Intense call schedule

[Colinator]

For those of you at or hoping to match at CHOP or Boston Children's, what about the program overcame the Q4 x 11 mon x 3 years? I ask b/c CHOP was one of my favorite programs but I'm liking ranking it lower b/c (a) the call schedule and (b) the absence of residents at the didactic components of the day. Can anyone convince me I'm being silly or am misinformed? Thanks!!

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[sam1]

Colinator, for me location is an important factor (my family is in california), so, although CHOP is one of my favourites and I would rank it number 1 any day, I have ranked it after california programs. If i had the option to do residency anywhere, then CHOP is still my first choice!.Its the best place to be. I think you have been misinformed about CHOP. I have a few friends there and they simply love the Program in every way.

 

[14022]

I think some people get caught up in the "rankings" and feel they have to be at the best place possible. Also, some personalities feel that getting killed by working Q4 for 33 of 36 months of residency is either admirable, enjoyable, or necessary for a good education. Personally, I feel that the ability to pursue outside interests is much more important than prestige and patient volume. There are many great programs that have such a better quality of life than some of these powerhouses. However, keep in mind that it may be more difficult to be a department chair or world-expert by going to some of those programs. It will NOT however, prevent you from becoming a great pediatrician or obtaining a great fellowship in your field of choice. So you have to look at your long-term goals in order to help make that decision.

 

[GoSprout24]

Colinator, this is a wonderful question. I would love to hear what current residents feel about this, or even how current applicants are forming their thought process. I have at least 2-3 programs that I would rank higher if it wasn't for the fact that they are q4 x 3 years (essentially). I know I hate call, and I feel like this would make me miserable for 3 years, no???

EDIT: UCSF and Columbia are other examples are intense call schedule programs... just to add to the debate.

 

[unagi2007]

Is Q4 9months/8months/7months the norm when it comes to call schedules in peds?

 

[Cardsfan]

Being at ChOP currently, I can clarify that there are 5 floor call months, 1-2 ICU call months, the rest is either rehab call (which is 8hrs of little-to-no interupted sleep) or sick relief from home(usually dont get called in). Second year is similar, and third year is much better, cant quote details at the moment. We do have nightfloat which will admit most gen peds cases after 11pm, while the on call intern covers the floor and admits the cases that need closer watch. I actually like call vs straight night float system since we do get out post call 12-1 during the week and 8am on weekends. Anyway, its misleading to say q4 x3 yrs, its more call than some places but I wouldnt change it. I guess when deciding on a program you have to decide what aspects are important to you, if you really like everything else about the program, my feelings are you will be happy despite the calls.

 

[veggie7]

Colinator, I totally agree ~ I had the same 2 concerns, but liked everything else about CHOP.
Cardsfan, can you comment on the didactic attendance? My day there morning report was quite well attended, but noon conference was not at all (maybe 5-6 residents total). Is this the norm? My other question is the "fellow presence" -- i know it's been asked to death, so i apologize, but i do have concerns about resident autonomy and my ability to leave as a good pediatrician if i never get to make a decision without calling someone first. So any light anyone can shed on this would be wonderful. Thanks! and good luck to all making their rank lists.

 

[Colinator]

Cardsfan, I stand corrected. I spoke with another resident at CHOP who shared the same call schedule clarifications. While only one month is guaranteed call free, many of the outpatient or elective months you'll only have 3-5 sick/back-up calls that aren't abused. So you may only get called in once. Also, with so many residents in the program, you can fairly easily swap calls to get a call free month if you so desire (for international rotations etc). Sounded a lot better after I spoke with this CHOP resident. Basically first year looks like 8 months Q4, the rest back-up then progressively better 2nd and 3rd year.

As for conference attendance, apparently morning report is new this year at CHOP. In the past, PGY-2 and -3 folks would have a senior report from 11-12 then interns had a conference at noon. The push was to get more attending involvement, hence the move to 7 am morning report. The poor attendance at morning report is a fact. Interns are basically on the floor seeing patients and writing notes from 7-8:15 while the upper-year residents may or may not make morning report (not such a great motivator when you don't have to come in for clinic until 8:30 on elective months right?). Noon conference, however, is generally well-attended and interns must take it upon themselves to go. Senior will cover their pagers and now lunch is offered, so no excuses about waiting in line in the cafeteria.

The resident I spoke with believes that as morning report evolves, more residents will attend.

Happy decision weekend!

