Psychiatry Residency that is healthy

[Mysterio123]

Hi,

I see a lot of residency that make residents work night shifts like 8pm to 8am.
I hope those doctors are alert and healthy but that throws off the circadian cycle and is documented to be unhealthy.

Are there any PSYCHIATRY residencies in US that don't force night hours/ "night call"? I understand its importance to ER and the such. But for other practices like psych I always believed that if you are happy and healthy, you can best help your patient to be the same.

Thanks for reading

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[Stagg737]

Do you mean that don't do overnight call? Anytime shifts aren't enforced it's dangerous for patient safety.

If you mean the former, my program has home call for overnight call. I interviewed at one place that I believe didn't have night call if I'm oremembering correctly (though they may have also been home call overnight).

 

[Mysterio123]

Do you mean that don't do overnight call? Anytime shifts aren't enforced it's dangerous for patient safety.

If you mean the former, my program has home call for overnight call. I interviewed at one place that I believe didn't have night call if I'm oremembering correctly (though they may have also been home call overnight).

I'm eager to do shifts at any hour of the day but night is for sleep and recovery.

What is a home call?
And if I may clarify, I mean are there any residencies in pysch that only have work hours in day time. Where night calls don't even exist.

 

[Stagg737]

I'm eager to do shifts at any hour of the day but night is for sleep and recovery.

What is a home call?
And if I may clarify, I mean are there any residencies in pysch that only have work hours in day time. Where night calls don't even exist.

I would be pretty surprised if there are residencies in any field where you never have night call. That's part of being trained to be a doctor is. I also personally think having no night call ever is a disservice to your clinical experience.

Home call means you are on call but you generally do not have to be at the hospital. At my program you only have to go in overnight if there is a stat consult (rare) or if someone is put in restraints (state law that the patient must be physically seen by a physician after being put in restraints within X hours). Otherwise if something comes up the unit calls you and you can place orders from home. So we have night call but we get to stay home for almost every night.

 

[Old&InTheWay]

As someone else has mentioned, you'll probably be able to find a residency with minimal call. The thing is though, that some patients actually need to come to the hospital during the night and need care then. While it is certainly important for you to be well, you chose a career (medicine) that takes care of people who don't always present at ideal times of day.

 

[Evidence Based]

There are very few residencies with no call, and I would argue that some call is a good learning experience. Nights are when you get to be more independent, and a lot of my best learning has happened then. Frankly, I would argue that every resident should take at least some overnight call.

Based on what you're saying, you might do better at a residency that does "night float." This is when you do several nights in a row. You can get all the sleep you need during the day. I've done a few weeks of nights, and while they're not my favorite (it can get lonely) I've certainly felt plenty well rested sleeping 8-9 hours during the day and then working at night.

With all this said, even the "hard working" psych residencies take much less call than the rest of medicine.

 

[Mass Effect]

As mentioned above, you're unlikely to find a residency that requires no overnight hours. Patients still come in overnight and someone has to cover. It will undoubtedly be the resident. I'd also argue that working overnight is beneficial to your education. The hospital is different at night and you have a lot more autonomy. As an attending, you will likely do call, at the very least at-home call. You should get used to it. You just flip your hours so you sleep during the day. Now, what you should be concerned about is the 24 hour in-house calls. Those royally suck, but again it's just part of training.

 

[splik]

several community programs have no overnight call or practically no call including UC Riverside, kaiser oakland, san mateo, stony brook - mather, hollywood memorial, cape fear, boise etc. While I do think the amount of call at many programs is excessive for the specific learning needs, and it would be better if residents instead were paid extra for overnight/weekend coverage, it will significantly stunt your development as a psychiatrist if never do overnight/after-hours as a resident, and you will not be ready for independent practice when you finish residency. Even psychiatrists who have office based practices still need to be able to manage suicidal crises and you get a certain experience on call you do not otherwise (with the exception of moonlighting).

 

[siliso]

Somebody’s got to take care of the people at night. Who you think is supposed to do it?

 

[MacDonaldTriad]

You do realize you went into medicine? I wouldn't want my psychiatrist to have never taken call. Please stay away from most of the good programs. It is shame that people have mental health needs at inconvenient hours, but they do.

 

[birchswing]

I have a question that was raised by this: Are there psychiatric emergencies that can only acutely be handled by a psychiatrist?

