Anyone using a points based call system?

[slappy]

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If so, please post the specifics of the system you follow in your residency program. I'd like to compare notes.

 

[hamstergang]

Can you explain how your program does it so the rest of us can compare notes too?

 

[slappy]

Okay. Each hour of call is 1 point x PGY year x modifier. The modifier is lowest for short calls, a little higher for long calls, and highest for holidays. Everyone tries to have equal number of points by the end of each year.

 

[johnhoedack]

Okay. Each hour of call is 1 point x PGY year x modifier. The modifier is lowest for short calls, a little higher for long calls, and highest for holidays. Everyone tries to have equal number of points by the end of each year.

So a pgy1 is supposed to do exactly 4x as much call as a pgy4?

 

[slappy]

So a pgy1 is supposed to do exactly 4x as much call as a pgy4?

No, a PGY4 is supposed to do exactly 4x less call than a PGY1.

 

[OldPsychDoc]

No, a PGY4 is supposed to do exactly 4x less call than a PGY1.

But they can do 4x as much in any given call shift!

 

[nancysinatra]

How many modifiers do you have and how many hours of each type of call are there in the year?

And how many people in each PGY year? And I take it the PGY2s do 1/2 the call of the 1s, and the PGY3s do 1/3 the call?

It seems to me that the math for this gets extremely complicated.

 

[vistaril]

Okay. Each hour of call is 1 point x PGY year x modifier. The modifier is lowest for short calls, a little higher for long calls, and highest for holidays. Everyone tries to have equal number of points by the end of each year.

the idea of having pgy4's(and even pgy3's) doing in-house call is ridiculous imo. Residency is supposed to train us for the real world(right?), and nowhere in the real world do community psychiatrists sit around in a call room and wait to be told when to go see a pt for admission or whatever. or when a pt comes into the er.

I can buy(sort of) that for junior residents call is a chance to get more pt encounters, see acute presentations, just learn more in general.

But imo pgy3's and 4's in this field should never be in house.

 

[Armadillos]

the idea of having pgy4's(and even pgy3's) doing in-house call is ridiculous imo. Residency is supposed to train us for the real world(right?), and nowhere in the real world do community psychiatrists sit around in a call room and wait to be told when to go see a pt for admission or whatever. or when a pt comes into the er.

I can buy(sort of) that for junior residents call is a chance to get more pt encounters, see acute presentations, just learn more in general.

But imo pgy3's and 4's in this field should never be in house.

Isn't there some national rule across all specialties that junior residents need to have someone more senior in house for supervision/backup? Or is that just institution dependent?

 

[vistaril]

Isn't there some national rule across all specialties that junior residents need to have someone more senior in house for supervision/backup? Or is that just institution dependent?

I think so...and that(for psych) is ridiculous in itself, but whatever. The pgy2's should be the ones doing that(and the 1s should be home). As few people should be there as possible.

Of course, another question to consider- why must anyone be in house? At some programs there may be a need for others....at others there isnt. Some psych programs are smaller and have less acute volume and total # of beds than many large non-academic comm systems, and they don't have anyone
in house.

 

[Doctor Bagel]

Isn't there some national rule across all specialties that junior residents need to have someone more senior in house for supervision/backup? Or is that just institution dependent?

It's complicated, but interns need direct supervision immediately available (like inhouse) just until they are certified by their program to work with supervision not immediately available. I'm forgetting the ACGME works, but what it essentially means is that interns have to have an upper level resident or attending with them in the hospital until the program says they are OK to work on their own. At my program, that means the attendings working with them in the inpatient unit do an assessment and certify this, which is generally predicted to happen in the first month of training. I'm not sure what the clear standards are (or if they exist) for the program to affirm that an intern is OK to go working alone. Either way, we have interns in the hospital alone starting pretty early in their year. Other weirdness -- interns can't technically be "on call," but they can work shifts up to 16 hours even overnight. I'm not sure what "call" is supposed to mean.

As for upper levels being on call, I'm so glad I'm not in our primary call pool.