Night Float weekend

[Crayola227]

No one has claimed that a post call day is better or equivalent to a real day off.

But in the old system, post call days were in addition to your actual days off. All the DOMA stuff is new as a result of the 2011 restrictions.

So it's not that a post call day is as good as a real day off; that's a false comparison.

It's that the combo of call days + post call days is better than 14-16 hrs for 6 straight days.

Total hours spent in the hospital is essentially a given when not on something light. The question is distribution.
I didn't mean to say it was like a day off, but questioned whether the sacrifice of regular bedtime for post call days despite working the same total hours, what the cost/benefit is. I agreed that it might be preferable to have longer spurts (30 hr call) followed by longer rest (post call day and extra sleep). But, some people might find doing that q4 or 5 or whatever more disruptive to sleep than consistent 14-16 hour days. Although even at busy institutions I've seen more variability, like 12 hrs 10 hrs then 16 hrs, 10 14 16 14 13 16 10 over and over with 4 days over the month off, would have a more consistent bedtime but feel like a daily meat grinder. You're right, 16 & 8 gets old fast, shoving together two day's worth of hours to 30 (and a good proportion of the hours less work) then post call, plus day off, while still hitting 80 hours, might feel like more restful and the post call day is a stretch out of the hospital you might enjoy, whereas the 8 every night for 6 days of the week is only enjoyed by the unconsciousness of sleep. So the old system may be maximizing hours awake out of hospital. I see the appeal of the old system.

As @Perrotfish said, some people may not do as well with a clock that isn't more regular.

However it's done, I'm just glad we're trying to help each other get home when we hit 80. It doesn't always happen but I'm glad a limit's been set and it's the goal.

One thing I liked with a month of nightfloat I never mentioned was that since you admit to teams, and get sign out on everyone night after night, and get the same calls, you do actually get to know your crosscover census of like 40-50 to some extent. It's neat watching the other team do their thing and see how that plays overnight. Again, I definitely see value to overnight work, however it's structured.

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[Law2Doc]

Total hours spent in the hospital is essentially a given when not on something light. The question is distribution.
I didn't mean to say it was like a day off, but questioned whether the sacrifice of regular bedtime for post call days despite working the same total hours, what the cost/benefit is. I agreed that it might be preferable to have longer spurts (30 hr call) followed by longer rest (post call day and extra sleep). But, some people might find doing that q4 or 5 or whatever more disruptive to sleep than consistent 14-16 hour days. Although even at busy institutions I've seen more variability, like 12 hrs 10 hrs then 16 hrs, 10 14 16 14 13 16 10 over and over with 4 days over the month off, would have a more consistent bedtime but feel like a daily meat grinder. You're right, 16 & 8 gets old fast, shoving together two day's worth of hours to 30 (and a good proportion of the hours less work) then post call, plus day off, while still hitting 80 hours, might feel like more restful and the post call day is a stretch out of the hospital you might enjoy, whereas the 8 every night for 6 days of the week is only enjoyed by the unconsciousness of sleep. So the old system may be maximizing hours awake out of hospital. I see the appeal of the old system....

I think SouthernSurgeon explained my point pretty well, but I'll expand on it. Even if under both systems you are still working 78 hours, there's a huge psychological difference if you aren't spending at least part of every day in the hospital. With night float your day off in my example is a Saturday where you leave the hospital in the morning followed by a Sunday where you come in in the evening. So you feel like you are working both days (and you are). With a call system your one day off in seven in my example is totally off.

And for most of us, staying on a sleeping at night schedule except for one call day keeps us much less tired at baseline than trying to sleep during the daylight hours 6 days out of 7.

 

[Crayola227]

It comes down to different strokes for different folks. Everyone has made a good.case for.both systems.

I do really appreciate the depth with which you explaines this. Unless there was some deep discussion I never would have been well informed on this.

There's been some bitching about lengthy posts (from me) but these threads as I see it have value beyond OP topics and advising them (we gave them our 2 cents) or laughing at our own snarkiness (haha I do). The next time some clueless med student or resident types in "night float" in terror, this most recent thread will have a lot of food for thought.

Could be good.in future if things change

Thanks guys

 

[Crayola227]

Southern doc,

I'm realizing now what was key on my block was that you truly had a day off. It was hard to do anything before or after any 12 Hour shift no matter what. Frankly though 10 pm to 7 am on days Im no good.to anyone since I'm sleeping on day . shift those hrs so why not be in hospital?. Then I sleep the hours no one would would expect to see if If I worked days. Each morning I could have a few hours for stuff that's hard to do days, dentist, haircut, etc.on days.
Although now it occurs to me to fit with post call allows that too.

