Medical specialities/residencies with no night calls

[emilyy13]

Hi,

Last year I was diagnosed with narcolepsy, which is a chronic sleep disorder. My physician told me to have a better sleep schedule, and I'm aware of the decrease of my narcolepsy attacks. I don't want to give up my dream of having a career in medicine, but I also know that I can't work night shifts without risking my own health. Which specialties/residencies would allow me to have a better sleep schedule? I've done some research and some of the answers I got were psychiatry and dermatology.

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[stickgirl390]

Maybe PM&R?

 

[Lawpy]

Feels like the answer is more program dependent

 

[xffan624]

Pathology?

 

[Ms Procrastinator]

I think Derm and PM&R require a prelim year. Are you talking about residency or after because a lot of residents' work schedules are crazy. I would recommend optho, FM, PM&R, path and derm, but the residency part's tricky.

 

[operaman]

In addition, you may find that other fields are open as well depending on how the individual programs manage their overnight call obligations. For example, there are many surgical sub programs that have "at home" call where essentially you work all night and get no post call day and it's all ok per ACGME so long as you still keep under 80 hours total. Other surgical subs have a night float rotation where you do a couple months of nights as a 2 and 3 and then otherwise have no primary night call. The float transitions might be challenging but you'd basically consolidate your rough days into a couple short spans at known times, and you could even take some vacation time during those times to maximize your recovery and get back on a normal schedule.

Just one example of many, but essentially you have many options open to you in terms of fields, but obviously finding a cushy derm residency is much easier than matching one of the smaller number of competitive surgical sub programs that have a manageable float system.

 

[sloop]

It’s going to be nearly impossible to make it through residency in virtually any specialty without doing some call and/or night float.

As an attending, though, you can choose jobs in many specialties that won’t involve being in the hospital after-hours. At least in my specialty, psychiatry, it is relatively easy to find outpatient jobs that don’t involve call (or, if they do, it is outpatient “call” which basically is infrequently having to hold a pager overnight in case a patient has an urgent concern).

 

[frenchyn]

Hi,

Last year I was diagnosed with narcolepsy, which is a chronic sleep disorder. My physician told me to have a better sleep schedule, and I'm aware of the decrease of my narcolepsy attacks. I don't want to give up my dream of having a career in medicine, but I also know that I can't work night shifts without risking my own health. Which specialties/residencies would allow me to have a better sleep schedule? I've done some research and some of the answers I got were psychiatry and dermatology.

Are you premed? Derm is a nice option after residency but going into med school aiming at derm is risky.

 

[ciestar]

I think Derm and PM&R require a prelim year. Are you talking about residency or after because a lot of residents' work schedules are crazy. I would recommend optho, FM, PM&R, path and derm, but the residency part's tricky.

Im FM and have had my fair share of nights.

and yes, both require prelim years.

 

[Ms Procrastinator]

Im FM and have had my fair share of nights.

and yes, both require prelim years.

I was thinking FM after residency. In certain areas you could have a nice part-time schedule. I felt OP would need all the options they could get. I'm having a hard time recalling residencies that don't do nights so OPs gonna have a hard time residency wise. If they can survive residency there are some good specialties.

 

[Dr G Oogle]

I think it will be hard to get through any residency without night call, home call doesn’t mean you’ll get sleep it just means you wait to get paged in your own bed, night float allows you to get sleep during the day it is still very disruptive to our diurnal cycles. And residencies may not rank you highly or at all irrespective of med school stats if you list this as a condition.

 

[Redpancreas]

Hi,

Last year I was diagnosed with narcolepsy, which is a chronic sleep disorder. My physician told me to have a better sleep schedule, and I'm aware of the decrease of my narcolepsy attacks. I don't want to give up my dream of having a career in medicine, but I also know that I can't work night shifts without risking my own health. Which specialties/residencies would allow me to have a better sleep schedule? I've done some research and some of the answers I got were psychiatry and dermatology.

At the beginning of residency when I knew jack squat. I noticed I had some night shifts in December and I figured days would be more helpful and didn't feel like messing up my sleep schedule. Tons of people were willing to switch their days for my nights. On the switch form, the reason I put was: personal preference, don't like nights. I was called by one of the chiefs who asked me why I wrote that and I said given the option I'd rather have days but if it was a problem I could just do the nights. She said that I would have to do the night shifts and told me that ACGME requires a certain amount of night rotations AND that if I had any limitation, I would have to notify the chiefs immediately so they could make accomodations. I said I had none and did my shifts which was a pity because I did not have medicine days until early April and hardly had any admissions on my nights.

