Call burden as an attending and as related to subspecialty choice

[propofabulous]

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I am a CA-1 who has thus far very much enjoyed my clinical anesthesia training.

I have noticed however that I respond poorly to taking weekly overnight call. The after effects of the consistent 24 hours of sleep deprivation (markedly slowed cognition, relative exhaustion, impatience) tend to last for days. To compensate, I have become very disciplined with my sleep, doing whatever it takes to get 8 hrs/night when not on call. By the time I get back to feeling normal, I'm taking another call, and so the cycle repeats itself. Simply taking a few "calls" as a medical student during my surgery rotation was unfortunately not enough to reveal this functional deficit, and had I known how poorly I would handle this sleep deprivation, I may have sadly chosen another specialty.


My question is this:

1) How is (your) call as an attending, as far as frequency and % of time you are able to sleep? At my institution, the attendings are rarely ever in the OR, as the resident team usually is able to handle most issues. As far as I know, the attending may be sleeping through the night (or not). Without getting too personal, has this affected your family life?
2) Are there jobs out there after residency with minimal to no overnight call burden? I don't mind working hard - 60, 80, 100 hour weeks, whatever. I just have found that I need my sleep. Likewise, I prefer not to work in an outpatient surgery center where I may quickly lose my skills, but I know that I can't have my cake and eat it too
3) Are there jobs out there that have some type of night float service? I don't mind working weeks or a month at a time of night float. As the long as the hours are consistent
4) If all else fails, which subspecialties REDUCE call burden? The ones that come to mind are chronic pain and possibly regional? It is my understanding that peds, cardiac, and OB all tend to increase call burden

Thank you everyone so much for your time.

 

[Man o War]

Definitely not cardiac. We take a lot of call since there is fewer of us.

 

[Consigliere]

Work at a surgery center....no nights, no call, no weekends. Boom! Problem solved.

 

[AdmiralChz]

Picking a specialty based on perceived CALL BURDEN is a horrible idea. Some practices are all over the map in terms of how much call you take. Do something you enjoy, then find a job that suits you.

At my practice, it’s relatively easy to “sell” your call since we are highly reimbursed for it. That being said as a newbie it would probably stick out if you refuse to take much (I average 1 weekend every 6 weeks and 1 overnight weekday every 2 weeks).

And yeah, if you truly want no overnight call you’ll likely be forced into outpatient ASC jobs (termed the feminist-hating “mommy track”). But be prepared to make significantly less than your colleagues in more typical practices.

 

[AdmiralChz]

To more directly answer your questions - the calls don’t affect me too much as it’s well-worth my time and I know about them months in advance as our schedule is built in semi-annual chunks so I can plan accordingly. I get a post-call day off (and pre-call) to do stuff with the wife and fam if needed.

Night float system? Some academic centers have it, and many CCM jobs require new grads to do it. No thanks!

 

[deleted126335]

Huge local variation. I cannot overemphasize this point. If you poorly tolerate call as a (presumably) 20-early 30s. You will want to shoot you self after doing a 24 up the whole time when you are 50. Pick your job accordingly. Don’t choose your sub specialty accordingly with the exception of forget about ICU.


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[sevoflurane]

I take a lot of call, but I also take a lot of vacation. That’s how I like it as my net income balances out at MGMA average or above.

 

[deleted162650]

I take a lot of call, but I also take a lot of vacation.

Also known as the “DINK track”. 😉

 

[IMGASMD]

Chronic pain and no gen anesthesia, then you can have no call schedule. Surgi-center or working for some endo suite.

But it’s practice dependent. I’ve had offers for 14x3..... I’ve had offered for 1:5 post call day off. I’ve had 24 hour OB and 1:10. Mommy track 7-3 M-F. So if you can think of it, I am sure someone has done it before.

 

[nimbus]

Being on 24 hour call doesn’t mean you will get zero sleep for 24hours. You may be up all night if you have a busy OB rotation but on peds and cardiac, I would imagine you sleep most nights.


For me I have 18 in-house overnight trauma calls per year, 4pm-7am. Pre and postcall days are usually off and, with rare exception, I usually get 4-6hours of sleep. Maybe once a year I get no sleep. Also up all night with a heart 1-2x per year. I consider it very reasonable.

