PM&R On-Call

[Hemisphere]

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hey guys, was wondering if current residents could talk
about what on-call nights are like...
what kinds of things do you get called about,
is it quiet or do you get hammered?
what is your call schedule like??

If you answer, please include what program you
are resident at too if you don't mind and be honest
rather than trying to "sell" your program.

I'm just getting hammered in TY
each time on call, and was wondering
what next year is gonna be like, LOL

 

[SG1]

We have home call--approximately q6. Weekend call runs from 5P Friday to 7A Monday.

The crappiness level of call varies. Some suck and some (rare) nights I think my pager is broken 'cause it never beeps. Our nurses are great, so they don't call after 11 unless it is important. (You dread the 4AM page not because it's 4AM but because it usually means something bad is going on.) We have to come into the hospital if someone has chest pain, AMS, shortness of breath, and in the case of the lovely patient on coumadin who has unwitnessed fall out of bed. Calls that allow you to stay in the comfort of your own home include pain med adjustments, UTIs, fevers, inability to sleep, and occasional calls about labs/blood sugars. Our nurses try not to call on anything that can wait 'til the morning.

At our program, call is generally much better than intern call if for no other reason than that you usually get to sleep in your own bed & shower before you come in to work. The down side is that if you do get hammered, you're stuck at work 'til you finish your day, even if you go little to no sleep. (I.e. no leaving at noon post-call.) Weekends are pretty exhausting, but it's worth it to work one weekend and be completely free for the next 5. Hope this helps.

 

[axm397]

hey guys, was wondering if current residents could talk
about what on-call nights are like...
what kinds of things do you get called about,
is it quiet or do you get hammered?
what is your call schedule like??

If you answer, please include what program you
are resident at too if you don't mind and be honest
rather than trying to "sell" your program.

I'm just getting hammered in TY
each time on call, and was wondering
what next year is gonna be like, LOL

resident at RIC
Call about 10x/6months as PGY2, 2 weekend notewriting per 6months
less as PGY3, 1 call 1 wkend as PGY4. 1-2 holiday calls per year as PGY2&3

overnight in-house call covering 150+ patients including pediatrics. need ACLS and PALS training. Call intensity varies. Some nights, can get up to 4-6hrs of sleep, other nights, you're up all night. Some calls you can take care of on the computer in the call room (i.e. order ambien, reporting abnormal glucose, etc.), others you have to go see pt (falls, mental status change, chest pain, etc.)

If there's a code, the hospital code team responds. (rarely get through the ABCs by the time they get here) If pt acutely sick, transfer to ER. Nurses quality varies - some call for EVERYTHING, others don't call for ANYTHING, most are in between.

Weekend calls start 8am, leave next day at 8am unless you are on inpt then you stay until about noon so you can round and write notes. Admissions post-call day done by coverage person.

on call room being nice helps - full size bed (real bed, not hospital bed), nice size TV, DVD player, refrigerator, microwave, capuccino/tea/pod machine, couch, free food (up to $10 per meal), computer, bathroom with shower (although I haven't been brave enough to take a shower there) I usually bring my own pillow and blanket to make it a bit cozier. Many of us have significant others or friends who can bring us food and visit.

The inpatient residents sign out when they finish their work incl all admissions. On call resident does not do admissions. The sign out is over the phone and brief - just DNRs and pts w active issues. Sign out can start at 4pm and go to whenever. If primary resident still there, nurses will page them with issues.

I am doing two months at a community hospital rehab where we take home call for 3wks (our choice). Cover about 16-18pts all adults. You can go all day without a page.

So bottom line is call sucks, the suckiness varies, and the number of call can be proportional to whether the nurses like you or not.

Nothing is worse than intern year though... those q4 days with endless admissions and pages are in the past... you guys are almost half way done!

 

[macman]

hey guys, was wondering if current residents could talk
about what on-call nights are like...
what kinds of things do you get called about,
is it quiet or do you get hammered?
what is your call schedule like??

If you answer, please include what program you
are resident at too if you don't mind and be honest
rather than trying to "sell" your program.

