Should How Much Call Is Involved As Intern Influence Where You Do Residency?

[CorpuSpongiosum]

Was it an issue for you?

Should it be for me/us? Does it ruin your life? Or is it worth it in terms of how much you learn?


Thanks

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[gutonc]

Was it an issue for you?

Should it be for me/us? Does it ruin your life? Or is it worth it in terms of how much you learn?


Thanks

No, maybe, maybe, maybe in that order.

I don't think it should be a deal breaker if you otherwise love the program but it's something to be aware of. More than the call schedule itself (qwhatever, +/- NF), you may want to consider the number of call months per year as a more important issue than the frequency of call. It might be easier to survive 7 mos of Q4 overnight than 11 months of q5 w/ night float.

 

[muscles]

It was for me to an extent because my wife and I just had an 8 month old and quite frankly, I didn't want to be gone all the time. Michigan really seems to have a lot of safety nets in place to prevent you from being overworked, and its a great program, so it works out well

 

[dragonfly99]

It was not an issue for me.
Yes, I think I should have considered it.
No I don't think you necessarily learn more from taking a lot of call, say 10 or 11 months, vs. 8 or 9. In fact, sometimes it's the opposite, because if you are on a noncall month it might be an elective you chose or a consult month, which in internal medicine can be more educational than another month as a ward intern acting as a note writer, order enterer and H and P factory, aka scut monkey.
That's not to say I think you should choose a weeny residency, because I think there is some value in a rigorous residency, but I think it's good you are thinking about these issues.

I do think that hospitals that make interns do more call months are either
a) front loaded, where you may do an extra month or so of call in 2nd and 3rd year due to the intern year being lighter,
or
b) rely heavily on residents and interns to "run" the ward services and hospital, which has both its good and bad points. It's good because the resident, not the fellow or attending, is generally running the day to day activies on the service/ward. But it's bad because often the service/work aspects of the residency may outweigh the learning part.

I think also you have to realize that sometimes the program directors stretch the truth about how many call/ward months you will be doing. I was told 9-10 and it was on the web site for my program, but instead I got 11 call months of Q3 and Q4, and 1 clinic month as an intern...OK well it was 10.5 because I had a 2 weeks vacation block. It wasn't so awful and heinous in hindsight, but I think it would have been better, in terms of generalized fatigue and mental burnout, to have had an ER month or a consult month or some sort of elective thrown in there.

 

[elwademd]

Was it an issue for you?

no.

Should it be for me/us?

depends on your expectations of internship and residency. depends on where you are in life.

a young single guy (mid-20s) is going to be at a different place in life than a older married gal (mid-30s) with kids. and because of where they are in life, their priorities are going to be different, and the expectations (hopes) of internship and residency may be different.

Does it ruin your life?

depends.

if you have high expectations of a great social life during an icu or ward month, you may end up pissed off a lot if some things happen (people calling in sick, emergencies with patients, sleep deprivation, etc.).

Or is it worth it in terms of how much you learn?

you definitely learn in internship and residency. just how much you learn is partially dependent on how much you see. but there's also a part that doesnt necessarily need to be done in the hospital. where that balance is, i don't know. and honestly, i don't think anyone really knows.

suffice to say, you'll learn your entire career. its not as if the learning stops once residency finishes... as long as you continue to seek knowledge. and therein may be the most important issue, you've got to want to learn to be in this business/field.

 

[TommyGunn04]

As an aside, be careful not to make the assumption that night float = less intense.

Night float sounds wonderful when you hear about it from a flyer, website, or program director on your interview day, but if you talk to truly honest residents about their experiences with it, I've found that feelings are quite mixed (many people hate it, actually).

For one, the hours can actually be worse. If you're supposed to leave the hospital at 10pm, it's not unusual to actually leave at or 12 or 1am instead, especially early on in the year when you're less effiient. Then you still have to be there at 6:30 the next morning, and work a full day. So instead of just doing 28-30hrs of straight call but being off the next day, you work an 18hr day, sleep 4-5 hrs if you're lucky, then come back and work another full 12-14hr day. It's still about as many hours worked per 48hrs, but it's a much smaller block of time with which to recover. At many programs, night float also = much longer days and often no weekdays off. This can actually be worse for family, as you may be gone from 7-7 every day, and get home after your kid is in bed each night. This also makes it tough to get any sort of personal business done (haircuts, banking, dry cleaning, etc.), since you may never leave the hospital during normal business hours. To the contrary, a traditional q4 overnight call schedule can get you out by 4pm pre-call, and days off during the week, plus a nice long 16+hr block of time to recover post-call.

Many night float schedules also entail more weekend and night coverage when you're on what should be an easier clinic rotation. So instead of working a couple intense 70-80hr/wk blocks followed by a nice 45hr/wk clinic month, you might have 65-70hr/wk rotations for 11 months a year.

It's definitely a trade off, so you have to figure out what's most important to you, and what type of a system fits your learning style. Personally, I didn't want to be handing off patients I just admitted to someone else, as I felt that the first 12hrs was the most critical and informative time in a patient's care, and I wanted to be there to learn from those experiences. I also didn't want to be inheriting patients I didn't admit when I came in the next day, which is quite common in a float system. So I thought of overnight call as a good thing for intern year. Some systems thus have maintained intern overnight call, but utilize night float only for junior/senior residents.

...something to think about...