Article 14 : On-Call
ARTICLE 14: ON-CALL
14.01
Definitions
In order to provide
quality service and care to patients, safety of operation and enhance the well-being and education of each Resident Physician, duty hours will be limited to provide a balance of patient care, service, clinical experience and academic pursuits. This article will define:
(a) Regular duty hours; and
(b) On-call duty hours.
14.02
Regular Duty Hours
(a) No Resident Physician shall be scheduled or required to perform more than twelve (12) hours of clinical duties in any one (1) day, unless scheduled as on-call.
(b) Resident Physicians on Emergency Medicine rotations who are scheduled for shifts shall not exceed a total of sixty (60) hours of shifts per week.
(c) Resident Physicians on Emergency Medicine Rotations who are scheduled for shifts shall not be required to work additional on-call duties.
(d) No Resident Physician shall be scheduled or required to work any hours on Saturday, Sunday, or Named Holidays (weekend days) with the following exceptions:
(i) Where the Resident Physician is scheduled as on-call.
(ii) Where the Resident Physician is scheduled for an Emergency Medicine shift, as part of an Emergency Medicine rotation.
(iii) Where a Resident Physician is not scheduled as on-call on a weekend day, a stipend of $100 shall be paid to a Resident Physician required to perform patient rounds on an assigned hospital service during a weekend day. Any individual Resident Physician shall collect no more than one (1) stipend amount per day, and the stipend amount shall be paid no more than once per day for any individual service at a hospital site.
14.03
On-call Duty Hours
(a) On-call duty hours refer to those times the Resident Physician carries clinical responsibilities beyond the regular duty hours defined in Article 14.02. This typically includes evenings, overnight, and weekends. For the purpose of this Article, a weekend will refer to the period of time from 1800 hours Friday to 0600 hours Monday. Two (2) types of on-call duty hours are recognized in practice:
(i)
In-house call:
In-house call refers to clinical service, or immediate availability for such service,provided by the Resident Physician beyond the regular duty hours, where the Resident Physician is required to remain in the hospital for that time period.
(ii)
Home call:
Home call refers to clinical service, or immediate availability for such service, provided by the Resident Physician beyond the regular duty hours, where the Resident Physician is not required to remain in the hospital for that time period.
(b) The determination of the type and frequency of on-call shall be made on an educational basis by the departmental Residency Program Committee or its equivalent, subject to consultation with and approval from the relevant Associate Dean.
(c) All Resident Physicians performing on-call duties shall be scheduled for on-call by twenty-eight (28) day blocks, subject to Article 14.03(b).
14.04
In-house Call
(a) In-house call is on a one-in-four (1:4) basis. The number of days on service is specific to any individual Resident Physician, and reflects the number of days on service subtracting any time the Resident Physician is away on vacation (inclusive of the weekend prior to or following scheduled vacation as per Article 12.07), Education Leave, Sick and Special Leave, and Maternity/Parental Leave, as follows:
- 1-6 days onservice - 1 in-house call
- 7-10 days on service - 2 in-house calls
- 11-14 days on service - 3 in-house calls
- 15-18 days on service - 4 in-house calls
- 19-22 days on service - 5 in-house calls
- 23-26 days on service - 6 in-house calls
- 27-30 days on service - 7 in-house calls
- 31-34 days on service - 8 in-house calls
The 31-34 days on service calculator only applies to the first or last rotation of the academic year in the event that the rotation is in excess of twenty-eight (28) days.
For the purpose of call calculation, the weekend free of on-call shall be in the same
rotation as the scheduled vacation.
(b) No Resident Physician shall be scheduled for in-house call duty, or a combination of in-house and home call duty, on two (2) consecutive days except where agreement is reached with PARA in accordance with the Letter of Understanding Re: Night Floats and Night Shifts (see page 35).
(c) (i) No Resident Physician shall be scheduled for in-house call duty on any portion of more than two (2) weekends out of any four (4) weekends unless agreed to by PARA in advance. PARA shall provide written confirmation of such agreement to the appropriate Associate Dean in advance.
(ii) In the event that a scheduled rotation has five (5) weekends, a Resident Physician shall not be required to work more than three (3) of those five (5) weekends.
(d) No Resident Physician shall be scheduled for any in-house call duty on any portion of more than two (2) consecutive weekends, unless agreed to by PARA in advance. Scheduling must consider the Resident Physician's immediately preceding call schedule whenever possible. PARA shall provide written confirmation of such agreement to the appropriate Associate Dean in advance.