I'm just getting hammered in TY
each time on call, and was wondering
what next year is gonna be like, LOL

yep-I remember the good 'ol days of admitting unstable pts. at 2am......fond memories. The fortunate reality is, this is PM&R and if someone is acutely sick-they don't belong on your floor or in your unit. That being said-sometimes its a chore to find an accepting service (including the service that sent them to you and forgot to mention a few of the 'issues' 🙂 )

I'm getting a little off track. Looks like SG1 above is at my program or at a program with an indentical call schedule. I like home call (who wouldn't I suppose) and really there should not be a reason for a doc to be in house for rehab pts. I suppose programs that have sicker pts. (RIC, others?) or otherwise have a free standing unit have to do this for medical and legal reasons, respectively. There is also a difference of an opinion within the profession whether physiatrists should be the primary medical person and engage in highly active medical management. I think one of our chiefs said it best: "Mr. X did not come to the Mayo clinic for us to work up his medical issues, get a consult."

We now have one of those 'rapid response team' programs which is basically for a situation that is not quite a code but heading that way. This will take a little stress from home call in that if someone sounds really crappy over the phone, I'll just ask them to call that team while I'm enroute.

To actually answer your question-sounds like it depends on the program you are headed to, but regardless, it is a different pt. population and you are really only expected to do the basics and if that is not helping, you get them the heck off your floor.

It will be better next year.

 

[Llenroc]

People's experiences here sound brutal. It's almost making me rethink going into PM&R, of which I was thinking about partly due to attractive lifestyle considerations.

I know someone who did their residency in Toledo, and they said all their call was from home, and they almost never went in. And on Scutwork, they say similar things.

But all this talk of staying up all night on in-house calls, and home calls where you have to come in lot sounds painful. I've done surgery and OB/GYN and even on those residents will get a couple of hours of sleep on most call nights.

 

[Brooklyndo2.1]

lleneroc, there are programs out there that have the attending take first call and only wake up the resident if the patient needs to be seen....

 

[drusso]

I think one of our chiefs said it best: "Mr. X did not come to the Mayo clinic for us to work up his medical issues, get a consult."

Ah, yes, the good 'ol days...Mr. Jones congratulations on your brand new triple liver-kidney-lung transplant with bonus triple vessel CABG unfortunately complicated by peri-operative stroke, exploratory laparotomy, multi-organ system failure, ARDS, and critical illness polyneuropathy. Now that you've had every world famous surgeon has been inside your body cavities and sub-specialist consulting in your care I, Dr. PGY-2 PM&R resident, will be managing all your post-operative and medical issues...

 

[Disciple]

People's experiences here sound brutal. It's almost making me rethink going into PM&R, of which I was thinking about partly due to attractive lifestyle considerations.

I know someone who did their residency in Toledo, and they said all their call was from home, and they almost never went in. And on Scutwork, they say similar things.

But all this talk of staying up all night on in-house calls, and home calls where you have to come in lot sounds painful. I've done surgery and OB/GYN and even on those residents will get a couple of hours of sleep on most call nights.

I wouldn't worry about too much.

During residency, I never once had to return to the hospital after going home and generally slept at least 6 hours per inhouse call night.

You just need to find the right programs. I wouldn't say they're a rare find.

 

[Llenroc]

Schweet. Which one's your program. 🙂

 

[SG1]

Ah, yes, the good 'ol days...Mr. Jones congratulations on your brand new triple liver-kidney-lung transplant with bonus triple vessel CABG unfortunately complicated by peri-operative stroke, exploratory laparotomy, multi-organ system failure, ARDS, and critical illness polyneuropathy. Now that you've had every world famous surgeon has been inside your body cavities and sub-specialist consulting in your care I, Dr. PGY-2 PM&R resident, will be managing all your post-operative and medical issues...

too true....

Even though there are some crappy days, I still love this field & can't imagine doing anything else. Our patients are fun. We have outstanding staff. AND we can see the effects (usually positive) of our work at the end of the day (or week).

 

[Finally M3]

People's experiences here sound brutal. It's almost making me rethink going into PM&R, of which I was thinking about partly due to attractive lifestyle considerations.

I know someone who did their residency in Toledo, and they said all their call was from home, and they almost never went in. And on Scutwork, they say similar things.

But all this talk of staying up all night on in-house calls, and home calls where you have to come in lot sounds painful. I've done surgery and OB/GYN and even on those residents will get a couple of hours of sleep on most call nights.

Come to UMich; we have homecall. I was on call Sunday, my last call was 7 PM, next page was at 630 AM when I was on my way into work

However, if your patients crash, you're expected to be there. However, since we're part of University Hospital, the code team will be there. Same goes for the peds inpatients.