I don't know a lot about this, but I've heard of Haldol and Ativan being the combo emergency rooms use to sort of "knock someone out" for lack of a better term. Is there a situation where the symptoms would be so distressing and not amenable to what an ER doctor would have available that a psychiatrist would be required acutely? Or maybe be required to see the acute presentation in order to make a diagnosis if the presentation changed too much by the time the psychiatrist saw the patient?

 

[Monocles]

According to the rumors, a lot of the Kaiser residencies seem to not have any call!

 

[whopper]

Many don't have overnight call or more limited versions of it.

But I wouldn't call a residency with an overnight call unhealthy. It can be a vital tool in training. Do you absolutely have to do call do to be a good psychiatrist? No but the word "absolute" is very extreme. A psychiatrist that's never done ER psychiatry will likely not be good at it until they've done it for several weeks.

 

[mbgr2014]

Pretty sure USC Palmetto also has no/minimal call.

 

[Mass Effect]

I have a question that was raised by this: Are there psychiatric emergencies that can only acutely be handled by a psychiatrist?

I don't know a lot about this, but I've heard of Haldol and Ativan being the combo emergency rooms use to sort of "knock someone out" for lack of a better term. Is there a situation where the symptoms would be so distressing and not amenable to what an ER doctor would have available that a psychiatrist would be required acutely? Or maybe be required to see the acute presentation in order to make a diagnosis if the presentation changed too much by the time the psychiatrist saw the patient?

Not all psych patients are in the ED. Some are on the medicine floors, some on the inpatient psych unit. Some need better care than Haldol and Ativan. Some don't respond to it. Some need to be restrained on the psych unit. Some need to be admitted to the psych unit. Some need to be discharged from the psych unit for a transfer to the medical floor for acute medical issues. Some are delirious on the medical floor. Some are trying to leave AMA and need a capacity eval that hospital policy dictates psych to do.

Bottom line, yes, there is a reason for psych to take call.

 

[whopper]

I occasionally get beeped in the middle of the night due to a real psych emergency. It's rare but it happens. Maybe on the order of every several months.

Guess what? Having done call and ER psych for years makes me not scared of getting beeped. Does it suck? Yes but only cause I get woken up in the middle of the night.

Like I said, you don't absolutely have to do call but if you don't your odds of being totally unprepared for a middle of the night emergency skyrocket. Personally I would rather get extra training to be a competent physician.

If you want to avoid them, I'd still look for programs that make you do call but perhaps on a more comfortable schedule. E.g. instead of every 3 days maybe once a week. Either that or if they don't have call make sure you get ample training in emergency situations. I don't see a learning curve value in doing too many calls. That's where it's more suffering than it's worth. Also some programs might have a tough 1st year call schedule but then 2nd year onwards it could get much easier.

(A main reason why I have very little confidence a psychologist-prescriber program where all they have to do is shadow an actual prescriber for a few months will substitute for an actual psychiatrist).

 

[Candidate2017]

I have a question that was raised by this: Are there psychiatric emergencies that can only acutely be handled by a psychiatrist?

On the psych ward I like to think of it as medical emergencies rather than psychiatric emergencies: When the nurse pages at 3 am about some patient's rash, chest pain, tachycardia, glucose, agitation, headache, blood pressure, fainting spell, muscle ache etc, there needs to be a doctor available to determine if it is potentially life threatening, not life threatening but action needs to be taken or if it can wait.
But here are some nurses that believe "crying" or needing cough syrup at 3 am is a psychiatric emergency.

 

[FlowRate]

real psych emergency

Just curious what you mean by that.

 

[whopper]

Addressing this and the following with the same statement.

Are there psychiatric emergencies that can only acutely be handled by a psychiatrist?

Any idiot with an MD can knock someone out with Haloperidol and Lorazepam. If those were the answers to psych emergencies you wouldn't need a psychiatrist.

Like most of us here know you need to know your antipsychotics. E.g. Olanzapine, Ziprasidone, when would you use these instead of Haloperidol? The knowledge of avoiding Olanzapine IM and Lorazapine IM together, etc.

But beyond taking people out with antipsychotics, other psych emergencies involve dealing with cluster B patients having some type of behavioral disturbance where medications should be in general avoided, dealing with people claiming to be suicidal that after an evaluation you're willing to kick out of the ER but then the up the ante and do something quite histrionic such as go to the pharmacy down the road, come back and put a razor to their neck etc. Other examples: knowing when to involve the police in a manner that's still HIPAA appropriate, bad reactions to meds-what to do ASAP, spotting issues like catatonia or NMS.

