Providing after-hours on-call clinical coverage in academic health sciences centres: the Hospital for Sick Children experience

AN INCREASING NUMBER OF ADMISSIONS OF PATIENTS requiring complex and acute care coupled with a decreasing number of pediatric postgraduate trainees ha s caused a shortage of house staff available to provide after-hours on-call coverage in the Department of Pediatrics at Toronto's Hospital for Sick Ch ildren. The Clinical Assistant program created to deal with this problem wa s short on staff, did not provide adequate continuity of care and was becom ing increasingly unaffordable. The Clinical Departmental Fellowship program was created to address the problem of after-hours clinical coverage. The p rogram is aimed at qualified pediatricians seeking additional clinical or r esearch training in one of the subspecialty divisions in the Department of Pediatrics. We describe the hiring process, job description and evolution o f the program since its inception in 1996. This program has been mutually a dvantageous for the individual fellows and their sponsoring divisions as we ll as the Department of Pediatrics and the Hospital for Sick Children. We r ecommend the introduction of similar programs to other academic medical dep artments facing staff shortages.