Also, I believe the sniping comment made about the BIDMC ED should be clarified. (I, too, should disclose that I'm a current Longwood resident.) For those who may not know, BIDMC represents the merger of the previous Beth Israel Hospital and the Deaconess Hospital into the Beth Israel Deaconess Medical Center, the flagship institution of CareGroup Healthcare System and one of HMS's 4 main teaching hospitals.
I'm not saying that it's not hard work; in fact, the residents do feel overworked at times, particularly after a busy shift in the ED. However.... there is a TON of support in place. On any given night, there is both a PGY1 and a PGY2 on call at the BI. So, from the PGY1 perspective, there is always a psych PGY2 (in addition to Medicine, Surgery, Neuro, etc...) that is in-house should any problems arise. From the PGY-2 perspective, there is always a PGY-1 in-house to help with consults in the ED. On back-up, there is always a Longwood PGY-4 on home-call who expects to be called for difficult cases and who expects to come in if too many urgent consults are called simultaneously (this may happen a handful of times during any particular resident's PGY-4 year). Beyond this, there is a specific attending on back-up for this particular hospital who also knows that they can be called in if the volume were to grow too high (I've not seen this happen, but all attendings know that it can) or if there is a very particular situation involving a VIP or a complicated legal situation requiring an attending. Beyond THIS, the CL Director and the Chief are always reachable, and, in my experience, I had to contact each of them in the wee hours (for 2 completely different situations), and each was compassionate and professional and offered to come in.
In addition to all of this, there is now a full-time bedsearcher (this evolved because residents complained that bed searching was a time suck, and the hospital realized that it would save $ by funding such a position), and the ancillary services in this tertiary care center are impeccable -- I never had to draw blood, start IVs, take EKGs, etc., even when they were necessary STAT (for these, I'm referring to patients on the psych unit; if the pt were in the ED, the medical ED personnel would obviously be responsible for these things). Also, there is now a very well-paying moonlighting position at the BI where one of the main tasks of the moonlighter is to round on the ED patients who had to board overnight due to bed shortages in the city - neither on-call resident (PGY1 or PGY2) needs to round on these patients at the start of the shift if they do not wish.
So, all of this being said, while I acknowledge that call nights can be busy (oh, did I mention that PGY2's are on night float, so most of these busy nights are 12-hr shifts and not 24-30 hr calls), the support structure is in place. Whether or not the PGY2 utilizes the support is another question... but, if he/she doesn't, it has nothing to do with the culture of the program.
As Doc Samson alluded to in an earlier response, the administration prides itself on advocating for residents and providing the most sound training experience they can - within reason, of course. Support structures have been developed over time, and I would advise you, HMSPSYCH, if you are truly a member of our program (which has yet to be proven), that you should make an appt with ANY of our training directors or bring these issues up at the next House Officers' Association meeting or Training Committee meeting, or any of the other bazillion regularly-scheduled feedback sessions that we have. Making vague, incisive statements on an anonymous forum serves nobody's interest, least of which your own.
