A rant, pure and simple!

[Toadkiller Dog]

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Allright, here is some more food for thought for all of you applying: The concept of "home" call.

I just spent a 4-day weekend on call (Th-Fri-Sat-Sun) because there was a meeting all the attendings and residents were at (a pseudo-holiday weekend). I slept perhaps a grand total of 10, maybe 12 hours the entire time. It went something like this:

Thurs: 7am to 3 am. Open globe, orbital cellulitis, other crap. Admitted 2 patients. Come home. Get beeped back at 4am. Back home at 6am, sleep for 2 hours.

Fri: Attending calls 8:30 am, wants me to go see a pt in the hospital. I go. Get bombarded with ER calls, inpatient consults, clinic follow-ups for the rest of the day. Mac-on Retina detachment comes in at 7:30pm, stay till 10 to help attending fix it (basically standing there while he lasers). Home at 10:30. Beeped back to ER at 12 midnight. Back home by 2:30AM. Beeped to ER at 4. Back by 5:30, sleep until 9.

Sat: Cover inpatient consults for all our hospitals. Home at 5pm, beeped back at (no kidding) 5:10. In ER until 3 am with multiple trauma consults. Called at 4am by neurosurgery to come see a patient for a blown pupil. I refused, and said I'd see them in the AM. Got 4.5 hours of blissful, uninterrupted sleep.
Sun: In at 10 am. The usual bombardment of fielding phone calls from attendings' patients, ER calls, etc. Day ends with angle closure glaucoma at 11:00pm. I couldn't break the attack, had to call my senior in. Finally got her squared away ~1:00. Home by 1:30, slept 3.5 hours. Back to hospital at 5:30 am to round on all my patients before Grand Rounds.

And to top it all off, I had a full day of clinic and hospital follow-ups on Monday!

Gee, even the neurosurgery residents at least got to go home and sleep a little bit! I worked ~100 hours with very little break. Does this sound safe for patient care (or me driving back and forth?) Holy smokes. Suddenly q3 call doesn't sound so bad!

Sorry if I sound a little loopy. I'm post-post-post-post call. But glad I got my half-hearted rant off my chest. I'm going to bed now. 😴

 

[orbitsurgMD]

Allright, here is some more food for thought for all of you applying: The concept of "home" call.

I just spent a 4-day weekend on call (Th-Fri-Sat-Sun) because there was a meeting all the attendings and residents were at (a pseudo-holiday weekend). I slept perhaps a grand total of 10, maybe 12 hours the entire time. It went something like this:

Thurs: 7am to 3 am. Open globe, orbital cellulitis, other crap. Admitted 2 patients. Come home. Get beeped back at 4am. Back home at 6am, sleep for 2 hours.

Fri: Attending calls 8:30 am, wants me to go see a pt in the hospital. I go. Get bombarded with ER calls, inpatient consults, clinic follow-ups for the rest of the day. Mac-on Retina detachment comes in at 7:30pm, stay till 10 to help attending fix it (basically standing there while he lasers). Home at 10:30. Beeped back to ER at 12 midnight. Back home by 2:30AM. Beeped to ER at 4. Back by 5:30, sleep until 9.

Sat: Cover inpatient consults for all our hospitals. Home at 5pm, beeped back at (no kidding) 5:10. In ER until 3 am with multiple trauma consults. Called at 4am by neurosurgery to come see a patient for a blown pupil. I refused, and said I'd see them in the AM. Got 4.5 hours of blissful, uninterrupted sleep.
Sun: In at 10 am. The usual bombardment of fielding phone calls from attendings' patients, ER calls, etc. Day ends with angle closure glaucoma at 11:00pm. I couldn't break the attack, had to call my senior in. Finally got her squared away ~1:00. Home by 1:30, slept 3.5 hours. Back to hospital at 5:30 am to round on all my patients before Grand Rounds.

And to top it all off, I had a full day of clinic and hospital follow-ups on Monday!

Gee, even the neurosurgery residents at least got to go home and sleep a little bit! I worked ~100 hours with very little break. Does this sound safe for patient care (or me driving back and forth?) Holy smokes. Suddenly q3 call doesn't sound so bad!

