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Psychiatry Residency Program

Tour of Duty

Time Off From Work
 

In order to allow for time off from work while maintaining the continuity of classes and clinical coverage, the following guidelines have been established. Residents receive 28 days (4 weeks) of vacation, which must be taken one week at a time during each calendar year; in addition to 2 personal days( LICENSURE PROCEDURE). All annual leave or sick leave request must be submitted in the appropriate form (please contact program director's office) The resident may request vacations to the PROGRAM DIRECTOR who will verify feasibility for approval. The office of the Program Director approves the vacations. Request for vacation MUST BE at the time requested by the program director usually on June of the preceding year.

PGY-I year vacations will be assigned upon requested, if feasible, with the exception of the following transition period: July, PRITE week, Competence exam week and In the month of December.

During the PGY-II, residents may take vacation at any time except for the following periods: Month of July, PRITE week, Competence exam week and December or other time as necessary in an emergency situation.

There are similar restrictions for the residents in the PGY-III and the PGY-IV years, PRITE week, Competence exam week. Vacation during the last month of training is discouraged and/or there is an emergency or call situation that might required for them not to have vacations.

The residency allows time off for licensure examinations. Requests for any time of leave (other than vacation ,and sick) like time outside conference time, and time for licensure examinations should be sent in an electronic message including: resident coverage, and submitted first to the Chief resident prior the office of the Program Director whose approval is required. There may be restrictions due to other resident or staff vacations, which conflict with the requested vacation.

There are holidays per year allowed:

  • New Year’s Day

  • Martin Luther King Jr.’ Birthday

  • President Day

  • Memorial Day

  • Independence Day

  • Labor Day

  • Veterans Day (while at San Juan VAMC)

  • Thanksgiving Day

  • Christmas Day

Residents notify to their clinical service director, office of the Program Director, and their supervisors of absence due to illness. They let know the office of the Program Director of any classes that they will miss, so that she/he can inform their teachers. The hospital has requirements regarding sick leave that the resident will need to address. This information will be provided in the Office of the Program Director.

Time for maternity and paternity leave should be those established by the federal government and State local laws when applied. Vacations and sick may be applied toward this time off. It is imperative that any leave related to maternity or paternity’ requests be made to the Residency Program Director at the earliest possible date, in order to allow for the necessary modification of a resident’s individual curriculum within the training guidelines and to allow for crucial clinical coverage.

Sick Leave – Residents will have 15 calendar days during academic year. Absence of residents to undergo USMLE, American Specialty Boards and State Licensure examination will be authorized.

Leave Without Pay – Is a temporary non-pay status and absence from duty to be granted only on the employee’s request. The authorization of LWOP is a matter of administrative discretion.

Residents on extended leave may be required to extend the period of residency training in order to comply with the required training experiences as stated and in compliance with the ACGME requirements.

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Time On Duty / Night Call
 

The working day for all residents starts at 7:30 am Monday through Friday and ends when all work has been completed, usually not before 5:00pm. Later work hours will be necessary when the workload requires them, for night call, to meet with families of inpatients, to see outpatients in the early evening after their work and/or if necessary to attend evening seminars or individual supervision.

PGY-I residents take Internal Medicine or Pediatrics night call while they are assigned on their Internal Medicine or Pediatric rotation. During the Internal Medicine or Pediatrics rotation there is no psychiatry night call. Psychiatry night call begins when the resident begins his/her psychiatry rotations. In order of our residency to follow the ACGME on duty hour's policy, the office of the program director with the approval of the related committees and faculty has created a floater system. The frequencies of night call its determined by the PGY level at the time he/she enters the program.

Our residency has established a floater system that each Pgy-1 and 2 have on a weekly basis. The average number of floaters is 8 in their first year of training and an average of 4 in the second year. The maximum frequency of night call on weekends depends on the level of training. The number of calls changes to the next PGY level and continues to do so with each subsequent year according the following schedule:

  • PGY-1: average of 8 floaters and coverage of short calls on weekdays as well as Fridays and Saturdays

  • PGY-2: average of four to five floaters – three (3) short calls (average)-equivalent and Sundays

