night float?good or bad?

Started by coolbabe76
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coolbabe76

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i wanted to know opinion of people who have worked in both these systems.--with and without night float...
which is better and why?

should that be a priority while ranking programs/?
 
Night float v. call: pros & cons to both, IMHO.

Night float pros: sleep in your bed every night if you're not night float, one person on nocturnal schedule, fewer 30 hour calls overall.

Night float cons: sucks to be night float (imagine covering 60 g-surg patients, and none of them are really your own), never have the post-call afternoon free, day residents have to stay to sign out to night float, even if the work is done (if night float doesn't start til 7, you could be sitting around awhile).

I personally like a call system better than night float, but I think there's no real right answer.
 
Programs that didn't have a night float system tout that it is because education takes a beating or is the sacrifice for having it. Seems to me like it would be educational and demanding in itself even if you would supposedly be missing out on bedside teaching. Besides, is 1 month in 12 an okay holiday from that kind of teaching?
Any thoughts?
 
penguins said:
Programs that didn't have a night float system tout that it is because education takes a beating or is the sacrifice for having it. Seems to me like it would be educational and demanding in itself even if you would supposedly be missing out on bedside teaching. Besides, is 1 month in 12 an okay holiday from that kind of teaching?
Any thoughts?
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I find the feeling of being woken from sleep to answer a page so horrible, that I'm giving heavy consideration to programs that have nightfloat.
 
toxic-megacolon said:
I find the feeling of being woken from sleep to answer a page so horrible, that I'm giving heavy consideration to programs that have nightfloat.
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Me too - I would much rather do 12 hrs a day for seven days straight rather than a couple of 30 hour shifts in there even though yeah, the post-call day is nice. But definitely not nice enough ..

Although, both me and toxic are applying this year and I think the OP was asking for people who've actually done both.. I'd be interested to hear yr experiences too.
 
First of all, call system should not be a very high priority when ranking. More “important“ priorities aside, call systems can always change once you start and you really don’t know ahead of time which one will be right for you. However, if you’re pretty split between 2 places, it is something to think about.

I experienced both systems during my intern year (8 weeks of NF and 1 month of Q4 call). Personally I preferred the Q4 call. Being on NF was tough on my wife (a civilian) and I as we didn’t see each other all week. Other people in my program with spouses had a similarly tough time. Also, while night float ‘saves’ you from the 30+ hour days, it makes your ‘regular’ day longer as you have to wait until the NF gets in to sign out and go home, usually this is around 7 or 8. That makes for a lot of 12+ hour days. Many people don’t mind this in exchange for less long calls. I personally more enjoyed the Q4 system and trading one bad day for going home before lunch post-call and 2 ‘regular’ (~7-5) days. You’re going to work 70-80 hours either way……it is just divided differently. However, I have no idea what q4 is like for months and months, it’s probably not fun, so maybe I’d change my mind if I knew.

Keep in mind that to say, “we have a night float” does not always mean the same thing. The night float system I experienced ran Sunday - Thursday nights. The ‘day’ people then took 24 hour call on Fridays and Saturdays. So you still had 2-3 24 hour calls a month. Some programs have a 7 day a week NF system which might be better, or might not, I don’t know. Other places have the NF come in later in the evening (9 or 10) and have some of the day people take a “short call” to cover the evening hours (shortening the NF shift and cutting down on the 12+ hour days in exchange for some 15-16 hour days)....this is what I always wished for. I’ve also heard of NF that just takes admissions while others are Q4 and handle the floor. There is a lot of variability.

