Typical call night as residents

[codeb1ue]

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Just curious, what is a typical call night like in Anesthesiology residency? Particularly how busy it is, the stress level, how many of you are usually together? Are you typically just getting paged when an emergent trauma case comes in? Code blue intubations? OB epidurals? If multiple cases come in, are their backup residents that usually get called in? What if none of those are going on during the night... are you getting paged for any other things? Inpatient pain service issues?

I am currently a 2nd year IM resident contemplating the switch from IM to Anesthesiology and just wanted to get a sense of what I'm getting into. Like most people, I hate being on call overnight, usually alone trying to deal with new admissions while getting paged nonstop by nurses and pharmacists for the multiple patients you are cross-covering about order clarifications, any slight change in vital signs, etc.

 

[Idiopathic]

every place is different. our residents deal with a fair amount of trauma, floor/ICU intubations and codes, levelled cases (appys, etc.) and pain calls (epidural beeping, pain poorly controlled after femoral catheter, etc), but NO ADMISSIONS and NO PAGES FOR DIET ORDERS!!

we also have a separate OB team, I know some places have it all lumped in together

 

[G-Man82]

At my place, we're a major trauma center in the inner city. There are a total of 2 attendings plus 5 residents (sub in 1-2 CRNAs occasionally) each night. One resident (no CRNAs permitted to do OB) and one attending are dedicated to L&D. The other team manages the main OR: Level 1 traumas that go to the OR and other emergent cases, such as "emergent" D&C/D&Es, appys etc. The pain pager is also our responsibility. If there are pre-ops to be done (also no CRNAs permitted), the first year resident typically does them. The code pager is carried by 2nd year or higher residents or CRNAs, though if a first year goes with them, typically they can do the airway. Some nights it can be really busy with 3 rooms running b/c of multiple traumas, some nights not nearly as bad.

Here's what I love to NOT have to do now that I'm no longer a medicine prelim: no stupid diet orders for the AM (never understood why those were considered urgent enough to call nightfloat), no order clarifications (basically told pharmacy to page someone else each time), no calls for BS pain from drugseekers who just want their percocet fix. No running from one end of the hospital to the other all night. No BS calls from the ER for admissions. No random consults from ortho because of HTN (130/90), or AMS (pt on dilaudid pca that they inappropriately set).

Hope that helps. The residency is tough - I think my hours are actually tougher than medicine, but definitely more regular. Hope that helps.

 

[Lightwand]

Just as idiopathic said, it's different everywhere.

In my residency we tend to be fairly busy at night and it isn't uncommon to run rooms all night long.
Overnight we have a CA1, CA2, CA3, attending, plus 2CRNAs. We have bunches of CRNAs that peel out at 7/9/11.

As residents we take 24 hour call.
CA1's do training-level appropriate cases, lots of appys, choles, ortho and as the year progresses they start taking some of the bigger cases.
CA2's do index cases, peds, neuro, level 1's, major vascular, anyone super sick. Also go to airways with the CA3 when not in a room.
CA3 acts as a junior attending. Helps run the board, goes for all inductions/wake ups. Carries the trauma pager, carries the airway pager (for codes and ICU/floor intubations). Manages the PACU.

Some nights we run rooms all night long, other nights there might not be any cases after midnight. Depending on the case mix and your training level, you might be running your ass off all night or you may be sleeping 8 hours.

We have separate OB, separate acute pain, separate heart call.

But we're never getting called about colace, restraint renewals, home med issues or any of that other nonsense!

 

[DreamLover]

At my place, we're a major trauma center in the inner city. There are a total of 2 attendings plus 5 residents (sub in 1-2 CRNAs occasionally) each night. One resident (no CRNAs permitted to do OB) and one attending are dedicated to L&D. The other team manages the main OR: Level 1 traumas that go to the OR and other emergent cases, such as "emergent" D&C/D&Es, appys etc. The pain pager is also our responsibility. If there are pre-ops to be done (also no CRNAs permitted), the first year resident typically does them. The code pager is carried by 2nd year or higher residents or CRNAs, though if a first year goes with them, typically they can do the airway. Some nights it can be really busy with 3 rooms running b/c of multiple traumas, some nights not nearly as bad.