I say this to illustrate that depending on the residency, ACGME will mandate a certain amount of night rotations AND that chiefs ideally want to know your diagnosis of narcolepsy prior to making your schedule. That brings up an interesting, ethical scenario of whether you're obligated to report this during your residency application. If I were you, I would not report because at this stage, people nitpick even the smallest things when assessing candidates and it will be another reason for them to discriminate against you. However, I do not know if there are policies where you would need to report a medical condition. This might be something you consult with your physician about as well as your medical school and potentially just consult (not get) a lawyer.

In terms of fields, in general I would imagine Family Medicine, Neurology, or Internal Medicine with accomodations would be good options. Psychiatry, Ophtho, PM&R and Dermatology are others with consideration of the preliminary IM year. All of these residencies will require some nights especially during the IM preliminary year and most likely during residency while on call. Now, there may be some programs where this is mitigated and maybe you can consider that as a deciding factor when the time comes to apply, interview, and rank. Ultimately, all the fields I listed as good options would allow you to ultimately practice in a less stressful setting with minimal sleep issues, but will require some accomodations .

Surgical subspecialties, General Surgery, OB/GYN and Emergency Medicine would be poor choices.

@NotAProgDirector I'd be interested to hear your opinion on the second paragraph.

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Review of previous threads: google "SDN Narcolepsy residency"

Narcolepsy and Application

I was recently diagnosed with narcolepsy, which explains why my undergrad was so difficult. I graduated with a 3.3 cGPA and no sGPA, and am currently working on my prereqs as a post bac (4.0 so far). I was a collegiate athlete and had practice at 5:00 am every day as well as in the evening...

forums.studentdoctor.net

This one talks about a diagnosis made before med school and whether or not to disclose. I find it interesting how everyone was about being tight lipped about it, but now what happens in residency? Expectations should have been tempered at that point. Someone did mention it, but then someone else implied he'll be fine with his meds.

Narcolepsy diagnosis

I'm currently a second year medical student and, to my surprise, I was diagnosed with narcolepsy this year. I'm on medication and it has helped some, but I will always be in a sleep deprived state. I have been able to manage it well thus far because my first 2 years of medical school have been...

forums.studentdoctor.net

In this one, there is hope provided and NAPD makes an appearance saying it is an ADA qualifying dx. meaning residencies need to make a reasonable accomodation, but doesn't expand too much on the implications in residency applications.

Quoted: Narcolepsy and medical school

Posted for a member - I have no particular insight into this condition and how it would affect medical school or residency. I am currently a sophomore and am toying with the idea of applying to medical schools. I believe I have the grades, E.C.s, passion, and work ethic to succeed in medical...

forums.studentdoctor.net

NAPD makes another appearance here adding something I agree with that the residency schedule is limited as it's is interrelated as changing one person's schedule is needed to fix anothers. There are programs that will be supportive and there are others where I'm sure PDs will try to spite you for making their life difficult.

 

[YCAGA]

This isn’t medical advice (hopefully that is obvious), but have you talked with your doctor about treating your narcolepsy with medication? That could make it so nights are not as difficult or harmful for you.

There are a lot of IM and FM residencies that don’t do 30 hour call anymore…just night float. Which is still nights I guess, but at least it is a regular scheduled for a few weeks…a schedule that would be easier to stay on with medication I would imagine.

If you literally can’t work nights or can’t take some 24 hour call, even if it is like q14, during medical school or residency, medicine probably isn’t the right profession for you. I don’t think any speciality or even any medical student can go 7+ years of training and never stay up past 10pm or whatever.

 

[mrbreakfast]

In terms of fields, in general I would imagine Family Medicine, Neurology, or Internal Medicine with accomodations would be good options. Psychiatry, Ophtho, PM&R and Dermatology are others with consideration of the preliminary IM year

Neurology overnight call can be brutal - it's akin to working a medicine call and a long ED shift simultaneously - and in many instructions is 24+ hours. I had a great call last night, which translates to only 10 new consults/strokes during the night and 45 minutes of sleep over 26 hours. Also, at least in my intuition, there's at least one ophtho resident in-house overnight.

OP is going to have overnight shifts, period. There is no specialty that doesn't have it. For example, my derm friends take rare home call but do get called, and occasionally get called in. I have been called overnight by PM&R residents, who again seem to take home call but get called. A very large FM or IM program with night float may be able to accommodate, but just maybe.

