NO Night float/ night call residency? Does that exist?

[Mad Jack]

This is definitely not the case at my program. My night floats on IM as an intern and my psych calls as a PGY-2 have involved about the same level of overnight activity.

But did any of it actually require you to be in house? Or could you have handled it via phone?

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[MSTP18]

What about path?

Who do you think oversees the blood bank my dude? In fairness it is home call though and way less calls than other specialties but still not immune to being woken up in the middle of the night. There's also even rarer the chance of being called in for a frozen. So far the latest frozen I've had was like 9:30pm on a weeknight and that was just because the ORs were running behind schedule. The overlap between "surgeries that require frozens" and "emergent surgeries" is basically zero. Transplants and emergent neurosurgery 2/2 a mass are basically the only ones I can realistically see falling into that category.

 

[sloop]

But did any of it actually require you to be in house? Or could you have handled it via phone?

Lots of it has required me to be in house. There are multiple pages on each call shift that have required me to be there in person. Lots of medical problems that need to be dealt with. Maybe some programs just rapid people off the service at the smallest sign of trouble but we don’t do that here. We are doctors and are expected handle medical issues. We also have several subspecialty inpatient services that would be straight up dangerous to run without a provider in house (eating disorders for example).

 

[Mad Jack]

Lots of it has required me to be in house. There are multiple pages on each call shift that have required me to be there in person. Lots of medical problems that need to be dealt with. Maybe some programs just rapid people off the service at the smallest sign of trouble but we don’t do that here. We are doctors and are expected handle medical issues. We also have several subspecialty inpatient services that would be straight up dangerous to run without a provider in house (eating disorders for example).

We don't handle the medical issues on service, the division of labor just doesn't fall that way where I'm at. More power to the true med/psych programs out there, but we just don't do much medicine on the psych service (even if I have personally pushed for more involvement, as has our PD)

 

[Lexdiamondz]

Echoing the sentiments of others here, overnights are going to be a part of whatever you do in medicine. Some fields will have fewer (psych, derm, PM&R) whereas others will feature night call as a prominent part of your training and career (EM, IM, Surgery). Personally, while I hate circadian rhythm shifts, overnights were where I had my most growth as a physician. When you're the most senior doctor in house and the decision making rests with you, you're forced to grow and take ownership and that is how you mature. Medical training is supposed to be hard - lives are literally at stake and sometimes it will suck. If you don't want that then go sell trinkets on Etsy from your parent's basement.

 

[SourceOfDenial]

I'm considering Psychiatry because I enjoy talking to people and cheering them up.

Have you considered a career as, I don’t know, a clown?

 

[Splenda88]

Yeah, I was actually thinking about that myself-- it seems more probable that residents still work overnight shifts during a period of time when they're on 'night float'. I think getting rid of night shifts all together wouldn't be too good for education regardless, especially in a field like IM.

Why?

 

[siliso]

More than half the action takes place at night. Observing and dealing with the responses to your interventions after initial workup and decision making is highly educational in a way that doing the initial ordering and then signing out to go home is not. Being the top doctor in the house until morning gives you chance to develop independent judgment and Make Decisions and lead/supervise...but with the backup that you could and sometimes should call your staff and they’ll be there in the morning to critique and correct regardless. Even as an intern running the nighttime cross cover is the most autonomy you’ll generally get.

 

[Splenda88]

Occupational Medicine
AOEC - OEM Training and Education

Just an example, highest hit in google. We have one of these 2 year residencies at my location and it seems pretty.....easy?

Occupational Medicine Residency | USF Health

"Highlights of our program include:

• No call, no nights, no weekends, no pagers – Work/clinic hours are 8a-4p on most rotation, guaranteeing you have ample time to balance work with graduate courses, research, and leisure activities"

I think you have to do a preliminary year for occupational medicine...

 

[fldoctorgirl]

Why?

The response right below this basically sums it up.

 

[Cawolf]

I think you have to do a preliminary year for occupational medicine...

I see that now, didn't realize they did an intern year prior. Thanks.

 

[Mysterio123]

On my EM rotation we probably averaged at least suicidal ideation per shift. Psych has to go see them regardless of when it happens.

