?Night float- impact of 80 hr work week?

[TheJayBee]

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I am curious about everyone's impression of night float in OBGyn residency.

What do you think of as pros and cons?

If you reply, please share some context of your experience with night float. Have you trained in an OB Gyn residency with or without night float since 2004?

IMHO, night float has lost many advantages since the 80 hour week went into effect.

Programs with night float generally require residents to stay until pass on's- so your routine days are gonna last until 6 or 7 pm.

These weeks on NF (months in some programs) are also hard to catagorize as OB vs Gyn vs Subspecialtiy- so residents often end up with less scheduled Gyn Surg (eg hysts) and elective time compared to programs without night float.

In programs without night float, you have call during the week several times a month. But the days of Q3 call for weeks at a time went away with the work hours restrictions (if not, please share). Post call you leave by 9 am and have the day free. And on days you are not on call you can jet home by 5:30 pm (at least here).

These pros and cons are generally not considered.

Given the changes following the 80 hr work week, our residents annually vote against going to a Night Float system. (The assistant PD allows the residents to decide).

Again- night float has some real nice aspects. But it is not a slam dunk.

What you think??

 

[tiredmom]

Question: In a program without night float - do you get days off other than your post-call day? I'm sure that varies between programs, but wondering if it's a stupid question to ask about?

 

[fuzzyerin]

I don't know if I agree with you. I'm the PGY2 on nightfloat covering gyn and gyn onc right now and I was in the OR twice last night, so I don't think you can say necessarily your surgical skills decrease. If anything, you learn to assess patients who need to go to the OR NOW and get to take them. I'm becoming more comfortable saying "she's acute, she's going" to an attending who's at home. And I've even had the opportunity to do a hyst on nights with the oncology service, and there aren't many second years in August who will tell you they first assisted and did their own side on a hyst at that time in the year. Our program has 3 in house overnight - OB junior, Gyn/Onc, and OB Chief, who also covers the gyn resident if I have questions.

I have 24 hour call on Sunday (actually 22 - 8 am to 6 am) and then Monday, Tuesday, Wednesday, Thursday nights from 5 pm to 6 am. I've walked out the door between 6am and 6:30 am. The day team will often be there later than 5 pm because they're tying up loose ends. And I don't know, personally, I hate 24 hour call and would rather do that infrequently than q4. (Yeah, they may have gotten ride of q3, but I'd guess most programs w/o night float are q4, at least for junior residents.) And I don't know if post call residents in non-night float all leave by 9 am....that's probably program specific.

And don't think of it as a day free. Think of it as a day to sleep. When you've been up for 24 hours straight, you can sleep for 22 hours. I have. You're that damn tired.

 

[MichiMO]

I know at some programs I've rotated at, the post call residents have to cover clinic until noon on post call days. Definitly did not seem like fun to me.
Also, there seems to be an impression on SDN that q3 is gone. At both programs I have rotated at, interns have been q3 for many months of the year.

I'm with fuzzyerin, 24 hours straight in a hospital starts to make me feel ill by the time I am 16-18 hours into it. My goal is to do that as infrequently as possible. I also don't think you learn anything much past 14 hours of being at work and a post-call day is by no means quality time off, even though it may get counted as a down day. Also, I think people get the false impression that without a night float you get weekends off. At all the programs I've been in, residents were still working 3/4 of all weekends every month without a night float.

Another plus of night float, when you are on a rotation, you spend every day at that rotation. Without it, it seems like post-call days really cut into education time. Granted, I have never been a resident in either system, but as a student rotating through the different types, I really think night float makes for a sainer life.

 

[Diane L. Evans]

I would go to a program with night float. First you'll have a normal schedule. Be on call only 3 weekends at most amonth intern year. And when you are on night float you'll have weeekends off (you'll be exhausted but it will be well worth the effort).

Just my 2 cents

 

[TheJayBee]

Thanks Diane.

This is valuable feed back.

I am curious if you trained as an OB/Gyn R1-R2 prior to the 80 wk week. This has had an impact on the pro's and con's of Float vs No-Float.

