Maximum hours worked during clinicals

[junebuggy]

Hi everyone,

 

Just had a general question for those who are more knowledgeable in this matter than myself. I spoke to a friend in PA school who is currently doing their clinical rotations in a teaching hospital and often have to work an overnight 30 hour shift similar to residents at the hospital. I'm thinking of applying again, but wanted to get a straight answer on this before doing so. I ask because she stated that the medical students she works with are only allowed to work a maximum of 16 hour shifts per ACGME guidelines. So, it's actually a two part question.

 

1) Does anyone else have overnight call during their clinical rotations? If yes, how many hours straight are you scheduled for?

 

2) Does anyone know if PA clinical rotations fall under the ACGME guidelines for duty hours? If not ACGME, who regulates the number of hours you work?

 

Any help or information is greatly appreciated, thank you.

[marktheshark89]

Yes overnight call happened, frequently on surgery and obgyn. Also worked night shifts in the ED. I was never scheduled more than 16 or so hours straight, but I know classmates who were.

[rev ronin]

Scheduled? What's that?  Seriously, on all my rotations, the only one who cared where I was when was me.  I had one inpatient rotation where I was scheduled to work with a preceptor who was 6 to 6, but he didn't show up until 8 most days.  I pulled overnight call in my general surgery rotation twice in six weeks, at my initiative.  I did as much work as I could stand in my ED rotation, often 70 hour weeks.  I showed up extra days when my preceptor was off, and got to work with other professionals, or sometimes I just took extra certification classes like ABLS or PALS when I should have had my days off.

 

No one "made" me do this.  In fact, the closest thing I had to being told when to show up or not show up was by the surgical residents on my general surgery rotation, who admonished me to not be a "buddy f*er" by showing up for a final day when the other PA students on my school were planning on already being gone, thus calling attention to their asymmetrical absence.  Whatever.

 

Oh, and I wasn't aware at the time of any work hour restrictions applying to PA students, but this was 2011-12.

[RealityCheck]

Ok, this was 25 yrs ago -- we did whatever the residents did. I trained in an urban trauma center 1000 bed hospital. We didn't have a whole lot of outpatient clinics.

 

We did not get summers off - we went straight through - 27 months.

 

Ortho - 3rd night call - overnight with clinic or OR next day. So, basically 36 hours in the hospital. So, yes, I was in the hospital overnight every 3rd night for 6 weeks and spent most of the night in the ER or OR. We worked nights, weekends and some holidays.

Surgery - 3rd night call - same deal.

Medicine - something like 4th night call in the hospital.

OB/Gyn - I was in an outpatient clinic, M-F, no call except your 2 weeks of delivery and you did whatever your senior resident did and they had all kinds of weirdness like the House Mouse who took inpatient call and the delivery teams - very complex.

Family Practice - we did rural preceptors and you were expected to do whatever your preceptor did.

Psych - was in the county ER - some overnights - very wild and weird place to be.

 

I was single and I was a sponge. I took whatever chances I had to scrub in, watch, do. As a senior PA student I was running codes in the ER when we had too many dying people for the on-call team to handle and my senior residents trusted me due to having been there and learned. If you weren't learning in my hospital -you weren't trying and probably in a broom closet hiding. 

 

Clinical rotations are what you make of them and an opportunity to learn. Expecting to be home everyday at 5 is not appropriate and should never be expected.

 

There are residency rules now to keep medical residents from making bad mistakes when tired. Having PAs as housestaff who work regular hours has helped that situation as well. Residents come and go but the housestaff is the constant and the continuity for the patients.

 

Ask what the expectations are when you start a rotation and ask the senior resident or attending or the provider in charge of the clinic. Make sure they have your cell phone and can get you into learning opportunities when available. Be a sponge.

 

My two cents, again

[junebuggy]

Mark, Rev and Reality I appreciate your replies thus far.

