Baylor (Houston) Call Schedule?

[I_love_UMKC]

Can anyone please list how the call schedule is for Baylor IM program (specifically for the intern year)? How busy are the calls? Thanks...

---

Members don't see this ad.

 

[drfunktacular]

There is a wide variety given the multiple teaching sites and rotations.

CURRENTLY, at BT and VA it is essentially a night float system where you will admit 3 days out of 8, and as interns you will be in-house overnight for cross-coverage 2 nights a month. The specific hours vary but you will only be in house overnight twice a month. You will essentially always cap (8 per team) on these calls. CURRENTLY on ICU/CCU rotations at BT/VA you will be overnight about q5-q6.

CURRENTLY, at SL you will take overnight call something like q5 to q6 during your SL months (2-3 as an intern). The business varies widely depending on which attendings are admitting that night and how busy the floors are.

I emphasize CURRENTLY because Baylor, like every institution, is currently reorganizing call duties to come into compliance with the new guidelines offered by the ACGME.

All that said, I would caution you strongly against choosing your training institution based on call schedules. Wherever you go, you will do things the way they're done at that place, and you won't know the difference. Also, the concept of "call" is undergoing a lot of change thanks to our ACGME overlords so you can't really predict what things will be like in your 2nd and 3rd year anyway.

 

[I_love_UMKC]

There is a wide variety given the multiple teaching sites and rotations.

CURRENTLY, at BT and VA it is essentially a night float system where you will admit 3 days out of 8, and as interns you will be in-house overnight for cross-coverage 2 nights a month. The specific hours vary but you will only be in house overnight twice a month. You will essentially always cap (8 per team) on these calls. CURRENTLY on ICU/CCU rotations at BT/VA you will be overnight about q5-q6.

CURRENTLY, at SL you will take overnight call something like q5 to q6 during your SL months (2-3 as an intern). The business varies widely depending on which attendings are admitting that night and how busy the floors are.

I emphasize CURRENTLY because Baylor, like every institution, is currently reorganizing call duties to come into compliance with the new guidelines offered by the ACGME.

All that said, I would caution you strongly against choosing your training institution based on call schedules. Wherever you go, you will do things the way they're done at that place, and you won't know the difference. Also, the concept of "call" is undergoing a lot of change thanks to our ACGME overlords so you can't really predict what things will be like in your 2nd and 3rd year anyway.

First, thanks for taking out the time to answer my question in detail, much appreciated! Well, I am going to be a Prelim IM intern, so call schedule does come into my equation. I want to have a solid medicine year (where I can be solid at IM), but at the same time, not be overworked to death.

Couple of more questions for you, if you don't mind:

1) How is the teaching/didactics for the IM? How would you rate the friendliness and the "laid-backness" of the faculty?

2) Will I be well-prepared to handle the bread and butter IM cases after the first year?

3) So, it seems as an intern, I will be in-house overnight for only 2 nights/month at BT and VA and only 2-3 nights/month at SL. That seems a considerably easy call schedule compared to other programs (I like it), or am I missing something here (as that's about 24-26 calls/year)? I don't think you do NF for interns right?

4) With the new ACGME rules, if anything, wouldn't the schedule improve for the interns at Baylor?

5) Are the Prelim IM treated differently then the Categoricals at Baylor (given more call, more ward months etc)?

6) I realize intern year is quite tough no matter where, but from the schedule, it seems quite manageable at Baylor. Would that be a reasonable assessment?

If you want to PM me the answers instead of putting them here, that would work too.

 

[drfunktacular]

1) Baylor has a very large faculty, so it is hard to generalize too much, but essentially everyone I have worked with has been at least professional, and most are very fun and like to teach residents and students. Conferences are good for the most part but some services can be very busy so it is sometimes hard to prioritize going to conference when it means you will be at work for an hour later in the evening (I imagine this is true at every busy program)

2) Yes, to the degree relevant to any specialty you will be going into after a prelim year, you will be as competent to handle regular medicine stuff as anyone else, and much moreso than your colleagues who spend next year in a cush transitional year. That said, I don't think there are any derm/ophtho/rads/etc out there who choose to spend their time managing diabetes when they have a friendly medicine consult service to do it for them.

3) Most/all programs will be transitioning to night float based systems with little in-house overnight call. At Baylor night float admissions are done by upper level residents, so it won't matter to you. In-house cross-coverage overnight is done by interns on their 2 nights/month at VA and BT.

