Weekend/Night Coverage in Gen Surg Residency

[Dares Dareson]

Hi, guys. I'm taking an informal poll of general surgery residents. For those of you in night float systems, do your chiefs/PGY5s work weekends or nights? In my program chiefs do not work any weekends whatsoever. I'm wondering how common this is. Thanks.

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[mikeGR]

Hi, guys. I'm taking an informal poll of general surgery residents. For those of you in night float systems, do your chiefs/PGY5s work weekends or nights? In my program chiefs do not work any weekends whatsoever. I'm wondering how common this is. Thanks.

Never heard of chiefs not taking weekend call.

 

[ThoracicGuy]

Hi, guys. I'm taking an informal poll of general surgery residents. For those of you in night float systems, do your chiefs/PGY5s work weekends or nights? In my program chiefs do not work any weekends whatsoever. I'm wondering how common this is. Thanks.

Must be nice...

 

[Miles Gloriosus]

that happens b/c the chiefs abusing their power making the call schedule or is that a formal scheduling thing for the program?

When you say they take no call, you mean they take no in-house call? Not even home call with a junior resident in house?

I suspect that an attending has heavy involvement on call, like an attending on duty in the hospital 24/7. In my academic center at a level 1 center when I was in training that was the set up. An attending would take a 24 hr shift with a pgy4 and pgy 2/3 + pgy1 on their trauma rotations.
Night float covering non-trauma GS was a pgy3 with two pgy 1 or 2s. The chiefs were not in house but could come in (not that often) if one their service patients had an emergency post op complication.

Vascular was a separate department/service from GS with their own team.
GS night float resident would call transplant fellow if there was an issue with transplant patients.

 

[LucidSplash]

I took home call as a chief when on service for one of the tertiary hospital services. I typically only came in to operate or if the in-house senior is especially concerned about a patient/unsure if they needed to go to OR. When on the community services, still took home call but would go see consults overnight if needed to be seen to determine if needed overnight OR. Standard gallbladder etc we would see in the am.

Chief year is supposed to be training wheels for practice. So it makes sense for chiefs to take home call. But not to take any call? More than a little odd, unless there’s something else about the schedule that isn’t being communicated. Is it just a certain rotation?

 

[droliver]

Just for context… I had 6 mos Q2 in house call at a level 1 trauma center as a PGY5. 😵‍💫

 

[Smurfette]

Usually the chief or the senior resident would round on the weekend in my program with 1-2 of the juniors.
Chiefs took home call, except on trauma. Trauma was q3 in house. For everything else, you were expected to come in for anything operative or if SHTF/back up requested.

 

[Dares Dareson]

I took home call as a chief when on service for one of the tertiary hospital services. I typically only came in to operate or if the in-house senior is especially concerned about a patient/unsure if they needed to go to OR. When on the community services, still took home call but would go see consults overnight if needed to be seen to determine if needed overnight OR. Standard gallbladder etc we would see in the am.

Chief year is supposed to be training wheels for practice. So it makes sense for chiefs to take home call. But not to take any call? More than a little odd, unless there’s something else about the schedule that isn’t being communicated. Is it just a certain rotation?

We have a night float system here, and are on a 13 blocks (as opposed to monthly). The fifth years take one block of in house night float along with a junior resident but otherwise work literally no weekends and no nights. For the rest of the year, night float is covered by a 3rd or 4th year as senior who staffs with the attending and weekend days and nights are covered by 3rd and 4th years reporting directly to the attending. It is like this for every rotation.

I think what happened is, we had fewer residents until our cohort expanded this year, and the fifth years would work nights and weekends just like fourth and third years. But this is the first year we have more residents after the ACGME approved increase in our compliment and now the fifth years are not needed to establish minimal coverage. The fifth years have been incredibly lazy this year, not even covering weekends when someone is out sick or someone has a fellowship interview or something like that.

Also, at one of our two clinical sites, chiefs are not allowed to board or start cases without an attending present. Additionally, we have a tradition of anyone staffing consults with the attendings; they do not really care if it is an intern or a chief resident.

I'm a fourth year about to be fifth next year, and while the prospect of working a five day work week sounds nice, it just does not seem right, both in terms of my learning, the knowledge I would like to give to junior residents, and experience in the OR.