 

[Hemisphere]

WEll, u might rethink going into clinical medicine itself, not sure there is a residency program where residents don't "go into the hospital a lot" and get paged in the middle of the night, even pm&r it can happen. maybe not in derm or rad onc maybe?? those are pgy-2 specialities as well though, and you still have to get through the transitional year or prelim year. I knew a guy who switched into medical consulting out of clinical medicine, and was just stoked all the sleep he was getting he couldn't believe it. maybe there is one area masters in public health, but that is not really clinical practice too. Some nights this year my pager seems spend more time beeping than it does being quiet.
PGY-1 TY 6 mo's left!

People's experiences here sound brutal. It's almost making me rethink going into PM&R, of which I was thinking about partly due to attractive lifestyle considerations.

I know someone who did their residency in Toledo, and they said all their call was from home, and they almost never went in. And on Scutwork, they say similar things.

But all this talk of staying up all night on in-house calls, and home calls where you have to come in lot sounds painful. I've done surgery and OB/GYN and even on those residents will get a couple of hours of sleep on most call nights.

 

[axm397]

People's experiences here sound brutal. It's almost making me rethink going into PM&R, of which I was thinking about partly due to attractive lifestyle considerations.

I know someone who did their residency in Toledo, and they said all their call was from home, and they almost never went in. And on Scutwork, they say similar things.

But all this talk of staying up all night on in-house calls, and home calls where you have to come in lot sounds painful. I've done surgery and OB/GYN and even on those residents will get a couple of hours of sleep on most call nights.

The difference is that most IM, surgery, and ob/gyn calls are q3-q4 whereas at an average PM&R program, even if inhouse call, it's more like q14. So even if we complain about our calls, we're only talking about 2 calls a month if that. The probalm is we are lazy by nature and our bodies get used to not taking call - so when we do, it's more of a pain. I remember when I started my pgy2 year I couldn't believe I only had 1-2 calls per month and had pretty much most of my weekends off. Those days of "golden weekends" and average 1 day off per week, are long gone. So need to take things in context.

 

[Disciple]

I remember when I started my pgy2 year I couldn't believe I only had 1-2 calls per month and had pretty much most of my weekends off. Those days of "golden weekends" and average 1 day off per week, are long gone. So need to take things in context.

You're comparing PM&R call to IM intern year.

The difference is that PGY-2 IM call (interns do the scut) is a step up from IM intern year call.
PGY-2 PM&R call is like IM intern call, just toned down.

 

[Karaoke]

Don't stress out there, my friend. If you go into PM&R, your call in residency
will be a cakewalk compared to internship. Internship was *bad*.

At NYU, the calls are frontloaded / dumped on PGY2s, meaning you'll do
maybe 4 or 5 calls a month. PGY3s seem to do about 2 calls a month, and
PGY4s, god bless'em, take maybe a call a month if they're taking call at all.

We have in-house call, but it's really pretty great in my opinion. As with most
programs, how often you get called depends on which nurses are on that
night. I sleep like a rock, so even if I get called I just get up, tool around
with whatever little issue it is, and then go right back to bed. I get 5 to 7
hours of sleep on call, and then I go home at 8am the next morning. No
notes post-call, no rounding post-call, just sign out and go home. I never
have to sleep it off the next day, so sometimes I just wander around
Manhattan being a tourist. I used to think I'd much prefer home call, but
this system that I'm "stuck" with is pretty okay with me.

NYU has rapid response teams and code teams who are very quick to
answer a cry for help. I've never had to use a code team.

The call rooms at our two main hospitals, Bellevue and Rusk, are pitiful. I
don't even want to go into here, but it's bad. My med school had better call
rooms for their *students*.

Quick recap:
- NYU PM&R call
- PGY2s bear the brunt of it
- in-house, go home at 8am the next day
- usually 5 to 7 hours of sleep
- ancillary staff varies, but rapid response teams are great
- call rooms are awful
- bring a book

 

[Nico47]

I can't say much because I haven't started residency yet, but I know that Loyola (just outside of Chicago) has home call for all but four months of residency.
After speaking with PGY-4s there (all three of them), it sounds like they had to go back to the hospital from home just once out of three years. -Not bad! 😉

 

[Ligament]

PM&R calls are easy in general if you are in a NON freestanding rehab facility. Compared to other specialties we are about as well off as Derm or Rad Onc. And if you get a pain fellowship after a PM&R residency you have no call forever and can make as much as Derm and Rad Onc. 🙂 Kinda kidding...no I'm serious....