4) Yes and no. As at most programs, the elimination of 24-30 hour call shifts means no post-call days, no "early" days. Ergo, you will not sleep in the hospital, but you will rarely go home before 5-6PM so your overall hours will probably increase, or at least it will feel like it. Again, this is not specific to Baylor, it will be happening everywhere (thanks, ACGME).

5) No

6) I actually enjoyed it, although if you have a few ward months stacked in a row it can start to grind down your will to live (I assume this also is not Baylor-specific). You will be busy, but I never once violated duty hours as an intern, even in the ICU, even when we had more 30-hour calls.

 

[firsttima]

This is great information, thank you. Another question from applicant:

Are you happy with your training at Baylor?
How would you compare it to UTSW? (Maybe you cannot)
How about Emory?

The match list doesn't always show this, but have your colleagues been able to get INTERVIEWS for fellowships all over the US including west and midwest?

Thanks.

1) Baylor has a very large faculty, so it is hard to generalize too much, but essentially everyone I have worked with has been at least professional, and most are very fun and like to teach residents and students. Conferences are good for the most part but some services can be very busy so it is sometimes hard to prioritize going to conference when it means you will be at work for an hour later in the evening (I imagine this is true at every busy program)

2) Yes, to the degree relevant to any specialty you will be going into after a prelim year, you will be as competent to handle regular medicine stuff as anyone else, and much moreso than your colleagues who spend next year in a cush transitional year. That said, I don't think there are any derm/ophtho/rads/etc out there who choose to spend their time managing diabetes when they have a friendly medicine consult service to do it for them.

3) Most/all programs will be transitioning to night float based systems with little in-house overnight call. At Baylor night float admissions are done by upper level residents, so it won't matter to you. In-house cross-coverage overnight is done by interns on their 2 nights/month at VA and BT.

4) Yes and no. As at most programs, the elimination of 24-30 hour call shifts means no post-call days, no "early" days. Ergo, you will not sleep in the hospital, but you will rarely go home before 5-6PM so your overall hours will probably increase, or at least it will feel like it. Again, this is not specific to Baylor, it will be happening everywhere (thanks, ACGME).

5) No

6) I actually enjoyed it, although if you have a few ward months stacked in a row it can start to grind down your will to live (I assume this also is not Baylor-specific). You will be busy, but I never once violated duty hours as an intern, even in the ICU, even when we had more 30-hour calls.

 

[drfunktacular]

This is great information, thank you. Another question from applicant:

Are you happy with your training at Baylor?
How would you compare it to UTSW? (Maybe you cannot)
How about Emory?

The match list doesn't always show this, but have your colleagues been able to get INTERVIEWS for fellowships all over the US including west and midwest?

Thanks.

1) Yes

2) UTSW is a much more intense place for good and for bad, depending on your perspective; I had/have no interest in doing 5-6 unit months as an intern (ask the residents at your IV what the PGY-1 "pulmonary" rotation involves). If you want to be pulm/CC or cards or a hospitalist this experience will appeal to you. I personally cannot wait until I can spend my days in an outpatient clinic and take little/no hospital call. Take it with a grain of salt, but my very limited experience of friends at UTSW is that they are stressed/overworked, moreso than residents at Baylor. Parkland is a crazy place, but Ben Taub is a similar safety net hospital for the under-served population in a similarly large diverse city, and I imagine you will see similar amounts of bizarre disease. I have no knowledge of Emory.

3) I am not aware of any of my peers who are unhappy with the interview opportunities offered to them. Particularly in Texas/the South, but even more generally the Baylor name does carry some cachet in terms of producing hard-working residents with very good clinical training. In the competitive specialties, particularly cards, you have ample opportunity to secure LORs and research projects from well-known faculty both at Baylor and Texas Heart.

I should also throw in a plug for Dr Hamill, the PD. He has had some rather difficult situations to deal with in recent years (I will refer you to various news sources and hyperventilating SDN threads from ca. 2005-2009) but he remains an incredibly committed advocate for the education and sanity of the Baylor residents, and in addition to being a very nice and down-to-earth guy with a good sense of humor, he works tirelessly to address the concerns of residents and ensure the quality of our clinical and academic experiences. For you ID nerds out there, he is also well-known as an expert on fungal diseases.

 

[I_love_UMKC]

drfunktacular, thanks for taking out the time to answer the questions. That's incredibly helpful and fantastic information, and has really helped me to put things in perspective. Few last questions (these are the only ones that what I can think of for now):

1) If NF admissions are done by seniors only, does that impact the learning and education for interns (given that I'll be doing Prelim IM only). I'm assuming you learn a lot from the patients when you are the one that admits them and follow their course, but maybe I'm making a wrong assumption.

