Hi,
Applying into IM and interested in two programs one with 4+2 w/ heavy 24 +4 hour call schedule vs program with traditional schedule with no 24 call (uses night float).
I'm thinking that 4+2 would allow for me to see my daughter more and even the 24 hour call allows for more face time on post call days. Plus w/ 4+2 it seems that would lead to better primary care exposure.
Any thoughts? Something I'm not considering? I know q5 24 call is not ideal but does 4+2 make up for it?.
TIA
There are several dogmas in Internal Medicine training about which systems are the best and while I generally agree with the conventional wisdom, I strongly believe each program evolves within their framework to make things ideal and each negative has a redeeming quality somewhere else. I have experience with X+Y AND traditional scheduling having moved around within residency a bit. I think you've correctly identified that the most desirable quality for you with a family is the 4+2 block scheduling system.
With the 4+2, you guarantee a third of weekends off which I think is huge for family. If you feel you can tolerate the 24+4 calls, go with that schedule because it favors family and hopefully on the weekdays your kids are occupied and in the age of FaceTime you can always say goodnight from the callroom.
Traditional scheduling (non-X+Y) has a fair amount of heterogeneity per program to it as well so you need to do some more research as like I say, the programs often evolves over time to fit their framework. At some programs it's only a traditional schedule for primary services. How much of the traditionally scheduled residency is straight up primary services? At a place I know well, only 4 months were truly primary services where you only have 4 days off a month whereas the rest was a mix of electives and other rotations. If you're looking at a schedule where you're expected to work 6/7 days each for every rotation, that's somewhat grueling.
Everyone has their own preferences. If I were to design my own training, I would personally design it as traditionally-scheduled, drip admission system, with daily night float support because of my personality.
Traditional: I do well in settings with consistency and don't like the whole work-hard, play-hard environment (Y weeks, etc.). The cons of the traditional set up are that you're going to be conditioned to hate clinic because it's always going to seem in the way. Imagine prerounding and preparing your presentations for your inpatient rounds and simultaneously thinking about the clinic patients you're about to see once you round...and imagine if it's a different/backwards EMR... The flip side to that though in my mind though is that your job in the real world (should you stray away from academics) is more likely going to include situations where you have to step away from the floors to go to clinic so you at least get that experience while the X+Y system insulates you a bit from that with the Y week filled with academic lectures and such. For academic and lecture purposes, I don't believe in being bolused full of knowledge one week (Y week) and then going 4 weeks with less and would rather have one daily conference on a daily topic and learn a little everyday.
Drip: I prefer a drip system (ex. 2-3 admits per day) vs. a bolus admission system where some days you are designed to get none and other days you get filled with up to 6 in some form of rotation. Again some may prefer having that lighter day but I prefer keeping everything consistent.
Night Float: Highly prefer dedicated night float across ALL services if that's a possibility as opposed to the 24+4. Be advised some places do nights but then manage to still require their day residents to do 24+4s. While the 24+4 no doubt breeds toughness and I think everyone loves to tell their friends they're on a 24+ hr call, I don't really see it's purpose. Some say it allows for continuity of care, but I think that's BS because unless you are turning over your patients q24H (uncommon on academic IM) you're still getting the same continuity by just seeing them every dayshift and if night and day teams are signing out well to each other, you're aware of what the consequences of your day actions were on night team and vice versa when you're on nights. Also, there's the notion that the 24+4 builds toughness and endurance...which is true...but for what exactly? The 24+4 is hardly something you'll do as an attending so why bother throwing off your circadian rhythm and trimming years off to do it in residency if you can avoid it? If you can avoid 24+4, avoid it. That's my hot take.
