Article 9 – Scheduling and Call

Home Heavy call defined as:

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

Please note that every hour in the hospital after midnight will count as two (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

Call Conversion 

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 one (1) in four (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 voluntarily performs In-House call duty in excess of one (1) in four (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.

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.

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.

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.

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

For the purpose of determining the maximum number of call shifts when a resident is on both in-house and home-call within the same rotation, the “blended call frequency formula” will apply:

The total number of home-call assignments multiplied by three (3) plus the total number of in-house call assignments multiplied by four (4) shall not exceed a total of thirty (30) over a twenty-eight (28) day period.

(# of Home Call Shifts x 3) + (# of In-House Call Shifts x4) < 30 in 28 day period

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 Handover

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 Handover

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 Schedule Posting

Final call schedules for each service shall be provided to residents and RDoS no less than four weeks in advance of the first day of the block.

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.

9.8.4 Emailing Call Schedules to RDoS and PGME

Program Directors, via the Program Administrator 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.

In the event that a particular service or elective period does not have on-call duty periods, the Resident shall not be reallocated 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).

Call scheduling models which differ from the limits outlined in this collective agreement may not be implemented until they have been reviewed and approved by both PGME and RDoS. PGME will maintain a repository of all existing alternate call scheduling models. Changes to existing alternate call schedule models will require new review and approval before implementing the changes.

Before implementing back-up call schedules, programs must obtain approval from both PGME and RDoS. Residents on back-up call schedules will be paid home-light stipends, regardless of whether they are called in to work the shift. Call conversion will apply to any shift worked where the call duties became in-house in nature during the shift, and in-house stipends will be paid in these instances. PGME will maintain a repository of all existing back-up call schedules. Changes to existing back-up call schedules will require new review and approval before implementing the changes.

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. (Article 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 their 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, Obstetrics and Gynecology, and Pediatrics; shifts shall not be scheduled in excess of five (5) shifts per week, with maximum duty hours pro-rated by duration of shift. For example, CTU float shifts at twelve (12) hours per shift, and ER shifts at eight (8) hours per shift. No resident shall be expected to participate in clinical duties for twelve (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 place of residence after working anytime between 12:30–9 am will be fully reimbursed by the Employer for taxi/rideshare fare home. Supporting receipts will be required for any such claim and may be rejected by the Program Director if found unreasonable.