Do Doctors Get Snow Days?

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Dear Director: During a recent snow storm I couldn’t get in for a shift and I caught a lot of grief from my medical director about it. What’s my responsibility and what should I do if it happens again?

I feel your pain, but unfortunately, regardless of the weather, the shifts still need to be covered. Part of what separates health care workers, and in particular, emergency physicians, is that when disaster strikes, we run towards it, not away. Everyone who works in a hospital knows that the ED is always open and the community and hospital leadership expect us to be staffed. It’s part of why I got rid of my sports car during residency and bought an SUV. Getting stuck at the hospital once was enough for me.

Part of our mentality as emergency physicians needs to be that we’re going to get to work to do our shift regardless of what else is going on. During one storm, I was called by a doc an hour before he was due in for work. He said the weather was too bad and he wouldn’t be able to get in. When I asked him what he suggest happen, he was silent, waiting for me to offer to do the shift. If you can’t get there or you think it’s too dangerous to drive, why is it better to make someone else do it?

When you work in a 24/7 business, you know there will be personal sacrifices. You will miss your share of holidays, parties and other events. That sense of sacrifice – which we all signed up for and which makes the emergency department tick – has to be stepped up even higher in a natural disaster. Unlike planned events, these often require more time or even extra shifts in the hospital. That means sacrificing time with our families, the ability to care for our homes (shoveling out the driveway may not be fun but is a necessity), taking risks on dangerous roadways – all of which can take its toll on our households.

Priorities
“I can’t make my shift in an hour because . . . I have rotavirus, my kid was in an accident, my father had an MI, my wife is in labor, etc…” These are all fully acceptable to me for missing a shift and passing on the responsibility of finding coverage to the ED director. Since we all put our family first – and occasionally our own health – these types of problems are the perfect reason to have an on-call list for the group so that there is a clear person available and responsible to cover a shift in an emergency. But at some point near the top of your priority list, you must include work and the team that you work with. Successful EDs are based on teamwork which requires an underlying sense of commitment and dedication to the job and each team member. There is certainly a time for putting family first, but be careful of what constitutes an emergency and be sure to have plans in place for the non-emergency situations (sick child home from school, etc…).

Responsibility
I was working a shift when my relief called me 30 minutes before shift change to say that a micro-tornado had blown through his neighborhood, knocking down several trees including one that blocked the only road off the small peninsula he lived on, and therefore he wouldn’t be coming in. It was a pretty reasonable excuse, but as he was laughing at the reason he couldn’t get to work, he was also passing on the responsibility of finding my own relief while continuing to see patients and wrap up the active patients that I had (we did not have an on-call schedule at the time). Once the schedule is out, you own your shifts. In this type of situation where you can’t get in, you should be making your own phone calls.

Furthermore, weather emergencies, be it hurricane, blizzard, or wind storm, rarely pop up without warning. If you know it’s going to snow six inches overnight, get up an hour early to deal with the delays. If you know it’s going to snow 15 inches in the eight hours before your shift, go into work that much earlier while the roads are okay. Several years ago, I came into the hospital and slept in a call room to make sure I wasn’t snowed out for my 7 am shift. Call rooms seem much worse and uncomfortable than when I was a resident. Over the last few years, I’ve stayed at a lower end hotel that is about a half mile from the hospital. They offer a hospital rate (my company pays the bill) and the night before a storm, there’s usually a fair number of ER docs and anesthesiologists staying there. The hotel offers breakfast, I know I can walk to work if necessary and I don’t lose hours of sleep digging out my car (covered parking) or fighting traffic.

Years back, I had one doctor walk two miles to a car rental company because his road likely wouldn’t be plowed for several days and he couldn’t get his SUV through the three feet of snow on his side street. Maybe he was dedicated; maybe he just didn’t want to lose pay for three days. But he did make his shifts. That’s taking shift ownership to a whole new level. One key element was this doc’s awareness of the limitations around him, namely his town’s inability to plow side streets in a timely manner. Limitations might relate to your personality, your car, your lifestyle or your distance from work. The more aware you are of these factors the better off you’ll be in an emergency.

My good friend, Matt, lived and worked along the Gulf of Mexico in 2005. He had plenty of notice that Katrina, a Category 5 Hurricane, was coming ashore. He sent his family to another state, went into the hospital for his shift armed with 3 days of clothes and scrubs in a duffel bag. When the storm was over, he went back to his house to find it gone. Yes, completely gone along with almost everything he owned. He returned to the hospital, duffel bag (now with dirty clothes) in hand, where he lived and worked for a few more days. Because the hospital needs staff, it’s in their own self interest to make sure that physicians and staff have a place to stay and food to eat. Although Matt made it into work, not all of his colleagues could, and I’m sure each of us can find scenarios where you might not be able to make it into work. Consider the massive snow storm where highways shut down or roads don’t get plowed for days. It’s not realistic to show up for work 2 or 3 days early because you’re afraid you won’t make it in. In these types of extreme cases where disaster disrupts travel for days, it may require the scheduler to blow up the existing schedule, take advantage of the team, and assess the assets available. Most of us have had to sleep in the hospital to insure staffing would be present in 12 hours. Perhaps other colleagues live closer. These situations require leadership, communication, flexibility, and sometimes a little personal sacrifice in order to assure we’re there to serve the community.