 

That was some good information. I would definitely adopt the "sponge" approach and learn as much as I could if given the opportunity to PA school. What scares me is that I have family obligations and would want to know that the schedule, although arduous, is not insane. My friend is currenlty doing her family medicine rotation and they have her doing 30 hour call every fourth day. The ACGME guidelines state that PGY 1 be scheduled at most 16 hours and PGY 2 can do the 30 hour shift. I feel like her program and maybe the hospital is taking advantage of her and her fellow students by working them this much. That is why I was wondering, who regulates duy hours for PA's. This is pertinent to me because her program due to geographic reasons, would be my top choice program. But I would reconsider going there if the hours she she is working are really allowed. Any more insight into this matter would be appreciated. Also, since all of the clinical rotations are done at a teaching hospital for this particular PA program, the PA students are essentially treated like residents, which doesn't seem very fair.

 

 

The folowing is from the ACGME handbook, updated June 2014 regading duty hours:

 

 

"Are first-year residents allowed to remain on-site for an additional four hours after their sixteen-hour shifts for didactics, patient follow-up, and care transition?

PGY-1 residents must not remain on-site after their 16-hour shifts. Periods of duty for first-year residents must not exceed 16 hours in duration."

[EMEDPA]

trauma surgery: alternated 24 and 12 hr days for 5 weeks. > 600 hrs for this rotation

psych 40 hrs/week m-f

EM 60 hrs/week

Peds em 50 hrs/week

internal med 50 hrs/week

obgyn 50 hrs/week

FP 45-50 hrs/week

em elective 50 hrs/week

 

somewhere between 2750-3000 hrs for clinical year.

[RealityCheck]

I don't think anyone regulates this. I think it is school to school and opportunity to opportunity.

 

Not that it is right -it is all I knew -- my school told us all those years ago - you cannot have a job and we basically own you for the duration. You will be available when needed and follow the same as the residents and medical students.

 

Where I teach now gets the summer off - I wouldn't want that - I would want to forge ahead and get done.

 

So, not sure what to tell you about regulations. Maybe the governing body of PA education might know or even AAPA.

 

Hope it works out for you!

[dchampigny]

I believe the maximum number of hours per week you can work is 168.........

 

 

seriously what are you supposed to do, say "Sorry guys, I gotta go home and study?"

[MediMike]

As I was informed as physician assistant students we are not covered by the ACGME.  You are not a resident while you are performing clinical rotations.  

 

Obligations or not you've got to sacrifice sometimes.  Not every rotation will be horrendous, but I remember doing rotations as EM mentioned above where I was there for 15hrs/day/6 days/week.  Some of those hours were by choice, but a huge chunk weren't.  This is unfortunately how you learn medicine is by being immersed in it.  

 

Not trying to talk you out of the field but feel like you should be aware of what is necessary at times.  

[Timon]

I just got my next months elective rotation schedule taking place at an Urgent Care. I'm scheduled to work 228 hours next month at the urgent care. This does not include my patient logs I have to do for my program, clinical write up, discussion paper, and challenger question base assignments. This also doesn't include 1 day for traveling back to Nevada followed by my End of Rotation Exam, a full day of lecture / PANCE review, and an OSCE the next day and traveling back to California to resume my Urgent Care rotation.

 

I had an EM rotation where I worked 21 x 10 hour shifts with varying start times from 6a-3p one day and then 12noon-12am the next and then 8pm-6am the day after that.

 

Your rotation experience will be mixed. I've had some that were Cush, show up at 4pm and done by 8pm and then stay on call. Others I've had just 9am-6pm with a 2 hour lunch. Some I've worked M-F with half days Thursday and Mondays.

 

My first day in Surgery I showed up at 6am and we finished at 4am the next morning.

 

Honestly, your schedule will vary according to your clinical rotation site and your preceptor's hours.

[junebuggy]

RealityCheck, MediMike, dchampgny, Timon and especially EMEDPA with your years of wisdom,

 

Thank you all for your contributions to the question I posed, each of you makes valid points. As a preface, I am not opposed to working long hours in general and working extra hours in a rotation that I have an interest in or one that I would like to pursue a career in; similar to an audition rotation for med students. What bothers me, is having to work long extraneous mandatory hours in rotations that I may not like, but not sure if these hours are regulated somehow. I say this because at the teaching hospital I would be doing my rotations, there are 3 other medical school students who rotate through there and one of the schools states there there students are to adhere to the ACGME, PGY-1 guidelines whereas the others are similar to my friend's PA program and don't have any hours regulations. From your responses thus far, it seems so arbitrary and variable in the hours that you have all done in your rotations. I just wish there was some uniformity for PA students to ensure their health and well being like they do for residents. I will reach out to the AAPA and ARC-PA and see what I can find out regarding this matter. Any information I get, I will post on this thread. Thank you all again.

