Moonlighting

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PURPOSE:

The purpose of this Policy is to support the physical and emotional well-being of the trainees of the

Neurocritical Care fellowship program at New York-Presbyterian Hospital (NYPH), promote an educational

environment, and facilitate patient care. Procedures have been developed to regularly monitor trainee work hours forcompliance with this policy and the ACGME Program Requirements.

POLICY:

  1. It is the policy of the Department of Public Health at NewYork-Presbyterian Hospital to comply with New YorkState 405 Regulations and with ACGME policy on work hours for postgraduate trainees. These are the minimumstandards on work hours that programs must follow.
  2. Compliance: The program director is accountable for ensuring compliance with work hours policies. The GMECommittee and DIO receive periodic reports on work hour compliance as part of the QA process.
  3. The program will use an approved web-based work hour logging system (currently MedHub). Trainees are required log their work hours weekly. Compliance of this requirement will be reviewed by the NYPH GME Office,followed by the full GMEC.
  4. Definition:  Work hours are defined as all clinical and academic activities related to the educational program –  patient care, both inpatient and outpatient, administrative duties related to patient care, the provision for transferof patient care, time spent on clinical activities while on call, and scheduled academic activities such asconferences.
  5. Work hours must be limited to 80 hours per week averaged over 4 weeks, inclusive of all in-house clinical andeducational activities, clinical work done from home, and all moonlighting activities.
  6. Trainees must have 8 hours off between scheduled clinical work and educational periods. Trainees must have at least 14 hours free of clinical work and education after 24 hours of in-house call. The Neurocritical Care fellowship does nothave 24-hour in-house call shifts.
  7. Clinical and educational work must not exceed 24 hours of continuous scheduled clinical assignments. Up to 3 additional hours may be used for activities related to patient safety and/or trainee education.
  8. In rare circumstances, after handing off all other responsibilities, a trainee, on their own initiative, may elect to remain or return to the clinical site (1) to continue to provide care to a single severely ill or unstable patient; (2) for thehumanistic attention to the needs of a patient or family; or (3) to attend unique educational events. These hours count toward the 80-hour weekly limit.
  9. Trainees must have a minimum of one day in seven free of clinical work and required education. This rule cannot be averaged over 4 weeks as outlined in New York State 405 regulations. At-home call cannot be scheduled on these days.
  10. Time spent on patient care activities while on at-home call must count toward the 80-hour maximum weekly limit. At-home call must not be so frequent or taxing as to preclude rest or reasonable personal time. All clinical work conductedwhile on at-home call must also be included toward the 80-hour limit.
  11.  Moonlighting is defined as voluntary, compensated, medically-related work performed beyond a fellow’s clinical experience and education hours and additional to the work required for successful completion of the  program. Our trainees are allowed to moonlight and must obtain written permission from the Program Director to engage in moonlighting activities. All moonlighting activities must comply with work hours regulations and be reported on the work hour log.