I think many/most residencies have transitioned to a night float anyway, so all it means is you just sleep during the day instead.


Are you a premed? If so, you should seriously consider psychology. You'll have a nice lifestyle, save a lot of time/money, and actually work at cheering people up by talking to them. The patients you will see as a psychiatrist are well beyond this, and you will find you cannot have a meaningful conversation with many of the patients you will see, particularly on inpatient.

I'm not sure how so many people know I'm premed without my saying so, but yes.

 

[Mysterio123]

If you don’t mind me asking OP, what year in school are you? Maybe it’s just me, but your comment of “I'm considering Psychiatry because I enjoy talking to people and cheering them up,” kind of sounds like you don’t actually have much experience with Psychiatry

Clinical rotations are ~3 years away for me.
But I have worked at a senior center where people had depression and loneliness.

 

[evilbooyaa]

I'm not sure how so many people know I'm premed without my saying so, but yes.

Because this is a pre-med style question. Nothing against you, but you demonstrate an understanding of psychiatry on the level of somebody who has zero exposure to it. Any residency where you have to do an intern year means you will be doing some nights, even if it's just for a small portion of 1 year.

 

[Candidate2017]

Odd, I've had plenty of 12+ hour shifts on weekends with no attending backup where I was functionally alone and had patients threatening the lives and safety of themselves and my staff and I never felt in over my head. And throwing down with attendings from other specialties is par for the course, I don't see it as being intimidating at all

Seems like you're not intimidated because you're not required to handle medical issues on the psych floor while on call. That's an anomaly. The splitting of overnight responsibilities for the psych ward between medicine and psych is a disservice to your training and sort of an insult. If you do inpatient as a psych attending, you will be expected to handle and/or recognize medical emergencies on your unit while on call.

 

[Mad Jack]

Seems like you're not intimidated because you're not required to handle medical issues on the psych floor while on call. That's an anomaly. The splitting of overnight responsibilities for the psych ward between medicine and psych is a disservice to your training and sort of an insult. If you do inpatient as a psych attending, you will be expected to handle and/or recognize medical emergencies on your unit while on call.

I mean, I still have to recognize medical emergencies while I'm there, obviously, since I'm seeing my patients every day and they are ultimately my responsibility, and we'vehas plenty of them that I have managed just fine until I could arrange for transfer to the medical floor. But we don't have patients that are all that sick generally since they have to be medically cleared prior to admission and our floor doesn't have oxygen, IVs, suction, or the like. We are a community program running out of a community hospital, our psych nurses just aren't down for providing full spectrum care and it would be almost impossible to draw nurses to the area that would. All of the other local psych hospitals run similarly, and any med/psych patients either get stabilized on a medical floor before receiving further psychiatric care or get transferred to the city, which is several hours away. It was similar in the community psych wards back in my home state as well- I literally never saw one of the psychiatrists use a stethoscope let alone manage a medical emergency. Regardless, I don't plan to do inpatient as an attending, and certainly not at an academic center, so that's not really a worry of mine.

 

[IlDestriero]

I’ve never seen a dermatological emergency so critical that someone would have to come in urgently at night to address it.
Almost every field could be day only if you’re flexible on income and location and find the right group, but you’d have to survive residency first.

 

[MSTP18]

I’ve never seen a dermatological emergency so critical that someone would have to come in urgently at night to address it.
Almost every field could be day only if you’re flexible on income and location and find the right group, but you’d have to survive residency first.

Obligatory:

 

[siliso]

I have called an endocrinologist in the night and a rheumatologist and dermatologist on the weekends...but those are rare enough to stand out in my mind. Erythroderma from CTCL was why, for the derm. But it’s true if anything’s that bad to merit a 3am call it’s probably bad enough for a surgeon on the burn unit. Myxedema coma for endo and I don’t remember why rheum...some deathly febrile shocky illness with rashes and lumps but no pathogen, I think. All of these people did 1-3 years with some nights before becoming the people I really rarely call at night.