(e) In the interest of safe patient care and respect for the personal safety, well-being, and the educational requirements of the Resident Physician, sign-over of patient-care responsibilities and pertinent patient information shall begin no later than the twenty-fourth (24th) consecutive hour on duty. Apart from handover of patient-care responsibilities, no Resident Physician shall be required to assume new responsibilities following the twenty-fourth (24th) hour of duty. Such handover shall not exceed two (2) hours.
(f) Whereas in-house call maximums are defined in Article 14.03(a) and are averaged over a defined number of days on service, a Resident Physician shall not be required to perform more than four (4) in-house calls in a period of less than ten (10) consecutive days, unless requested by the Resident Physician in advance.
14.05
Home Call
(a) Home call is on a one-in-three (1:3) basis. The number of days on service is specific to any individual Resident Physician, and reflects the number of days on service subtracting any time the Resident Physician is away on vacation (inclusive of the weekend prior to or following scheduled vacation as per Article 12.07), Education Leave, Sick and Special Leave, and Maternity/Parental Leave, as follows:
- 1-5 days on service - 1 home call
- 6-8 days on service - 2 home calls
- 9-11 days on service - 3 home calls
- 12-14 days on service - 4 home calls
- 15-17 days on service - 5 home calls
- 18-20 days on service - 6 home calls
- 21-23 days on service - 7 home calls
- 24-26 days on service - 8 home calls
- 27-29 days on service - 9 home calls
- 30-32 days on service - 10 home calls
The 30-32 days on service calculator only applies to the first or last rotation of the academic year in the event that the rotation is in excess of twenty-eight (28) days.
For the purpose of call calculation, the weekend free of on-call shall be in the same rotation as the scheduled vacation.
(b) No Resident Physician shall be scheduled for home call more than three (3) consecutive days, unless agreed to by PARA in advance. PARA shall provide written confirmation of such agreement to the appropriate Associate Dean in advance.
(c) No Resident Physician shall be scheduled for home call duty on any portion of more than two (2) weekends out of any four (4) weekends, unless agreed to by PARA in advance. PARA shall provide written confirmation of such agreement to the appropriate Associate Dean in advance.
(d) No Resident Physician shall be scheduled for home call duty on any portion of more than two (2) consecutive weekends, unless agreed to by PARA in advance. PARA shall provide written confirmation of such agreement to the appropriate Associate Dean in advance. Scheduling must consider the Resident Physician's immediately preceding call schedule whenever possible.
(e) In the interest of safe patient care and respect for the personal safety, well-being, and educational requirements for the Resident Physician, any Resident Physician on home call who stays in or returns to the hospital to attend to a patient between the hours of midnight and 0600 hours is entitled to relieve themselves of all responsibilities immediately after handover of patient-care responsibilities. Handover shall commence no later than the twenty-fourth (24th) hour of duty and shall not exceed two (2) hours.
14.06
Combined Call
(a) In circumstances where call is a combination of in-house and home call (combined call), the maximum number of call is dependent on whether the majority of scheduled call is in-house call or home call. The number of days on service is specific to any individual Resident Physician and reflects the number of days on-call subtracting any time the Resident Physician is away on vacation, Education Leave, Sick and Special Leave, and Maternity/Parental Leave, as follows:
On primarily home call service:
- 9 home call: 0 in-house call
- 8 home call: 1 in-house call
- 7 home call: 2 in-house call
- 6 home call: 2 in-house call
- 5 home call: 3 in-house call
- 4 home call: 4 in-house call
On primarily in-house call service:
- 7 in-house call: 0 home call
- 6 in-house call: 1 home call
- 5 in-house call: 2 home call
- 4 in-house call: 4 home call
(b) A Resident Physician shall not be required to perform home call on the day preceding or following an in-house call.
(c) Combined call shall not account for any portion of more than two (2) weekends out of any four (4) weekends.
(d) No Resident Physician shall be scheduled for call on any more than two (2) consecutive weekends, unless agreed to by PARA in advance. Scheduling must consider the Resident Physician's immediate preceding call schedule whenever possible. PARA shall provide written confirmation of such approval to the appropriate Associate Dean in advance.
14.07 All duty schedules shall be provided to PARA and the affected Resident Physicians on a regular basis and available at least one (1) week prior to its effective date. Nothing in this sub clause precludes changes to the posted schedule due to unforeseen circumstances, but these changes shall be communicated to PARA by the end of that scheduling period.
