New Rules for Scheduling
The new HOA contract has a few new rules regarding how schedules are made.
A big topic at this year's chief dinner was scheduling and the processes that must be followed in order to stay in compliance with the contract. We want to make sure people know a couple of new provisions in the HOA agreement. You can find them in Article VIII and Article XIII of the contract.
There are new rights concerning work hours and home-call. If home call activities place you over 24 hours of continuous duty hours, you must be given a minimum of 14 hours off before your next shift. In addition, the contract provides further protections at a lower threshold. If, for any reason, home-call activities prevent sufficient rest, you have the right to contact your Program Director to discuss an appropriate rest period before your next shift. You cannot be retaliated against for exercising this right.
There are also new contractual guidelines for Preventative Care and Personal Days. Both must now be requested 45 days in advance. It is at the discretion of the program whether they will entertain a request with less than 45 days' notice. The Department must provide a Yes or No answer within 7 days of your request. If your request cannot be accommodated, you and your Program Director must mutually agree on an alternate. The contract also now clearly spells out that a Personal Day cannot be used as a substitute for your normal release day. Similarly, if you are taking time off for a job interview the Department must work to accommodate this by modifying your schedule or your release days. If it cannot be accommodated, you can request to use Vacation or your Personal Day.
Resource: Scheduling Basics Printable Infosheet
View our FAQ for further details on new and old House Officer scheduling guidelines:
House Officer Schedules
What the Collective Bargaining Agreement has to say about your schedule.
You must receive your detailed schedule 30 days in advance. Many of you receive your block/rotation schedule 6 months or even a year in advance. However, you must receive your detailed schedule 30 days in advance. Your detailed schedule should include specific days on and off; you should also know your expected start-time and location.
- A detailed schedule should be posted 30 days in advance.
- Once posted, work schedules shall not be arbitrarily changed.
- Changes to posted schedules may be necessary due to unforeseen circumstances.
- Programs will attempt to minimize such changes
The only exception is for the July schedule for incoming house officers.
Vacation Adjacent Schedules
A vacation day is a full calendar day; starting at midnight (12:00 AM) and running entirely through the last minute of the day (11:59 PM). You may not be assigned an overnight shift or call that extends past midnight and into your scheduled vacation day.
Holiday Blocks are not vacation and are not protected by the contract. Thus, the rules about overnight shifts extending into your time off do not apply.
Educational and clinical work hours must be limited to 80 hours per week over a 4-week average.
Residents must receive 1 day off in 7 averaged over a 4 week period. The day off must be a full calendar day free from all responsibilities. The intent is that no house officer would work more than 2 weeks without a day off. Vacation, personal, and preventative care days do NOT count as release time.
What Counts Toward Work Hours?
- Clinical and educational activities related to the residency/fellowship program
- Inpatient Care
- Outpatient Care
- Administrative duties relative to patient care
- The provision for transfer of patient care
- Time spent in-house during call
- Time spent on-site when taking at-home call
- Scheduled activities such as conferences
- Clinical work done from home, such as charting in the EMR and patient-related phone calls
What does not count?
- Reading, study, or preparation time spent away from the work site
- At-home call (except active patient care such as charting and phone calls or time spent on-site)
Home Call Fatigue Mitigation
If home call activities place you over 24 hours of continuous duty hours, you must be given 14 hours off before returning for your next shift.
For example, if you work a long day shift and then receive back-to-back phone calls while on home-call that evening and log 24-hour continuous duty hours, you MUST be given 14 hours off before your next regular shift.
While scenarios like the one described above should be exceedingly rare, the contract does provide further protections at a lower threshold. If, for any reason, home-call activities prevent sufficient rest, you can contact your Program Director to discuss an appropriate rest period before your next shift. You cannot be retaliated against for requesting such a rest period.
Maternity Scheduling Considerations
When scheduling House Officers in their last trimester (and two months postpartum), there are certain requirements.
- They cannot work more than 12 consecutive hours.
- They cannot be scheduled overnight call.