In closing, we have an important job. Our doors are always open, regardless of the emergency and or the environment. Without commitment, dedication, sacrifice, and teamwork, that is not possible. I don’t believe that everyone should own a Humvee to get to work, but I do believe that it’s important to recognize that we must plan ahead so we can get to work, we must take ownership of our shifts, and we must also recognize that work (i.e. shift coverage) must be one of the top priorities in our life.

Photo by Anthony Quintano (@AnthonyQuintano)

14 Comments

  1. Michael, I’m in Michigan. If we couldn’t move snow nothing would ever happen between Novenber and May. Leaving that aside let me just say I worked for years at a hospital that had a great volunteer group of old guys who would use their 4 wheel drive trucks and even snowmobiles to bring in essential people. ED docs were on the list. Boiler operators were on the list. Nobody from administration was on the list. I think it was actually fun.The number of patients was down and our spirits were up. A mash-unit atmosphere to say the least. Like it or not if we don’t show up the place is in deep shit. Ours is not some union job. This is what we do. When the going gets tough the tough get going. I hope a little of this spirit still remains. Greg Henry

  2. robert fawcett on

    So could this commitment to be there “no matter what the weather” would be a good excuse to deduct your 4wd as a work tool necessity as you could not perform your job without it! 😉

  3. There are options. I have walked 13 miles to work. In the Blizzard of ’78 in Boston State Police on snow mobiles escorted me between two Lynn, Ma hospitals. There are always ways to get the ED to relieve your colleague who worked 12 hours or more.
    Tris Dammin

  4. Jamie Easterly on

    I’ve just a read a few articles in this month’s issue. The majority of the articles are informative and have a few good points. After reading Silverman’s fantasy piece followed by Setu Mazumdar’s practical section, I am thankful that Silverman is NOT my “Leader.” The financial article from Mazumdar’s article describes our job as something we like to do and the job is a means to an end. The main point is to: Save a good percentage of your money, pay off your debts, reduce your shifts, and enjoy life. When a shift needs covered because it can’t be filled because someone has a morning meeting to attend, I have little interest in doing the shift. When someone is sick or truly cannot work, I am willing to help. Silverman probably thinks that not doing everything you can to work a shift in the ED is preposterous and easily passes judgement upon the hard working EM physician. Imploring the physician to risk their lives to get to the shift is ridiculous. If the road is blocked by a tree and impassable, the EP physician isn’t showing up and Dr. Silverman should man up and take care of the issue. And ‘yes’ the reason is quite funny. To give the EP physician hell for not making it is insulting. Particularly if the EM physician does not own any part of the ED/contract.
    Additionally, many of us have families, and packing up a suitcase for three days is ridiculous. I’ve never seen an administrator do that.

    Our job is full of nonsense. Long are the days when the work was a lot of fun and fulfilling. Now its full of pts/hr, patient satisfaction issues, EMR, lack of support from admin, lack of staffing, unhelpful consultants, etc. Occasionally we get a thank you from a patient. I’m not risking my life, my family, and livelihood to get to the ER under dangerous circumstances.

  5. William S.VaughnIII on

    No, we do NOT get snow days! I remember catching BIG GRIEF from my now ex-wife about going in during a snowstorm. Everyone has family and THE ER NEVER CLOSES!

  6. Dr. Common Sense on

    If you can’t make it in, you can’t make it in. If you are dealing with bad weather, wake up a little early and give yourself some extra time to get there just like you would for any other job. If you are dealing with dangerous weather, you need to ensure your and your family’s safety. This isn’t a union job, but maybe it should be.

  7. My attitude is if the shift is open and I’m available I’ll always help out. BUT I’d like to see that taken into acct. by the suits who decide on our bonus. If it’s not, they can go and get the stranded ED Physician to the hospital.

  8. ….and wake me up when the admins, sub-specialists, and PCPs actually give a darn. Meanwhile, we dream about running a MASH unit? Please. Altruism only goes so far and then you realize that despite our best humanitarian efforts we’re still undercut by the suspicion and brush-off ov our “colleagues”. I recall my grandfather recounting stories of walking uphill, both ways, in a snow storm, to school…..yeah, I didn’t believe him either. EM as a specialty is still lagging behind the healthcare delivery system despite all these efforts and glory evoking diatribes. Kudos to the Admin crowd who can still Monday-morning quarterback the system to “look” important. Roll your sleeves up and dive into the pit! Delusional…..

