Physicians-in-training function under the supervision of Lahey Clinic staff physicians at all times. The program director of each training program is responsible for the overall performance and supervision of the trainees in that program. Faculty members responsible for supervising participation in patient care by physicians-in-training shall be medical staff members in good standing, with relevant clinical privileges at Lahey Clinic. No Lahey Clinic medical staff member shall leave patients in the charge of physicians-in-training as primary coverage. In the case of clinical consultations, no Lahey Clinic medical staff member called to consult shall leave primary responsibility for the consultation up to a physician-in-training.
The extent of participation of physicians-in-training in the care of a patient shall be disclosed and clarified to the patient and/or family members. Each patient's attending physician and consulting physicians shall coordinate with the responsible faculty physician in supervising patient evaluations, treatments and procedures provided or performed by physicians-in-training. In compiling performance evaluation and quality improvement data from patient encounters where physicians-in-training have participated in patient care, the supervising faculty physician shall be responsible for the activities of the physician-in-training and all information, conclusions and improvement data shared with the supervising Lahey Clinic faculty member.
Assignment of Patients
All inpatients under the care of the three staff electrophysiologists are considered "teaching" patients in relation to the arrhythmia service fellows. These patients, combined with those consulted upon by the staff electrophysiologists, constitute the inpatient arrhythmia service, and all are assigned to the electrophysiology fellowship program for teaching purposes. Patients located in the intensive care units or admitted via the Emergency Department will typically be assigned to the medical residency house staff and, therefore, will not be followed by the physician assistant. However, electrophysiology fellows are expected to be familiar with all such patients and to be closely involved in their management.
Orders
Fellows and physician assistants may write orders in the inpatient or outpatient records of all patients under the care of the three staff electrophysiologists. These orders do not require co-signature of the staff physician, but all orders that deviate from standard preprinted procedural format require discussion with the relevant staff physician.
Call Responsibilities
The ACGME Policy on Resident Duty Hours (effective July 2003) is available at www.acgme.org; the Lahey Clinic residency in Clinical Cardiac Electrophysiology adheres to this policy and generally far exceeds its requirements. The fellows and three staff physicians assume an equal share of week-end call for the arrhythmia service so that the fellow is on call on average one week-end in seven; when a fellow is on call there will be a designated staff electrophysiologist available to provide support for clinical or procedural management as appropriate. Fellows will not be expected to assume any on call responsibilities during the working week except for calls related to hospitalized patients that they have operated upon or seen in consultation; this responsibility ensures continuity of both the care and education experience. Fellows will not be expected to be resident on call but will be available by telephone from within 30 minutes of the hospital at all times when on call; a mobile phone will be provided. On call responsibilities include daily rounds on all arrhythmia service patients as well as consulting patients on other services. In addition, the on call physician is responsible for making the arrangements for the performance of all necessary invasive or non-invasive procedures related to arrhythmia investigation or management. Should the routine and emergency weekend call responsibilities lead to an excess of hospital hours worked in any week (>80 hours) the designated staff electrophysiologist will assume call responsibility. In order to document duty hours all fellows are required to keep a record of time spent in the hospital during randomly sampled weeks of the year.
Compensation and Benefits
Typically, the fellows are compensated at the current Lahey Clinic salary level for PGY-6 or PGY-7. Fellows receive malpractice coverage, medical and other benefits in accordance with the terms and conditions of employment outlined in the House Staff Manual (see Salaries and Benefits). Each fellow is provided with private office space, a dedicated telephone line, and a personal computer. Fellows are provided with Lahey e-mail accounts for the duration of employment at Lahey Clinic. Within the fellow's office is housed a comprehensive library of arrhythmia texts and current as well as bound journals of subspecialty interest not carried in the institutional library.
Vacation and Professional Leave
Each fellow receives 15 days of vacation in each calendar year, as indicated in the House Staff Manual and the fellowship agreement (see Terms of Employment). Weekends and clinic holidays are not charged as vacation time. Fellows must schedule all vacation and professional leave in conjunction with, and with the assent of, the program director. Vacation time must be used during the term of the fellowship program, as unused vacation cannot be sold back. Vacation time allocated during a partial calendar year will be allocated on a prorated basis.
All on-site CME courses sponsored by Lahey Clinic Foundation are open to Lahey Clinic residents and fellows on a space-available basis with the approval of the course instructor and the program director. Registration fees are waived for residents and fellows. Any paper or poster presented at a local, national or regional society meeting will be supported financially by Lahey Clinic and, in addition, the electrophysiology program strongly encourages the attendance of the fellow(s) at one major cardiac/electrophysiology meeting per year. Full financial support is provided for such attendance. Usually the fellows attend the NASPE meeting, but the ACC or AHA meetings also qualify for financial support.