Surgery programs that use a night-float?

[Castro Viejo]

I've heard that there is a rare breed of general surgery prorgam out there that does not require overnight call, but has a night-float system similar to the ones found in other specialities (most prominently, internal medicine). Has anyone ever spotted one of these rare beasts? Is this relatively common? I'd think not, if I've never spotted one, but hey, I don't exactly pay attention.

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[intern in waiting]

Be careful about what the programs mean by 'night float' I'm starting an Internal med residency in june with night float but we still take overnight call q3-5, it's just that there is a dedicated night float team of 2 interns and one uppper year that does most of the cross cover and admissions for one 'shift' during the night. when I'm on I still cover my team and do admissions for the other shift. It's a good system in that I should get a little sleep if all my patients are tucked away but it's a far cry from some programs that send you home at 8 pm.

 

[Magree]

Hey intern in waiting:

Most places seem to stop admitting at some time like 9 or 10pm after which I presumed the night-float took over. Is that how it works for you? Do you get much sleep or are you still working all night? I've never heard of a program that sent you home at 8pm.

M-

 

[intern in waiting]

there's 3 shifts each night 4pm-9pm, 9pm-2am, 2am-7am , there's 2 on call teams and the night float team, each one takes a shift for admissions. so if you get the middle shift you're kind of screwed but if you get an end shift and finish admissions quick you can get some sleep. Night float does cross cover and you cover your own team.
There are a significant number of programs (usually medicine community programs) that let you take call till 8pm and then go home-you usually get home around 10pm when you finish the last admission and night float does the rest. I think the community programs use it to draw residents. I really doubt that surgery programs would ever go to this.

 

[droliver]

Night float for surgery is not an embraced principle because of the continuity of care issues that tend to develop when patients are passed off like this.

 

[surg]

I am unaware of any major program that uses a true night float system for the coverage of patients. To cover the two aspects of call separately...
In some hospitals the ER admits either all go to one service or rotate to different services on a set schedule meaning that if you are on 1 in 3 and that service is admitting 1 in 4 you are only personally at risk for true ER stuff about 1 in 12 days of that month if each service has 3 interns (assuming that you didn't set up the schedule to have yourself on each ER admit night by accident!). This might not be true if you use cross cover though.
Cross cover happens in virtually every major program these days due to the lack of resident manpower to create true 1 in 3 schedules using only people from that service (unless they have senior residents taking intern call too, a very suboptimal solution in my estimation). Cross cover means that when you are on call, you take calls not only for your service, but also for another one (or two) services. This dramatically increases your workload in terms of patients and things to remember since you don't know those patients on the other service very well. Also because there are fewer interns on each service it means you are more likely to be on when your service is admitting from the ER as well. The upside is that there is fewer nights in house (relative to covering the service with only two interns going q2) More sleep at home balanced by less sleep in the hospital...
From a workload perspective, probably the most important thing that decreases workloads is having a dedicated trauma team that takes trauma 24-7. It is very busy when you are on trauma, but otherwise the general surgery teams keep getting pulled down to the ER in the middle of the night to deal with it, completely destroying your night.
Sorry I couldn't answer your question directly, hopefully this will help you seek out a sane program in regards to work hours.

 

[droliver]

agreed

 

[Winged Scapula]

I too am unaware of any major or even minor shift toward general surgery programs using a night float system. As for ER hits, we rotate admissions on an Attending Basis; so if you are on call the night your attending is on call for ER/Trauma, the admission comes to your team if its a true General Surgery problem (ie, not a known Colorectal, CT, etc. patient). Fortunately for me, its mostly the Trauma attendings who do the admitting, with the rest of the General Surgery attendings splitting the rest of the nights, so its not too bad if you aren't on Trauma.