Good luck making those rank lists. Try not to get too hung up on the call comparisons, the grass might be greener no matter which one you end up with.
 
avgjoe said:
the post-call day is nice
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I think the post-call day is nice for a medstudent, but its hell as a resident. You come home at 1pm with a pounding headache, smelling like a VA patient. You barely have the energy to keep your eyes open, let alone stand in the shower, so you collapse onto your couch/bed. You wake up at around 6pm, still feeling like crap (4 hours of sleep over a 36 hour period is just not enough for me), so you wake up feeling like death, you smell even worse, its dark outside and your whole day is shot. You stuff your face because you haven't eaten in 24 hours, and before you know it, its time to get back into bed to work another 15 hour day! At least this is how it works in surgery.

avgjoe said:
Although, both me and toxic are applying this year and I think the OP was asking for people who've actually done both
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I'm actually an intern this year. 😉 Changing specialties.
 
your avatar is nice...nice pic.....toxic.... 😎

and out of curiosity, what will be your new branch?
 
coolbabe76 said:
your avatar is nice...nice pic.....toxic.... 😎

and out of curiosity, what will be your new branch?
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Changing from ER to Surgery. I know most people go the other way. 😛
 
T.M.

I'm curious... what made you decide on the switch?
Was it easy to find a position?
Are you doing an intern year in surgery or medicine or other?
And if surgery are you staying at the same institution?
Will intern year count?
Sorry for all the questions... I had a friend who did 3 internships and I'm just curious how you got things to work...
 
toxic-megacolon said:
Changing from ER to Surgery. I know most people go the other way. 😛
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Nice! Rare to see that transition. Always nice to see someone switching over to the dark side, though. 🙂
 
i like nightfloat for couple of reasons:

1. i like to sleep in my own bed, there is something refreshing about being able to take a shower at the end of day. also, consistent sleep cycle, i would rather sleep on an opposite schedule few weeks a year, than to have my sleep cycle flipped q4 days ... but thats just me


2. for pt care, it is prob better, contiunity of care ... postcall, most of your pt workup / consults happens on that day or during the days in general, i would like to be around to find out what happens

3. most true nightfloat places have a system so that if you are done (say at 4pm), you can signout to oncall team that will crosscover for few hrs, who will then signout to nightfloat when they get in. the key is good signouts!!


although one huge plus of overnite call is - running errands during your postcall day (cuz every other place is only open mon-fri 9-5)

with all of this said, i do agree with folks that this should not be a deciding factor, however, if all else equal, two programs in similiar city with similar reputation blah blah, i would def consider call schedule

just my 2cents
 
JKP said:
I'm curious... what made you decide on the switch?
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I've answered this question so many times during interviews it makes me cringe, but the short SHORT version of it is 1) I love the OR 2) I really want to have full control about what happens to my patients and 3) I was afraid if I did ER, I'd enjoy it for a few years, but start developing regrets since all my "cool" patients are always being snatched away by surgeons and intensivists. I will miss the ER people, definatly the coolest personalities in medicine!

JKP said:
T.M. Was it easy to find a position?
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I'm in the match right now. Got most of the interviews I applied for.

JKP said:
T.M.Are you doing an intern year in surgery or medicine or other?
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Neither, doing a (very cush) transitional year.


JKP said:
T.M.Will intern year count?
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No. But that said, even if it did, I would feel NOT prepared to start a PGY2 surgery year. (Did I mention this TY is CUSH???)


JKP said:
T.M.Sorry for all the questions... I had a friend who did 3 internships and I'm just curious how you got things to work...
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No problem! 🙂 Feel free to PM with specific questions.
 
MM4 do you have a family?
Because if you do the Q4 really is terrible. Not only do you not have a set schedule you can never plan any weekend getaways except for the 3 weeks of vacataion. Also your day-night cycles are jumbled.

I moved programs specifically for this reason and I would not choose to go to any program other than one with night float. Yes the 6 weeks 14 hrs shifts are a lot but you get your best experience and yes you have you weekends off (off Friday 9am come back sunday at 6pm). Then the max calls/mo you have is 2-3 either Fri/Sun or Sat as an intern upper level 1-2/mo.

Just my 2 cents if I can save anyone the hassel of switching
 
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