[rev ronin]

If you dedicate your life to your rotations, 70-80 hours is sustainable. You just have to ignore home and family responsibilities to do it. In my general surgery, rotation, I'd work 60 hours in 5 days, then drive 2 hours "home" to spend time with my wife and kids.  The more you put into it, the more you get out of it.

[delco714]

You're not a licensed provider who is in charge of patient care. Regulation Limiting hours is for those who

that on lack of sleep and overworked could endanger lives of which they oversee. And yes this starts in residency for docs and pa-c

[MediMike]

Again, as Delco has stated, you are NOT a resident while in PA school.  You will not be a danger to those you serve, and your health and well being are yOUR responsibility.  You run the risk of having a crap schedule for at most 4-6 weeks depending on your program.  Every rotation in school is valuable both for your future as a provider and passing your boards.  Picking and choosing which princess rotations you're going to work hard at and really dedicate yourself to is a rather poor attitude to start off with. You're not going to like everything in life, but some stuff you've got to do.  Best advice is to suck it up if you actually want it.

[cinntsp]

Suck it up, buttercup! You can survive a year of hard work.

 

Sent from my Nexus 5 using Tapatalk

 

 

[junebuggy]

Cinnstp, MediMike, delco and rev ronin,

 

Thank you all for the words of encouragement. I'm definitely not a slacker and I am acutely aware of what I'm signing up for since I have a friend in PA school going through this right now and other friends who are also PA's. I guess my overall gripe with the whole thing is that it shows the fragmentation of our profession and professional groups in that we don't have a centralized and agreed upon guidelines for clinical rotations. As I have mentioned in my previous posts, medical students and residents have the ACGME and its rules looking out for them regarding duty hours, what do PA's have? Each of your responses to my question of who regulates your duty hours was different which proves my point that there is no central system to look out for PA's. Whose mercy are we at? The program's? The clinical site supervising physician? The hospital you're rotating through? The secretary of the clinical rotation site? Etc. I hope the question I posed encourages dialog, which it already has and maybe as a result, change can come about which can help the safety of our future PA students and the integrity of our profession. Again, thank you to everyone for contributing to the discussion thus far.

[FfIghter23]

Cinnstp, MediMike, delco and rev ronin,

 

Thank you all for the words of encouragement. I'm definitely not a slacker and I am acutely aware of what I'm signing up for since I have a friend in PA school going through this right now and other friends who are also PA's. I guess my overall gripe with the whole thing is that it shows the fragmentation of our profession and professional groups in that we don't have a centralized and agreed upon guidelines for clinical rotations. As I have mentioned in my previous posts, medical students and residents have the ACGME and its rules looking out for them regarding duty hours, what do PA's have? Each of your responses to my question of who regulates your duty hours was different which proves my point that there is no central system to look out for PA's. Whose mercy are we at? The program's? The clinical site supervising physician? The hospital you're rotating through? The secretary of the clinical rotation site? Etc. I hope the question I posed encourages dialog, which it already has and maybe as a result, change can come about which can help the safety of our future PA students and the integrity of our profession. Again, thank you to everyone for contributing to the discussion thus far.

If you feel comfortable at your rotation and feel like you have grasped all clinical presentations of any patient that could walk through the door.... By all means tell your preceptor and he should hire you on the spot.

 

I could have been at every rotation for 16 hours a day for 7 days a week and I still would have wanted to see more patients and to learn more. Medical education is a marathon and not a sprint. You should understand that by now. You have between four and six weeks to suck it up at a given rotation and learn as much as you can and then it's over and you move on to the next one.

 

As my favorite Peds physician says to his medical students "I'm not training you to work at a grocery store. Lettuce and milk may have an expiration date but these are people and you are expected to keep them alive." I carry that weight everyday and you should feel that weight everyday of training.