While I was at U of C, most of the psychiatrists and residents were quite astute with emergencies. Last place I worked they were not. E.g. at U of C malingerers would get kicked out, cluster B drama-medication was often times avoided with people getting appropriate referrals for DBT, while at the last place I worked almost all malingerers made it into inpatient, got to stay in the unit for weeks, cluster B drama patients got what they wanted-which usually meant more Lorazepam, or a catatonic patient with pretty extreme muscle rigidity is only left to stay in his room without anyone addressing it and it being labelled as depression (a reason why I left).

 

[MedMan80]

I have no problem with overnight call as a learning opportunity, the problem comes when cash-strapped systems utilize overworked residents to do this when nobody else is willing to do it. The resident has no choice and gets stuck dealing with overnight emergencies with minimal oversight because they are stuck in indentured servitude. My advice to anyone interviewing is closely examine and compare the call schedules for all of your programs, don't even allow the possibility of burnout to happen!

 

[Marasmus1]

As a trainee who did Q3 calls in first year and Q5 calls in second, there is no psychiatric emergency that B52 would not be able to deal with.

Besides the joke, It could be argued that the training would not be complete without overnight exposure. However, to the best of my knowledge there is no psychiatric issue that arises only between 8 pm - 8 am. From healthcare perspective, It would be ideal to have a covering psychiatrist over the night (Though many hospitals do not have any covering psychiatrist over the night) From training perspective, exposure is beneficial but consistent overnight calls do not add any value to your training. Been there and done that.

 

[Taddy Mason]

...However, to the best of my knowledge there is no psychiatric issue that arises only between 8 pm - 8 am...

I’ve had at least 2 codes on our inpatient unit while on overnight call as well as NMS, 5–HT syndrome, and dystonic reactions that happened to pop up over night v. the day - stuff happens overnight and there’s definitely utility in having someone available.

 

[GUH]

I’ve had at least 2 codes on our inpatient unit while on overnight call as well as NMS, 5–HT syndrome, and dystonic reactions that happened to pop up over night v. the day - stuff happens overnight and there’s definitely utility in having someone available.

A "code", if you're referring to something like cardiac arrest, is decidedly not a psychiatric issue and really should be handled by a physician who regularly handles such emergencies. But NMS, serotonin syndrome, and dystonia are appropriate to be treated by a psychiatrist, so long as they are related to the patient's psychiatric treatment.

 

[clausewitz2]

As a trainee who did Q3 calls in first year and Q5 calls in second, there is no psychiatric emergency that B52 would not be able to deal with.

Besides the joke, It could be argued that the training would not be complete without overnight exposure. However, to the best of my knowledge there is no psychiatric issue that arises only between 8 pm - 8 am. From healthcare perspective, It would be ideal to have a covering psychiatrist over the night (Though many hospitals do not have any covering psychiatrist over the night) From training perspective, exposure is beneficial but consistent overnight calls do not add any value to your training. Been there and done that.

At least where I am training I see the utility of night call v day call as learning to be comfortable not intervening.in a dicey situation. Any monkey can reflexively admit anyone who walks in the door who has ever had a suicidal thought, and you're right that that is not valuable training or a learning experience.

What you should learn on night call is knowing when you should say "you are having suicidal thoughts AND I am sending you home/back to your therapist/to this IOP tomorrow morning." And learning to do it without the safety blanket of an attending sitting right there with you.

 

[Taddy Mason]

A "code", if you're referring to something like cardiac arrest, is decidedly not a psychiatric issue and really should be handled by a physician who regularly handles such emergencies. But NMS, serotonin syndrome, and dystonia are appropriate to be treated by a psychiatrist, so long as they are related to the patient's psychiatric treatment.

Obviously, but I was there to determine wether or not a code or IM actually needed to be called and manage it initially until the code team arrived. Both of which I feel are reasonable expectations for anyone doing inpatient work.

 

[Mass Effect]

As a trainee who did Q3 calls in first year and Q5 calls in second, there is no psychiatric emergency that B52 would not be able to deal with.

Besides the joke, It could be argued that the training would not be complete without overnight exposure. However, to the best of my knowledge there is no psychiatric issue that arises only between 8 pm - 8 am. From healthcare perspective, It would be ideal to have a covering psychiatrist over the night (Though many hospitals do not have any covering psychiatrist over the night) From training perspective, exposure is beneficial but consistent overnight calls do not add any value to your training. Been there and done that.