I'm thinking maybe the solution is to have a chief resident on home call a week at a time and consults are staffed with him or her? Is that how most places do it? I'm pretty sure our attendings would enjoy not being woken up at night. The 3rd and 4th year residents, however, would probably miss scrubbing cases that come in overnight, however. Some of my best experiences were as a 3rd year covering night call and scrubbing with the attending.

 

[Dares Dareson]

that happens b/c the chiefs abusing their power making the call schedule or is that a formal scheduling thing for the program?

When you say they take no call, you mean they take no in-house call? Not even home call with a junior resident in house?

I suspect that an attending has heavy involvement on call, like an attending on duty in the hospital 24/7. In my academic center at a level 1 center when I was in training that was the set up. An attending would take a 24 hr shift with a pgy4 and pgy 2/3 + pgy1 on their trauma rotations.
Night float covering non-trauma GS was a pgy3 with two pgy 1 or 2s. The chiefs were not in house but could come in (not that often) if one their service patients had an emergency post op complication.

Vascular was a separate department/service from GS with their own team.
GS night float resident would call transplant fellow if there was an issue with transplant patients.

Yes I mean literally no call (see above). I think it is because our trauma attending is always in house and the general surgery attendings expect to get calls to staff throughout the night. Our chiefs, except for the one block they do in house night float, have zero involvement on nights and weekends. I'm not sure there is another program in the world that does it that way.

It has really affected morale of the program generally and no one looks up to our chiefs as leaders. Especially when they don't even cover for people who are out sick. But I am not here to bitch about it, what's done is done this year. I will be a chief next year and while I do like the prospect of having every weekend off but I'd rather continue to grow as a surgeon and do a good job. I'm looking for ways to accomplish this.

 

[ThoracicGuy]

We have a night float system here, and are on a 13 blocks (as opposed to monthly). The fifth years take one block of in house night float along with a junior resident but otherwise work literally no weekends and no nights. For the rest of the year, night float is covered by a 3rd or 4th year as senior who staffs with the attending and weekend days and nights are covered by 3rd and 4th years reporting directly to the attending. It is like this for every rotation.

I think what happened is, we had fewer residents until our cohort expanded this year, and the fifth years would work nights and weekends just like fourth and third years. But this is the first year we have more residents after the ACGME approved increase in our compliment and now the fifth years are not needed to establish minimal coverage. The fifth years have been incredibly lazy this year, not even covering weekends when someone is out sick or someone has a fellowship interview or something like that.

Also, at one of our two clinical sites, chiefs are not allowed to board or start cases without an attending present. Additionally, we have a tradition of anyone staffing consults with the attendings; they do not really care if it is an intern or a chief resident.

I'm a fourth year about to be fifth next year, and while the prospect of working a five day work week sounds nice, it just does not seem right, both in terms of my learning, the knowledge I would like to give to junior residents, and experience in the OR.

I'm thinking maybe the solution is to have a chief resident on home call a week at a time and consults are staffed with him or her? Is that how most places do it? I'm pretty sure our attendings would enjoy not being woken up at night. The 3rd and 4th year residents, however, would probably miss scrubbing cases that come in overnight, however. Some of my best experiences were as a 3rd year covering night call and scrubbing with the attending.

When I was in training, staff, particularly at the university hospitals would want to know about new consults and whatnot. I don't think they would give that up to calling a chief. This plan is something you will need to discuss with your attendings. Perhaps if you had one attending that you could bounce ideas off and see how they respond before doing anything more. You'll likely rock the boat with your fellow residents, though, who will see you as ending a nice benefit. Will that be worth it? Only you can answer that.

 

[TypeADissection]

I had a similar experience to many above. Halfway through my residency we got busted badly for work hour violations. We were on the old call system and it was expected that you would hang around post-call to cover some cases. So many of us were stretching out to 30+ hours straight in the hospital. When they audited our a$$es, they can see when we timestamp our orders on EPIC so it was fairly easy for them to put the pieces together. Probation got handed down and we transitioned to a night float system.

Long story short, everybody took call. As the administrative chief, I was always fair and made sure everyone got the same number of weekends. More importantly, I also made sure that I didn't avoid putting the weaker junior residents on with me. I'm 5 years out of gen surg and 3 years out of vascular and it all seems like a whole different lifetime ago now. Crazy how long and painful those nights were, yet how fast those years flew by.