Anyway in my life now no one calls me at night or on the weekend ever unless it’s during the quarterly weeks of inpatient attending that I choose and like to do. And when they do call it’s for advice and support and then I go back to sleep. So I worked all night on many occasions for a few years, it was good for me and also sucked and it’s over. There’s a lot of good times and camaraderie and learning to be had at 3am with your team over some pudding cups pilfered from the fridge, along with the miseries. If you hate what’s hard and tiring and can’t see any upside to it just don’t do this, it’s in no way required to become a physician or necessary to have a happy life. If you don’t love (sick, nasty, tired, suffering, annoying) people and working hard and thinking hard and having hard conversations and making life and death decisions it won’t be anything but a burden to you, and you’ll end up on here bitching eternally, and no salary will make up for that.

 

[mvenus929]

Not that I’m aware of. Maybe ones where you’re less likely to be called in...derm? I’ve almost never called a derm resident after hours. Path? Maybe surgeons call them overnight. Other than that the only specialties I can think of never calling after hours are subspecialists who’ve already gone through night call in IM or surgery. And even then...I’ve at least once called in even the endo fellow late at night. So you put up with it a few years. No one calls me at night now except occasionally when I’m staffing inpatient wards. Very occasionally.

I'm a (peds) endo fellow, and I get called all the time at night. Part of that is because kids with diabetes scare people (so I get lots of calls from adult EDs), but I also get a number of patient calls, then the odd thing that comes in overnight--concern for new onset adrenal insufficiency, new onset diabetes, thyroid storm... Incidentally, all things I saw in the hospital today.

 

[siliso]

I rotated in adolescent medicine elective once in residency and was shocked to learn that the peds residents were expected to call the endo fellow or staff in the night for like correction doses of aspart. A cultural difference, I wouldn’t even expect the intern to have to ask the senior what to do about a high sugar overnight in an adult patient, after maybe July. And that’s why I’m IM and not peds or med peds. Sick babies too sad and scary.

 

[deleted500612]

Hi,

Are there any specialties/ residency programs in US which don't make residents work throughout the WHOLE night?

I doubt you'd have to do night shifts in a pathology residency or those random laboratory based specialties (clinical microbiology etc)... There are a few other specialties you would only work night shifts in your intern year (derm, ophthal, rad-onc for example) but those also tend to be highly competitive. Any other specialties I can think of off the top of my head you will be doing plenty of night shifts all throughout residency and if you can't stomach that thought then residency probably isn't for you.

 

[ortnakas]

I dislike nights as much as the next intern, but I agree with others above who said nights are when you learn the most, at least in IM. You’re it (at a lot of programs, anyway) so you have more autonomy and more responsibility, and because most social issues can be deferred to day team, you spend your shift on learning/doing actual medicine.

 

[txplcoord]

I doubt you'd have to do night shifts in a pathology residency or those random laboratory based specialties (clinical microbiology etc)... There are a few other specialties you would only work night shifts in your intern year (derm, ophthal, rad-onc for example) but those also tend to be highly competitive. Any other specialties I can think of off the top of my head you will be doing plenty of night shifts all throughout residency and if you can't stomach that thought then residency probably isn't for you.

When I worked in transplant, we frequently paged the on call pathology resident to read frozen sections of organs to make sure they were able to be transplanted. It was so frequent that pathology residents would call us each night before they went home (they took home call and read slides uploaded online) to see if any organ recoveries or transplants were anticipated overnight so they were aware they would be called. Granted, we were at a large transplant center but this occurred about 3 times a week at least.

 

[MSTP18]

I doubt you'd have to do night shifts in a pathology residency or those random laboratory based specialties (clinical microbiology etc)... There are a few other specialties you would only work night shifts in your intern year (derm, ophthal, rad-onc for example) but those also tend to be highly competitive. Any other specialties I can think of off the top of my head you will be doing plenty of night shifts all throughout residency and if you can't stomach that thought then residency probably isn't for you.

Clinical micro is a subspecialty of pathology, the lab doesn't stop running overnight, and problems that can impact patient care don't limit themselves to M-F 9-5. As I said in my other post, our middle of the night calls are way less than any other specialty so if you want "less middle of the night calls" sure, path applies, but if you want "zero calls in the middle of the night" then path still gets crossed off the list.