Since you bumped a year-old thread to make this point, do tell us more. What year in training are you? I have yet to see any psych intern working Q3 call and I'm familiar with a great number of psych programs. Are you at a very small community hospital? If so, that might explain why you also don't believe in psych call.

 

[Mass Effect]

Obviously, but I was there to determine wether or not a code or IM actually needed to be called and manage it initially until the code team arrived. Both of which I feel are reasonable expectations for anyone doing inpatient work.

This.

Also, don't forget restraints on the inpatient unit. Some hospitals also have "behavioral codes" for severely agitated patients on the medicine floors.

 

[asdf123g]

Home | Psychiatry | Programs | Residency Program | Cape Fear Valley Health

www.capefearvalley.com

"We are a community program that provides one-on-one faculty supervision and support. We are committed to your training first and service needs second. We have NO OVERNIGHT call during your four years of training."

 

[Mass Effect]

Home | Psychiatry | Programs | Residency Program | Cape Fear Valley Health

www.capefearvalley.com

"We are a community program that provides one-on-one faculty supervision and support. We are committed to your training first and service needs second. We have NO OVERNIGHT call during your four years of training."

Yeah, many small community programs don't do overnight call, particularly on the DO side, which this is. Doesn't mean overnight call isn't helpful. There's a reason that when the match was split, the majority of DO students wanted an ACGME psych residency.

 

[comp1]

I would think that home call is becoming the large majority. There are very few psychiatric issues that can't be managed over the phone, or in our new pandemic era, video health. Also, a great number can simply wait until the morning. It seems to me that programs with psychiatric residents in house overnight aren't being particularly efficient with their use of a very valuable resource. A resident taking in house overnight call can't be seeing patients the next day, whereas one on home call can. It's also a heck of a lot more likely that you'll be doing something resembling "home call" in attending practice than that you'll be spending the night physically in a psych ER. I can't think of any actual psychiatric hospitals nearby that have attendings in house overnight. I would argue that home call trains you a lot more in the way you'll actually be practicing than spending the night in a call room.

 

[asdf123g]

Yeah, many small community programs don't do overnight call, particularly on the DO side, which this is. Doesn't mean overnight call isn't helpful. There's a reason that when the match was split, the majority of DO students wanted an ACGME psych residency.

I'm not disagreeing but I was curious what psychiatry-specific reasons are there?

 

[Mass Effect]

I would think that home call is becoming the large majority

Then you would think wrong.

Also, a great number can simply wait until the morning. It seems to me that programs with psychiatric residents in house overnight aren't being particularly efficient with their use of a very valuable resource. A resident taking in house overnight call can't be seeing patients the next day, whereas one on home call can

Call up the highest-ranked psych programs in the country and be sure to let them know they're not being efficient.

It's also a heck of a lot more likely that you'll be doing something resembling "home call" in attending practice than that you'll be spending the night physically in a psych ER. I can't think of any actual psychiatric hospitals nearby that have attendings in house overnight. I would argue that home call trains you a lot more in the way you'll actually be practicing than spending the night in a call room.

Where are you in your training and how many "actual psychiatric hospitals" are you in contact with? Because ALL psych hospitals have someone overnight. If part of a hospital, they at least have hospitalists. In standalone psych hospitals, it's either an IM doc or a psych doc. And every psych ER place I'm familiar with (and I interviewed at a few) have coverage overnight.

 

[Mass Effect]

I'm not disagreeing but I was curious what psychiatry-specific reasons are there?

I think those questions were answered.

 

[comp1]

I've worked personally in four inpatient psychiatric units throughout my training. I'm an attending of several years now. Perhaps it's a regional thing? Only one of those hospitals had a psychiatrist in house overnight and it was a resident...again being kind of inefficiently used in my opinion. The remainder had attendings (or residents) on call from home. I'm aware of the practices of all the hospitals in my region and literally none have any psychiatrists in house overnight. Medical emergencies are transported by EMS to a local ED if it's a freestanding hospital or if the psych unit is attached, the internists (who are present in house on the medical side of things) are called by a rapid response. One of the units I've worked in does have a mental health NP some nights, but not all and it's mostly to reduce the home call burden for the attendings. I agree that psychiatric emergency rooms would likely require someone in house 24/7, but those are extremely rare around here. We mostly have what are called "intake stabilization units" and those can generally also be managed over the phone until the morning. None of those locally have a psychiatrist in house 24/7, but they do sometimes have urgent care kind of hours for the psychiatrists in house, like 8 AM-10 PM.

