Duty Hours & Moonlighting
PM&R Residency Program Manual
PM&R Resident Duty Hours and Moonlighting Policies
PM&R Resident Duty Hours
Providing PM&R residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Our program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of a resident’s time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of both patients and residents.
Definition of PM&R Resident Duty Hours: Duty hours are defined as all clinical and academic activities related to the PM&R residency program, i.e., patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site.
PM&R Resident On-Call Activities: The objective of on-call activities is to provide PM&R residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution.
PM&R Resident At-home Call: At-home, or pager call, is defined as call taken from outside the assigned institution. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. When PM&R residents are called into the hospital from home, the hours spent in-house are counted toward the 80-hour maximum work week limit.
It is expected that PM&R residents not on scheduled call will be available to the department between the approximate hours of 8:00 a.m. and 5:00 p.m. Monday through Friday (this schedule may vary somewhat, contingent upon patient care needs or fulfillment of other duties, including mandatory coverage of sporting events). Per ACGME requirements, duty hours inclusive of all in-house call activities are not to exceed 80 hours per week, averaged over a 4-week period, maximum. (Home-call does not count towards the 80 hrs unless you come into the hospital.)
- On average, night call will not be more often than every third night (averaged over a 4-week period) and, in general, will range from every 6th to 15th night after the internship year.
- At a minimum, residents will be afforded on average one full day (24 hours) out of seven completely free from all clinical, educational and administrative duties, averaged over a 4-week period. (Vacation does not count as days off.)
- There will be at least 10 hours off between daily duty periods, and after in-house call, for rest and personal activities.
- In order to ensure and monitor assignment of reasonable inpatient/outpatient duty hours and responsibilities, rotation and on-call schedules will be prepared in advance by the Chief Resident and/or Program Director’s designee.
- Residents will have access to suitable private sleeping quarters as well as toilet/shower facilities while on call. Meals will be provided to on-call residents at the hospital cafeteria; vending machines will be available after the dinner meal.
- Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service. The Program Director, residency coordinator, and faculty will monitor the demands of duty hours and at-home call made on the residents, and schedule adjustments as necessary to mitigate excessive service demands and/or fatigue if it becomes an issue.
- Backup support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care.
PM&R Resident Moonlighting
PM&R residency education is a full-time endeavor, the Program Director must ensure that moonlighting does not interfere with the ability of the PM&R resident to achieve the goals and objectives of the educational program. Since residency is an ongoing responsibility, it is important that residents not commit to activities while off duty which require significant contributions of time or effort. Specifically, moonlighting is not encouraged, and all major commitments outside of the routine that require significant contributions of time or effort must be cleared with the Program Director in advance.
- Moonlighting by PM&R residents is discouraged.
- Any ongoing moonlighting by PM&R residents should be declared to the Program Director.
- Any moonlighting in the parent facilities that occurs within the residency program and/or sponsoring institution or the non-hospital sponsor’s primary clinical site/s, i.e., internal moonlighting, counts toward the 80-hour work week maximum.
- Under certain circumstances, at the discretion of the PM&R Residency Program Director, exceptions to this policy will be made on a case-by-case basis. In the event that an exception is made, the resident’s performance will be monitored closely. If there is any indication that performance or learning is adversely affected, permission to moonlight or engage in the designated activity will be rescinded.