Here's what I love to NOT have to do now that I'm no longer a medicine prelim: no stupid diet orders for the AM (never understood why those were considered urgent enough to call nightfloat), no order clarifications (basically told pharmacy to page someone else each time), no calls for BS pain from drugseekers who just want their percocet fix. No running from one end of the hospital to the other all night. No BS calls from the ER for admissions. No random consults from ortho because of HTN (130/90), or AMS (pt on dilaudid pca that they inappropriately set).

Hope that helps. The residency is tough - I think my hours are actually tougher than medicine, but definitely more regular. Hope that helps.

My residency was similar-

2 seperate teams OB and Trauma for main call, plus there were people on call for 3 different ICUs, Peds and Hearts.

OB and Trauma were each a jr and sr resident plus an attending, we also had an 11-7 CRNA for late night non emergent/trauma cases etc.

The trauma team would carry the code pagers and go to all codes, level one traumas in the trauma bay and do floor/ICU intubations.

The OB Sr would carry the pain pager and field all of those calls and do consults etc.

Some nights would be crazy all night and sometimes not so much, but overall we were pretty steady and I was tired post call almost 100% of the time.

All in all, I enjoyed doing this as a team model and it was our motto to work as a team (Jr/Sr resident) and if at all possible, never go alone (To a code/Trauma/Intubation etc) We were a relatively large residency so we were amazingly able to cover all of this call and still have a great lifestyle. BUT I am SO glad to be finished and working and all my call except OB is from home and not nearly as crazy as it was in residency....a very nice change of pace!!

Good Luck!!

 

[CrazyShadowDog]

.

 

[DreamLover]

Q-what? At my institution here, anesthesia takes Q4 call during their OR months, heard it can vary greatly.

Ours varied....We took more call as a CA-1 and by CA-3 we were taking the least amount of call, so we were what you would call a "Front loaded" program. As a CA-1 on main OR months, you may have 4-6 calls/month (mixed between trauma and OB) Our ICU months were Q 3 with our post call days off, and our Peds months were Q 4. Our Heart call was from home, about 1 weekday/week and one weekend/month. By CA-3 year, we had fewer months of main OR (More time for electives) and our Main OR month calls were more like 2-3/month.

We did several ICU months though, so we certainly took our fair share of call. But it was all manageable and much more tolerable than my intern yr of medicine with 10 months of Q4 call (Barf)

But honestly, pick a specialty because you can see yourself doing that for 30 years...not based on what a couple years of call are going to be like!

I wish you luck and again...I am glad that I am through that portion of life 🙂

 

[TrustMe]

We had 2 teams on each night. 2 residents and an attending covering the OR's and 2 residents and an attending covering OB. The Jr. OR resident would have the code pager for codes and intubations and the Sr. would go with them if not in the OR. Nights were variable as others have said, although we were not a Level 1 trauma center so we didn't have to worry about that side at night.

CA-1/2 yrs we had 5-6 calls/month except on pain and ICU months. Pain was home call and ICU months were usually 6-8/month. CA-3 we took less OR call (3-4/month). I have had nights where I was too tired to drive home and would sleep in the call room for 3-4 hrs post-call and then go home and go to bed. And I have had nights that I slept 6-8hrs and went home and was up all day.

I would do transplants and ruptured AAA's all night any night if it meant never getting paged at 3am for colace orders on a sleeping pt. or for the nurse to make me aware of normal vital signs from 3 hrs ago.

Good luck with your transition.