  • PGY-3: one to two calls per month (average) on Saturdays

  • PGY-4: no calls in house

Weekday night call other than on Fridays and on the eve of an official holiday runs from 4:00pm –8:00pm and the floater resident will be on call from 8:00pm-8:00am following day. Calls on Friday’s night runs from 4:00pm until 8:00am following morning; Saturdays and on the Sundays prior to holidays begin at 8:00am and last twenty-four hours or until the resident on call is relieved by the incoming resident designated to be on-call. Sunday's calls are run in two shifts: one from 8:00am until 4:00pm and the other turn from 12:00n (noon) until 8:00am next morning. This system of floater and divided shift were done to comply with residents ACGME requisite of working hours and continuity of patient care. The resident on-call may not leave the hospital until relieved by the incoming resident. PGY-III calls will be mostly on Saturdays, Sundays and Holidays from 8:00am to 4:00pm in the Acute Inpatient Ward at the San Juan VAMC. PGY 2 & 3 will be second call for PGY-1. All patients seen and evaluated must be consulted with the Attending Physician on call at the San Juan VA Hospital When less night call is needed per month, there will be a reduction in night call per PGY level, although the overall frequencies among residents in the same level of training will be kept equitable. Further reduction of night call will be distributed based on seniority.

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There is also a list for back-up call of residents who take over should either of the two first call residents. Become suddenly unable to complete call. Each resident will agree to sign up for two separate weeks of call back up per year (July 1 – June 30). The back-up call resident must be available that week for emergencies. First year residents will be responsible for back up call over the two weeks of Christmas and New Year’s, and each holiday week satisfies back up call for the year. If a resident is asked to do back up call, the resident who is off will have to pay that resident back for the call that was covered. If possible, senior  residents will be assigned only one week of call back up for the year, and if a senior is called in, the resident who is off will be assigned an extra make-up call. The call schedule will be redone, if needed, to protect the back-up call resident from two consecutive nights of call. The above will be done following closely ACGME Common Duty Hours Standards.

The PGY-2 assigned assistant to the chief resident has the responsibility of arranging the monthly night call schedule. During the orientation period (four weeks in July) there will be a special night call schedule, during which time new residents will audit call with ongoing residents; audit call only lasts for several hours and does not count as regular call. During the orientation period the chief resident will explain to the new residents various aspects of night call including the proper notification procedure for time away from duty.

Attendance to off campus rotations is a requirement. If an off campus class or rotation is canceled on a day that is not a holiday, residents are expected to report to the clinic and use this time to complete their administrative work, assist in the clinic, or read.

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Duties While On Call
 

At the VACHS-San Juan VA, the resident on call is responsible for covering the inpatient and emergency (PIC) psychiatry units and providing consultation to the other services floors. After4:00pm in week days consults are delegated to the on call resident. The resident is to call the attending on call when guidance is needed regarding decision making. The resident in the Psychiatry Intervention Center (PIC )is open 24 hours a day 7 days a week . The resident on call will do consultations to the medical emergency room. If the psychiatric emergency room physician determines that a patient needs evaluation, he/she will then contact the psychiatry resident on call that will assess the patient and consult with attending physician on call. If the patient needs admission to the psychiatric ward, the resident may proceed with admission to the floor. Patients admitted to the floor are required to have a full history and complete physical examination done upon admission by the on call resident. In acute and critical medical decompensate, the resident on call may call other departments such as medicine for emergency consults.

An attending physician is always available as administrative back up to the on call resident for consultation about any serious problems on the call and must be consulted at all times. During the first month of call there will be an additional upper level resident serving as back up for the PGY-1 resident on call.

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Moon Lightly
 

Moonlighting is not encourage and prohibited for the resident on level 1 to 3; PGY-4 are allowed to perform moonlighting if follow the rules and policies as established by the program. The program Director must approve the time work in moonlighting in order to observed residents comply common duty hour's standards. Moonlighting is only allowed at affiliates sites of the Institution.

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Outside
 

After a resident has completed one year of training in psychiatry and in good standing then, he/she
becomes eligible to receive additional days of time off for attendance to conferences approved by the
training director.

These must be requested at least three months in advance, using the appropriate form and procedures available at the office of Training Director. Approval for attending outside conferences is dependent upon classroom attendance, and will be based on the consideration of the merits of the conference and whether it enhances or augments your ongoing residency training.

Residents are strongly encouraged to join the APA, which provides free membership during the PGY-1.

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