 

[B-Bone]

I'm in a private group where everybody does everything (cardiac, OB, etc) and I take overnight in-house call about 20 times/year. Our overnight calls start at either 2pm (weekdays) or 5pm (weekends). We gave up 24's a few years ago because everybody hated them and there were safety concerns as our calls got busier. Call still sucks, but way less than it used to. Rarely sleep on call.

 

[p30doc]

There are general anesthesia jobs out there with no call, no nights, no weekends, no holidays. Your pay will be reduced to reflect that though.


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[Shimmy8]

60 24 hour shifts a year. Get some sort of sleep (4+ hours) most nights. But we can be incredibly busy during the day—trauma, heavy complex ortho/neuro, vascular, thoracic. No OB tho.

Lot of time off to compensate. Love it.

 

[GravelRider]

Call blows. There really is no way to sugar coat it. It is easily the worst thing about our job. I don’t care how easy or hard the calls are. No amount of money really makes call any better. If you can stomach doing pain then that is totally the way to go simply to get out of the call burden.

The best thing about call is it really makes you think twice about sleeping with that random cute nurse because that will cause a divorce, which means you’ll be one of those bitter dudes (assuming you’re a dude) taking call into your 70s. I can’t think of a worse fate than lying on a smelly twin size bed in a windowless call room with no air circulation babysitting an epidural as a 60 year old.

 

[San Marzano]

Call blows. There really is no way to sugar coat it. It is easily the worst thing about our job. I don’t care how easy or hard the calls are. No amount of money really makes call any better. If you can stomach doing pain then that is totally the way to go simply to get out of the call burden.

The best thing about call is it really makes you think twice about sleeping with that random cute nurse because that will cause a divorce, which means you’ll be one of those bitter dudes (assuming you’re a dude) taking call into your 70s. I can’t think of a worse fate than lying on a smelly twin size bed in a windowless call room with no air circulation babysitting an epidural as a 60 year old.

Huh, that post took an interesting turn.

 

[T-burglar]

if you work in a private group that incentivizes call then call is great

 

[Consigliere]

Huh, that post took an interesting turn.

But a depressingly realistic one.

 

[chocomorsel]

if you work in a private group that incentivizes call then call is great

Money is not the answer to everything. Yeah, I know this is America and all, but being up and running around, busting your ass for 24 hours+ is completely unnatural and some people are really affected by this.

The OP is not asking how to get incentivesed for call, he or she is trying to find ways to minimize being awake for an extended period of time as it’s harming his or her health.

 

[bigdan]

OP -

If you want little in-hospital time and/or few overnights, avoid ICU fellowship* like the plague.

Someone has to replace the K. Someone has to take the planned and unplanned admissions, and the “outside hospital” transfers. That person is you, no matter the time.

*Disclaimer: I love ICU, work in an ICU, and think anesthesiologists are primed to (potentially) be the best intensivists. But it’s A LOT of hours.

 

[WholeLottaGame7]

Thank you everyone so much for your time.

Regional fellowship trained attendings are in the general call pool at most places, so would be taking overnight call.

The only way I can think of to really get out of the chance of being in the hospital overnight is A) chronic pain or 2) outpatient surgery center.

You might be able to find an ICU position where you take a bunch of nights in a row if you wanted.

 

[deleted171991]

There are ICU places where the night call is not so bad, or there is a fellow/NP covering (lower chances of being woken up).

But one should NEVER do critical care (from anesthesia) unless one LOVES critical care (and I mean MICU-level critical care).

 

[jwk]

True 24 hr call is honestly just stupid from a potential liability standpoint. You can bet you will get asked questions about that if you have a bad outcome and the lawyers come calling.

Our anesthetist shifts are limited to a max of 16 hrs straight. Our doc night shifts are only 10 hrs (8p-6a). Even "double shifts" for the docs only go from 6:30am to 8pm - 13-1/2 hrs.

 

[chocomorsel]

There are ICU places where the night call is not so bad, or there is a fellow/NP covering (lower chances of being woken up).

But one should NEVER do critical care (from anesthesia) unless one LOVES critical care (and I mean MICU-level critical care).