 

[AF_PedsBoy]

Q4? That's it? The majority of the time we were Q3-4 and my surgery resident friends tell me they hit Q2 on a semi-regular basis. I think I hit
Q5 once or twice the entire year

 

[idealist22]

as a BCRP (boston combined) resident, i too want to clarify our call schedule. don't get me wrong, it's a tough schedule, just like CHOP's. but it's not as bad as it sounds.

as an intern, you do 5 floor months (with nightfloat 7 nights/week) and 2-2.5 NICU/nursery months with q4 call. the rest consists of 1-2 months of ER; 2+ outpatient months, which typically have either a couple of weekend ER shifts per block or q4 overnight cross cover; your guaranteed call-free block, which is either elective or "primary care block;" and of course vacation (almost 5 weeks in intern year, more than other programs i've seen!). sometimes you get lucky and have no cross cover at all on some outpatient blocks. i had 2 months of call-free rotations (elective, child development, and allergy clinic) my intern year.

junior year also has less call time than it appears at first. this includes:
1) 2 weeks of call free elective
2) 2-4 weeks of sick call during which you basically hang out anywhere within an hour of the hospital in case you get called in (on my sick call, i spent several afternoons at the beach and only got called in twice to cover two ER shifts)
3) 4 weeks of elective with q4 cross-cover call (other than those cross-cover calls, expectations are low for our electives - residents often spend elective time with their kids, doing fellowship/job interviews, or just relaxing)
4) several junior rotations are call-free as well, including the ICP (step-down ICU), bone marrow transplant (call free but you have to round on saturday morning), and outpatient GI (morning clinics only for 10 days!). They're planning on making outpatient pulmonary call-free next year.
5) one of the nicest things about junior year is that unlike intern year, when you stay post-call 'til 12 or 1 on weekdays, junior year you typically sign out and leave immediately after rounds. if you've had a good night and you get done at 9 am, you have a whole day off!

senior year, with its months of elective and 3 months of "career development block," is a cushy experience!!

hope this is helpful to those of you who might be intimidated by our schedule.

 

[mytirf]

Q4? That's it? The majority of the time we were Q3-4 and my surgery resident friends tell me they hit Q2 on a semi-regular basis. I think I hit
Q5 once or twice the entire year

Where is your program? because it is very hard to maintain work hours as Q3 and impossible at Q2. Your program therefore would be in violation of the ACGME work hours mandate and you should report them. If you don't or try to fudge on hours and your program is audited you can be suspended directly. Don't like a program take advantage of you and your co-residents.

BTW how does a schedule work that is Q3-4?

 

[AF_PedsBoy]

NMCP - while I was on NICU the week leading up to my Step III they thoughtfully put me on call Sunday, Wednesday, and Saturday (30 hours, 12 hours, 30 hours, 12 hours, 30 hours=114 hours on paper, with my Step III being the NEXT day. They solved THAT fiasco by just making Saturday and Sunday normal days which brought me down to about 100 hours). While that was uncommon, a mix of lots of Q3 with a little Q4 and hinting if you didn't document your hours "correctly" you may not be efficient enough for the program; although granted it was improved to actually hitting the 80 fairly regularly the past year with JCAHO coming through. The year we joined NMCP they DID get tagged - because the *Navy* interns were consistently documenting over 80 hours; the disgruntled AF interns didn't even get factored in because we came in late and hadn't been integrated yet. And my friend managed to pull 5 Q3 calls back to back because she was on a clinic rotation - that's right, outpatient is fair game.

As to Q2 - you'd have to ask my surgeon buds how they do it, because I seriously don't know with the hell I get with Q3; one of them is at Loma Linda and the other is at Mount Sinai, NY. Did I mention my bud at Loma Linda totalled his car falling asleep after a call while driving home?

 

[BigNavyPedsGuy]

NMCP - while I was on NICU the week leading up to my Step III they thoughtfully put me on call Sunday, Wednesday, and Saturday (30 hours, 12 hours, 30 hours, 12 hours, 30 hours=114 hours on paper, with my Step III being the NEXT day. They solved THAT fiasco by just making Saturday and Sunday normal days which brought me down to about 100 hours). While that was uncommon, a mix of lots of Q3 with a little Q4 and hinting if you didn't document your hours "correctly" you may not be efficient enough for the program; although granted it was improved to actually hitting the 80 fairly regularly the past year with JCAHO coming through. The year we joined NMCP they DID get tagged - because the *Navy* interns were consistently documenting over 80 hours; the disgruntled AF interns didn't even get factored in because we came in late and hadn't been integrated yet. And my friend managed to pull 5 Q3 calls back to back because she was on a clinic rotation - that's right, outpatient is fair game.

