Home call vs Inpatient call

[jimj]

Quick and dirty discussion topic on Home Call vs In House Call:

Which current PM&R residency programs have it? You're take on Pros and Cons with each?

Do what you will with this. Interesting to hear how residents feel about each side.

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[Paddington]

I ranked highly mostly programs that had in house call, not because I like in house call, but because I liked those programs. Initially, one of my attractions to rehab was the promise of a Dermatology or Rad Onc like home call residency for average Joes with average scores, but in the end that didn't matter as much.

Covering even 50 rehab patients is not bad. You'll get fewer calls than you'd get with 1/3 as many Internal Medicine patients. Also you're not doing admissions at night. You'll easily sleep most of the night and then leave the next day at noon.

OTOH, home call in some PM&R programs can be a real screw. I know one person who ends up going in several nights in a row, and having to put in full work days in between. People in rehab wards still develop chest pain, mental status changes, etc. It's much less painful to quickly assess them, write a note, and then transfer them out to the ED if you're sleeping downstairs than it is to do all those with driving in to the hospital and driving home if you've got home call. IMO, PM&R home call only really works in the small programs with minor/"Ortho" rehab departments that just take very basic cases, with no more than 20 patients or so.

 

[topwise]

Yes, home call can be lovely or it can be a nightmare. The nightmare is when you have to drive to the hospital in the middle of the night to take care of a sick patient and then still have to work the entire next day. Or worse, if that happens two or even three days in a row.

But to be honest, I still prefer home call to inhouse call. It is just depressing to have to spend the night in the hospital! Even if I only got to go home for a few hours and still had to work the entire next day, I'd still prefer it to being forced to stay in the hospital all night. And that situation has been rare for me... most times I was doing inhouse call, I didn't have to come in at all... and sometimes I didn't even get paged all night.

 

[DOctorJay]

I don't think you can really say one is better than the other because it is very dependent on the program and what types of patients get admitted to that facility. I take home call and it really hasn't been all that bad. We have a virtual network so I can put in orders and look at results from home and then get back to sleep. I don't mind this set up mostly because I live literally 2 minutes from the hospital and would much prefer sleeping in my own bed than having to stay in house.

 

[PMR 4 MSK]

Home call I used to come in about 1x/mo. Most calls can be handled by phone.

Larger programs = more pts = more likely to need in house call, but less call nights/month. On most iof my inpt rotations, I covered my own patients after hours Mon - Thur, on call doc took them Fri - Mon

 

[RUOkie]

Home call I used to come in about 1x/mo. Most calls can be handled by phone.

Larger programs = more pts = more likely to need in house call, but less call nights/month. On most iof my inpt rotations, I covered my own patients after hours Mon - Thur, on call doc took them Fri - Mon

Back in the day, when I was training we did home call covering a week at a time (3 hospitals). Sometimes nothing all week, somtimes no sleep all week. I felt that home call prepared me better for the real life issues of covering a rehab unit. (which I use very little now)

In my first job out of training, we covered call for 4 inpt rehab units, one of which was a TBI/SCI unit, and another at a Level I trauma center. We were on call 1/12 weeks. The weekend coverage/call was brutal, far worse than anything I did as a resident.

 

[Atlantic]

Home call can be great when you have well-trained nursing staff, electronic medical record, residents that give good sign out, and a good relationship with the ER and consulting physicians. Our program takes home call for 4 facilities and I've rarely had to come in to see a patient overnight. Additionally, we only take one call night at a time as opposed to week long call.

 

[Finally M3]

When I interviewed, I crossed off all programs that had in-house call

It can be a pain and there were several 'puckering' call nights, but I would much rather be electronically tethered than stuck in the hospital.

Definitely, though, need to hone your medicine skills and be comfortable phone triaging.

 

[Nico47]

I'm at Loyola and we do home call.

I would say 80% of the time it is fabulous.

But that other 20% is less than desirable. Having to drive to the hospital in the middle of the night is no fun (this becomes necessary if a patient falls, has sudden mental status changes, etc.). Occasionally your sleep is interrupted the entire night by pages, and yes you still have to do a full day after that.

This month I did four nights of in-home call. I got a total of 5 pages after bedtime and they were all simple things like med renewals. -A beautiful thing!

You have to be careful though. Some programs say they have home call, but you're supposed to cover multiple hospitals and the drive-in rate is super high. Best thing to do is get the real scoop from residents, as is being done here (I hope).