- Although it should be avoided, they technically can work night-float. However, the 12-hour limit still applies. That means if the night float shifts are greater than 12 hours when you include sign-out and any post-shift charting, they cannot be scheduled for that shift. They need to be able to drop what they are doing at 12 hours and leave.
House Officers can schedule accommodations for job interviews.
- You must notify your Program Director within 24 hours of accepting an interview invitation.
- You must work together with your Program Director to find shift coverage.
- Your program should make reasonable attempts to modify your schedule or days off to accommodate interviews.
- If your program is unable to modify your schedule, you can request to use vacation time or your personal day.
Official Contract Language
ARTICLE VIII. WORK HOURS/WORK SCHEDULES
¶58 - With respect to House Officer work schedules and release time, the Employer is responsible for remaining in substantial compliance with Accreditation Council for Graduate Medical Education (ACGME) requirements.
¶59 - Clinical and educational work hours are defined within the ACGME Common Program Requirements. The Employer is responsible for addressing areas of non-compliance in a timely manner. The House Officers are responsible for timely and accurate submission of their work hours. The Employer and Association agree that work hours include all clinical and educational activities related to the residency/fellowship program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities such as conferences. Clinical work done from home, such as charting in the EMR and patient-related phone calls must count towards the clinical and educational work hour limit. At-home call, defined as call taken from outside the House Officer's assigned site, is not included in the clinical and educational work hour calculations except for time spent in active patient care responsibilities as described in the preceding sentence. Time spent on clinical or educational activities on the hospital premises after arriving from "at home call" are also included in work hour calculations. In circumstances where a House Officer's clinical activities during at-home call result in a continuous period of 24 or more reportable work hours as defined in this paragraph, the House Officer must receive a minimum of 14 hours of release time before reporting for their next work period shift. In any other circumstances where the House Officer's clinical activities during at-home call prevent rest sufficient to mitigate fatigue prior to their next work period, the House Officer should contact their Program Director, or their designee, to discuss arrangements for an appropriate rest period and for ensuring continuity of patient care.
¶60 - Clinical and educational work hours do not include reading, study, or preparation time spent away from the duty site.
¶61 - Clinical and educational work hours must be limited to eighty (80) hours per week, averaged over a four (4)-week period, inclusive of all in-house call activities and designated off-premises activities. Residents must be provided with one (1) day in seven (7) free from all educational and clinical responsibilities, averaged over a four (4)-week period, inclusive of call. For purposes of this Article, one "day" or "release time" is defined as one (1) continuous twenty-four (24)-hour period, free from all clinical, educational, and administrative duties. Although the one (1) day free in seven (7) is averaged over a four-week period, the normal expectation and intent is that a House Officer would not work more than two (2)-weeks without a day off. House Officers will not be retaliated against for reporting work hours accurately or for reporting violations.
¶62 - It is a responsibility of the House Officer to accurately report clinical and educational work hours to their Program Director by logging them in MedHub within the specified time frame and reporting any frequent or unusual violations directly to the Program Director. The Program Director, representing the Employer, is responsible for monitoring clinical and educational work hours for compliance with the above standard. In the event that a House Officer does not obtain release time in accordance with the standards set forth in paragraph 61, an alternative day off will be scheduled within the four (4)-week period. If alternative day(s) off cannot be scheduled then the House Officer will receive additional compensation equivalent to 1/365th of their annual base salary, for each day of release time that is not provided. Also, the Employer must immediately discontinue any work schedule practices that are not in compliance with these standards.
¶63 - If a House Officer's schedule is inconsistent with the above, the House Officer or the House Officers Association may request the work schedule to be reviewed by the Program Director. If work schedule concerns are not resolved to the satisfaction of the House Officer, the House Officer or the House Officers Association may appeal any work schedule concerns to the Graduate Medical Education Committee, or their designee. In such a situation, the decision of the Graduate Medical Education Committee will be final. It is further agreed that there shall be no retaliation, in any form, towards any House Officer as result of requesting review of their work schedule.
¶64 - It is further understood that days off taken as vacation days will not be counted as release time as defined in paragraph 61. For example, if a Resident works the first two (2) weeks in a month and takes the latter two (2) weeks as vacation, the resident shall still be entitled to two release days for the first two (2) weeks in that month.