Of course, rotating in the MICU, I see a lot of thinking and not enough doing. It is quite stimulating the zebras that they see and their knowledge base in IM is awesome, but I feel like they drag their feet in acting. But like you said, sometimes nothing works as well. lol

 

[Velefunt]

lying on a smelly twin size bed in a windowless call room with no air circulation babysitting an epidural

You can't but laugh that this statement rings true for so many of us. I read your "cute nurse" reply to the wife, and we shared a laugh and a high-five.

 

[deleted171991]

Of course, rotating in the MICU, I see a lot of thinking and not enough doing. It is quite stimulating the zebras that they see and their knowledge base in IM is awesome, but I feel like they drag their feet in acting. But like you said, sometimes nothing works as well. lol

I think that MICU training (or IM residency) plus anesthesiology = sweet spot on the thinking vs doing curve.

 

[aneftp]

Work at a surgery center....no nights, no call, no weekends. Boom! Problem solved.

My experience with surgery centers is that for every 1 good job. There are 5 bad surgery centers in terms of pay and hours worked.

Cause u will be killing urself having to work 10 hours x 5 days a week running around at surgery center. Seeing between 30-50 patients a day yourself.

A 50 hour busy surgery center weekday job is equivalent to a 70 hour hospital job (with post call days off)

 

[Kevin Durant]

So what I'm hearing is if I want a position with a good balance of pay/hours, I basically have to go for a pain fellowship?

 

[deleted171991]

So what I'm hearing is if I want a position with a good balance of pay/hours, I basically have to go for a pain fellowship?

If you want both good pay and good hours, you are in the wrong specialty.

 

[IMGASMD]

If you want both good pay and good hours, you are in the wrong specialty.

Oh and I also want to live at a good location, where cost of living is low, but within one hour drive of a metropolitan area. I personally don’t mind the cold, but missus does, so not too cold and not too hot. Preferably close to a nice beach. Also I have a few little ones who needs to be in a good school district, don’t think I make enough for private school.
Where is this bridge that I am suppose to buy again?

 

[Kevin Durant]

Oh and I also want to live at a good location, where cost of living is low, but within one hour drive of a metropolitan area. I personally don’t mind the cold, but missus does, so not too cold and not too hot. Preferably close to a nice beach. Also I have a few little ones who needs to be in a good school district, don’t think I make enough for private school.
Where is this bridge that I am suppose to buy again?

With how much jade you have, you could afford the damn Brooklyn Bridge.

 

[ERRES2288]

If you want both good pay and good hours, you are in the wrong specialty.

The only specialties with good pay and hours are rad onc derm

 

[abolt18]

If you want both good pay and good hours, you are in the wrong specialty.

I think I can be happy starting out with good pay, followed by good hours after I’ve achieved my financial goals.


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[TIVAndy]

if you can tolerate clinic and like procedures then go for chronic pain. i'm very happy with my current no call no weekend and living a normal life.

 

[dhb]

Something nobody has mentioned yet is that if you are in a group of 15 MD you are only taking 2 calls/month. Not all practices are level 3 trauma centers with 5000+ deliveries/year; in some practices you'll sleep all night 90% of the time or even be on home call.

 

[chocomorsel]

So what I'm hearing is if I want a position with a good balance of pay/hours, I basically have to go for a pain fellowship?

There are day doc positions and they aren’t all in surgicenters. Some of them pay well for day doc. As in 300k+. Those people never make partner though in most practices.

 

[aneftp]

There are day doc positions and they aren’t all in surgicenters. Some of them pay well for day doc. As in 300k+. Those people never make partner though in most practices.

Those jobs are getting rare. Why pay doc $300k plus when u can pay crna less

Even my sister all MD group. Daytime docs makes around 250-270k 5 days a week. Trust me. U do not want to work 5 days a week with no early or short day. Working 7-4pm as daytime doc. No time
For basic stuff like running errands etc. you will get tired. Get home and just want to do nothing after getting off work.

The key to no calls is working 3-4 days a week. But that’s another financial hit u will take working 1-2 less days

No magic solution for many unless they made their money and looking to ride off to sunset In the mid to late 50s.

