Call Questions

Call at my program goes like this.

We try to combine AP/CP as much as possible. Sometimes we can't if the person has not had surg path yet.

We take call a week at a time. Normally the first year residents get 5 or 6 weeks of CP call and 3 or 4 weeks of AP call. It goes down from there, this year I am have 3 weeks of both AP and CP call. We take beeper call from home.

All the issues you mentioned happen on call. And, yes the attendings come in pretty much anytime we have to. I would say we get called in for something about once every other call period. Normally apheresis is what gets us. Frozen sections after hours are rare.

We handle autopsy call with a seperate person. The first year who is on autopsy gets it every other weekend. The rest of the weekends are split among the rest of the residents. We have about 150ish autopsies a year so a few come on the weekends.

CP call is by far the busiest of the call. It can range from about 8 calls to 20ish a week. Some people are just unlucky hehe. The majority of the calls are in the early evening, but every couple of nights the 2am call will drag you out of sleepyland. But, considering the alternative of what your classmates will be doing in surgery, internal med, etc... we have no room to complain.

Hope this helps.

1. Do you take combined AP and CP call at the same time or is it split?

We take AP and CP call at the same time. Autopsy is covered on the weekends by the residents on autopsy, not the regular call folks.

2. How often? One week at a time or a night at a time? How much in a year?

One week at a time. First years get 7 weeks/year. Second years get 6. Third years get 5 or 4 and fourth years get 4 or 3. We have two types of call. One covers the university hospital and the other covers our large private hospital. At any one time, there are two residents on call, one covering each.

3. What are some issues you address on call? Apheresis? Frozens? Autopsy? Blood smear review? Does the attending ever come in as well?

We cover aphereses, frozens after five pm, immunosuppression protocols (a staining protocol performed on BALs or other specimens to look for bugs), mislabeled specimens, critical value dumps, gram stains and other general lab questions. We always have attendings who are available for consult; when we have to come in, they come in as well.

4. In house call or beeper call? Roughly how frequent does that beeper go off?

Beeper only. The number of pages per call can vary from literally zero to being up to your neck in it. It probably averages out to about 2 calls a night over a full years worth of call. Most are during waking hours but, as GP said, there are occasionally those ones that come at 3 am. They are thankfully not too common.

Anyone else out there willing to post some more information?

Thanks,

-Salty

SaltySqueegee said:

Anyone else out there willing to post some more information?

Thanks,

-Salty

Click to expand...

On surg path, we are on frozens/surg path call every fourth day.

On autopsy, you are typically on call two weekends each month. This consists of doing any autopsies that come in before noon.

On CP, we take call a week at a time.

We have separate AP and CP call. Residents only take call for the hospital that they are rotating at.

At main hospital:
AP call: from home, usually Q4-5, with one weekend per month. This can vary depending on other factors. Handle frozens (every night on call ) and rush bxs done on weekends. Attendings or surg path fellows come in to read frozens.
CP call: from home, usually Q5, one weekend per month. Typically responsible for blood product approval that doesn't meet criteria, new leukemic smear review if hem/onc wants you in, and stat malaria smear reads. Attendings come in if you need them for something.

At county hospital:
AP call: usually every other night, handle frozens only, usually 2 weekends per month (you rotate with the other resident on surgicals); attendings come in to read frozens.
CP call: a week at a time, cover similar things as main hospital CP call; less calls overall which makes it more bearable, although carrying the pager for a week straight really sux.

At VA:
From what I understand AP and CP call here is scant to absent (ie you carry the pager but rarely get called).

We take call a week at a time and it is combined AP/CP call. You start out with 8 weeks of call as a first year and it decreases to 4 by your senior year. By convention the first years take call over the big holidays at our program (Christmas, New Year's, Thanksgiving, etc.).

The call is taken from home and there is the rare issue that requires one to come in overnight or on the weekend (plasmaphresis, leukophresis, stat peripheral smear for malaria or heme malignancy, etc.) The majority of issues, as has been noted on this thread, are blood banking/laboratory issues that require you to release a unit, explain a test to a clinician or tech, or chase down a resident by phone with a critical lab value. Oftentimes while on call, a frozen section will emerge from the OR after normal duty hours (say 1700 or 1800) for which you are responsible. The attending has to come in for any issue complex enough to require a resident to be there. Phone issues can generally be handled by the resident, though the attending is available if needed.

As has been stated by others, volume depends. Some residents are black clouds and seem to get all the malaria smears, emergent leukophreses, and bizzare 3 am calls that require hours to sort out. In general though, nobody ever gets out of a week without 2-3 late night calls and we probably average around 15-20 calls per week.

Separate AP and CP calls, although usually you do both. The only time you do only one of them is when the AP only or CP only people take call (and the numbers of them are increasing, which is irritating for the rest of us because it means more call). Personally, I think CP-only people should get double the call because they are so unbusy with clinical duties.

Call lasts for 24 hours, although during the weekday most things that would go to the call resident are supposed to go through the actual service the question is related to (like if it's an autopsy question they are supposed to just call the morgue) but a lot of times they are lazy and just call the on call resident.

Every day one (or two if AP/CP split up) resident is on call, we go home when frozens are done and no others are potential (usually 7-9pm). Sometimes you get a late case and have to stick around for it, last time I was on call I was there until 11pm. Also occasionally have to come back in the middle of the night. You rarely have to come in for CP issues and can deal with them over the phone, although there are more CP calls. Call officially starts on weekdays at 5pm and goes until 8am. Weekends it starts at 8am. Autopsies are separate call and are done by first year residents, who are on call for the whole weekend but only during autopsy hours, which are 7am-1pm. You don't start night call until about late july or august during early second year at which point you have rotated on all the key services.

I have had 24 hour periods with NO pages and some with 20-30 over the 24 hours. Attendings are always available as backup but rarely required except for approval for stat ANCAs or new pheresis or for weird situations.