Article 9 – Scheduling and Call

Home Heavy call defined as:

• A home call where during the period of 5:00 pm and 8:00 am, the resident has to spend more than 4 hours after 5:00 pm and/or 2 hours after midnight out of home (i.e., in the hospital) more than 50% of the time and over a given call period.
• A home call during a weekday or stat holiday, where the resident has to spend 12 hours or more during a 24-hour period in the hospital more than 50% of the time over a given call period. 

Please note that every hour in the hospital after midnight will count as 2 hours for the calculation. This formula is used to determine the call designation for each specific program and each specific call period. Any Home call not meeting the above definition is Home Light.

Home Heavy

Home Light

In House

ICU/CCU

Conversion Shall Apply

Effective on the date of implementation, a Resident who is scheduled for Home Call but who works more than four (4) hours in the hospital during the call period, of which more than one (1) hour is past midnight and before 0600 hours, shall be remunerated at the In-House call rate for that call duty period. The Employer shall have the right to implement reasonable rules to verify that the Resident qualifies for call conversion for that call duty period.

Both parties hereto accept that, in order to provide adequate service and care to patients and to enhance the medical education of Residents and so facilitate the realization of their educational objectives, that duty hours be limited to provide a balance of patient care, clinical experience and academics. No Resident will be required to do more than 1 in 4 in-house call averaged over an academic rotation. The duty period referred to is from 1700 - 0800 hours Monday through Friday, and 0800 - 0800 hours Saturday, Sunday and statutory holidays. This duty period shall be referred to as “in-house-on-call” duty.

In services where in-house call is scheduled as partial or split-shifts (scheduled as less than 1700-0800 weekdays or 0800-0800 weekends), each part of the partial call shift or split-shift constitutes one call duty period for the purposes of call frequency maximums and call stipends.

Exceptions, based on academic need or exceptional situations, will be monitored by RDoS and the College of Medicine. Where concerns arise, discussion will be held at a Joint Consultative Committee meeting.

In the event that a Resident performs In-House call duty in excess of 1 in 4 by assignment, such work will be paid at the following rates:

There will be no prorating of these amounts for partial duty periods. Extension of hours pertaining to a critical medical situation or completion of training or service requirements will also not be considered. In-House-on-call duty periods that result from any leave of absence granted to the Resident pursuant to this Collective Agreement will also not be considered. Extra rotations in excess of the principle of one (1) in four (4) averaged over an academic rotation will be voluntary and must have the mutual consent of the Resident and the Program Director.

No resident will be required to do more than one (1) in four (4) ICU/CCU call averaged over an academic rotation.

In the event that a Resident works 24 hours on/24 hours off ICU/CCU, rotations in excess of the principle of one (1) occasion in four (4) days averaged over an academic rotation, he/she will be paid a stipend as follows:

There will be no prorating of this stipend, and partial duty periods will not be considered. Extended hours resulting from a critical medical situation or completion of training or service requirements will not apply.

For the purposes of determining the remuneration for rotations in excess of the principle of one (1) in four (4) averaged over an academic rotation, the calculation will not include rotations that result from the granting of education leave, examination leave, compassionate leave, paternity leave, and the six (6) days off during the Christmas/New Year’s period to other residents on the service. With the agreement of the Program Director or the Administrative Resident where this duty has been delegated by the Program Director, the existing practice whereby residents may interchange duty hours amongst themselves is recognized, provided that adequate patient care is provided. Additional remuneration will not be provided in such cases. Permission for such interchange will not be unreasonably withheld, but consecutive twenty-four (24) hour shifts will never be considered. The reason for the rotation in excess of the principle of one (1) in four (4) averaged over an academic rotation must be clearly defined so as to be able to determine that the Resident doing the excess rotation is to be remunerated.

Extra rotations in excess of the principle of one (1) in four (4) averaged over an academic rotation will be voluntary and must have the mutual consent of the Resident and the Program Director.

No Resident will be required to provide more than one (1) in three (3) call averaged over an academic rotation.

A Resident will be scheduled to work a reasonable number of hours. The training/employing organizations will undertake to limit the average number of hours, having due regard for sound patient care and treatment, and the educational requirements of the Resident’s program.

Residents who are not on call may be contacted and invited to participate in a case. However, except in the event of an emergency of qualified medical personnel not being available, all residents will be free to decline such invitations.

Residents who are not scheduled to be on call will not be expected to attend rounds on Saturdays and Sundays that are for service purposes only. However, this does not preclude the scheduling of teaching sessions on weekends, which Residents will be expected to attend.

9.8.1 Home Call

Residents are to be relieved of clinical responsibilities after twenty-six (26) hours from the previous day’s start time on the first post-call day at the Resident’s professional discretion at such point as they feel their ability to safely care for patients may be compromised.