[rev ronin]

It's worse than that.  Preceptors will have COMPLETELY different ideas of what you can or should do, and some of them will just expect you to be on the same page.  Some will mostly ignore you, some will pimp you, some will guide you.

 

In other words, you're at EVERYONE's mercy.  Mind you, if a preceptor does something completely unethical or illegal, like ask for financial or sexual quid pro quo, you can get them fired and possibly arrested or investigated, but that still doesn't mean you'll get a passing grade on that rotation.  But that's something I've never heard of happening.

 

What I HAVE heard of is that sometimes, a rotation ends up being a lot of shadowing, and that's a rotten rotation: you should be the one DOING stuff.  Other times, rotations end up being overly laissez-faire, and you wind up with a pre-signed prescription pad on day one and expected to manage.  Those are more reasonable extremes of bad rotations.  Honestly, I never had anyone try to get ridiculous work hours out of me, but I did end up with too little responsibility on one rotation, and too much latitude and not enough guidance on another.

You need to know your skills and your limits, ask to be involved in things you love, spend as much time doing meaningful work, and practice speaking up for yourself before you get anywhere.  You only get a few weeks in each of a series of learning environments, so learn to make friends fast, whether it be with nurses, residents, or other PA and med students.  You're PAYING to be there, so ask to watch and then to do.

But at the same time, the first surgery with any new surgeon he'll pretty much have you stand there and do and say nothing, just keeping your scrubbed-in self with hands on the drapes.  But if you engage appropriately, be quick with the right answers when he lobs a softball question or two your way about what's going on... you'll be doing more next case.

[greenmood]

That is why I was wondering, who regulates duy hours for PA's. This is pertinent to me because her program due to geographic reasons, would be my top choice program. But I would reconsider going there if the hours she she is working are really allowed. Any more insight into this matter would be appreciated. Also, since all of the clinical rotations are done at a teaching hospital for this particular PA program, the PA students are essentially treated like residents, which doesn't seem very fair.

 

The school might regulate hours, but the only way mine did so was to insist we work at least 35 per week. 

 

You can do anything for six weeks. But it doesn't sound like you're willing to do so. Honestly, as a student I enjoyed that there was no difference in expectation between me and residents or other students. I wanted the rich clinical experience that I believed I was entitled to have, and I fought to stay longer so that I could get it. You would rather have a preceptor send you home while he kept the others to teach them more? While she kept the others and let them scrub on a late case? While he showed the others how to follow up on the ACS patient you just got through the ED? No way. When are you going to learn what you just missed? Most places only give you one rotation in each specialty, you should make the most of it.

 

You're acting concerned for the profession and for PA students as a whole here, but none of the actual current/former students are complaining. I find that rather telling. 

[EMEDPA]

as was pointed out above, programs and sites usually establish minimums, not maximums. my very first rotation (trauma surgery) was alternating 24 and 12 hr days for 5 weeks. 1 day off in 5 weeks. I lived in the residents' quarters at the hospital for this and 2 other rotations(em and peds em)   it was my best rotation. another site told me to be there at least 5 days/week and at least 10 hrs/day. I did 6 days/week and 12 hrs/day(it was an em elective).

[skyfall]

I had occasional night calls during surgery. I loved it though because those were usually more emergent cases, things you don't get to see often. I don't know if there's a limit on max hours. During IM, I did ~12 hours/day, and I would had to work every other weekend. Exhausting schedule, but this gave me lots of experience and I learned a whole lot!  Your preceptor is grading you, so it's up to you to please them. Just remember, it's also like a job interview. If they see you are capable of handling the hours/work, there may be job opportunities. I love learning and practicing medicine, so for me, the extra hours and the tougher rotations were the best ones.

[JohnnyM2]

What I get from all these excellent responses is that you can expect to learn a lot but you cannot expect to have your hours limited by a regulating body. I get the impression that you would really like someone to regulate the hours PAs spend on rotations. People here are trying to tell you to forget about hours and just get as involved as you can. If you want to be protected by regulations it will come at a cost to your education. Careful what you ask for.