OP, I would look into medication. I know someone with mild-moderate narcolepsy who is wrapping up a busy IM residency. Also, I don't know if this applies to narcolepsy, but in residency you really get used to operating on little/no sleep.

 

[canadapath]

Pathology, hands down.

 

[Wordead]

Pathology, hands down.

We do call pathology in after hours at times. But yeah maybe a better choice than the other fields.

 

[Dral]

I'm derm and I did have about 2 weeks of night float as in intern.

If you are private practice derm you can probably pretty much avoid overnight disruptions.

As a resident (or an attending at an academic program or linked to a hospital), you will get an occasional o/n call from the ED about a rash or a r/o SJS/TEN.

Edit: Below post reminded me that I had to do a few overnights in the ICU as well (I try hard to put that month or so out of my mind...I see it's generally working).

 

[NotAProgDirector]

As mentioned in those other linked threads, narcolepsy is clearly an ADA qualifying diagnosis. The ADA requires that employers make reasonable accommodations for those with disabilities. However, "reasonable" isn't whatever you ask for -- it's what you and the employer agree upon. Residency programs can claim that night shift coverage is part of their curriculum, and hence you can't simply be excused from it. There may be other accommodations available -- for example, I believe there are devices that you can wear that sense if you are falling asleep and wake you up.

If you tell programs about this, they will certainly rank you lower for it (those with night shifts).

You can certainly plan on a career in Pathology or Dermatology. As mentioned, Derm requires a prelim year which will likely have nights in it, and Derm is very competitive -- you should not go to medical school with "only derm" as a plan. Pathology is currently less competitive, but may not be the type of medicine you want to practice.

Ultimately I expect this will end up in the courts at some point. A resident will claim they cannot work nights because of narcolepsy, another sleep disorder, or Type 1 Diabetes, or something else. A program will refuse, and a lawsuit will (perhaps) bring some clarity.

There are some potential solutions:

1. Programs could decide to allow residents to be excused from nights for ADA reasons, and instead assign them additional weekend shifts. This might make it more fair for the residents left with more nights -- they would get less weekends on their other rotations. If we assume a 1:1 exchange, my program has about 6 weeks of nights with each week being 4-5 shifts (no 24 hour shifts, no other nights). If we assume that's about 28 night shifts per intern, it would be 14 extra weekends of work. This becomes an enormous problem, since that's most of the free weekends an intern would have in the program.

2. Programs could decide to change the way resident salaries are paid. I could choose a "day" rate and a "night" rate that, when combining 46 weeks of days + 6 weeks of nights = current resident salary. Then, if an intern cannot work nights, they simply would get paid less.

3. The 14 hour night shift (5:30P to 7:30A) could be split in two, and those with ADA restrictions could work only a half a shift -- but end up with twice as many of them. This solution would work well if there were two interns with the same restrictions -- since they could share the shift. Since each "night shift" in the schedule would now take 2 days to complete, residents might need to have their total training time increased to make up the difference.

4. Programs could decide that night shifts aren't required for any residents at all, cover them some other way.

 

[Redpancreas]

Damn OP, definitely don’t list this until you match into a program then based on NAPDs post.

 

[Bobblehead]

I would consult with your physician about what narcolepsy treatment options there are for you so you can understand how you respond to them. With that understanding you'll have a better sense of how much night work you could potentially handle.

 

[radsisrad]

Derm if you manage to be a rockstar med student. Path if not.

Ophtho (mentioned above) is not a good idea. Programs are small, so night coverage, once assigned, isn't very flexible. And busy nights/calls can be very busy.

 

[JBM16BYU]

Maybe PM&R?

PM&R residency still has night shifts, plus a preliminary/transitional intern year which will likely have night shifts as well. Some PM&R programs do overnight call at home versus some overnight call at the rehab hospital. Attending position night cal will likely vary depending on practice and subspecialty.

 

[Stagg737]

I'll add one for psychiatry. No pre-lim year in residency, after that many programs will do home-call only. Mine we only have to go in overnight for a stat consult and that's not too common. If we have to go in, then we get to leave work by noon (at the latest) the following day. If it was a really bad night, attendings will often tell you to just take the next day off and cover for you (without using a sick/vacation day). Also, many programs have no call for senior residents. At my program, you never have to take overnight call again after PGY-2 year if you don't want to. As an attending, you can easily find outpatient jobs with no overnight call. Imo, psych and PM&R are the two most life-style friendly general fields by far.