14.08 In the event PARA believes the limits of Articles 14.02, 14.04, 14.05, or 14.06 are not being adhered to, PARA may refer the issue through the relevant Associate Dean to PGME Council. Failing resolution, PARA may refer the issue to an Adjudication Board constituted pursuant to Article 27.
14.09
Call Stipends and Emergency Medicine Shift Stipends
Resident Physicians shall receive on-call remuneration for each in-house and home call assigned per Article 14.03 as follows:
(a)
In-house Call: Resident Physicians shall receive remuneration for each in-house call assigned and worked. For clarity, in-house call stipends shall be paid for any form of in-house call coverage lasting twelve (12) hours or more, of which one (1) full hour is after midnight and before 0600 hours. Remuneration for in-house call shall be as follows:
(i)
Weekday In-house Call: Effective July 1, 2010, a Resident Physician shall receive remuneration at a rate of $114.11 for every weekday in-house call assigned and worked. For the purpose of remuneration, the weekday in-house call rate shall apply to in-house callshifts that commence on weekdays (Monday through Friday).
· Effective July 1, 2011, the rate for weekday in-house call stipends shall be $115.25.
· Effective July 1, 2012, the rate for weekday in-house call stipends shall be $117.56.
(ii)
Weekend/Named Holiday In-house Call: Effective July 1, 2010 a Resident Physician shall receive remuneration at a rate of $172.80 for every in-house call worked on a weekend or Named Holiday as defined in Article 13.01(a). For clarity, the in-house call rate for weekends and Named Holidays shall apply to on-call shifts that commence after 0500 hours on Saturday, Sunday and
Named Holidays.
· Effective July 1, 2011, the rate of in-house call stipends for call performed on weekends and Named Holidays shall be $174.53.
· Effective July 1, 2012, the rate of in-house call stipends for call performed on weekends and Named Holidays shall be $178.02.
(b)
Home Call and Emergency Medicine Shifts: Resident Physicians shall receive remuneration for each home call assigned and worked. Remuneration for home call shifts shall also apply to shifts worked in emergency medicine where one (1) full hour worked on the shift occurs between midnight and 0600. Remuneration for home call shifts shall be as follows:
(i)
Weekday Home Call: Effective July 1, 2010, a Resident Physician shall receive remuneration at a rate of $57.06 for every weekday home call assigned and worked, and emergency medicine shifts where one (1) full hour worked on the shift occurs between midnight and 0600 hours. For the purpose of remuneration, the weekday home call rate shall apply to home call shifts that commence on weekdays (Monday through Friday).
· Effective July 1, 2011, the rate for home call stipends shall increase to $57.63.
· Effective July 1, 2012, the rate for home call stipends shall increase to $58.78.
(ii)
Weekend/Named Holiday Home Call: Effective July 1, 2010, a Resident Physician shall receive remuneration at a rate of $86.40 for every home call or emergency medicine shifts where one (1) full hour worked on the shift occurs between midnight and 0600 hours, on a weekend or Named Holiday as defined in Article 13.01(a). For clarity, weekend and Named Holiday rates shall apply to home call shifts that commence after 0500 hours and exceed seven (7) hours on Saturday, Sunday or a Named Holiday.
· Effective July 1, 2011, the rate of home call stipends for call performed on weekends and
Named Holidays shall be $87.26.
· Effective July 1, 2012, the rate of home call stipends for call performed on weekends and
Named Holidays shall be $89.01.
(c) A Resident Physician who is scheduled on home call but who is required to work more than four (4) hours in hospital during the call period, of which more than one (1) full hour is past midnight and before 0600 hours, shall be remunerated at the rate for in-house call. The rate of compensation will account for pay differentials for weekends and Named Holidays (Articles 14.09(a)(ii) and 14.09(b)(ii)). The Authority shall have the right to implement reasonable rules to verify that Resident Physicians are entitled to be paid the in-house call rate for that call period.
(d) Remuneration for call shall be paid no less frequently than on a quarterly basis, payable in the second pay period following the end of the quarter. Entitlement to the call stipend may be determined from examination by the Authority of the call schedules, or by such other measures as the Authority reasonably requires of the Resident Physician.
(e) PARA will be provided no less frequently than on a quarterly basis, with information concerning the number of home call and in-house call stipends paid to each Resident Physician, and the dates on which each call or shift was worked. This information will include the Resident Physician's full name, service and hospital site.
(f) PARA dues will also be deducted from call stipend and emergency medicine shift stipend payments.
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