 

[RussianJoo]

at my program our call schedule is pretty light. CA-1's have 3 calls per month, CA-2's have 2 calls a month and CA-3's have 1 call a month during our OR rotations, in the SICU we're Q4. Sometimes if you do something really stupid the PD will punish you by giving you an extra Saturday call. When on call we do OB only, (which kind of sucks), there are 2 of us a CA-1 and either a CA2 or 3, we work as a team, i.e. as one person. Usually the senior resident will do the paper work as the junior resident does the epidural, that way by the time the epidural is done so is all the paper work and we can go back to sleep, mostly the senior is there for supervision or if the junior needs help. for c-sections the senior will float in and out of the room once the case gets started... We also have a CRNA on OB call with us and an attending, The attending we almost never see, he just floats around eventually and co-signs the charts. We rotate epidurals and C-sections with the CRNA.

We also have an attending on call in the main OR but he works with CRNA's they do all the overnight cases, emergencies and code blue intubations. I personally wish it was the other way around. With Trauma we have designated trauma months when we just work nights and do all the traumas.

OB call can be hit or miss but I usually get at least 3 hours of sleep. The best part of being on call in anesthesia, and I am surprised no one has mentioned this yet, is I am relieved at 6:30am sharp by the morning person and am usually home by 7am on my post call day. No rounding post call, at least not during our OR months. SICU call is pretty busy with patients trying to die on a nightly basis, and then you do have to round post call and stay till the noon lecture (cause sometimes you'll be the one giving the noon lecture).

 

[drccw]

at my program our call schedule is pretty light. CA-1's have 3 calls per month, CA-2's have 2 calls a month and CA-3's have 1 call a month during our OR rotations, in the SICU we're Q4. Sometimes if you do something really stupid the PD will punish you by giving you an extra Saturday call. When on call we do OB only, (which kind of sucks), there are 2 of us a CA-1 and either a CA2 or 3, we work as a team, i.e. as one person. Usually the senior resident will do the paper work as the junior resident does the epidural, that way by the time the epidural is done so is all the paper work and we can go back to sleep, mostly the senior is there for supervision or if the junior needs help. for c-sections the senior will float in and out of the room once the case gets started... We also have a CRNA on OB call with us and an attending, The attending we almost never see, he just floats around eventually and co-signs the charts. We rotate epidurals and C-sections with the CRNA.

We also have an attending on call in the main OR but he works with CRNA's they do all the overnight cases, emergencies and code blue intubations. I personally wish it was the other way around. With Trauma we have designated trauma months when we just work nights and do all the traumas.

OB call can be hit or miss but I usually get at least 3 hours of sleep. The best part of being on call in anesthesia, and I am surprised no one has mentioned this yet, is I am relieved at 6:30am sharp by the morning person and am usually home by 7am on my post call day. No rounding post call, at least not during our OR months. SICU call is pretty busy with patients trying to die on a nightly basis, and then you do have to round post call and stay till the noon lecture (cause sometimes you'll be the one giving the noon lecture).

Wow dude... you're in a pretty cush place it sounds like...but how much freakin' OB does your hospital do....

3 residents+CRNA each night on OB????
1 in 10 call as a CA1, 1:15 as a CA2, 1:30 as a CA3??

No cases at night? Damn....

that's better than I have it as an attending....

Where are you? I'm leaving private practice...

drccw

 

[JSBMD]

I would have serious worries about lack of clinical experience in that program if I were you RussianJoo.....

 

[RedAnesthesia]

at my program our call schedule is pretty light. CA-1's have 3 calls per month, CA-2's have 2 calls a month and CA-3's have 1 call a month during our OR rotations, in the SICU we're Q4. Sometimes if you do something really stupid the PD will punish you by giving you an extra Saturday call. When on call we do OB only, (which kind of sucks), there are 2 of us a CA-1 and either a CA2 or 3, we work as a team, i.e. as one person. Usually the senior resident will do the paper work as the junior resident does the epidural, that way by the time the epidural is done so is all the paper work and we can go back to sleep, mostly the senior is there for supervision or if the junior needs help. for c-sections the senior will float in and out of the room once the case gets started... We also have a CRNA on OB call with us and an attending, The attending we almost never see, he just floats around eventually and co-signs the charts. We rotate epidurals and C-sections with the CRNA.

