night float vs. call

[PAgirl]

The program where I did my surgery rotation had night float as opposed to overnight call. The residents did two months of night float every year and were on overnight call about two weekend days a month. One of the residents had come from another program (which closed) where they did q3 call. He said he liked that better because when they weren't on call and it wasn't as busy they could leave earlier in the day, like 4:00, instead of waiting until 6:00 for sign out to the night team, because the person on their team who was on call would be there. I think I would like being on night float for a few months because your body would adjust to the schedule, rather than getting no sleep every few nights. Plus, my body does very poorly on no sleep. But I can see the advantage of being able to leave earlier in the day.

Here's my question: which do you like better- night float or q3 call?

Also, how much do you think this aspect of a program should factor into my decision of how to rank programs, if at all?

Thanks in advance. You guys are great.

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[Winged Scapula]

Also, how much do you think this aspect of a program should factor into my decision of how to rank programs, if at all?

Thanks in advance. You guys are great.

I have no experience with NF so cannot comment on the pros/cons.

I can however caution you not to choose this as a significant factor in ranking as program structure changes, administration changes, etc.

Just because they have "call schedule X" when you rank them in no way means that it will remain the same when you show up or from year to year. Programs should always look to ways to improve residency training and this may be reflected in different schedules, or it may simply reflect a census change or change in number of residents available to take call.

 

[maxheadroom]

I think I would like being on night float for a few months because your body would adjust to the schedule, rather than getting no sleep every few nights. Plus, my body does very poorly on no sleep. But I can see the advantage of being able to leave earlier in the day.

Caveat: I have never done a night float system. The Gen Surg guys experimented with it after I finished my prelim rotations. My observations based on what they had to say . . .

1. Your personal schedule gets really screwed up. If you have a SO, they have a hard time adjusting to when you're around. If you have kids, it's a real mess because Daddy (or Mommy) is home during the day and asleep. All of the things that you try to do in the afternoon or evening are buggered up. And it's really hard to make the physiological adjustment.

2. For senior residents, it means that you have a couple of months a year in which you don't do good cases, but cover Trauma and do the crap General Surgery that comes in at night. Most of the late night ex-laps are less than fulfilling in an educational sense (from what my senior Gen Surg friends say).

3. It breeds a shift-work mentality. 'Nuff said.

My Plastics program discussed a night float while I was still there (our call was pretty brutal). The senior residents shouted it down because we were willing to pay the price of late nights in order to operate during the day. Those major cases will never come again with a knowledgeable attending -- it's better to learn it while you have them there. We went to a system in which a resident could go home post-call if they were up the night before. It was quite telling -- all of the senior residents stayed and worked, but the juniors were outta there.

As WS noted, I wouldn't make a decision based on something like this. Systems change frequently. The important thing to look for is residents who seem to get along with each other and a faculty that is responsive to the needs of their residents.

 

[blue2000]

We have both in my program, though things have gone to more of a night float schedule over the course of my training, there are pros and cons to both. The benefits to call is that if you are in house, you are out of there (at least at my program, which is probably 95% compliant with workhours) by noon, so you can nap, etc in the afternoon and still have a long evening with your loved ones. Call schedules also tend to set you up for more golden weekends, which if you like to leave town and ski like I do, it helps. Our night float works six nights a week, so you it's kind of a grind to work and never get a golden.

I really enjoyed my night float chief rotation at the county trauma hospital last year as a four. It was busy, I operated a ton and got a ton of independence, which was really beneficial to me. It is also probably safer in a big busy hospital to have a fresh night crew come in to operate.

One thing that I think is important is assessing "home call." We're on home call as chiefs at our university hospital, and I spend the majority of my nights in the hospital doing BS consults, sometimes doing a lap appy. It's all the pain, none of the pleasure and leaves me totally exhausted for my big cases the following day. If you leave the hospital at ALL during your call the 30 hour rule is not in effect.

Admittedly, as a chief, I want to operate as much as possible so I hate any extra hours that don't contribute to my OR time, so seeing re-admits at 3 AM when I have a retroperitoneal sarcoma to remove that day is PAINFUL!! Oh well, that's life.