9.8.2 In-House Call

A Resident who is required to provide care of a continuing or intensive nature shall be relieved after patient care handover. Patient care handover shall commence at the 24th hour and not exceed two (2) hours. No new clinical duties shall be assigned or undertaken after twenty-four (24) hours barring emergent circumstances. The Resident shall resume work on regularly scheduled hours the subsequent work day.

9.8.3

Call schedules for each service shall be posted covering a one (1) month period, and, they shall be posted not less than four (4) weeks in advance of the beginning of the scheduled period on appropriate departmental bulletin boards. Copies will be distributed to the appropriate Resident. With the agreement of the Program Director or the Administrative Resident where this call has been delegated by the Program Director, the existing practice whereby Residents may interchange call hours amongst themselves is recognized, provided that adequate patient care is provided. Permission for such interchange will not be unreasonably withheld.

In the event that a particular service or elective period does not have on-call duty periods, the Resident shall not be re-allocated to do on-call duty periods on another duty service unless a traditional combination of more than one (1) service on-call block applies. The foregoing shall not mean that the Postgraduate Program shall be precluded from the implementation of new call arrangements in the furtherance of educational objectives to meet changing needs or new programs.

Persons on a service with on-call duties will not be available for on-call duties on another service (be the call in-house or out-of-house on either service).

9.10.1

PGY3 residents on CTU call are considered CTU Senior Night Float. 

The night float periods will be as follows:

Senior residents will come to work at 7:30 p.m. to perform bedside teaching with two junior residents on-call, will stay in-house until at least 11:30 p.m., and will then be on home-call until 7:30 a.m. for CTU senior consults.

Senior residents will do one or two weeks of nights consecutively for two to four weeks during their senior year.

Senior residents are first call from Emergency and will distribute consults between two take residents.

Senior residents on-call during the day would cover on-call consults until 7:30 p.m. This would be twice a week for RED and BLUE seniors and once a week for SILVER seniors.

Seniors on subspecialty and CTU will cover Friday night call, Saturday call, and Sunday day call.

9.10.2

Residents will be paid the home-heavy stipend and will not be entitled to the excess of 1 in 4 call stipend.

The Ophthalmology residency program is considered home heavy call and is paid a home heavy stipend.

Call will not exceed one (1) in three (3) averaged over a three-month rotation, even in cases of prolonged resident absence. Remaining call will be covered by staff.

Call periods will be scheduled with one resident covering home heavy call for the period of either Monday through Thursday night consecutively, with post-call days available at the resident’s professional discretion OR Friday through Sunday night consecutively, with post-call days available at the resident’s professional discretion.

Program Directors, via the Program Administrative Assistant with the assistance of the Administrative Resident as necessary, will email to RDoS all final resident duty schedules on the day they are posted in the program.

Vacation time, sick leave and leave of absence for any purpose shall not be regarded as time available for on-call duty periods; rather, the number of duty periods shall be pro-rated to the number of days actually worked. (Articles 12.0 and 13.0)

Other than in exceptional circumstances, no Resident shall be selected to be on call for more than two (2) out of three (3) consecutive weekends. Once in every three (3) week cycle, a Resident must have from the end of the regular working day on Friday until the start of the working day on Monday morning free from clinical responsibilities. The onus is on the Resident to notify the upcoming rotation coordinator at least five (5) weeks in advance in order to accommodate scheduling, so that the Resident will not be required to work more than two (2) out of three (3) consecutive weekends when changing rotations. If the Resident does not have his/her upcoming schedule at least four (4) weeks in advance, the Resident should immediately notify the relevant schedulers who will then be responsible for aligning the two (2) call schedules so that they do not violate the two (2) out of three (3) rule.

In the interest of patient safety and Resident well-being, neither party encourages consecutive twenty-four (24) hour call. However, it is recognized that residents may on occasion choose to do consecutive twenty-four (24) hour call on certain services. With the approval of the appropriate program committee(s), Residents assigned to those services may opt to accept sequential twenty-four (24) hour call periods. This option must be exercised prior to preparation of call schedules.

For those Residents who participate in shiftwork, including but not limited to Emergency Medicine, Internal Medicine and Pediatrics; shifts shall not be scheduled in excess of 5 shifts per week, with maximum duty hours pro-rated by duration of shift. For example, CTU float shifts at 12 hours per shift, and ER shifts at 8 hours per shift. No resident shall be expected to participate in clinical duties for 12 hours preceding and after the shift.

For Residents with extra clinical duties, for example Family Medicine Residents with obstetrical duties, any excess clinical duties shall be restricted per call frequency and duration expectations. This includes maximum number of days spent performing excess duties per month, as per current call and shiftwork restrictions. If the Resident’s duties meet the requirements for call conversion, the resident shall be appropriately compensated and be entitled to a post-call day.

To ensure Resident and Public safety, Residents who feel they are unsafe to drive their vehicle from the training facility to their residence after working an in-house or converted call shift will be reimbursed by the Employer for taxi fare home to a maximum of $25 per occurrence. Supporting receipts will be required for any such claim and repeated claims by a Resident may be rejected by the Program Director if found unreasonable.