"Cushy" IM residencies (light call)

Discussion in 'Internal Medicine and IM Subspecialties' started by NancyPansy, Sep 27, 2014.

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  1. NancyPansy

    NancyPansy 2+ Year Member

    Aug 19, 2014
    Hello all! I'd really appreciate it if anyone could point me to some IM residencies that they feel have a light call schedule so that I might consider eventually applying to them (I'm planning to apply to both IM and FP). I'm open to going anywhere in the country.

    The thing is that I don't tolerate all-nighters very well in the physical sense. I'm very conscientious and thorough about whatever I happen to be working on, but ever since I can remember I have felt pretty ill every time I pulled an all-nighter which I blame on asthma (so far, for lack of better explanation). It doesn't matter if I'm at a party having the time of my life, so it's not at all something I can control. If I ever find a cure for this, that would be super but for now I'm trying to find a residency that requires the least call or an arrangement that allows for longer work days in place of all nighters (does "night float" work that way?).

    I would rather work 16 hrs a day, than say 12 hour days + a 30 hour shift once a week, if that makes any sense. Cushiness isn't necessary in terms of academics or the quality of performance expected from residents at the program, it's only about the sleeplessness aspect.
    medstudent7860 likes this.
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  3. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    A large percentage of IM residency programs work on a night float model these days. To the best of my knowledge, my former program doesn't have a single 24h shift anymore at any level, on any rotation. This is not universal but it's not unique.
  4. DermViser

    DermViser 5+ Year Member

    Apr 4, 2009
    Wow. I just thought the work got shifted up in years. Intern's work get shifted up to PGY-2/PGY-3 due to work hours.
  5. gutonc

    gutonc No Meat, No Treat SDN Administrator 10+ Year Member

    Nope. Some stuff has been off-loaded to mid-levels and there has been an increase in non-teaching hospitalist services. There are also more inpatient/night float months for R2s and 3s.
  6. dozitgetchahi

    dozitgetchahi 7+ Year Member

    Oct 20, 2008
    We still do full q4 30 hour call shifts (or whatever the limit is under the ACGME rules) on most ward months as PGY 2/3s.

    It blows and I wish I'd looked closer at the call structure of the programs when I was ranking. I got faked out by documentation that was like 'ALL NIGHT FLOAT!'***

    (***For PGY1s only in fine print at the bottom)
  7. NancyPansy

    NancyPansy 2+ Year Member

    Aug 19, 2014
    Wow I'm sorry this happened to you :(. This is why I'm hesitant about applying to places I haven't researched and seen reviews of. It's difficult not to miss fine print when you're applying to a bunch of programs and focusing on doing well on interviews. Hopefully you're close to the end of your residency.
    DermViser likes this.
  8. Trogghunter

    Trogghunter 7+ Year Member

    Nov 16, 2009
    My program has a 2+2 model where rotations are split into 2wk increments. ie 2 wks ward with 2 wks consult service or 2 wks icu with 2 wks outpatient. We have a total night float system, no call. The latest I stay when I'm 'long' is 7pm when we sign out to the night guys. Also, night team does 5 nights a week and the other 2 are covered by nocturnists. You can't even get burnout after 2 weeks. It's amazing, and we have protected didactics. It's not possible to make them all, but we have 12 a week m-f.
  9. drfunktacular

    drfunktacular ANA ≠ SLE 10+ Year Member

    Oct 5, 2004
    Make sure you give your choice careful thought...

    My program started night float when I was a PGY2 whereas before we'd had a short call/long call schedule where you ended up staying overnight every 8 days. As a PGY2/3 I had to do months of night float where I would be working nights for like 5 days straight and it sucked SO BAD. I would wake up at 5PM to go to work from 7PM-7AM where the only people I saw were patients and the ER docs dumping them on me, then I would go home and go to sleep at like 9AM while my wife was at work. I would much rather have had periodic overnights than doing whole blocks of night float.
  10. Lazarius


    Dec 7, 2013
    Agree with the above post. We do 2 weeks blocks of night float quite often as PGY2/3 (working 6 nights in a row from 7-7) and it sucks really bad. your life turns into work/sleep with zero time to spend with kids or friends. I would take a periodic overnight call system anytime over this.
  11. dermie1985

    dermie1985 2+ Year Member

    Jun 1, 2013
    Some Kaiser programs have a "overnight night float" system with the addition of a "day admitting team"....meaning the regular ward teams only have call days where really they only pick-up overnight patients + anyone admitted to the inpatient day team the day before + anyone admitted between 5-7 PM. This takes a lot of the initial work-up off the regular ward teams....but means the months you're on the day admitting team can be brutal in terms of just constantly admitting and working up patients.
  12. NancyPansy

    NancyPansy 2+ Year Member

    Aug 19, 2014
    Thanks all, I'm glad to learn all-nighters are not that common anymore. I guess I will have to be selective about the arrangement I choose :)

    Thanks for the advice, Drfunktacular, it definitely makes sense that most people would prefer the occasional all-nighter to having their schedule destroyed by working from 7:00PM to 7:00AM. It's just that I have a very strange health problem. I attribute it to asthma because it seems like the most plausible. Basically I get very bad dyspnea when I stay up way past my bed time. It never fails. EVER. I don't believe it's related to anxiety or boredom because, like I said, I could be having the time of my life at a party and it still would happen. I have never passed out or anything but have had scary moments where it was getting way too difficult to catch my breath, that's why I try to avoid all-nighters like the plague LOL.