We also have an attending on call in the main OR but he works with CRNA's they do all the overnight cases, emergencies and code blue intubations. I personally wish it was the other way around. With Trauma we have designated trauma months when we just work nights and do all the traumas.

OB call can be hit or miss but I usually get at least 3 hours of sleep. The best part of being on call in anesthesia, and I am surprised no one has mentioned this yet, is I am relieved at 6:30am sharp by the morning person and am usually home by 7am on my post call day. No rounding post call, at least not during our OR months. SICU call is pretty busy with patients trying to die on a nightly basis, and then you do have to round post call and stay till the noon lecture (cause sometimes you'll be the one giving the noon lecture).

I agree JSBMD in that your program appears to be lacking clinical experience. Going from residency to being an attending is going to be a challenge for you as it appears the workload is so light. Additionally, I would be pissed as a resident if my program allowed CRNAs to do code blue, emergencies and overnight cases. How much OB do you really need if that is all you do on call?

My program is a workhorse program and I would put up our clinical experience with any program in the country. The call schedule is about 4 to 5 overnight call(24hr call) a month and we have about 2 or 3 late calls (last resident out that is not overnight which usually translates in being out between 7-9pm) a month. Most resident who aren't late or overnight call get out anywhere from 4:30 to 6:00pm. Two residents, one crna and one attending on call at night. There is one junior resident with one senior resident. Upper level residents have same amount of call as do junior residents so it is not a front loaded. Duties of call include performing overnight emergencies, responding to traumas that come into the ER, stat intubations, code blue,transplants, as well as covering any questions regarding non-OB epidurals. Junior resident carries an ASCOM phone as does attending so it is easy to pick up the phone and call for help if needed. The medical center is one of the biggest transplant centers in the country for liver, pancreas, small bowel and kidney. Our OB team is separate from the general OR team and has their own separate call schedule. There is an attending that supervises the OB resident during the day, however, the general OR attending supervises the OB resident at night which can make it challenging for the attending if stat c-sections occur during a liver and trauma.

 

[RussianJoo]

Wow dude... you're in a pretty cush place it sounds like...but how much freakin' OB does your hospital do....

3 residents+CRNA each night on OB????
1 in 10 call as a CA1, 1:15 as a CA2, 1:30 as a CA3??

No cases at night? Damn....

that's better than I have it as an attending....

Where are you? I'm leaving private practice...

drccw

not too much OB I think ~6,000 deliveries a year. and it's only 2 residents a senior and a junior who basically work as one, i.e. one senior resident could handle everything on their own, but the junior is there to learn.

I don't know what the call is like for attendings but they don't pay that much and i don't think the call schedule is that good.

 

[RussianJoo]

I would have serious worries about lack of clinical experience in that program if I were you RussianJoo.....

Funny, cause all I hear from residents that have graduated and current seniors about to graduate is how much experience and knowledge they have. The last years graduating class all passed their writtens and it's been that way for many years. Many get great jobs, 2 years ago 2 graduates got $500K a year jobs in North Dakota Those that graduated in June said that their regional experience made them very attractive to places where they interviewed for jobs.

We rotate at two Level 1 trauma hospitals in a crime filled midwest city. Most of the patients are ASA 3 or sicker, and are having surgery because they're not complaint with treatments and would rather spend their money on booze and drugs than on medications. Many have never seen a doctor. A lot of our surgeons suck and a lot of times have to go back and re-open a few days later. So I am not worried about training or experience, the call is the only bad thing. We don't carry the code pager because well we don't have an extra free resident at all times and we need to have a free resident at all times if you want to have the code pager, we're all either in rooms or taking care of pacu/pre-op area and can't leave.

The hospital where we do call doesn't get traumas so a lot of the overnight cases aren't major and just stuff that spilled over from that day, so nothing really new or different then the day to day stuff. We do a few months of just nights in our trauma centers where we get plenty of action from the knife and gun club. Yes our program isn't a work horse like some others (we work on average 60 hours a week), but this gives us plenty of time to read, something that a true work horse program lacks.