2) What's the cap for each team and interns (if any)?

3) What's the average census, and how many patients are cross-covered typically on an average call night?

4) Do you cross-cover one hospital at a time on a call, or do you cross-cover multiple hospitals?

5) I'm not aware of the past difficult situations and Dr. Hamil. Are there any links to those hyperventilating SDN threads?

 

[flipmd]

drfunktacular, thanks for taking out the time to answer the questions. That's incredibly helpful and fantastic information, and has really helped me to put things in perspective. Few last questions (these are the only ones that what I can think of for now):

1) If NF admissions are done by seniors only, does that impact the learning and education for interns (given that I'll be doing Prelim IM only). I'm assuming you learn a lot from the patients when you are the one that admits them and follow their course, but maybe I'm making a wrong assumption.

2) What's the cap for each team and interns (if any)?

3) What's the average census, and how many patients are cross-covered typically on an average call night?

4) Do you cross-cover one hospital at a time on a call, or do you cross-cover multiple hospitals?

5) I'm not aware of the past difficult situations and Dr. Hamil. Are there any links to those hyperventilating SDN threads?

Heh, the system was so confusing I don't think I had a firm grasp of it when I entered my rank list a few years back. It's also been changing a lot since a few years ago - for the most part for the better, especially as ACGME has become more stringent, for good or for bad. The changes also had the effect of decreasing the front-loaded nature of the program, with more responsibility (eg. night admits) going back to upper levels. But hey, night float rocks!!!

On to your questions:
1) It probably does, but as an intern, you'll be thankful that you're not doing the night admits because cross-cover takes so much of your time. You get to do night admits at SLEH (3 months/year as prelim, 2-3 night calls/month). Between these night SLEH admits, 4 ward months, 2 ICU/CCU months, and 1 ER month, you'll see plenty enough patients to learn from. Also, these night admits that have an initial workup done by the night resident end up accounting for only about 20% of the patients you carry in your ward months, with the others being new admits from the ER (or less commonly, clinic).

2) Cap is 10 patients/intern (20/team). Personally, I've never hit my cap, but is definitely not unheard of. It's not rare, but it's definitely not the norm. In a month - out of 8 teams in Ben Taub for example - I've probably seen some team cap 2 or 3 times (not sure if they're the same team or different teams). Admitting cap is 8 per team of 2 interns and a sub-I on long admitting days (2 days in 8), and 4 per team on short admitting days (1 day in 8).

3) Average census, because we admit 3 days in 8, fluctuates daily. However, I would say average peak patient loads would be about 7-8 patients/intern, with trough days being 2-3 patients/intern. Cross cover, you basically take care of the whole hospital and don't expect to sleep more than 2-3 hours if at all in Ben Taub and the VA (hey, it's only 2x/month, and you get off at 7am sharp - resident covers for your patients post-float). In SLEH, it's hit or miss, sometimes you have a busy night, sometimes you sleep 8 hours, but you do stay til after morning rounds at SLEH (11am average).

4) One hospital at a time. You'll have plenty on your plate as it is.

5) Past difficulties = rumors of Baylor's demise because of finances. NOT going to affect training, but has definitely hurt its reputation, as some top applicants have steered clear of Baylor for a few years. Although this year we had a good crop of applicants, according to top brass.

To be honest, I feel that doing prelim year at Baylor is going to be tougher than most average prelim interns want to get into, especially if you're thinking of the year as just an added hassle on the road to whatever specialty you're going into. However, it's a great learning experience. Also, most of what you're going to learn in IM, especially your 'clinical eye', you learn during internship. You just add a lot of nitty gritty during your R2 and R3 years.

Again, if you're thinking about doing prelim at Baylor, it's going to be a given that you're going to be learning a lot during that year. Despite the changes, it's still a bit front-loaded, and you're going away before the schedule sweetens up big time. The question is if you're willing to work hard or if you'd rather be in a cush prelim. Also, you're going to have the same rotations as the categoricals (minus the once a week continuity clinic and no ambulatory month).

 

[I_love_UMKC]

Thanks flipmd, that's very helpful, appreciate it a bunch! Thanks drfunktacular once again.

 

[drfunktacular]

Just an FYI that Baylor was just last month granted a 5 year accreditation cycle from ACGME

 

[DrVanNostran]

When looking at the Baylor schedule, it seemed like the call schedule gets tougher as you progress from a PGY-1 to PGY-3. Did you guys feel the same way?

A few programs seemed to acknowledge this because of the new intern rules and other tried to emphasize that this wouldn't happen since they created a new system.