as a cross over on the subject of senior staffing in Emergency Departments from the Australian e-med line I am sending this from Drew Richardson in Canberra John Vinen in Sydney had estimated that 15 specialists are necessary to provide comprehensive specialist presence but that is clearly some years off (although I see that the Brigham and Women's Hospital in Boston has 21 staff specialist for patient load of 40,000 + patients - many will be part time) Drew has produced the best calculations I have seen for some time and reached the conclusion that 10-11 is the optimal number for good cover balanced with a good lifestyle I would agree with this and have been stating this loudly for some years to our management (i.e. myself mainly!) We have gone from 1 to 5 over the past 4 years but it is bloody hard covering 16/7 plus on call every day plus all the other commitments with 5 FTE - but we are doing this and it is starting to show results in terms of patient care and our profile as speciality In NZ our manpower planning is being reviewed but an 11 FTE minimum formula for major hospitals is taken as definite and there are enough trainees in the system to get there by 2010. Please read the e-mail below very very carefully it offers a framework for the entire future of the speciality of Emergency Medicine if it is to survive and provide the service required. JohnC TOIL means time of in lieu(? spelling!) -----Original Message----- From: Richardson, Drew [mailto:[log in to unmask]] Sent: Tuesday, 5 November 2002 12:34 p.m. To: Emed-Aus Subject: RE: Weekend cover I must disagree again: in the real world it is true that no administrator will pay 15 FACEMS to cover 14 shifts a week. The reasonable minimum to avoid burnout and adequately renumerate us is: 4 x 10 hour shifts per week Maximum 1 in 4 evening/weekend/call TOIL - 25% weekday evenings, 50% Sat, 100% Sunday 25% non-clinical time (more for director) 10% Leave (add more for sabbatical) Now even within this, there are problems with definitions - do I mean 1 in 4 weekends in the year, or 1 in 4 whilst you are there? Can your TOIL be taken as hours (shorter shifts) or must it be taken as whole days? Can your TOIL be taken on Non-Clinical Days thus increasing your proportion of clinical time actually worked? Depending on how you answer these questions, you come up with 9-11 FTE, and on reasonable answers get 10 clinical FTE (probably 11 with director). For example, here are two possible rosters for 8 people (need 10 to account for leave) that cover two day shift, two evening shift weekdays, one of each weekednds (24 clinical shifts/week) that work 34 hours per week, 40.13 including TOIL, one using hours, one using shifts for TOIL. Both give 7 days off in a row once in 8 weeks, maximum of 6 days clinical in a row. (1) Non Clinical Shift every Week MON TUE WED THU FRI SAT SUN D08 D08 E10 N08 E10 N06 D08 D08 E10 N08 D08 E10 N08 E10 E08 E08 D08 D08 E10 N08 E10 N06 D08 D08 E10 N08 D08 E10 N08 E10 D08 D08 (2) Exclusively 10 hour shifts (reduced non-clinical shifts - some weekday time after handover to be non-clinical) MON TUE WED THU FRI SAT SUN D10 D10 E10 E10 N10 D10 D10 E10 D10 E10 N10 E10 E08 E08 D10 D10 E10 E10 N10 D10 D10 E10 D10 E10 N10 E10 D08 D08 If the director helped out with some weekends, that makes it about 10 weekends worked each year (definitely less that 1-in-4 whilst there), only half of them requiring on-call overnight. That is the sort of life we are looking at. As both an administrator and clinician, I'd rather be paid than take TOIL. Loking to the future, if it is night cover you want, then you can easily cover one shift x 24 hours with the 10 FTE AMWAC suggested, but (1) you would need at least 15 bodies doing that 10 FTE to keep nights down to 2 per month and (2) that is not when the patients come - it is far more important to have multiple FACEMs during day and evening shift than one at night and (3) the penalty loadings should make TOIL not an option - it has to be money. Drew Richardson -----Original Message----- From: John Vinen [mailto:[log in to unmask]] Sent: Monday, 4 November 2002 8:55 To: Tim Green; John Chambers; Robert Dowsett; Emed-Aus Subject: Re: Weekend cover Sorry to say but you are all wrong in relation to the number of EP's required to staff an ED. I refer to my previous calculations using the NSW "award" for staff