I am at a university program so there are definitely worse places out there.

 

[RussianJoo]

I agree JSBMD in that your program appears to be lacking clinical experience. Going from residency to being an attending is going to be a challenge for you as it appears the workload is so light. Additionally, I would be pissed as a resident if my program allowed CRNAs to do code blue, emergencies and overnight cases. How much OB do you really need if that is all you do on call?

My program is a workhorse program and I would put up our clinical experience with any program in the country. The call schedule is about 4 to 5 overnight call(24hr call) a month and we have about 2 or 3 late calls (last resident out that is not overnight which usually translates in being out between 7-9pm) a month. Most resident who aren't late or overnight call get out anywhere from 4:30 to 6:00pm. Two residents, one crna and one attending on call at night. There is one junior resident with one senior resident. Upper level residents have same amount of call as do junior residents so it is not a front loaded. Duties of call include performing overnight emergencies, responding to traumas that come into the ER, stat intubations, code blue,transplants, as well as covering any questions regarding non-OB epidurals. Junior resident carries an ASCOM phone as does attending so it is easy to pick up the phone and call for help if needed. The medical center is one of the biggest transplant centers in the country for liver, pancreas, small bowel and kidney. Our OB team is separate from the general OR team and has their own separate call schedule. There is an attending that supervises the OB resident during the day, however, the general OR attending supervises the OB resident at night which can make it challenging for the attending if stat c-sections occur during a liver and trauma.

I am only a CA-1 and we don't stay late because we can't do many of the cases that run late to help out, As CA-2s and 3's we stay late which like at your program is 7-9pm, The earliest I've gotten out was 4pm, usual day gets me out at 5pm then I have to do my post-ops and maybe a pre-op or two, so I don't leave the hospital till about 5:30 on average, As CA-2's and 3's we'll sometimes come in at 4am to start a room early, sometimes stay till 11 at night to finish a room. The two things we lack are transplants and code blue intubations, but we intubate plenty of people on the floor during our SICU rotations, and sometimes the attending will tell us (the seniors) to go to the ER for a stat intubation.

It sounds like your call is pretty light if only 2 resieents one CRNA and one attending can cover so many different places. What happens if there's a code blue and you're all busy? it wouldn't take much to tie up 4 people, especially if one is a CA-1 and needs more help than usual. the code blue doesn't get tubed? At my place I guess we have a little more supervision because attendings or seniors are always present for things like induction, or any procedure (so that ties up two people right there.) I am sure my program isn't as great as yours but we're not hurting for numbers, during our regional months, we do 10-15 blocks a day.

It's mid September of my CA-1 year and I've done 187 cases, that's over 15 cases a week. Is that light?? I don't know, while at work I don't really have an extra minute to use the bathroom unless someone breaks me which is usually just a 30min lunch.

Seniors take the same amount of call as juniors? that sucks, especially when you should be at home studying for the boards and are stuck doing some bs case cause you have such frequent call as a senior and they need to have multiple rooms running.

 

[JSBMD]

I think you were trying to sugar-coat your residency call experience, RJ.

That's why I said sounds like not enough experience to me. Now that you are expanding on the program, it's starting to sound more like a residency.

Realize that you only get three years to learn and see things as a resident with a safety net of experienced attendings beneath you. After that, your safety net becomes your malpractice insurance. Not a great time to be seeing things for the first time. That is one of the beauties of "tough call". Programs often allow a bit more independence during call nights. This allows residents to gain confidence at trying things and problem-solving (sort of) on your own.

Believe me, you will know what I'm talking about when you push propofol on your first case post-residency....

