IM Residency and Lifestyle

[Future GI Guy]

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I was wondering, for anyone in the know, what are the programs that offer their residents the most support, best benefits and lifestyle benefits?

I'm speaking with regards to overnight call schedule (i.e. intern night float?) and malignancy of the program in general.

Anyone have any suggestings?

 

[AJM]

That's a tough one to answer, because there are so many IM programs out there, and their levels of malignancy are constantly changing. It also depends on if you will be looking at primarily academic programs or if you are going towards the community hospital program route.

As far as residency programs changing, I think that there have been many programs in the past few years that have moved to a "nicer" system utilizing night float, having a cap system in place, etc. For example, University of Washington has always had a reputation for being an incredibly malignant program, but they are now in the process of working out the details of a cap system to make the resident's lives so much easier. Hopefully in the next couple years it will lose it's malignant reputation.

Also, because night float is becoming increasingly popular these days, it might be a better question to ask which programs DO NOT have night float/cap system, etc.

I will assume because of your name that you are thinking mostly of academic residency programs. The programs that have impressed me the most, or that have most impressed my classmates that i've talked to, by how well the residents are treated and how supportive the administration is are: Brigham, Stanford, Penn, Cornell, and Wash U (St. Louis). Those are just the ones that I have specific information about -- I'm sure there are tons others that treat their residents well.

PS -- As a side note, when I say that the residents are treated well, I don't mean that they don't work hard. At all those places they work very hard (which is typical for IM programs), but they are also looked out for by a very responsive administration/program director, and there are steps that have been taken to make sure that they do get certain amenities, like sleep. :wink:

If you have more specific questions, please ask.

 

[dbiddy]

The nicest I've seen is Providence Portland. Nice city. 50hrs/week in your intern year, with slightly less in 2nd and 3rd. Call every second week during wards because of the night float system. They treat you well and have alot of connections for fellowships. Only drawback is that its a community program, but I don't really care about namebrands.

 

[AnnK]

Could someone explain how a night float system works? Is that like where someone is assigned just to work nites for a period of time?

Thanks!
Ann (i do so loath working post-call)

 

[Future GI Guy]

Ann.

My understanding of the night float system is fairly primitive, but I have spoken with some residents about it.

Generally, night floats are set up in the following way:

Take an Internal Medicine Residency that has 13 residents in each of the PGY-2 and 3 years. 26 spots total.

Each resident would serve as Senior Resident on Night Float for 2 weeks out of the year. Thus, you'll have 26 residents times 2 weeks each, and that covers the whole year.

That means that, when there is a night floater, the on call team only admits to, say, 10pm. It's a short call. That team takes care of their admits and goes home when work is done (sometimes midnight or 1am). Then the floater comes in and admits all the patients that come in after 10pm. The floater works until 7am, checks out the patients to the next days on-call team, and the floater goes home and sleeps. (Generally, they are excused from next day duty. Including lectures and stuff).

Thus, if you work 2 straight weeks of what is, essentially, a night shift, you'll have the other 50 weeks with no overnight responsibilities. Pretty cool, eh?

I understand that things often work different for the intern on call, and that every residency that has a night float system for upper level residents doesn't necessarily include interns in that system. Regardless, they are usually responsible for the in house patients that have been checked out to them. So, if someone needs Tylenol at 3am, the intern's getting the call. This is changing slowly, as well, and Intern Night Float is coming into the system pretty rapidly.

Hope that explanation helps you. If I'm wrong, please correct me, for anyone else who might know a little more.

 

[AnnK]

Thanks alot for the explanation. I have seen that sort of thing go on for upper level residents.
Intern night float. Ill have to be on the lookout for it. Seems like it could make intern year much more tolerable.

Ann

 

[NuMD97]

Oh, Ann! I hate to bust your bubble, but here goes:

The way we did night float is as follows:

We had five teams, with a resident and two interns per team. Plus the medical students -usually two - one third year and one fourth year. One team would be oncall and would admit as well as manage their own in-house patients previously admitted. The other four teams' interns and sub-interns signed out to the night float intern their patient load. The hospitalist service signed out to the float intern as well. This means that you were usually responsible for approximately 55-62 patients that you were not very familiar with except for a brief summary plus med and "to do" lists (eg.: check labs, check wounds, unstable pressures, etc.) during the sign-out. All throughout the night from 5:00 PM sign-out time (or as I used to call it, "When the gun goes off") until 7:30 AM (more likely 8 AM when the last stragglers showed up) you are responsible for putting out any fires that would develop during the course of the night. If you slept at all you usually got about two hours, because the pager would go off continually. The first time you do float, you listen ernestly to each intern present each patient, but it is a difficult task indeed to keep in your mind 62 individuals who often have similar case histories, and patients you yourself have never examined. After that first night, I discovered the best way to do it was to flag any potential problems, note the allergies, as well as the meds that were absolutely not to be used (usually due merely to the preference of the intern or attending that wouldn't normally be readily apparent), and what labs needed to be checked and work that needed to be done in the course of the night, in general. You are off 36 hours, except when you have to be in continuity clinic. The time off that you have before you "float" again is much needed for sleep mostly, and to just recoup from the events of the night before.

I hope this gives you a better picture. But night float is definitely more desirable than a system that allows for admitting new patients as well as cross-covering all the other patients already in the hospital.

Just one person's experience. 🙂

 

[dbiddy]

I've worked in both situations described above. Both systems are better than none, because cross-cover can be a bitch when you're already super busy. In addition to the Providence program in Portland, the Jersey Shore program in Neptune, NJ also has this and also has the cushy calls.

It is definately a big factor for me in selecting where I want to go. The only bad thing is that when you are post-call and didn't get home til after midnight the night before, you are still expected to have a full day on your post call day.