As to Q2 - you'd have to ask my surgeon buds how they do it, because I seriously don't know with the hell I get with Q3; one of them is at Loma Linda and the other is at Mount Sinai, NY. Did I mention my bud at Loma Linda totalled his car falling asleep after a call while driving home?

Are you still at that program?

 

[Palmetto]

Or, you could always go with a night float system like Hopkins. 3 q4 call months in the entire residency. Otherwise, it's one friday call, one saturday call, and two goldens on about half of the non-ICU months. The other half of non-ICU months is weekend ED coverage x2 with two golden weekends. The ICU months are one friday, one saturday, one week of night float which includes Sunday call, and one golden weekend. We also do 4 weeks of ward night float during each year.

On one hand, it's nice to have the "extra" weekend off every month and I certainly don't mind not being exhausted during the week, which allows me to actually read. On the other hand, I'm on one of our q4 call months right now (and working hard, as you can see...) and it's nice to have the post-call day to do errands. If you're not exhausted. So both versions have merit, and I imagine the grass can be greener on the other side.

Call schedule was a moderate factor between the programs I chose, but not a deciding one in any case. Plus, how will you tell good stories as an attending if you don't take 14 months of call your intern year uphill both ways shoeless in the snow?

 

[drbetty]

would love to hear more about lifestyle and camaraderie at these large programs. do you feel like you have time to read about your patients? how many pts do you typically admit each night? do fellow residents get along/hang out? also, what about face-time/teaching with attendings?

thanks in advance!

 

[Jonath00]

Is Q4 9months/8months/7months the norm when it comes to call schedules in peds?

Yes. Peds is tougher than IM.

 

[Freibi]

Plus, how will you tell good stories as an attending if you don't take 14 months of call your intern year uphill both ways shoeless in the snow?

Maybe in 20 years, there will only be q6 call and you'll be a hero for having lived through q4s way back when...

 

[drbetty]

as an intern, you do 5 floor months (with nightfloat 7 nights/week) and 2-2.5 NICU/nursery months with q4 call. the rest consists of 1-2 months of ER; 2+ outpatient months, which typically have either a couple of weekend ER shifts per block or q4 overnight cross cover; your guaranteed call-free block, which is either elective or "primary care block;" and of course vacation (almost 5 weeks in intern year, more than other programs i've seen!). sometimes you get lucky and have no cross cover at all on some outpatient blocks. i had 2 months of call-free rotations (elective, child development, and allergy clinic) my intern year.

junior year also has less call time than it appears at first. this includes:
1) 2 weeks of call free elective
2) 2-4 weeks of sick call during which you basically hang out anywhere within an hour of the hospital in case you get called in (on my sick call, i spent several afternoons at the beach and only got called in twice to cover two ER shifts)
3) 4 weeks of elective with q4 cross-cover call (other than those cross-cover calls, expectations are low for our electives - residents often spend elective time with their kids, doing fellowship/job interviews, or just relaxing)
4) several junior rotations are call-free as well, including the ICP (step-down ICU), bone marrow transplant (call free but you have to round on saturday morning), and outpatient GI (morning clinics only for 10 days!). They're planning on making outpatient pulmonary call-free next year.
5) one of the nicest things about junior year is that unlike intern year, when you stay post-call 'til 12 or 1 on weekdays, junior year you typically sign out and leave immediately after rounds. if you've had a good night and you get done at 9 am, you have a whole day off!

senior year, with its months of elective and 3 months of "career development block," is a cushy experience!!

Hi Idealist or anybody else that knows:

Is this still true? I am reviewing the current provided call schedule, and I am seeing only 1-1.5 call free months as a PL-2:

• elective 0.5 plus
• career development 0.5 plus
• stem cell transplant 0-0.5

And as a PL-3, I see 1.5 months of call-free elective and what seems like 2-2.5 months of q4 sick call during electives. But I also see q4 call listed under the 3 months of career development which is not sounding as cushy as this post has asserted?

 

[CTWhale]

Hi Dr. Betty,
Some of it depends how you define call-free. For example, everyone does 4-6 weeks of ER time per year, which technically does not count as call-free, though you work roughly 40-50 hours per week in 8-10 hour shifts during the week, 12 hour shifts on weekends, and never do overnight shifts as an intern (and almost never as a senior). There are other rotations, such as dermatology and renal, where again you do not count as "call-free" but will work 2 weekend day-shifts in a 2 week block, never overnight. Lastly, there are different sick-call shifts. For instance, I did genetics this year and was 3rd call sick call, meaning I only got called in if 3 different people called in sick. In an entire month I had a single 6 hour ER shift, but again technically it was not a call-free month. I can think of other examples but I think you get the point.
Best.