 

[RussianJoo]

I get plenty of independence right now.. Our first day on July 1st the attending was there for 5min during induction and I never saw him again, when I paged him for emergence he sent a senior resident. That's how it is everyday, We trouble shoot first and a lot of times have to call multiple times to get help, of course if we call overhead for "any available anesthesia attending to OR STAT" we get our whole department in the room in under 1 min. But still they throw us in the deep end and see how we do.

And I really wasn't sugar coating our call. Our call really sucks cause it's boring, but it's really easy, i mean seriously how many epidurals or c-sections can you do, I've already done over 30 epidurals and I am only like 10 weeks into residency, on call i literally do them in my sleep... I wish we had call in the main OR with some real cases but don't and never had, luckily there's plenty of action during the day and besides our call is pretty infrequent.

I guess it will be a tough transition to being an attending when I have to take call more frequently then I do now....

 

[OB1🤙]

RJ- you need to raise holy hell with your program to get that changed. That setup is just flat out wrong for an academic analogy program. You're being hugely shortchanged in your education to make the overnight call attending's life easier.

 

[RussianJoo]

RJ- you need to raise holy hell with your program to get that changed. That setup is just flat out wrong for an academic analogy program. You're being hugely shortchanged in your education to make the overnight call attending's life easier.

I'll try to raise some attention when we have our evals however it's tough to make a change unless there's a set plan in mind. I'll offer the plan that we trade places and have 2 CRNA's cover OB and the residents cover the main OR but the PD said they've tried that before and it didn't work out well so we'll see.

 

[OB1🤙]

The way to hardball it if they aren't receptive is to bring up the acgme survey. Say the residents collectively agree that service is getting in the way of education, which is an item on the acgme survey that will be scrutinized in the program's evaluation and ultimate accreditation. If you're being made to cover your bazillionth epidural while elsewhere crnas are doing traumas, emergency cases, and floor intubations, which have obvious educational value, say that will no longer be seen by the residents as acceptable. If they don't agree to change, you'll need buy-in from your co-residents to all actually say as much on the acgme survey.

The problem with this is that whoever raises the issue will inevitably suffer from being labeled a trouble-maker by the faculty, so I'd discuss it with your seniors and chiefs.

Cuz seriously, educationally valuable things are going on while you putz around on ob call for three years, and that ain't cool.

 

[dhb]

RJ- you need to raise holy hell with your program to get that changed. That setup is just flat out wrong for an academic analogy program. You're being hugely shortchanged in your education to make the overnight call attending's life easier.

The way i see it he's getting plenty (too much?) independence and good clinical experience with a sweet call deal.
Call is a btch and i never though there was much to learn doing train wrecks after being awake for 16h.
So my advice don't rock the boat, if you want to take extra call just go hang out with the OR attending on fridays or saturdays.

 

[RussianJoo]

The way to hardball it if they aren't receptive is to bring up the acgme survey. Say the residents collectively agree that service is getting in the way of education, which is an item on the acgme survey that will be scrutinized in the program's evaluation and ultimate accreditation. If you're being made to cover your bazillionth epidural while elsewhere crnas are doing traumas, emergency cases, and floor intubations, which have obvious educational value, say that will no longer be seen by the residents as acceptable. If they don't agree to change, you'll need buy-in from your co-residents to all actually say as much on the acgme survey.

The problem with this is that whoever raises the issue will inevitably suffer from being labeled a trouble-maker by the faculty, so I'd discuss it with your seniors and chiefs.

Cuz seriously, educationally valuable things are going on while you putz around on ob call for three years, and that ain't cool.

Wow thanks a lot for the great idea I totally didn't know this, I guess cause I haven't done one yet, the good thing is all residents in our program stick together and cover each others backs' so I'll talk to my class (we're super tight, go out and get drunk a few times a month) ,,and the chiefs and see what they think and then maybe post a "pledge" letter for all the residents to sign, stating that they pledge to write about this in their ACGME survey..,

To be honest i am trying to be chief one day and I've already gotten involved with the department, you know getting stuff done for my fellow residents, basically bugging our secretary about our educational fund money and call money and making sure that we don't get screwed out of it. They don't seem too pissed with me, one secretary is very pro-resident, trying to give use extra personal days off. Like we'll request a day and she'll mark it in our schedule but not take a vacation day away from our total days off. So I have inside help, and they look at it as the faster they get what i want done the faster i leave them alone.


thanks again. I am going to make a gem of this program, however, it might take firing some CRNAs for that to happen.

