Ophtho Residency Call

[questioning]

On average at your program how often do ophtho residents of each year take call? How often does home call require going in during the night? How many weekends per month are you on call?
Thanks!

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[bulldoc]

program i matched into is q4 primary call for first year (4 residents/year) then backup call 2nd and 3rd year. 1 weekend/month call during that year as well.

i believe it's like 1/2 - 2/3 of the time you'll be called in, with a couple to a few times where you'll be up all night.

 

[bucknut101]

At our program there is no set "q" schedule. Basically 1st years take all weekend call including Fridays and some weekday call throught the year. They are on call about 4-6 times a month. Weekends are 24 hour calls.
2nd years only take weeknight call which is about 1-3 times a month.
3rd years have 2 months of backup call.
We cover 2 level 1 trauma centers, a peds hospital (also level 1 trauma), a VA, and the university hospital, plus our attendings private patients. This can get pretty busy.
I'd say 90% of the time you will see at least one person on call on a weeknight. 100% of the time on the weekends.
I'd also say that we are much busier during the summer. One of my fellow residents saw 23 patients during a 24 hour call in July.

 

[diosa428]

So if you guys are on call or backup call, what's your schedule like (in terms of how many hours in a row you're "on")? Do you still have to come in the next day?

 

[Toadkiller Dog]

Our program (perhaps one of the busier ones, but representative of many of the ones out there) has q6 (weeknights and weekends) call for both first and second years. Weekends are Friday night until Sunday night at 5pm, then someone else takes over.

Call is very hit or miss in terms of business. We pretty much always get called in at least once. I tell people the "rule of 3's" which is that about 1/3rd of the time, we have a manageable night, where we are home by 9pm or earlier, about 1/3rd we are busy until midnight but get to sleep after that, and about 1/3rd we are called in after midnight (or never get home at all), and it sucks. In all reality, it's probably a little busier than that.

One of the major things that sucks about "home call" is that you never get the day off after call. Our resident manual says we are supposed to go home the day after an all-nighter, but no one ever does it and the attendings don't ask.

Bottom line: ophtho call is much busier than your friends in other specialties think it is, especially at the decent programs. In fact, my pager just went off, so I have to go (no kidding).

 

[bucknut101]

Our program (perhaps one of the busier ones, but representative of many of the ones out there) has q6 (weeknights and weekends) call for both first and second years. Weekends are Friday night until Sunday night at 5pm, then someone else takes over.

Call is very hit or miss in terms of business. We pretty much always get called in at least once. I tell people the "rule of 3's" which is that about 1/3rd of the time, we have a manageable night, where we are home by 9pm or earlier, about 1/3rd we are busy until midnight but get to sleep after that, and about 1/3rd we are called in after midnight (or never get home at all), and it sucks. In all reality, it's probably a little busier than that.

One of the major things that sucks about "home call" is that you never get the day off after call. Our resident manual says we are supposed to go home the day after an all-nighter, but no one ever does it and the attendings don't ask.

Bottom line: ophtho call is much busier than your friends in other specialties think it is, especially at the decent programs. In fact, my pager just went off, so I have to go (no kidding).

Good point about going home the day after home call. We are supposed to be monitored for "fatigue" by our faculty the day after call and sent home if the faculty member deems us too fatigued to work in clinic. Our PD and chairman made a big deal about it back in July. However this never happens.

Some of our first years back in the fall were routinely going home at noon post call claiming they were too fatigued to work. All this really does is annoy all your other residents in clinic because they have to pick up your workload.

And in all honesty if you are fatigued is patient care really going to suffer? Yeah in medicine or gen surgery you could make some mistakes due to fatigue that could cause a patient to die. But in ophthalmology I would say the stakes are lower unless you're doing surgery the next day. And usually we schedule our call so a resident his never on call the night before surgery.

 

[rubensan]

And in all honesty if you are fatigued is patient care really going to suffer? Yeah in medicine or gen surgery you could make some mistakes due to fatigue that could cause a patient to die. But in ophthalmology I would say the stakes are lower unless you're doing surgery the next day. And usually we schedule our call so a resident his never on call the night before surgery.

I think you need 8 hours of sleep MINIMUM before you put a patient behind the phoropter! My personal policy is POST-CALL means NO manifest refractions (for patient safety of course)

 

[bucknut101]

I think you need 8 hours of sleep MINIMUM before you put a patient behind the phoropter! My personal policy is POST-CALL means NO manifest refractions (for patient safety of course)

Because that extra 0.50 of cyl could blur that patient's vision just enough that he misses that first step of stairs and breaks his leg on his tumble downwards.

 

[rubensan]

Because that extra 0.50 of cyl could blur that patient's vision just enough that he misses that first step of stairs and breaks his leg on his tumble downwards.

EXACTLY! And that's just manifest! Don't get me started on post-call cyclopegic refractions necessitating retinoscopy!

 

[7ontheline]

In my experience (anecdotal of course) the only people who make a big deal out of duty hours and post-call stuff in ophthalmology are the lazy residents nobody likes. We also used to make sure you weren't on call before your OR days. Beyond that if you can't suck it up for the day you are not going to be very happy when private practice rolls around.

 

[bucknut101]

In my experience (anecdotal of course) the only people who make a big deal out of duty hours and post-call stuff in ophthalmology are the lazy residents nobody likes. We also used to make sure you weren't on call before your OR days. Beyond that if you can't suck it up for the day you are not going to be very happy when private practice rolls around.

Hmmmmmmmmm.... are these the same residents that have weekly doctors appointments and have to leave clinic early on a regular basis?

 

[Wolverine98]

In my experience (anecdotal of course) the only people who make a big deal out of duty hours and post-call stuff in ophthalmology are the lazy residents nobody likes. We also used to make sure you weren't on call before your OR days. Beyond that if you can't suck it up for the day you are not going to be very happy when private practice rolls around.

IME, the biggest pushers about these issues are the program directors. They're worried about it because the ACGME is ready to bring down the hammer on any violations; they put Hopkins IM on probation, so you know they won't hesitate to do it to an ophtho program. We've had to force residents to go home when they wanted to stay so they didn't feel like they were "abandoning" clinic or surgery.