    Maybe I'm too sickly for most residencies :(. It's something I'll have to keep in mind. I am considering psych as a different alternative (I used to plan on becoming a psychologist before I switched), it's just that I like the medicine aspect as well. Don't get me wrong, I do think I'm capable in an intellectual sense but it may be that some residencies are too physically demanding unless I deal with these health issues somehow.
  13. bakanoisha

    bakanoisha 5+ Year Member

    Apr 22, 2009
    NancyPansy - seriously. if you're having health issues, absolutely take care of yourself first. I feel like my residency is physically killing me with the non-stop service for 80hrs/wk and shifting from night to day and back again. I'm an otherwise very healthy, very active person. I'm sure there are programs out there that are better, but you don't know what you're getting until you're there. Be healthy and happy first and foremost.
  14. dozitgetchahi

    dozitgetchahi 7+ Year Member

    Oct 20, 2008
    Yeah, come to think of it I do agree with you.

    As I get used to overnight call I do find it more lifestyle-friendly than the endless blocks of daily shifts I did as an intern. You can actually get things done on the postcall day.
  15. drfunktacular

    drfunktacular ANA ≠ SLE 10+ Year Member

    Oct 5, 2004
    Yeah. Especially if your program is at a busy hospital like mine was: we would hit our admit cap within an hour or two of starting admissions from the ER, then just power through admitting and working up those people and usually get to catch a few hours of sleep before morning rounds (depending how incompetent the particular set of nurses on the floors that night were)

    Sent from my iPhone using Tapatalk
  16. color me gone

    color me gone

    Apr 28, 2015

    Forget cushy- the most common lie told about IM residencies is how good they treat their residents.

    Two questions to ask your residency director in your residency interviews:
    1) how many drop outs/ divorces/ suicides have there been in the last 10 years in this program?
    2) how many children have been born to residents in the past 5 years?

    If the director hems, haws, can't / wont answer these questions stand up and leave, quickly!!!!!!!

    My advice- leave the field, General IM is dying or better said is being suffocated like all of Primary Care. The specialties will be next after the ACA mandated ACO's capture more market share. Unless you like a) endless hours of paperwork ( last week I spent 42.5 hours just on notes and refills- didnt get the prior auths done.) and unless you like b) spending 100's of hours how to enter syntax perfect orders into EMR's ( I have used 7 none are quicker than paper) or c) unless 3 minute appointments turn your crank so you can get in your 40 pts/day and unless d) you understand that 18 hour days to get the paper pushed are the NORM for Traditional outpatient/inpatient practice and finally e) since Hospitalist loads are only slightly better with 15 pt-25 pts/ day. If you understand the above and still want to continue get a good antidepressant and a CPAP. I have 10 years in the field and still am 227 grand in debt from the schooling. ( private non dischargable loans at 12% since Clinton didnt fund HEAL) -------------- leave NOW!
  17. NurWollen

    NurWollen Strong with the Force 7+ Year Member

    Dec 27, 2007
    United States
    Sounds like you're saying leave medicine all together?
  18. ArkansasMed

    ArkansasMed 7+ Year Member

    Jul 22, 2009

    I actually like the first half of your advice. In regards to the second half, what were you loans to begin with? Did you capitalize on your interest like 3-4 times??? Clinton was like 15+ years ago.

    I would add one more point to this list.
    1) Number of drop outs in the program (or people kicked out)
    2) Divorces
    3) Suicides in 10 years (1 is probably not indicative of anything, but if there are multiple it may scream lack of support on the residency programs end.)
    4) Children being born
    5) Marriages that happened during residency.

    Cush/intensity is all relative. Some programs give a ton of responsibility or have high expectations for their residents but they are happy because of the support from either the program leadership, residents or both. Penn was a lot like this. The residents worked hard but were really happy and had solid morale. Interestingly enough, the program that I interviewed at that had the most residents with children/having children was Hopkins Osler (by a landslide too) since most regard this to be a pretty rigorous program. I think this was probably somewhat selecting since it is much more affordable to live with a family in Baltimore than Boston, California or almost any other East Coast city. All goes to show that it really is up to you to find a program where you get along well with the residents and can find yourself super happy.

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