 

[RussianJoo]

The way i see it he's getting plenty (too much?) independence and good clinical experience with a sweet call deal.
Call is a btch and i never though there was much to learn doing train wrecks after being awake for 16h.
So my advice don't rock the boat, if you want to take extra call just go hang out with the OR attending on fridays or saturdays.

Great Idea, I it totally never crossed my mind.. If a cool attending is on call and I have the weekend off just take call on friday night. And of course it helps if you have some skills and don't hold things up. I'll definitely take a look at the attending call schedule.

 

[dhb]

Great Idea, I it totally never crossed my mind.. If a cool attending is on call and I have the weekend off just take call on friday night. And of course it helps if you have some skills and don't hold things up. I'll definitely take a look at the attending call schedule.

👍

 

[RussianJoo]

So maybe someone can give me more ideas... I talked to two attendings that are younger and known to be more about resident education in my program. One had no problem with me doing lines, emergency floor intubations and other stuff that happens at night, and even last night allowed me to check the placement of a double lumen tube with a fiberoptic and put in a swan in the IJ this morning.

The other guy wasn't as enthusiastic but allowed me to be on call with him, when I asked him about doing cases he said that wouldn't happen simply because if I was in a room, then he wouldn't be able to supervise any other CRNA. I am sure the first dude won't put me in a room as well, not because I suck and they don't trust me, but because if **** hits the fan I am only a CA-1 or maybe it's the groups policy for the attending to not supervise both CRNA's and residents at once.

Seems kind of messed up that at most places attendings can only supervise 2 residents at a time while they can supervise 4 CRNAs at once...

Also it seems that at my program the attendings don't want to step on CRNA toes. For example I also wanted to do the A-line for that CABG this morning but the attendings said that the CRNAs do the a-lines, when I asked one of them why they allow the CRNAs to do them, he ignored my question.

I'll still comment about this to the ACGME when I meet with them but at the same time I don't want to stir the boat too, all the residents tell me that we shouldn't rock the boat too much and just get through the residency, that nothing will change and it might only make it harder for you to graduate, but I really want our call to change and think we should be in the OR at night.

 

[fakin' the funk]

Before this turns into the "rip on RJ's program" thread I thought I'd chime in for the OP.

We have a main OR (1 attending, 2 residents, 1 resident on home pager call) and OB call team (1 attending, 1 resident).

Main OR handles all "scheduled" OR cases which on weekends can be none or can go until 10pm, all add-ons, intubations and codes. Sometimes we sleep all night, sometimes we are doing "scheduled" lap choles at 2am, sometimes we are doing hemorrhagic shock gangbangers. Sometimes we just hang out and watch movies and play video games; we have great camaraderie among residents and between res/attg so a "slow" call night ends up being a fun call night.

If there are no cases, there is only airway/code to get paged about, which is rare (<1/shift). Hearts and liver transplants go to a separate home-call team; regional/pain are separate services.

OB is the usual, fairly slow/quiet during the day then epidural/C-section fest usually from 10p-7a.

 

[nervous student]

To the OP and RJ
Our schedule is three residents in the main OR (one resident from each CA year) and one attending and then one resident and one attending on OB overnight.

No CRNAs ever take call and the latest they work is 8pm (only in the main OR) Usually there are rooms running for most of the night. Once we are down to two rooms the CA-1 and CA-2 will be in the rooms and the CA-3 runs the PACU and breaks out the juniors. At night we respond to all traumas (we are a level one trauma center) all codes, carry the pain pager and do preops. Mostly we are all up for the majority of the night. Amazing clinical experience!

