Psych residency call question (cannot find definitive answer)

[drillers]

For my program we did night float. I figured most psych programs, especially the academic centers, are setup that way. Had a friendly disagreement with colleagues: IF a program has you doing "home call" (say 8pm - 8am) in lieu of "in-house", then is it true the program does NOT have to give you a post-call day? I figured either they did have to give you a full post-call day, or at least a half-day (friend who went to Central or Western MICH said he had half days after at home call).

I cannot seem to find any answers to this question, and among my colleagues, it seems they are certain I am wrong and that home call negates the rules for post-call days.

Can anyone chime in?

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[TexasPhysician]

I did home call with no post-call days. It was quite chill. Even if it was against the rules (don’t think it is), reporting it would have resulted in a worse call schedule. No one dared complain.

 

[UTsksk]

I had night float and then we also had another rotation at an off site hospital where we had home call every other night. There wasn’t any post call day off. Most nights were chill except for random 2 am pages from nurses.

 

[Stagg737]

Programs do not have to give you any time off after home-call. Our program does not and we have to be at work at our scheduled time and generally stay all day. If we do have a bad call night, we can leave work at noon and I’ve never seen an attending go against this policy (typically they’ll let us leave even earlier if everything is taken care of).

I had home call 3-4x per month during second year and only left early the following day once. Unless you take a sick day, there is no obligation from programs to give a post-call day for home call. If you physically get called in, I believe that changes things, but then there are a bunch of “if this, then that” situations.

 

[drillers]

Thanks guys, I definitely lost this round. It does make sense, but at my place you would have been up all night taking calls for admits, med changes, questions, seclusions, so I thought post-call days were mandatory per ACGME or something

 

[robellis]

Nope, home call equals no post call day, in house call means there is a post call day if you stay overnight

 

[wolfvgang22]

I would hope you would get off the next day if you are up all night on the phone. As someone who worked in house for 30 hours straight every 3rd day I'm not surprised you don't, though.

 

[clozareal]

ACGME doesn’t consider home call as actual call, even if you get called into the hospital. You can work more than 30 hours home call taking phone calls, doing telemedicine, or going in person the entire time and it doesn’t count as violating duty hour restrictions per the ACGME. Therefore, post-call days are not guaranteed.

 

[hallowmann]

The categorical residents here do heavy in-house short-call, weekend call, and a nightfloat in 1st and 2nd year. The seniors do home backup call to the junior that is in-house. Rarely get called on backup call. The only reason you'd get a post-call day here is if you actually had to get called in in the event of the junior getting sick or overwhelmed - rare (happened to me once).

 

[Psychresy]

@drillers
I'm at an academic center. We do not do in house overnight call, ever. All call is home and we are given the next day off.

 

[clausewitz2]

True home call doesn't count as work hours as far as ACGME is concerned. Only the time you spend actually working in the hospital does. So if you get called in from home, it counts towards your 80 hour weekly limit. Above posters are right that it doesn't count towards the 24+6 every third day limitation but ACGME does note that home call should not be so frequent as to preclude rest and reasonable personal time for each resident. You still have to have one day in seven free of all responsibilities, including home call.

That is to say, your program can't have you doing in-person call q3 and then at-home call every other day.

 

[Stagg737]

The categorical residents here do heavy in-house short-call, weekend call, and a nightfloat in 1st and 2nd year. The seniors do home backup call to the junior that is in-house. Rarely get called on backup call. The only reason you'd get a post-call day here is if you actually had to get called in in the event of the junior getting sick or overwhelmed - rare (happened to me once).

Sounds like my program minus the in-house short call (which is gross). Night float is a new implementation at my program so I never did it, but from what I've heard it's actually really chill most of the time (sleep in the hospital, then go home and have the day off for 2 weeks).

 

[hallowmann]

Sounds like my program minus the in-house short call (which is gross). Night float is a new implementation at my program so I never did it, but from what I've heard it's actually really chill most of the time (sleep in the hospital, then go home and have the day off for 2 weeks).

Haha, yeah there's tons of call those first two years. Basically every week. The nightfloat is definitely not like that. We cover like 100 psych beds and any ED or floor consults, so there's always something happening.

 

[Stagg737]

Haha, yeah there's tons of call those first two years. Basically every week. The nightfloat is definitely not like that. We cover like 100 psych beds and any ED or floor consults, so there's always something happening.

Gross