How does home call work?

[oncology2020]

how does call taken from home work in ENT? are the residents typically at home and come in only when paged for an urgent consult and allow the day teams to see the non-urgent cases or do they typically come in for all consults?

I know home call is more open to abuse by the department because the hours don't count towards the work limit. Anyone have any experience with this?

how do weekends work at most programs? how many weekends are people often working during the month while on service?

also do ENT programs typically have their own in-patient service or are they more of a consulting service/dump patients onto gen surg service?

i know it will be program specific and i've seen different things at different programs but just trying to get a better idea of how things are done at most programs..thanks for any clarification!

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[HighPriest]

Everybody is going to have a bit if variation in their answers. For reference, I trained at a military hospital, but spent about 10 months on outside rotations at a large university program.

The way home call worked for me, as well as for most of the other guys I've spoken with, is that the junior resident (usually an R2) fielded calls from patients and the hospital. If there was even a whiff of uncertainty in what to do, they would call the SR resident on call (usually the R5). If something needed to go to the OR, or if there was a significant change in patient status, the Sr resident would call the staff doc.

I always expected my Jr resident to see the patient before they called, unless it was an airway emergency, etc. as the year drew on and the Jr became more competent (assuming that they did), I was ok with them scheduling a follow up for non-urgent complaints. How busy they were varied dramatically. Sometimes they never slept, sometimes they never woke up at night. It mainly depended upon where they were taking call. Overall, it balanced out fairly well for us, and I don't feel like I was abused in terms of working hours. Certainly not to the extent of the GenSurg/Ortho guys.

Weekend schedules are going to vary by program, but the ACGME does have standards that programs are supposed to follow.

I have never heard of an ENT program that didn't admit it's own patients. We certainly admitted patients for things that I defer to the hospitalist now (not because I can't handle it, but because I feel that they can handle uncomplicated facial cellulitis). The only exception would be that I don't think most ENT departments have ICU admitting privelages like most GenSurg departments do. We're not critical care specialists. So ICU admits are sent to either the surg or med ICU with ENT consulting (which at our hospital meant making essentially all of the decisions) until the patient is ready to go to the floor. All that being said, if a patient is a brittle diabetic with CHF and bilateral AKAs, they would be admitted to medicine. We're not like the GenSurg cowboys, we know what we should and shouldn't tackle. But we're not as bad as Ortho; a hangnail is not a reason for IM transfer.

 

[DrBodacious]

I know home call is more open to abuse by the department because the hours don't count towards the work limit. Anyone have any experience with this?

Programs with home call usually have multiple hospitals with separate hospital based "services" while in house call makes more sense for one big hospital campus that can be cross covered by one person. The "separate services" call people are going to be individually less busy, so it wouldn't make sense to have them "cooped up" in the hospital and then missing cases the next day for duty hour reasons. Often times home call means you are on call more frequently (Q 1-3) as opposed to in house which seems like it is usually Q 4-7. Upper level call is almost always home call (I am not aware of any program that has in house call for upper level residents).

Personally, I had all home call at my program, and was on call fairly frequently, but I would enjoy things like going out to eat, catching a movie on the weekend, grabbing a beer while on call. Occasionally my plan was cut short, but more often not. This represents more what call is like out in private practice.

 

[oncology2020]

thanks for the insights guys

home call sounds reasonable, do people tend to prefer home call over in-house call?

 

[HighPriest]

When you don't get called: yes. When you do: not necessarily. And as a senior resident, it's fantastic.

 

[neutropeniaboy]

I personally hated home call.

I hardly ever went home, and when I did, I rarely stayed at home for long. Technically, we had home call. In reality, I learned to just stay at the hospital.