 

[sloop]

I'll add one for psychiatry. No pre-lim year in residency, after that many programs will do home-call only. Mine we only have to go in overnight for a stat consult and that's not too common. If we have to go in, then we get to leave work by noon (at the latest) the following day. If it was a really bad night, attendings will often tell you to just take the next day off and cover for you (without using a sick/vacation day). Also, many programs have no call for senior residents. At my program, you never have to take overnight call again after PGY-2 year if you don't want to. As an attending, you can easily find outpatient jobs with no overnight call. Imo, psych and PM&R are the two most life-style friendly general fields by far.

Agree that psychiatry could be a better option but OP will have to be careful about the particular programs they choose to rank.

Your setup seems pretty common, but there are also programs like mine which would be a pretty terrible choice for OP.

We do two weeks of night float in intern year. Intern year also has a month of ICU during which you switch between days and nights twice within a two week period. PGY-2 involves relatively busy call that averages out to about q12. PGY-3 has at least one month of nights in the emergency department and you have to carry the consult pager (home call) while on consults (2 months). In PGY-3 and PGY-4 you will also have to do weekend ED shifts which can be days or nights, which winds up being about once or twice a month on average.

 

[Stagg737]

Agree that psychiatry could be a better option but OP will have to be careful about the particular programs they choose to rank.

Your setup seems pretty common, but there are also programs like mine which would be a pretty terrible choice for OP.

We do two weeks of night float in intern year. Intern year also has a month of ICU during which you switch between days and nights twice within a two week period. PGY-2 involves relatively busy call that averages out to about q12. PGY-3 has at least one month of nights in the emergency department and you have to carry the consult pager (home call) while on consults (2 months). In PGY-3 and PGY-4 you will also have to do weekend ED shifts which can be days or nights, which winds up being about once or twice a month on average.

Yes, it can be very program specific. The good part is that every resident I asked about call during interview season was very open about their call schedules and whether they sucked or not. So it shouldn't be too hard to avoid those programs if OP were to apply broadly.

 

[sloop]

Yes, it can be very program specific. The good part is that every resident I asked about call during interview season was very open about their call schedules and whether they sucked or not. So it shouldn't be too hard to avoid those programs if OP were to apply broadly.

I agree. Just pointing out there is a ton of variability in psych in terms of nights/call, so OP would have to ask about it on interviews. But you’re right that there are a lot of programs in psych that would work well for OP (at least as well as you can do in terms of a residency).

 

[Redpancreas]

PM&R residency still has night shifts, plus a preliminary/transitional intern year which will likely have night shifts as well. Some PM&R programs do overnight call at home versus some overnight call at the rehab hospital. Attending position night cal will likely vary depending on practice and subspecialty.

I'm derm and I did have about 2 weeks of night float as in intern.

If you are private practice derm you can probably pretty much avoid overnight disruptions.

As a resident (or an attending at an academic program or linked to a hospital), you will get an occasional o/n call from the ED about a rash or a r/o SJS/TEN.

Im FM and have had my fair share of nights.

and yes, both require prelim years.

We do call pathology in after hours at times. But yeah maybe a better choice than the other fields.

See a lot of people pointing out their field has after-hour requirements/night call, etc. I think even residencies on the lower end will still have night call (ex.) 5-12 weeks). The big picture is the fields I have listed (IM, FM, Derm, PM&R, Optho) all allow for a long term (30+ yr) attending life which would allow for more regular sleep. OP should seek counsel from his Psychiatrist on whether he can still do night calls safely and how the medications will work. The answer based on a few experiences here seems to be that those calls are possible, but OP will need to discuss this with his own Psychiatrist. I think it's much easier to figure out how to manage 12 weeks of night call over 3 years. Also, I am not giving medical/legal advice here but I don't think it's in OPs best interest to disclose the condition on your residency applications.

Overall, if OP gets assurance from his Psychiatrist, I think OP should not be looking for a residency without night call which would exclude most fields. Instead, he or she should find something that allows for minimal night call/circadian rhythm disturbances (surgical subspecialties, EM) long term. Also, some have mentioned program specific stuff, but OP isn't guaranteed to get interviews or match at places without night work so I wouldn't hang a hat on that.

 

[Dave1980]

Hi,

Last year I was diagnosed with narcolepsy, which is a chronic sleep disorder. My physician told me to have a better sleep schedule, and I'm aware of the decrease of my narcolepsy attacks. I don't want to give up my dream of having a career in medicine, but I also know that I can't work night shifts without risking my own health. Which specialties/residencies would allow me to have a better sleep schedule? I've done some research and some of the answers I got were psychiatry and dermatology.

are we talking as a trainee or as an attending?