Sorry if I sound a little loopy. I'm post-post-post-post call. But glad I got my half-hearted rant off my chest. I'm going to bed now. 😴

Sounds like Kresge.

 

[Olddog1]

You should bring up with your program director the blatant disregard for ACGME work hours. Those hours were put in place to protect you and the patients from this very scenario.

 

[rubensan]

I think TD brings up a good point regarding the concept of "home call." It's not always as great as it seems, especially if you are covering multiple hospitals. We take in house call here at USC and it is slightly painful to be here o/n every 6th-7th night, but we go home at 100 PM (earlier on the weekends). It's nice to have a post call afternoon off to sleep, read, enjoy the LA sun or go to the dentist.

 

[JR]

Home call is an ACGME "grey area" since technically you are not in-house o/n. Post-call rules do not apply and no matter how hard you work o/n you still have a full clinic/OR/etc. the next day. On occasion, you may claim resident fatigue or the 10-hour-rule, but, for the most part, people don't do that (at least where I am at).

My advice- just stick with it. We all went through the agony of primary call and it does get significantly better as soon as you hit "the back up land"🙂

 

[Toadkiller Dog]

Yeah, I know it gets better. The thing that sucks is that our program has 2 years of primary call. Our problem is, we just don't have enough residents. We have enough work to take almost twice as many as we do. The good thing is we get lots of cases.

I *wish* we had in-house call, or at least a friggin' call room! My SO was totally pissed to see me driving back and forth on Sunday without any sleep.

The sad thing is that my program is one that is generally considered (on the interview trail) to be pretty resident-friendly.

 

[EYESURG]

I cover four hospitals too (University, Childrens, Major and small VA). I had to see a patient in each one of them last weekend and it sucked too! The small VA was 45 minutes away. I can't wait until second year.

 

[Toadkiller Dog]

I have received several PM's from people (mostly applicants) wanting to know what program I am at. What you folks need to know is that my program is not that unusual. Yes, we may be busier than many, but there are a *lot* of programs out there (especially the better-known ones) that work their residents this hard. I was totally not expecting this when I came in, because, like I said, my program is one that is generally not considered malignant.

And just for kicks, I totalled up the number of patients I saw over the 4-day weekend:
Children's ER: 3
Children's inpatient: 1
Trauma: 6
Regular ER: 5
Established patients I brought into clinic over the weekend because they called in complaining: 8
Inpatients: 4
VA Hospital: 1

Total patients seen over 4-day weekend: 28 (I think I left a few out, I can't really remember). And in all honesty, it could have been a lot worse. It was not the volume so much as the timing. As soon as I would get home, I'd get beeped back, even in the middle of the night.

So I think the other optho residents will tell you that this is not that unusual. So please don't think that I am at some outlier horrible program.

 

[babyblue_39]

I agree... there's a reason why its called residency and people who think we're not going to work hard just because Ophtho is a great lifestyle specialty are wrong. And I know 1st year is going to kick my ass. With that said, at least in Ophtho residency ends with residency.

 

[JR]

I hear you, my friend. Last year on a 24-hr Sat eye ER call I once saw a total of 28, including 2 open globes. I agree with you that in *many* ophtho residency programs residents work very hard. You do, however, learn a ton!

I have received several PM's from people (mostly applicants) wanting to know what program I am at. What you folks need to know is that my program is not that unusual. Yes, we may be busier than many, but there are a *lot* of programs out there (especially the better-known ones) that work their residents this hard. I was totally not expecting this when I came in, because, like I said, my program is one that is generally not considered malignant.

And just for kicks, I totalled up the number of patients I saw over the 4-day weekend:
Children's ER: 3
Children's inpatient: 1
Trauma: 6
Regular ER: 5
Established patients I brought into clinic over the weekend because they called in complaining: 8
Inpatients: 4
VA Hospital: 1

Total patients seen over 4-day weekend: 28 (I think I left a few out, I can't really remember). And in all honesty, it could have been a lot worse. It was not the volume so much as the timing. As soon as I would get home, I'd get beeped back, even in the middle of the night.