 

[CubsDynasty]

This is the problem with SDN. Always doom and gloom. You have overlooked the possibility of wife #1 being wealthy and cute-nurse #1 being wealthy. Problem solved.

 

[Psai]

Oh and I also want to live at a good location, where cost of living is low, but within one hour drive of a metropolitan area. I personally don’t mind the cold, but missus does, so not too cold and not too hot. Preferably close to a nice beach. Also I have a few little ones who needs to be in a good school district, don’t think I make enough for private school.
Where is this bridge that I am suppose to buy again?

I like the sound of all of those things

 

[Ezekiel2517]

Even my sister all MD group. Daytime docs makes around 250-270k 5 days a week. Trust me. U do not want to work 5 days a week with no early or short day. Working 7-4pm as daytime doc. No time
For basic stuff like running errands etc. you will get tired. Get home and just want to do nothing after getting off work

Then that's a crappy job. If you're working 7-4pm, 5 days a week as a "daytime doc", you'll be earning double that easily in my neck of the woods

 

[chocomorsel]

Then that's a crappy job. If you're working 7-4pm, 5 days a week as a "daytime doc", you'll be earning double that easily in my neck of the woods

And where is your neck of the woods?
Asking for a friend. You are welcome to PM me.

 

[invitro]

Do chronic pain. If you are willing to go Midwest/south 7-3, no call/no weekends is very doable. Maybe 4 days a week. 400+ easy.

I’m in peds cardiac anesthesia. Definitely would not do this field if you dislike call lol...many sick patients/callbacks. Poor payor mix. Bad schedule—>lots of single/divorced attendings. I’m a Chad so I don’t care, but if you are a family man/woman maybe not the best choice.

However....incredibly interesting and satisfying work. Gain a skillset that is pretty valued in peds anesthesia groups, children’s hospitals. Won’t get the highest paying job but great job security.

 

[BLADEMDA]

Do chronic pain. If you are willing to go Midwest/south 7-3, no call/no weekends is very doable. Maybe 4 days a week. 400+ easy.

I’m in peds cardiac anesthesia. Definitely would not do this field if you dislike call lol...many sick patients/callbacks. Poor payor mix. Bad schedule—>lots of single/divorced attendings. I’m a Chad so I don’t care, but if you are a family man/woman maybe not the best choice.

However....incredibly interesting and satisfying work. Gain a skillset that is pretty valued in peds anesthesia groups, children’s hospitals. Won’t get the highest paying job but great job security.

The term was later appropriated in the manosphere in incel forums to refer to sexually active alpha males.[5] Within the manosphere, Chads are viewed as constituting the top decile in terms of genetic fitness.[6] In online animation drawings in the manosphere, a Chad is further tagged with the last name Thundercock and is often depicted as muscular with a very pronounced crotch bulge.[7] Chads are sometimes portrayed as the opposite to omega or beta males, are portrayed as aesthetically attractive and the term Chad is sometimes used interchangeably with slayer.[8] Due to their characterization as being genetically gifted and privileged, though sometimes depicted as shallow, airheaded, arrogant, and overtly sexual[9], the term Chad is used in both a pejorative and complimentary way on incel forums.[10][11]

Sorry, but I had no idea what a "Chad" meant in conventional English.

 

[BLADEMDA]

Those jobs are getting rare. Why pay doc $300k plus when u can pay crna less

Even my sister all MD group. Daytime docs makes around 250-270k 5 days a week. Trust me. U do not want to work 5 days a week with no early or short day. Working 7-4pm as daytime doc. No time
For basic stuff like running errands etc. you will get tired. Get home and just want to do nothing after getting off work.

The key to no calls is working 3-4 days a week. But that’s another financial hit u will take working 1-2 less days

No magic solution for many unless they made their money and looking to ride off to sunset In the mid to late 50s.

That's me. But, depending on your career doing 40 hours at a surgicenter can still seem quite easy vs Level 1 trauma.

I do agree that with us becoming lowly employees the surgicenter really isn't better than your typical community hospital job with no trauma or the VAMC.