 

[Marasmus1]

Since you bumped a year-old thread to make this point, do tell us more. What year in training are you? I have yet to see any psych intern working Q3 call and I'm familiar with a great number of psych programs. Are you at a very small community hospital? If so, that might explain why you also don't believe in psych call.

It is relatively small program in an urban area, extremely short staffed. The point I was trying to make is consistent overnight calls do not have additional educational values for residents. I came across the thread while searching something else and wanted to drop a comment

 

[Marasmus1]

I've worked personally in four inpatient psychiatric units throughout my training. I'm an attending of several years now. Perhaps it's a regional thing? Only one of those hospitals had a psychiatrist in house overnight and it was a resident...again being kind of inefficiently used in my opinion. The remainder had attendings (or residents) on call from home. I'm aware of the practices of all the hospitals in my region and literally none have any psychiatrists in house overnight. Medical emergencies are transported by EMS to a local ED if it's a freestanding hospital or if the psych unit is attached, the internists (who are present in house on the medical side of things) are called by a rapid response. One of the units I've worked in does have a mental health NP some nights, but not all and it's mostly to reduce the home call burden for the attendings. I agree that psychiatric emergency rooms would likely require someone in house 24/7, but those are extremely rare around here. We mostly have what are called "intake stabilization units" and those can generally also be managed over the phone until the morning. None of those locally have a psychiatrist in house 24/7, but they do sometimes have urgent care kind of hours for the psychiatrists in house, like 8 AM-10 PM.

Where is that region? You are describing an ideal work environment to me.

Again Im not here to say overnight exposure is not valuable, as a matter of fact it is. But consistent regular overnight calls do not add anything extra to residents training in my opinion.

 

[Mass Effect]

Where is that region? You are describing an ideal work environment to me.

Again Im not here to say overnight exposure is not valuable, as a matter of fact it is. But consistent regular overnight calls do not add anything extra to residents training in my opinion.

I agree with you there. There IS educational value in call and it should be a part of training. There is nothing to be gained from regular overnight call and at some point, you negatively affect learning due to sleep deprivation and fatigue. I'm a fan of a night float system. The first few nights may be tough, but you switch your hours and it works without the nuisance of 24 hour call. When you're done, you return to day shift for the rest of the academic year.

 

[notdeadyet]

On many inpatient psych units (which residents often cover after hours and on weekends), the psychiatrist(-in-training) is responsible for the patients. That means medical as well as psychological issues.

If folks considering the field are actively pulling away from the medical side of the training, I’d recommend other fields. A psychiatrist without medical acumen is easily replaced by a Psych NP or psychologist (depending on the job).

Don’t avoid call, it’s where you learn to be a doctor. Don’t avoid overnight call, it’s where you learn to be one under pressure. I didn’t like call but I’m glad I did it. I don’t like exercise either, but I do that too. And for similar reasons.

 

[samac]

I interviewed at a good mix of community and academic, and it seemed really common for community programs to not have night call and academic programs to have it. Is it just because of demand?

 

[clausewitz2]

I interviewed at a good mix of community and academic, and it seemed really common for community programs to not have night call and academic programs to have it. Is it just because of demand?

Academic programs probably on average more likely to take medically sicker folks as most of the time they are also going to have consultants on tap in a way that is not as broadly true in the community. Medically more complicated people mean more likely to have a crisis overnight.

Easier to take a patient with serious kidney disease, f'r instance, if you can have a nephrology fellow come by on a daily basis.

 

[michaelrack]

If folks considering the field are actively pulling away from the medical side of the training, I’d recommend other fields. A psychiatrist without medical acumen is easily replaced by a Psych NP or psychologist (depending on the job).

That has not been my experience... there's no financial advantage for a psychiatrist to have "medical acumen ".
On the other hand, in some of my jobs I have made a little more than pure psychiatrists, but it's not due to my knowledge but rather is due to a piece of paper that says I am a board certified internist

 

[Mass Effect]

That has not been my experience... there's no financial advantage for a psychiatrist to have "medical acumen ".
On the other hand, in some of my jobs I have made a little more than pure psychiatrists, but it's not due to my knowledge but rather is due to a piece of paper that says I am a board certified internist

Not everything is about finances. Personally, I can't imagine working on an inpatient unit without knowing the very basics of medicine.

 

[hallowmann]

Night float was one of the rotations that I felt actually trained me to function independently as a physician. Even medical night floats usually involves having another resident (whether intern or senior) to bounce ideas off of. When you're the only psychiatrist in house and you make the decisions until 8 AM, you have to actually commit and take a stand and work with the limited resources available. That's not always the case in residency, and in fact unless you are forced to do it by your attendings, you could probably avoid it for much of your training.

