Call

[josephf1]

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What is the difference between call, night call, and night float? What are the ranges an intern must do these among IM programs?

 

[Blade28]

I'm not too familiar with all the intricacies of the Internal Medicine call system. They have terms like "short call," "long call," "cap," etc. with which I'm unfamiliar.

I can tell you that "night float" is usually the resident who only works night shifts - commonly something like 7 pm - 7 am every day besides one day off a week (usually Friday or Saturday).

For us, "in-house call" simply means overnight call - you come into the hospital in the morning at your usual time (whatever time that is), leave the next day around 12 pm to hopefully keep your shift length at 30 hours max.

For "home call," you answer your pager from home - thus you only need to drive into the hospital for emergencies, admissions/consults, etc.

 

[Apollyon]

I'm not too familiar with all the intricacies of the Internal Medicine call system. They have terms like ..."cap," etc. with which I'm unfamiliar.

The cap is the maximum number of new admissions/transfers an intern or the team can take on one call. The reason surgical residents don't have a cap (I believe) is because most of the surgery admissions on-call are "front loaded" - if not going directly to the OR, they will be tomorrow or the day after. Moreover, there's simply a larger number of IM admissions, so there has to be a limit.

 

[Blade28]

The cap is the maximum number of new admissions/transfers an intern or the team can take on one call. The reason surgical residents don't have a cap (I believe) is because most of the surgery admissions on-call are "front loaded" - if not going directly to the OR, they will be tomorrow or the day after. Moreover, there's simply a larger number of IM admissions, so there has to be a limit.

Actually, I was being sarcastic. I know what the Medicine "cap" is. 🙂

The reason we don't have a cap is we don't have enough teams to spread the load - often there's only one team on call every night, not multiple ones like in Medicine. And many of our patients are non-operative - besides the admissions for elective cases, many admissions (abdominal pain, SBO, wound infection, etc.) are just for non-op management.

And more admissions in Medicine? Please. I've seen their services here - e.g. at our county hospital, they tend to average between 5-15 patients on their census. We average 20-50.

 

[RTrain]

And more admissions in Medicine? Please. I've seen their services here - e.g. at our county hospital, they tend to average between 5-15 patients on their census. We average 20-50.

Of course, you mentioned one paragraph above that medicine has more teams. There may be more patients per surgical team, but I would wager there are more total medicine admissions.

[rant]At my county hospital, this is because the ER docs, not the inpatient attendings, decide who gets admitted and who does not. So when trauma, general surgery, neurosurgery, ortho, ENT, ob/gyn, or neurology turns down an admission that the ER wants, medicine gets it. We seem to be the only specialty that is not empowered to say, "No." It's fair, though, since we offer every fifth patient the ER hands us to the FP inpatient team, and they turn it down by saying they are "capped," a term that appears related to the phase of the moon since they are always open to patients from their clinic.[/rant]

Okay, sorry. As you were. 😉

 

[Dr. V]

"Capping" what a dream. Could you imagine telling your chief "sorry bud, I'm capped so I am going to bed, see ya in the morning". 😉

Last friday night I got 18 new patients from 5PM to 3AM, 3 of these were traumas with only about 3 or 4 needing to go to the OR. By far the great majority of surgical admissions do NOT go to the OR. It would be nice if they did.

 

[Blade28]

Of course, you mentioned one paragraph above that medicine has more teams. There may be more patients per surgical team, but I would wager there are more total medicine admissions.

Fair point.

I must reiterate that the majority of admissions to the surgery service DO NOT go to the OR during that hospital stay. That's a rather romantic notion - if only it were true!

 

[RTrain]

I must reiterate that the majority of admissions to the surgery service DO NOT go to the OR during that hospital stay. That's a rather romantic notion - if only it were true!

I imagine the worst of that is on trauma - I can only imagine how demoralizing it must be to work that hard for so few operative opportunities.

 

[Pir8DeacDoc]

I imagine the worst of that is on trauma - I can only imagine how demoralizing it must be to work that hard for so few operative opportunities.

This patient population is made all the more demanding secondary to their never ending social issues that landed them on the trauma service in the first place. Good luck getting a rehab bed or home IV ABX without an act of Congress. And there aren't enough narcotics in the world to treat some of these people. So glad my trauma days as primary service are done.

 

[Blade28]

I imagine the worst of that is on trauma - I can only imagine how demoralizing it must be to work that hard for so few operative opportunities.

Well, many Transplant services (once they've received a transplant, they're your patient for life, no matter what the reason - fever, diarrhea, malaise, etc.) are like this as well. We also have a few "dump" General Surgery services where there's very little operating, as well as those with lots of conservative management (minor burns in Burns; elective angios in Vascular; pain control/dehydration/failure to thrive in Surg Onc, etc.).

It's quite a misconception in non-surgical fields that all we do is admit and operate. Oh, if only it were that easy!

 

[Winged Scapula]

And don't forget the admit and work-up for possible transplant that doesn't match. Talk about a waste of time (although I imagine the proposed recipient is a little more disappointed about not being in the OR than the residents!).

 

[RTrain]

What is the difference between call, night call, and night float? What are the ranges an intern must do these among IM programs?

Oh, and sorry for the derailment, I can answer this. "Call," "night call," and "long call" are generally synonymous - "call" tends to simply refer to a period in which you or your team is taking admissions, and "night/long call" is the 24 hour/overnight period in which you are doing so. There are usually one or two "day call" or "short call" days during a call cycle, during which you take admissions before 5 pm. And "night float" is a resident or team who works overnight on duties that vary from program to program - taking admissions, taking overflow admissions, doing cross-cover, or whatever.

 

[GoodMonkey]

This patient population is made all the more demanding secondary to their never ending social issues that landed them on the trauma service in the first place. Good luck getting a rehab bed or home IV ABX without an act of Congress. And there aren't enough narcotics in the world to treat some of these people. So glad my trauma days as primary service are done.

lordy if that ain't the truth. pain. sheer pain.

and we 'cap' when the beds are all full.

 

[elwademd]

What is the difference between call, night call, and night float? What are the ranges an intern must do these among IM programs?

also take into account that every program may have its little nuances here and there that make the program different from others.

in my program, we're q4:
so, monday i was on call. my team was on call from 7 am monday morning until 7 am tuesday morning. personally, i was there from 7 am until 9 pm. then, the "night float" person came in from 9pm until 7 am.
friday i'm on call again. this time, no night float, and thus i'm on call from 7 am friday until 7 am saturday morning.

as mentioned above, some programs have long call and short call:
long call 7 am monday to 7 am tuesday
tuesday post call
short call 7 am to noon wednesday
long call 7 am friday to 7 am saturday

long call/short call programs seem to be at larger academic centers where there's also a larger night float system.

there are tons of nuances and differences out there, but hopefully this will give you some idea of what's out there.

 

[Apollyon]

Actually, I was being sarcastic. I know what the Medicine "cap" is. 🙂

The reason we don't have a cap is we don't have enough teams to spread the load - often there's only one team on call every night, not multiple ones like in Medicine. And many of our patients are non-operative - besides the admissions for elective cases, many admissions (abdominal pain, SBO, wound infection, etc.) are just for non-op management.

And more admissions in Medicine? Please. I've seen their services here - e.g. at our county hospital, they tend to average between 5-15 patients on their census. We average 20-50.

Sorry, I wasn't clear and was misinformed. At the same time, at every hospital I've ever been at, there's been more IM patients than gen surg (a big part being efficiency - the surgeons are always tight and moving people ASAP - but NOT dumping or inappropriate).