specialists. In any calculations you need to factor in leave entitlements and TOIL for after-hours work. Leave entitlements annually are: 5 weeks annual leave 5 week TESL TOIL entitlements vary a little but should be standardised to prevent administrators playing games. To cover 2 shifts/day one EP at any one time [many sites need two on duty during busy periods] 7 days a week you require [excluding the HOD]: This means that you require to cover 14 shifts per week. If you do the mathamatics you require a minimum of 15 FTE's. If you replace TOIL with payment fewer are required. You also require enough EP's to ensure that they are not overworked especially on weekends. The US experience clearly demonstrates that after-hours work dramatically increases burnout and the other adverse effects of shift work [relationship breakdown,ill health,suicide,etc]. JV ----- Original Message ----- From: "Tim Green" <[log in to unmask]> To: "John Chambers" <[log in to unmask]>; "Robert Dowsett" <[log in to unmask]>; "Emed-Aus" <[log in to unmask]> Sent: Thursday, October 31, 2002 1:19 AM Subject: Re: Weekend cover > John, > > I presume you only have one EP on day shift. At RPA and I'm sure other big > Australian centres we need 2 EPs each weekday day to cover the load. On > that basis we need 9-10 FTE to cover 16 hours x 7 days > > > Tim Green > > 30/10/02 14:11, "John Chambers" <[log in to unmask]> wrote: > > > we provide 16 hr cover 7 days a week with 5 FTE > > could just about do with 6.5 though > > John > > > > -----Original Message----- > > From: Robert Dowsett [mailto:[log in to unmask]] > > Sent: Wednesday, 30 October 2002 2:58 p.m. > > To: [log in to unmask] > > Subject: Re: Weekend cover > > > > > > > > We have 6 FTEs providing day time coverage only. Weekend shifts tend to be > > about 2 shifts every 5 weeks on average. We need 16 hour coverage but will > > need a minimum of 10 FTEs to do that. > > > >>>> Tony Nocera <[log in to unmask]> 28/10/2002 20:28:30 >>> > > We are being offered funding for two staff specialist positions provided > > we go to providing seven day a week 0800-2300 with seven EFT positions > > meaning our weekend roster will be one in three most of the year. Is > > anyone working less than one in four weekends? > > > > > > > > Tony > > > > > > > > __________________________________________________________________ > > > > This electronic message and any attachments may be confidential. If you > > are not the intended recipient of this message could you please delete the > > message and any attachments and advise the sender. Western Sydney > > Area Health Services (WSAHS) uses virus scanning software but excludes > > any liability for viruses contained in any email or attachment. > > > > This email may contain privileged and confidential information intended > > only for the use of the addressees named above. If you are not the > > intended recipient of this email, you are hereby notified that any use, > > dissemination, distribution, reproduction of this email is prohibited. If > > you have received this email in error, please notify WSAHS > > immediately. > > > > Any views expressed in this email are those of the individual sender > > except where the sender expressly and with authority states them > > to be the views of WSAHS. > > ###################################################################### > > > > Attention: > > This e-mail is privileged and confidential. If you are not the > > intended recipient please delete the message and notify the sender. > > Any views or opinions presented are solely those of the author. > > > > ###################################################################### > > -- > > > ###################################################################### Attention: This e-mail is privileged and confidential. If you are not the intended recipient please delete the message and notify the sender. Any views or opinions presented are solely those of the author. ###################################################################### ###################################################################### Attention: This e-mail is privileged and confidential. If you are not the intended recipient please delete the message and notify the sender. Any views or opinions presented are solely those of the author. ######################################################################