¶65 - If, during the term of this collective bargaining agreement, there is a change in the clinical and educational work hour standards specified by ACGME requirements, then those regulatory standards will take precedence over this language, and the parties will abide by any new standards promulgated by the ACGME. However, in no case will clinical and educational work hours exceed the limits set forth in paragraph 61. Prior to implementation of any change of practice due to a change in ACGME standards, the Employer and the House Officers Association will meet to review the revised standards and discuss implementation plans.
¶66 - The Employer recognizes that advance notice of work schedules is an important factor in a House Officer's ability to manage their professional and personal responsibilities. Programs shall post House Officer rotation call/work schedules a minimum of thirty (30) calendar days prior the start of the rotation/block. The Employer will make every effort to ensure that the posted schedule, or another resource provided to the House Officer (for example, their continuity clinic schedule), includes the dates of the assigned rotation or schedule, the location (name of building/suite), and anticipated start/end times. Once posted, work schedules shall not be arbitrarily changed. It is understood, however, that changes to posted schedules may be necessary due to unforeseen circumstances. Operational and patient care needs may require adjustments or additions to posted rotation call/work schedules from time to time, either prior to or during the rotation/block. Programs will attempt to minimize such changes. The Program Director retains sole final discretion to set and revise schedules, and to resolve scheduling disputes. Notwithstanding the foregoing, the Employer is not required to post rotation call/work schedules for the month of July in advance for incoming House Officers.
¶67 - Programs and/or individuals with oversight of schedule development may establish and communicate procedures for the development of schedules. House Officers are responsible for meeting any program timelines or requirements related to schedule requests. If the House Officer does not submit their requests by the specified deadline, they forgo the opportunity to have such requests accommodated for the applicable rotation/block. The parties acknowledge that unforeseen circumstances occur from time to time for both House Officers and the Programs. Unforeseen urgent circumstances, which are expected to be rare, may be considered if a House Officer misses a specific deadline for a schedule request. It is understood, however, that the Program will not delay the posting of schedules, nor incur significant additional burden to revise schedules that have already been developed, in order to accommodate late scheduling requests.
¶68 - The Labor-Management Committee shall have a standing agenda item for the purpose of addressing specific programs where House Officers have not received their schedules consistent with the provisions of paragraph 66. The HOA will provide the following details: the name of the program, the name(s) of the affected House Officer(s), the rotation(s) involved and the date(s) of the rotations, the name of the individual overseeing the scheduling, and any other pertinent information. The Employer will investigate reported issues and provide the Association with a response and the Program or Department's plan for improvement, within 14 days of the LMC meeting.
¶69 - House Officers returning to work from a leave of absence (LOA) shall communicate with their Program Director or the Program Director's designee at least two (2) weeks prior to their expected return-to-work date to confirm the date and discuss any matters related to the House Officer's anticipated work schedule upon their return.
¶70 - In addition, the Employer shall make every effort to honor the requests for the religious requirements by House Officers for observances of religious holidays. House Officers shall make such requests not less than sixty (60) calendar days in advance of the religious observance.
¶71 - Interviewing for future positions is an integral part of the training experience. Programs will make every reasonable effort to accommodate scheduling requests to attend interviews, which may include modifications to the House Officer's work schedule or scheduled days off. If the interview time(s) cannot be accommodated through schedule modifications, the House Officer may request to use vacation days or a personal day. It is the shared responsibility of the House Officer and Program Director, or the Program Director's designee, to assure adequate coverage when a House Officer is invited to interview. A House Officer shall provide notice to their Program Director, or Program Director's designee, of their intention to accept an interview no later than twenty-four (24) hours after receipt of the invitation.
¶72 - Maternity Scheduling Considerations: During the last trimester of pregnancy and for two (2) months post-partum, overnight call will not be scheduled and duty will be limited to twelve (12) consecutive hours. Exceptions may be approved by the House Officer's Obstetrician, or other appropriate physician only. A good faith effort will be made by the Employer to accommodate any other health care needs, including scheduling, that may arise during the course of the pregnancy.