Being on-call after residency

[Socrates25]

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I cant believe I didnt think about this before -- when you are in residency being on-call aint that bad because you get to have a post-call day where you go home early.

I cant believe I didnt think about this until now, but once you get a real job I'm assuming that no longer applies right? If you are on-call in your practice in a 1:5 system or whatever, you still have a full clinic to go to the next day right?

God that sucks. I need to think about being a hospitalist instead.

 

[gutonc]

I cant believe I didnt think about this before -- when you are in residency being on-call aint that bad because you get to have a post-call day where you go home early.

I cant believe I didnt think about this until now, but once you get a real job I'm assuming that no longer applies right? If you are on-call in your practice in a 1:5 system or whatever, you still have a full clinic to go to the next day right?

God that sucks. I need to think about being a hospitalist instead.

Yes, that is correct. And yes, it sucks, especially if you're in a procedural specialty. It's one thing to have to answer a couple of phone calls in the middle of the night. It's something else to have to go in and do an appy or a gallbladder (or a cath or an endoscopy or whatever) in the middle of the night and then continue on with your day the next day.

 

[Smurfette]

Yep. And when you are literally up all night and have clinic (and/or scheduled cases) the next day, it is not a good feeling. Certainly I've learned that I cannot plan an "early" day on my post call day. Some things can wait until morning (i.e. do verbal orders to admit someone and then see them first thing in the AM), but some things cannot wait. I have had bad luck with the middle-of-the-night stuff recently; my partner *rarely* gets any pages after 10 pm. They tell me it's a "new attending" curse.

I personally am not on a straight schedule....I may be on call a couple days in a row during the week (depends on the week), and my weekends on call are all 72 hour calls. The tradeoff is that if I'm not on call over a weekend I don't have to go into work unless I want to. This is one of those things that is very important to ask about when job searching. It also is prudent to have something in your contract about your call obligations. 1:5 call may mean every fifth day, OR 6 days a month (distributed however someone sees fit) OR one weekday a week depending on how the system works. I found groups were really variable with how this worked, so you need to know what you're getting into.

 

[mlw03]

thank you for a little reminder about another reason i enjoy being a forensic pathologist. not too many overnight emergencies in our business, and the very rare overnight scene calls are pretty much always legit.

as was mentioned, i guess you just have to be clear about your contractual obligations. with obligation comes money. the interventional radiologist who might be called in at 3am for an emergent procedure is taking home way more money than the general pediatrician who is probably only taking phone calls overnight.

 

[Buzz Me]

The experience of being on home call for weeks at a time is a little preparation for this (in my case). Often will go home late, get called back into the hospital an hour later, stay all night doing some disaster case in the OR, then have a full day the next day. Repeat a few times a week.

 

[45408]

There's so much variability here, even within similar fields or even the same field in different locations. You might get murdered every night on call, or you might get some phone calls and a consult that you can defer until 6-7am so you can see it before clinic/OR cases.

One thing to keep in mind is that hospitals are starting to think about requiring surgeons to tell their patients if they've been up for most/all of the night, and they're about to do an elective procedure.

Or you might be able to adjust your schedule a bit. I remember that one of our cardiac surgeons bumped a CABG from a 7am start to an 11am start since he was up late into the night. If it were my heart he were sewing, I'd appreciate the delay.

 

[Sneezing]

Its all in the job you sign on for or the practice you open. Call can be non-existant, trivial, frequent, light or heavy. Way too many variables.

 

[docB]

One thing about being an attending is that how much or little you work is about money rather than other people forcing you to do it. Some of the surgeons in my area took on some new health plan contracts and their volume went up. That also meant that their call went from the aforementioned "a few phone calls" variety to usually spending at least part of the night in one or more ORs. So they had to make a decision. Dump the contracts or change the system. They decided that the contracts were making them enough money that they changed their call set up. Now whoever is on call has the next morning off from clinic and they start back up after lunch. They don't schedule OR days after call.

They are pretty happy with this. They lose productivity, i.e. money by taking that morning off but they have decided it's better in the long run.