Noticed that you have been a member here since '98. {I would have private messaged you but did not see a way to do that.}

Thanks

 

[TheJayBee]

Question: In a program without night float - do you get days off other than your post-call day? I'm sure that varies between programs, but wondering if it's a stupid question to ask about?

I agree that it probably varies a lot. The assistant PD here is REALLY compulsive about allowing residents a balanced life and days completely off. That may be atypical.

Unless assigned call on Sat, you have at least a weekend day off each week. Eg. if call on Sun, then Fri noc off and Sat fully off. If call on Fri, off Sun is off.

Once a month there is a "golden weekend"- call on Thurs noc, out by 9 am Fri and then return to work Mon AM.

It is extremely rare to have continuity clinic post call (less than a few times a year), so generally out the door by 9 -9:30 am postcall. If not on call, weekdays get off between 4:30 and 5:30.

 

[pruritis_ani]

I work in a traditional call program. Intern year is the worst, with call coming about q 3-4. Still, that gives us plenty of time off. I mean, we work HARD when we are at work, and there are occasionally streches where we get 10-12 days in the hospital without a full day off, but those are rare. Typically, I get two weekends a month completely off, and one of those weekends is really Fri afternoon-Monday morning.

I never considered a night float program for several reasons. First of all, when you get in the real world, there is no night float. I think it is a good idea to learn how to handle a long day in clinic, night on L&D and follow with clinic the next morning, as most practicing docs have to live a life like that (not q 3-4, though, thank god!). Second, I think I get more out of having a couple of long weekends, plus a couple weekends where I just work one of the days than I would from a night float. The other programs at this hospital have night float, and they basically get 4 days a month off, unless they are on float. That would totally suck.

My normal week is basically a 6am-5pm day 4 days a week, 1 OR day, with 2 overnight calls mixed in there. Don't come in on the weekend unless I am on call. Post call I leave at 12noon during the week, by around 9am Sat or Sun.. 2 weekends a month totally off. I don't think there are too many programs out there that give you that much time off in a row while still giving you plenty of hours to learn your trade, and plenty of patients to see.

 

[MichiMO]

One thing I didn't mention in my earlier post which I think is really important to consider with either NF or a traditional call schedule, but especially NF, is what time check out is. There is a huge difference in your quality of life between being able to check out at 5 and checking out at 7. One huge perk of the hospital I rotated at (Good Sam in Phx) without NF is that checkout is at 4pm Mon-Thurs and 2pm on Fri. with no afternoon clinics on Fri. That schdule makes me consider the program even though it has q3 call. I would totally take that over a program with NF that didn't have checkout until 7pm.

 

[daisyduke]

I am at a program with a night float system, and I honestly don't see how it is the solution to the 80 hour work week. When I am on days, I repeatedly go over on my hours. Our day shift on the board is 8am to 5pm sign out. However, I get to the hospital 5-5:30am to round on my 15-20 postpartum patients, write their scripts, take out staples, and do their discharges. At the end of the day sign out starts at 5, finishes at 5:45, and then there is always about 30 min of stuff to finish up plus some random floor tasks for the postpartum patients. When you add it weekend call (friday overnight plus sunday day or saturday overnight), it is easy to work 90-100 hours. How do you guys manage your day float/night float to make the hours work?

 

[Flea girl]

I am currently on NF and I work Sun -Thurs nights. From 6:30 pm to 8:00am(sign-in to sign-out) no weekend call. At my program we have short call 2-4th years so, NF becomes 8:30pm-8:00am. At my program, the pd is really strict about getting the interns out of morning rounds by 0800. No morning clinics until pgy3 &4 and then they are supposed to be out by 1000 am on fridays. Days are 7:00am-7:00pm weekends only if you are on for call. Yeah, it is not a trip to the park but I appreciate it when I am sleeping in my own bed Sun-thurs nights, when i am not on nights! My family actually think I have more time at home when I am on nights...go figure! Good luck to all going throught the interview season! Trust me this next year is going to go by fast!