 

[deleted162650]

@propofabulous, correct me if I'm wrong, but it seems like your problem is not necessarily with call in general - but rather with the frequency/intensity of call you're currently being subjected to. I think you'll find that call is quite manageable in most PP gigs. In my midsize MD only group, our two primary call shifts (OB and Trauma) run 3p-7a. On average, we have 2 primary calls/month. Most of the time on call I'm getting at least 4 hours of sleep, rarely only 2 hours, and only a couple times/year where I don't sleep at all (level 2 trauma). Find a gig with no trauma and low volume OB and call is even less ominous.

Don't do pain unless you really want to do pain. I'd much rather sleep in the hospital 2 days/month than see chronic pain patients in clinic 2 days/week.

 

[deleted697127]

I am a CA-1 who has thus far very much enjoyed my clinical anesthesia training.

I have noticed however that I respond poorly to taking weekly overnight call. The after effects of the consistent 24 hours of sleep deprivation (markedly slowed cognition, relative exhaustion, impatience) tend to last for days. To compensate, I have become very disciplined with my sleep, doing whatever it takes to get 8 hrs/night when not on call. By the time I get back to feeling normal, I'm taking another call, and so the cycle repeats itself. Simply taking a few "calls" as a medical student during my surgery rotation was unfortunately not enough to reveal this functional deficit, and had I known how poorly I would handle this sleep deprivation, I may have sadly chosen another specialty.

Next year is subspecialty rotations. We are on 24 hr call q4 days for our 8 subspecialty months (2x cardiac, 2x OB, 2x SICU, 2x Peds) which I assume is the norm nationwide. So things unfortunately will only get worse regarding call burden.

My question is this:

1) How is (your) call as an attending, as far as frequency and % of time you are able to sleep? At my institution, the attendings are rarely ever in the OR, as the senior-junior team usually is able to handle most issues. As far as I know, the attending may be sleeping through the night (or not). Without getting too personal, has this affected your family life?
2) Are there jobs out there after residency with minimal to no overnight call burden? I don't mind working hard - 60, 80, 100 hour weeks, whatever. I just have found that I need my sleep. Likewise, I prefer not to work in an outpatient surgery center where I may quickly lose my skills, but I know that I can't have my cake and eat it too
3) Are there jobs out there that have some type of night float service? I don't mind working weeks or a month at a time of night float. As the long as the hours are consistent
4) If all else fails, which subspecialties REDUCE call burden? The ones that come to mind are chronic pain and possibly regional? It is my understanding that peds, cardiac, and OB all tend to increase call burden

Thank you everyone so much for your time.

Knowing your own tendencies is important obviously, however, how you feel after a call as a ca1 is not the same as how you will feel later on in residency or once you settle down as an attending. (Also Q4 24hour call is brutal for anesthesia) What you like will change as you get better and things that currently stress you out like lines or blocks for most residents end up being enjoyable rather than stressful at all. Start your job search early and you can likely find the exact combination that you are looking for once you actually figure out what that is.

Also, not everywhere but i am sure there are plenty of people out there who manage to get more sleep at work on call than at home with young kids.

 

[anbuitachi]

yea just do a day shift at amb center or endo or something. No call, make 250k. 7-3 or 4 daily. Can be tiring though but if that's your cup of tea then its all good. Or you can switch careers since you are still new in the game.. Lots of fields w no call. Or maybe consider EM. do a lot of cool stuff ... more variety of procedures than anesthesiologists.. all types of lines, some blocks, lots of ultrasound stuff, thoracotomy, suturing, reducing dislocations etc. Best of all, as an attending, work 3 days a week, get 4 days off, and let the NP/PA/Resident do all the scut work, drunk patients etc. Chill as hell

 

[nimbus]

Also, not everywhere but i am sure there are plenty of people out there who manage to get more sleep at work on call than at home with young kids.

This. Even if you’re awake, a long fem-pop is a relative sea of tranquility.

 

[deleted162650]

We had twins when I was a CA-2. Call nights were precious.

 

[Psai]

We had twins when I was a CA-2. Call nights were precious.

Hah I had a chief tell me that they got way more sleep on call nights than at home

 

[deleted126335]

Confirmed. Unfortunately, the post call discussion of who does the parenting that day was not infrequently contentious.


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