I also think it was the rotation that I did the most different things in the hospital, and as a result it forced me to learn how to do those things. First patient I pronounced, wrote the death discharge for, and filled out the state death report for was during that month (not even something I had to do on medicine up to that point - there was always a senior doing it). It sucked, but I recognize how much value it has in my training.

That said, it was a block of it, and maybe I did a handful of others throughout the year in PGY1-2, but I don't see a point in doing even q7 night shifts, that just seems cruel.

 

[Marasmus1]

I agree with you there. There IS educational value in call and it should be a part of training. There is nothing to be gained from regular overnight call and at some point, you negatively affect learning due to sleep deprivation and fatigue. I'm a fan of a night float system. The first few nights may be tough, but you switch your hours and it works without the nuisance of 24 hour call. When you're done, you return to day shift for the rest of the academic year.

The problem I had with night float system was my body and psychology did not react well to constant change of my circadian rhytm. On top of the Q5 calls I have, I had 2 weeks blocks of NFs interspersed in my academic year . It was like 2 weeks of NF --- 6 weeks of days with Q5 calls --- 2 weeks of NF-----4 weeks of days with Q5 calls --- 2 weeks of NF. When I say NF I am not talking about couple of ED consults and management of agitated patients in the inpatient. I am talking about 8-10 new patients in Psych ED plus inpatient issues if any.

By the of the end of second year, I am almost sure that I developed shift work circadian rhytm disorder and Chronic fatigue syndrome. Could somebody be tired all the time, weekday, weekend, vacation time? I saw it was possible.

 

[Mass Effect]

The problem I had with night float system was my body and psychology did not react well to constant change of my circadian rhytm. On top of the Q5 calls I have, I had 2 weeks blocks of NFs interspersed in my academic year . It was like 2 weeks of NF --- 6 weeks of days with Q5 calls --- 2 weeks of NF-----4 weeks of days with Q5 calls --- 2 weeks of NF. When I say NF I am not talking about couple of ED consults and management of agitated patients in the inpatient. I am talking about 8-10 new patients in Psych ED plus inpatient issues if any.

By the of the end of second year, I am almost sure that I developed shift work circadian rhytm disorder and Chronic fatigue syndrome. Could somebody be tired all the time, weekday, weekend, vacation time? I saw it was possible.

Sounds like it was your program that was the problem.

We had one month of night float. When done, you're done. In addition to that, you had weekend day and/or night shifts once every 6 weeks or so but those were nowhere near your night float months, unless you requested it (so if you were working M-F nights, you could request your weekend shift be Saturday nights during that month and then you're done with it all at once).

 

[Marasmus1]

Sounds like it was your program that was the problem.

We had one month of night float. When done, you're done. In addition to that, you had weekend day and/or night shifts once every 6 weeks or so but those were nowhere near your night float months, unless you requested it (so if you were working M-F nights, you could request your weekend shift be Saturday nights during that month and then you're done with it all at once).

I agree. I am all in for educational night coverage experience. But when it is abused under the umbrella of ``education`` I really do not see any value of doing it regularly. I recommend med students that They avoid programs with regular over the night coverage

 

[MacDonaldTriad]

Universities have more call because they run large hospitals. Community programs have large ambulatory systems and borrow some inpatient time from hospitals who are already set up to cover overnights. Bad comes with the good and good can come from the bad. Ask yourself if you want a university training or is that not your thing.

 

[Mass Effect]

Universities have more call because they run large hospitals. Community programs have large ambulatory systems and borrow some inpatient time from hospitals who are already set up to cover overnights. Bad comes with the good and good can come from the bad. Ask yourself if you want a university training or is that not your thing.

Or do the best of both worlds. I trained at a university program with the call mentioned above. It was humane AND educational. When your night call is just another rotation rather than a q5 nonsense, you can learn and still enjoy your life without sleep deprivation.

 

[samac]

Here’s to hoping the night call isn’t bad at my program. I know they have it but I don’t know how many weeks. All I know is their weekend call is pretty minimal and done by 3rd year. Whoops?

 

[Monocles]

Now I am revisiting this thread as a pgy-4, my thoughts are:

Random call nights of call on top of regular daytime hours is stupid and disrupts wellness.

Scheduled "night float" weeks or months (with days off) can be great for independent learning and working through vidja game backlogs during slow shifts.