 

[Redpancreas]

are we talking as a trainee or as an attending?

OP is in medical school. I think they're asking about both, at least I think OP needs to think about the ultimate goal and training can be figured out/accomodated.

 

[Hotshy]

Narcolepsy is covered under the americans with disabilities act. You have the ability to get a reasonable accommodation that will make a prelim year much more doable for you to get into a speciality that suits you.

This can also be applied to rotations in medical school.

 

[Stagg737]

See a lot of people pointing out their field has after-hour requirements/night call, etc. I think even residencies on the lower end will still have night call (ex.) 5-12 weeks). The big picture is the fields I have listed (IM, FM, Derm, PM&R, Optho) all allow for a long term (30+ yr) attending life which would allow for more regular sleep.

I'd argue that IM is not the best example of this and that psych would fit those criteria much better. Outpatient general IM would be fine, but most IM docs do not end up doing that, and hospitalist work along with most sub-specialties are not conducive to a more laid back or sleep-promoting career. Most psychiatrists end up in outpatient and FT work is typically 30-35 clinical hours per week, oftentimes without any kind of call. It's pretty difficult to find a field of medicine that is more lifestyle friendly than this (PM&R is probably the only one that this would be true for consistently). Though psych does have it's own separate set of challenges.

Instead, he or she should find something that allows for minimal night call/circadian rhythm disturbances (surgical subspecialties, EM) long term.

I could not disagree with the EM part of this more. EM docs will almost universally still be required to cover night shifts throughout most of their careers. The ones who don't are either senior staff who have been there long enough to have earned scheduling privileges or have found a pretty rare position. You could argue that only taking overnight shifts as an ER doc could have a more consistent sleep pattern, but the ER guys I've worked with who did this almost uniformly said it was not as consistent as most would think (other than one who had a legit circadian rhythm disorder). The other fields you mentioned above would all be far better options than EM.

 

[Redpancreas]

I'd argue that IM is not the best example of this and that psych would fit those criteria much better. Outpatient general IM would be fine, but most IM docs do not end up doing that, and hospitalist work along with most sub-specialties are not conducive to a more laid back or sleep-promoting career. Most psychiatrists end up in outpatient and FT work is typically 30-35 clinical hours per week, oftentimes without any kind of call. It's pretty difficult to find a field of medicine that is more lifestyle friendly than this (PM&R is probably the only one that this would be true for consistently). Though psych does have it's own separate set of challenges.



I could not disagree with the EM part of this more. EM docs will almost universally still be required to cover night shifts throughout most of their careers. The ones who don't are either senior staff who have been there long enough to have earned scheduling privileges or have found a pretty rare position. You could argue that only taking overnight shifts as an ER doc could have a more consistent sleep pattern, but the ER guys I've worked with who did this almost uniformly said it was not as consistent as most would think (other than one who had a legit circadian rhythm disorder). The other fields you mentioned above would all be far better options than EM.

Fields in parenthesis are the ones worst for narcolepsy. Completely agree EM would be a disaster for someone with the disorder. I think a 6am-6pm, one week on/off hospitalist job may suit someone well with narcolepsy, but not having the disorder I wouldn't know for sure. IM offers flexibility with chill clinic fellowships (Rheum, Endo, Geriatrics), outpatient IM, and hospitalist routes. I wouldn't rule it out if OP is interested.

 

[Stagg737]

Fields in parenthesis are the ones worst for narcolepsy. Completely agree EM would be a disaster for someone with the disorder. I think a 6am-6pm, one week on/off hospitalist job may suit someone well with narcolepsy, but not having the disorder I wouldn't know for sure. IM offers flexibility with chill clinic fellowships (Rheum, Endo, Geriatrics), outpatient IM, and hospitalist routes. I wouldn't rule it out if OP is interested.

Ah, I misunderstood the specialties in parentheses. Not sure I agree with the idea of hospitalist being narcolepsy-friendly, but there are sub-specialties of IM that are much more laid back.

 

[Redpancreas]

Ah, I misunderstood the specialties in parentheses. Not sure I agree with the idea of hospitalist being narcolepsy-friendly, but there are sub-specialties of IM that are much more laid back.

Yeah, IM is very versatile in that way. You have a year or so to sit back, try things out, and observe to figure out what you want before deciding unless you want GI/Cards where it’s better to start sooner.