You've sold me on the way it was before feeling better.

But ugh i dont know what one does wuth post call day as you said.

 

[Gfliptastic]

I'll chirp in on this tangent, even if I didn't have "old school" duty hours.

There are two valid points going. I agree w/ L2D's. Something very "psychological" about being able to leave the hospital/not be there. Even if it is mostly a "gesture", like Crayola appears to be suggesting. Because post-call I'm not necessarily conquering the world. I'm actually surprised when I accomplish anything on the mundane list of errands I compile during the 60-80 hr week. (ie- Holy s*** I went grocery shopping at the grocery store I live a mere 700' from!! Granola bars & bread for my peanut butter and jelly sandwiches - BOOM!)

I'm off right now. I'm in the ICU now, and had to do a 7am-5pm shift yesterday. I got dinner w/ a co-intern, then came home, fed my fish and vegged. Watched the Rousey fight and went to bed. Hardly anything accomplished. HOWEVER, the fact I'm not at the hospital right now is well worth it. I live 1.5 miles away from the hospital. If I went out on the main road from my condo, I can see the damn thing. But I smirk knowing I'm not physically there. I'm here, at my place, drinking beer at 2:30pm lol

In the context of this discussion (and thread) maybe Night Float is as bad as it will get for interns. I can't share stories like my preceptors/attendings who touted how +30 hour shifts test one's medical mettle. Ok, but I also know I'm fairly useless by hour 13 or 14. 24 hrs? I'd be jury rigging what synapses I could to make a cogent thought process!

 

[Law2Doc]

... Ok, but I also know I'm fairly useless by hour 13 or 14. 24 hrs? I'd be jury rigging what synapses I could to make a cogent thought process!

You get second (and third) winds on those long shifts, particularly if anything happens that gets your adrenaline going. Your synapses work much better than you think. In fact if you are busy you sometimes don't even realize how many hours have passed until the morning personnel show up and you are like "holy crap what are you guys doing here already".

 

[Crayola227]

I'll chirp in on this tangent, even if I didn't have "old school" duty hours.

There are two valid points going. I agree w/ L2D's. Something very "psychological" about being able to leave the hospital/not be there. Even if it is mostly a "gesture", like Crayola appears to be suggesting. Because post-call I'm not necessarily conquering the world. I'm actually surprised when I accomplish anything on the mundane list of errands I compile during the 60-80 hr week. (ie- Holy s*** I went grocery shopping at the grocery store I live a mere 700' from!! Granola bars & bread for my peanut butter and jelly sandwiches - BOOM!)

I'm off right now. I'm in the ICU now, and had to do a 7am-5pm shift yesterday. I got dinner w/ a co-intern, then came home, fed my fish and vegged. Watched the Rousey fight and went to bed. Hardly anything accomplished. HOWEVER, the fact I'm not at the hospital right now is well worth it. I live 1.5 miles away from the hospital. If I went out on the main road from my condo, I can see the damn thing. But I smirk knowing I'm not physically there. I'm here, at my place, drinking beer at 2:30pm lol

In the context of this discussion (and thread) maybe Night Float is as bad as it will get for interns. I can't share stories like my preceptors/attendings who touted how +30 hour shifts test one's medical mettle. Ok, but I also know I'm fairly useless by hour 13 or 14. 24 hrs? I'd be jury rigging what synapses I could to make a cogent thought process!

Keep in mind past intern year and it's nightfloat, seniors are no longer limited to 16 hr shifts, I don't know how it is everywhere (I know a program that makes nightfloat hellacious enough they guarantee 16 hr shifts always) so I'll bet one day you'll get to experience a 30 hr. shift for yourself. Just not as often as the old system did it.

 

[gutonc]

Then Saturday night you aren't really sure what to do with yourself. Do you stay up all night? Your friends and SO are all asleep so you don't have anything to do. I pretty much ended up sitting on the couch watching crap on netflix til I passed out around 2 am.

I had the somewhat unique experience of being in a program that had a mixed call schedule while I was there, including one rotation that went from Q4 overnight to NF halfway through my rotation on it. Clearly both systems have their ups and downs. Since I was able to compare apples to apples, I personally would go for an overnight call schedule (and this was in the University ICU). But my wife absolutely came down on the side of NF.

 

[Doctor Bagel]

Keep in mind past intern year and it's nightfloat, seniors are no longer limited to 16 hr shifts, I don't know how it is everywhere (I know a program that makes nightfloat hellacious enough they guarantee 16 hr shifts always) so I'll bet one day you'll get to experience a 30 hr. shift for yourself. Just not as often as the old system did it.

