Everyone knows the issue…physicians bring the call team in on Saturday or Sunday for a routine case. Or even for a non-STEMI that a couple of years ago, they would have held until Monday. Then there’s the inevitable, “While we’re here…” and what should be a short day turns into 10 or 20 hours over the weekend. Before and after 40-plus hour weeks. We are pretty sure the doctors aren’t going to stop, and management isn’t going to even ask them. So something else needs to be done to keep us from being burned out to the point of quitting something we all love. You know, I used to (and still do) tell Fellows, “If you want your staff to like you, have a life outside the hospital. No one has an issue with coming in for a legitimate emergency. We live for saving lives…it’s why we do what we do. But no one wants to come and work another 12-hour day because you don’t want to be at home.” I guess they didn’t really listen.
So…we need another solution. Here’s my suggestion (for what it’s worth): Change the shifts to 12-hour days. The weekend call team works Friday, along with the other daily teams and…
A team that works only Friday, Saturday, and Sunday, 12 hours per day. They are paid for 40 hours at a premium that compensates them for the loss of their weekends. They take no call; they only do emergencies while they are in house. There will be a call team for emergencies only, both during the day Saturday and Sunday while another case is going on and weekend nights. In other words, the call team goes back to what it originally was: a team for night and weekend EMERGENCY cases.
Who would do this? A quick FaceBook poll says that there are many people who would do this shift. Of course, they want the old fashioned weekend: work 24 and get paid for 40. I don’t think that will fly in this financial climate. The Friday weekend day allows the hospital to hire fewer employees to cover the shifts. For the weekday staff, this cuts down on overtime. Yes, you are working 12 hours while you are working, but you are only working 3 days per week. And you know what time you are getting off each day. A good manager will work with her people to let people have days off when they need to go to a function in the evenings, and you will be able to plan other functions for when you are off. A good manager will schedule call for when you are at work so when you’re off, you’re off.
Of course, this depends on a good manager.
Anyway, it will also require hiring 2 – 3 new teams plus the weekend team, depending on the number of labs you have. The big question is, will the extended hours pay for the extra people? Maybe some part-timers, who only work 1 or 2 days would help. But there is also the question of turnover. If the current hours are causing too much turnover, it would be worth it. It is very expensive to onboard someone every 2-3 months, not to mention how long it takes for them to be ready for call. And travelers can help immensely!
The biggest hurdle would be keeping the physicians in line. Upper management needs to be on board to ensure that:
1. Physicians don’t take advantage of 2 teams on the weekend. They must be reminded that the call team is only for emergencies (STEMI), and not for “emergencies of convenience”. Even a non-STEMI can be delayed for 24 hours and not violate length of stay rules.
2. Physicians must obey rules about loading times during the week. For example, a known CTO or peripheral cannot be started after 4:30 pm (if leaving at 7:30). These cases should not be scheduled after 3:00 p.m. Add-ons cannot be started after 5:00 p.m.
Remember: we are giving them 4 more hours each day; they need to respect that compromise.
I would love to hear responses on this, from staff, management and physicians. Who would do the weekend shift; who would hate the thought of going to 12-hour shifts; do managers think this could work? How much work would it be to set up? From physicians; would this help you manage your work-life balance? Because it would certainly help ours!
In short, I believe that the only way to cover the onslaught of new patients is to extend the work week, using more staff. This is one way to create jobs…and isn’t that a good thing?