So I think the other optho residents will tell you that this is not that unusual. So please don't think that I am at some outlier horrible program.

 

[rubensan]

but there are a *lot* of programs out there (especially the better-known ones) that work their residents this hard.

i agree. last night i saw 12 patients while on call. i agree with JR, the more you see and do, the more you learn. it's amazing how fast your clinical skills develop. levator aponeurosis dehiscence? who knew? "retrobulbar hemorrhage" with an IOP of 20? i don't think so! "angle closure glaucoma" in a paitent with 20/30 vision? nice try ER!

the silver lining in all of this is that our field is a CONSULT service. every time i walk into the ICU to r/o ocular involvement in a gorked out ventilated patient with fungemia in addition to 20 other items on the problem list, i am glad that i chose ophthalmology, especially when you hear "code BLUE" over the hospital paging system. 😉

 

[rubensan]

Established patients I brought into clinic over the weekend because they called in complaining: 8

PRICELESS! how many artificial tears did you prescribe last weekend?

 

[Toadkiller Dog]

I don't know about you, but we do a *ton* of this. We field all the patient phone calls at night and on the weekends, and when they call in and say (as many do) that "I just had surgery and now my eye is red and painful and my vision is bad", we just bring them in to clinic rather than see them in the ER.

I've had 5 or 6 patients waiting in clinic for me on a Saturday, with no attending or senior (or security guard, for that matter). It's especially painful when the ER is calling about an IOFB and you have 2 or 3 inpatient consults lined up after that!

Do other programs do this? Or do they make everyone go to the ER?

 

[JR]

Each program has slightly different types of pain. We have an open 24/7 eye ER (which is basically just several exam rooms, few inpatient beds, and a nurse on one of the floors of the institute); this means we don't just take call for the hospital, but for 50 other hospitals in the tri-state area..."we he a patient who was hit in the eye, his's got lid lacs, orbital fxs and his is high; we have no ophthalmology on-call, so we are just going to discharge/ambo/helicopter this pt to you"... that's daily occurrence. On top of that our main ER does not see eye patients; they get re-routed to us before they are even checked in🙂 . Oh, and there are also inpatient consults, night float for first-years, and three other hospitals we cover from home. Plenty of learning opportunities !

I don't know about you, but we do a *ton* of this. We field all the patient phone calls at night and on the weekends, and when they call in and say (as many do) that "I just had surgery and now my eye is red and painful and my vision is bad", we just bring them in to clinic rather than see them in the ER.

I've had 5 or 6 patients waiting in clinic for me on a Saturday, with no attending or senior (or security guard, for that matter). It's especially painful when the ER is calling about an IOFB and you have 2 or 3 inpatient consults lined up after that!

Do other programs do this? Or do they make everyone go to the ER?

 

[ophtho1122]

We are expected to come in and see our established eye center patients in the eye center, rather than send them to wait for 5 hours in the ER. Even though a lot of these calls end up being nothing, it is good for the patient and for word-of-mouth business for your eye center to do things in this way. Ophtho call is painful, pure and simple; especially if you are at a major trauma center. But, it will all be over before we know it. Time keeps ticking!!! Hang in there.

 

[rubensan]

Do other programs do this? Or do they make everyone go to the ER?

at usc, we take call at only one but very busy trauma center. the only way most patients get to see us (established or not) without a clinic appt is to go to the ER. if it's an eye patient, the ER triages it (checks vision, pressures, does a slit lamp exam). if they feel that it is blepharitis, conjunctivitis or dry eye they treat and we never here from them. anything more acute, they call us. i usually see whatever they want me to see, but at 300AM, the patients with pterygium X 2 years that now want it "taken care of" or the patients that broke their glasses and "want new ones," i usually make an appt for in my clinic within a few days. the flashers/ floaters, lid lacs, r/o retrobulbar hemorrhages, angle closure glaucomas and open globes, we see right away.

 

[Toadkiller Dog]

Well, glad to hear others have similar problems. Our call is just painful, and I get *very* tired of fielding phone calls from "established" patients. We even have a few who have figured out that if they get seen on the weekend by a resident, there is no charge!

Well, misery loves company, I guess.