I started internship in 2010 so just before the 2011 changes. Everyone in my program who started after me never had to do a 30 hour call. Plenty of 24 hour calls but no 30 hour calls, and man, there is a world of difference between those 2 things if you ask me. It's not the patient care aspects of 30 hour calls that suck -- it's the miserable, miserable post-call rounding. Luckily I trained in a specialty where post call rounding is not the norm and only had to do it on IM and peds. Now I'm feeling incredibly happy thinking I'll never, ever, ever have to do that again! Life really does get better. Hmm, here I was defending benefits of the pre-2011 world, but yeah, no post-call rounding has to be a good thing.

 

[Crayola227]

I started internship in 2010 so just before the 2011 changes. Everyone in my program who started after me never had to do a 30 hour call. Plenty of 24 hour calls but no 30 hour calls, and man, there is a world of difference between those 2 things if you ask me. It's not the patient care aspects of 30 hour calls that suck -- it's the miserable, miserable post-call rounding. Luckily I trained in a specialty where post call rounding is not the norm and only had to do it on IM and peds. Now I'm feeling incredibly happy thinking I'll never, ever, ever have to do that again! Life really does get better. Hmm, here I was defending benefits of the pre-2011 world, but yeah, no post-call rounding has to be a good thing.

Well, and I should say the rules are for 24 hrs, plus another 4 hrs possible under whatever conditions of patient continuity whatevs, and I rounded up from 28 allowed by ACGME.

Some.programs that's the reality.

And yeah, 24, 30, whatevs post call rounding sucks it.

 

[Doctor Bagel]

I would say that does make a big difference.

At my medical school, the expectation for the surgery residents was that 30 hours meant 30 hours. Period. You were going to be there the entire time (oh and your thirty hours started at 6am rounds on your call day, never mind that the residents all got there around 4:30 to pre-round). So the post-call interns were routinely there until noon.

Very different at my residency - post-call you round with the team at 6 (*surgery rounds mind you, not peds or medicine), done with rounds by 7:00 or 7:15, and then you're out. We would go get a breakfast at the cafeteria, then peace out. In bed by 8. Big difference. The only times we stayed late were to (voluntarily) double scrub a cool case and you'd usually only do that if you had a light night.

Yeah, I can totally power through a 24 hour shift, knowing that I'll be out of there 7 or 8 am. Having to stick around the following morning is a whole extra layer of misery.

 

[rokshana]

1. Call as a med student isn't the same. You might think it is at the time but you have no clue how sheltered you are from certain things.
2. Because of the 1 day off in seven rule you are in fact forever shifting your sleep cycle during long night float shifts.
3. again with call you might actually get a quiet night and sleep in the call room once in a while. With night float since its a work shift you generally are expected to work the whole time, as your sleep time is in the daylight.
4. Honestly a lot of us who lived through both regimes AS A RESIDENT can tell you with certainty that you were less tired on the non call days under the call system. Night float you are like a zombie months on end. So the latter is more dangerous in terms of driving, sticking, marriage. All you guys who graduated med school into the night float system got hosed. You just don't know how bad because you don't have the other to compare it to.

absolutely agree...

 

[rokshana]

Why does one month of nights make you a zombie for months? You mean the month of nightfloat adjusting, then the next month of days switching back, or that the nightfloat system means longer sustained hours over pretty much all the rest of the inpt rotations? Or all of that? I jus don get it I's a baby

which probably means you really shouldn't be giving out advice about something you haven't yet experience...given that you are what? an intern with a whole 6 weeks of experience?

 

[Crayola227]

which probably means you really shouldn't be giving out advice about something you haven't yet experience...given that you are what? an intern with a whole 6 weeks of experience?

Nope, I'm not. Didn't start in June/July, never said I did.

I've done a whole month of nightfloat, in addition to other months, which you might have caught if you read more carefully.

I love how you jumped into what was an otherwise respectful flow of information and opinions on nightfloat that was educational just to put down my experience which you know nothing of.

I have familiarty with the block system of nightfloat, but I have never done the old call system, or an overnight 24+/-4 hr call that PGY2s and up can do.

So do you have anything else to add that doesn't require incorrect assumptions about someone else's experience? And would you be capable of expressing that without needing to resort to blanket and incorrect dismissal of other people's experiences of working nights?

 

[Crayola227]

For the record, I loved night float. But I did it after having ICU and wards under my belt.