A few years back, during maternity leave, I met Jenn, a former resident of mine for lunch at a local Japanese restaurant. Jenn was finishing fellowship and able to meet me for sushi in our Brooklyn neighborhood. She brought her 8 month old son, Parker and I brought my 3 week old baby, Sam. During lunch she gave Parker an 8 ounce bottle of pumped breast milk which he happily gulfed down. As soon as I saw the bottle I started having palpitations about returning to work (albeit a few months down the road) and having to pump during my ED shifts. For me, pumping and working in the ED had always been a pretty awful experience. I immediately said to Jenn “Don’t you hate pumping at work.” To which she replied, “Nope, I just pump during my break.”
Break, what break? I had heard some rumors about breaks for attendings in the ED, but did it really exist? She then spent the remainder of lunch answering all my questions about formally scheduled breaks in her current ED.
Working in an Emergency Department is job that is physically, emotionally and intellectually taxing. Therefore it makes intuitive sense that people who work in such an environment for 8, 10 or 12 hours at a time should get a guaranteed period of time to eat, take a walk or just clear their head.
The unionized workers in the ED often get a 45 minute “lunch” break and a 15 minute “coffee” breaks during an 8 hour shift. They get an additional 15 minute break if they work longer. We also know that while the current RRC guidelines do not mandate breaks for ED residents during a shift, they do have guidelines for “strategic napping” during extended periods of time in the hospital. The question then becomes, if nurses, techs and residents get protection for breaks during their time at work, shouldn’t we provide the same for attending physicians as well?
To try and understand how a break system in the ED worked I spoke with Dr. Pat Carey, the Medical Director at St. Luke’s-Roosevelt Hospital (SLR) [now Mount Sinai- St Luke’s] in New York City. Jenn had just completed her fellowship at SLR and to my knowledge, the only hospital in my area that has formally scheduled breaks. Dr. Carey explained that every attending at SLR gets a 45 minute break during which a “break attending” completely covers patient care and resident supervision. Attendings take and receive sign out during that same 45 minute period, so each physician gets approximately 30 minutes of time to themselves. A swing attending basically relieves 4 sequential physicians for the first 3 hours of their shift and then takes their own break, after which s/he resumes clinical responsibility in a singular area for the remainder of their shift. She was very clear that the breaks are provided at a specific time, so if you don’t use it you lose it. She did concede that an attending may get a case s/he can’t leave and therefore lose their break, but that happens rather infrequently.
SLR physicians are hospital employees and when I asked about the financial implications of the extra coverage, she didn’t seem to think the hospital had any issue with it. She was also very clear that all the physicians seemed happier and more productive when they returned from their break, regardless of what they did with their time. It was very clear that that her department (which has been scheduling physician breaks for over 10 years) views this practice as an integral part of physician well being, which brings me back to my inspiration.
Emergency medicine is an evolving field. A specialty which used to be filled with moonlighting medicine and surgical doctors is now filled with dedicated and highly trained physicians who are looking for career sustainability and longevity. However, the shifts are long and often grueling. There are recommendations on shift scheduling and respecting circadian rhythms, but not much on what occurs during the individual shift. Formally scheduled breaks during ED shifts are a great idea for all ED docs, not just nursing mothers like me.
They are also beneficial for patients, as it is guaranteed that each patient is covered by a dedicated attending, with minimal “cross covering” since it is expected that each attending take care of anything that requires them to physically leave the ED during their break. After speaking with Dr. Carey I became convinced that a practice that sounds like a pipe dream to most of us in Emergency Medicine is actually practically possible and financially feasible. This is a wellness issue for men and women alike, but like everything else, the only way things will change is if we women make it happen.
A version of this article was originally published in the AWAEM Awareness newsletter September-October 2012.