c of a midlevel) but maybe that’s institution dependent, and not ACGME policy. (It wasn’t allowed at my institution, for example).