  9. Ted Switzer, MD on

    This story about dedication to duty reminds me of the time that Hurricane Rita was a category 5 aimed right at Lake Jackson where I was the ED medical director at the local hospital.

    I was on duty the very last night shift before the ED closed. The hospital was already closed to admissions and most people in town were evacuating but I stayed with a dedicated group of nurses to handle the stragglers. No back up. We felt deserted.

    We got several critical patients that night – including a trauma with crushed pelvis and a STEMI – all of which had to be flown to Houston.

    We had to set up a second heliport because we were also flying the ICU patients out. There were so many helicopters that it looked like a scene from a movie.

    I finished with the last patient at 07:00 and we officially closed the ED.

    I appreciated the dedication of the few who stayed to help before I evacuated myself.
    – Ted Switzer, MD, FACEP

  10. How sad for you younger docs! How sad that you cannot travel back in time and feel the comradeship, love and appreciation expressed by patients, staff and administration (yes, I said suits) who were all there helping when we stayed over and pulled extra hours/days of ED duty in blizzards, hurricanes, and community disasters; or when others could not get there safely.
    I am turning in my badge and key and cleaning out my locker today. I will walk out the door for the last time, but I will always cherish memories of the ED in rural Maine in the 1970s. We had our priorities right, but then so did our administrators, ED directors, families, colleagues, and even the patients back then.

  11. Ice storm is in the forecast and I left for my mid-morning 10 hr shift a few minutes earlier than normal. I take it safe and slow to get to this god forsaken pit. I used to really love my job, but the absurd rules the administrators have doled upon us, coupled with our uninspiring in-house YES Men ED Leaders have left me with no allegiance to what was once a department I would do almost anything for. I’m guessing Silverman falls into that category of ED Leaders. While I brave the roads and leave the safety of my home, all the suits are not showing up for work. Our ED Chairman isn’t either – its a snow day after all. He has little regard for the clinical side. His goal is to work as few shifts, pay someone else to do them since it is beneath him, never work weekends/holidays, collect his bonus, and get fat eating ham sandwiches during meetings. Dedication is not his strong suit and it spills over.

    ‘If you know it’s going to snow 15 inches in the eight hours before your shift, go into work that much earlier while the roads are okay.’……….Delusional.

    There was a time when I would leave an hour or two early for the shift and pack my Hermes weekender bag in case the department needed me because I was naively PROUD. I would even call to find out if they “needed” me. But times have changed. Now there is little to be PROUD about. Those that try to instill PRIDE, while running the docs into the ground are daydreamers and bad marketers. I’m watching the clock as soon as I show up wondering if my relief may come in 5 minutes early. I’m thinking I should follow in the footsteps of our dept chairman i.e. never help out clinically, do as little as possible, smile and walk around the dept while doing absolutely nothing.

    So what did I have in store in this dept after almost colliding into a semi trying to get to my venerable work site? 23 y/o on disability who vomited once and promptly called the ambulance, currently eating doritos. Spouse demanding admission for a minor gout flare. Intoxicated hairy man in bar fight who looks like he lasted 5 seconds with Ali. And of course a pseudoseizure and two dilaudid seekers who came by ambulance and demanded transportation home in this weather. Most of them won’t have co-pays, insurance premiems, or any skin in the game. All of them it seems were wearing the same soft drink logo pajamas that they slept in for the past two nights. And yes I was incredibly nice to them all and they’ll all get surveys. I should have just called in – its a SNOW DAY!

    • Like the article says…and what I tell my fellow colleagues…”you chose this 24/7 career” go get a 9-5 job if you dont like it.

  12. In my Baltimore area hospital, local volunteers with 4WD were sought to fetch emergency staff to duty during a severe (rare) crippling snowstorm. It was great fun to be “chauffered” to work (I lived 40 minutes and a tunnel away), getting to know some of the community in the process, and then to camp out at work until the roads were passable again and we were able to get home. I believe they fed us, as well until the storm passed. Really felt like a team effort that day more than any other in memory. And I guess I did go home early, once, in labor.

  13. during the joplin tornado after our hospital was destroyed I slept in the back of my Honda Element outside the back door of ourr temporary unit in the memorial hall. All the doctors on the staff not just er, showed up to do whatever they could….although not er trained they all remembered enough to help
    this went on for the next few months
    but yes, i have gone and slept in the hospital ahead of my scheduled shift when i knew one of our famous ice storms were on the way
    it’s what we do
    jim riscoe, m.d.

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