HWHHS - PA

Harvard Work Hours Health and Safety Group

A Scheduling Toolkit for Medical Professionals

HOME MANUSCRIPTS SAFETY RESOURCES SLEEP RESOURCES REPORT AN INCIDENT CONTACT US

Determinants of Alertness & Performance Important Considerations What needs to be in place before you start? Sample Schedules

HWHHS Intern ICU Intervention Study

HWHHS Revised Resident Work Schedule

European Working Time Directive Regulations

Work Hours for Junior Doctors in New Zealand

Night Float Systems

Managing the schedule change Working with the Harvard Work Hours Health and Safety Group References

HWHHS Revised Resident Work Schedule: Using Physician Assistants as Physician Extenders

Another strategy that is being explored throughout the US is the use of physician assistants to ease the burden on physicians. Some groups have reported success with this method; however, no comprehensive studies have been done to assess the impact on resident sleep and work hours (Oswanski 2004, Christmas 2005). The schedule below depicts the schedule we are currently investigating, using both physician assistants and circadian principles to reduce resident work hours.

Raster plot of a schedule using PAs to reduce work hours

*Note these schedules are presented for informational purposes only and the presentation of these schedules should not be considered an endorsement for implementation. Please contact us for more information.

There are several advantages to this method. The ability of PAs to take on the majority of responsibilities normally held by residents means that a PA can be scheduled in the same way as a resident. This is clearly a great advantage because a schedule may be designed in such a way to optimize coverage, while also taking circadian principles into consideration. A second advantage is that physician assistants would be permanent fixtures in the units in the same way as nurses. Presumably this knowledge of cultural procedures and familiarity with patients would provide added stability to a unit. A disadvantage of this method involves the cultural attitudes of both physicians and nurses towards the PAs. It has been reported that PAs have difficulty adapting to a culture where they are treated as shift workers rather than medical professionals (Mathur 2005). Another disadvantage to this method is retention of PAs. As PAs are not committed to a particular contract or training scheme, they are free to terminate their employment with a hospital like any other employee. Currently it is unknown whether there are enough fully trained PAs to employ them in this way on a nationwide scale. Our group is currently conducting a study examining this method in a surgical ICU setting. This page will be updated with results of the study as they become available.