 

[Miami_med]

The Night Float itself is a VERY painful rotation, especially if it's set up like it is at my home program where you are also covering some weekend 24 hour call. It sort of feels like flying back and forth to Japan once a week. In contrast to a q3 or q4 call schedule in which you have a bad nights sleep every third or fourth night, the night float basically destroys anything resembling a circadian rhythm. Having done it both ways, I know.

That being said, it makes the rest of your life much easier the rest of the year. So like all things, pros and cons. The existance of night float doesn't allow for any golden weekends on "the float." However, the existance of night float taking a day of weekend call every week allows the schedule to be set up for golden weekends every other week at my home program (when you average it out). Additionally, you are never post-call during the week. Atleast here, we still have overnight call on the weekends, but episodic nature of call (2-3x a month) really doesn't impact you very much at all. I was more tired as a medical student than I am on my non "float," rotations.

As the hammer of the ACGME continues to fall, I think that night float is simply a reality that cannot be ignored. Many of those who don't have it now will have it before the incoming interns become chiefs. As an intern, it probably matters a lot less, because scut and BS consults are equal opportunity offenders at 3:00 pm or 3:00 am at the modern hospital. On one hand, there are very few cases at night compared to the daytime, so they essentially never trickle down to me. On the other hand, I have no service during the day, so sticking around for an early case that may go uncovered is always a possibility. As a chief, I think that it is an unfortunate happening, because it kills operative months. That being said, every time the chiefs here have managed to kill night float, it comes back again after the program can no longer risk the inevitable duty hour violations that occur when those same chiefs stay around to do cases post-call. The night float is unfortunately pretty good at putting the program in something that resembles compliance. If you have a program where your seniors have to be in house to cover trauma, and you don't have an army of prelims, I don't really know how else to minimize work-hour violations effectively.

 

[Celiac Plexus]

The program where I did my surgery rotation had night float as opposed to overnight call. The residents did two months of night float every year and were on overnight call about two weekend days a month. One of the residents had come from another program (which closed) where they did q3 call. He said he liked that better because when they weren't on call and it wasn't as busy they could leave earlier in the day, like 4:00, instead of waiting until 6:00 for sign out to the night team, because the person on their team who was on call would be there. I think I would like being on night float for a few months because your body would adjust to the schedule, rather than getting no sleep every few nights. Plus, my body does very poorly on no sleep. But I can see the advantage of being able to leave earlier in the day.

Here's my question: which do you like better- night float or q3 call?

Also, how much do you think this aspect of a program should factor into my decision of how to rank programs, if at all?

Thanks in advance. You guys are great.

Having lived through an entire residency of night float, I can say that it was good and bad. Good for those who were not on night float since those people could get good quality reading/sleeping time at home every night. Night float also enables residents to have a couple of "golden" weekends per month which is sweet. You also don't need to stick around until the night float team comes in if your team consists of more than you. You can take turns going home after clinic or cases... but this is chief-dependent and you may have an old-school chief who will be the one leaving early every day .

The bad is that when you are on night float you live a discombobulated, perplexing, time-warped existence during which you spend 99% of your "off time" asleep or in a restless haze of confusion. The entire rotation will go by and you will feel like it's a block of your life that just disappeared.

Note: On night float you can actually get a lot of cases. Most of them are appies, ex-laps, or trauma, but there are also a lot of late cases that either started late, or are add-ons. A fair number of transplants get done at night too. If you are agressive, you can get a lot of operating done.

 

[BlackLung]

...Note: On night float you can actually get a lot of cases. Most of them are appies, ex-laps, or trauma, but there are also a lot of late cases that either started late, or are add-ons...

Factories and other industries seem to have graveyard shift production. When I had my MRI, they called and scheduled it for late night. They stated because of how busy they are, they run almost 24hrs a day for 6 out of seven days. I am curious... Do any hospitals currently or does anyone know of any plans to move ORs into more of a multi shift schedule of that nature?