On OB there is only one resident all night (and we do 9000 deliveries a year). Per night we do about 6-10 epidurals and a couple c-sections so 5 nights in OB and you have your minimums!

Overall OP you can see call varies and RJ you are not getting a great clinical experience.....well I guess it depends what kind of place you want to be when you finish.

 

[BobBarker]

"The CRNAs do the art lines."

That really makes my blood boil. You are in a tough situation. If you push too hard they will blackball you to oblivion.

 

[RussianJoo]

To the OP and RJ
Our schedule is three residents in the main OR (one resident from each CA year) and one attending and then one resident and one attending on OB overnight.

No CRNAs ever take call and the latest they work is 8pm (only in the main OR) Usually there are rooms running for most of the night. Once we are down to two rooms the CA-1 and CA-2 will be in the rooms and the CA-3 runs the PACU and breaks out the juniors. At night we respond to all traumas (we are a level one trauma center) all codes, carry the pain pager and do preops. Mostly we are all up for the majority of the night. Amazing clinical experience!

On OB there is only one resident all night (and we do 9000 deliveries a year). Per night we do about 6-10 epidurals and a couple c-sections so 5 nights in OB and you have your minimums!

Overall OP you can see call varies and RJ you are not getting a great clinical experience.....well I guess it depends what kind of place you want to be when you finish.

So what happens if you're all in rooms and a code blue is called? who goes to do the intubation? How many attendings are on call with you guys?

 

[nycitygas]

RJ do you work in pittsburgh? I think I interviewed at your program.
I take call @ 3 different hospitals. Two of them are set up with
1 att/ 1 res covering OB (usually a CA2) and an OR team made up of an attending a CA 1 and a CA2/3. The CA1 is the "OR" resident and the upper year is the PACU. The CA1 runs the room, the senior resident covers the PACU, floor intubation, helps out with cases, ect. There is a separate cardiac/transplant/pediatric beeper call.
The other place is 3 residents on CA1 (OR), CA2(PACU), and a CA3 (Team captain). The CA3 for the most part functions as an attending and although it seems redundant, is a huge help with all the **** that comes through there.
OB call at either place is hit or miss. OR call on the weekends at the non-trauma places can be very chill or very busy. I've had saturday day calls when ive done maybe 2 hours of work and 22 hours sleeping and watching movies. At the trauma center, call sucks bc u have to respond to trauma codes regardless if they are operative or not.
Taking OB call x 3 years would be boring after three years but I guess its good experience. CRNAs putting in the art line over you is absolutely wrong and should be brought up.

 

[nervous student]

RJ,

so if we are all in rooms there are at least two attendings since one attending can only cover two of us. If a code blue gets called at that time one of those attendings respond. Usually if three rooms are running two residents are in a room and one attending is covering the other leaving usually the CA3 out for intubations. If there is nothing going on then the ca3 will take the ca1 with them to a code/intubation.

Our hospital is pretty big so we have a ton of resp therapists that get to the code before us and often intubate. We then check them and often have to "reintubate". In the ICUs they call us directly and don't call an overhead code for intubation/cardiac arrest so it's not mass hysteria.

 

[turkeyjerky]

RJ,

so if we are all in rooms there are at least two attendings since one attending can only cover two of us. If a code blue gets called at that time one of those attendings respond. Usually if three rooms are running two residents are in a room and one attending is covering the other leaving usually the CA3 out for intubations. If there is nothing going on then the ca3 will take the ca1 with them to a code/intubation.

Our hospital is pretty big so we have a ton of resp therapists that get to the code before us and often intubate. We then check them and often have to "reintubate". In the ICUs they call us directly and don't call an overhead code for intubation/cardiac arrest so it's not mass hysteria.

Is it really common for RTs to intubate? They don't here and it seems kinda crazy to me.

 

[nycitygas]

At a lot of private hospitals, RTs intubate at code 99s. They are usually not allowed to push any propofol or sux, that has to be done or ordered by a physician.

 

[GasMask]

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