What do you really think of call?

[Igor4sugry]

---

Members don't see this ad.

I have been doing inpatient job at major academic center. The work is interesting and stimulating, challenging as well, but when I factor in our call environment and needs that arise for coverage when someone calls off it is less and less rewarding. The next job I am taking is all outpatient and no call.

I think being on call (have to go in and round on entire 24patient unit and phone call) personally is very draining, its as if you are working 2 weeks straight. Not only do I feel burned out after call (and the 14days on straight), but I also have this dread in anticipation of call (this can be just as bad). Particularly with having kids, I would choose to be home with them vs on call any-day.

Was wondering how much call influenced the type of job you selected (or type of job you left)?
I'm seeing more and more 7 on and 7 off psych job offers (maybe its in response to difficulty finding people to take on inpatient jobs that require call).

 

[PistolPete]

It sucks. I despise call, especially being woken up at night. It's draining for me, which is why my job next summer will have no call or weekends or holidays. I'm wondering if I should even pursue private practice, since most people that I talk to say that they're on call 24/7, 365 days a year! Some partner up with other psychiatrists, which I think is more realistic.

 

[wolfvgang22]

I loathe call. Particularly overnight call. Not because I'm not good at consultations or emergencies, or because I am lazy. In fact, I always feel a sense of accomplishment and enjoy assisting patients and other physicians when they need me most.

However, I learned a long time ago that if I don't get at least 5 hours of sleep, I am not as useful as I could be to my regular patients, and my health rapidly worsens, and I am unable to give 100% to others.

Also, like you, I am always on edge waiting for my phone to ring when on call, because I never want to miss a call and be one minute later to the hospital than I have to be, and never want to make a mistake because I am not fully alert. I am a very heavy sleeper, so nights I am on call I have one eye open rather than actually sleep. My stress level stays high and my health gradually worsens in this scenario, also. So, I avoid doing call as much as possible. Currently I cover ER and hospital C&L consults one week at a time, around the clock. I am paid well, but honestly I would rather make less money than do any call. Maybe others are "tougher" than me, and that's fine.

Too long, didn't read?

 

[675015]

I'm on call right now and as long as the Buckeyes pull out a win in Norman tonight, I'll be content.

Then again, I'm also a resident and probably at the peak of my ability to tolerate 24 hour overnight Saturday calls!

 

[postbacpremed87]

I'm on call right now and as long as the Buckeyes pull out a win in Norman tonight, I'll be content.

Then again, I'm also a resident and probably at the peak of my ability to tolerate 24 hour overnight Saturday calls!

What year are you in? Is your 24 hour call typically slammed beginning to end?

 

[carlosc1dbz]

I did residency call and it was not that bad the last two years because the senior on call went to bed at midnight. Woop! I started moonlighting the last year one overnight per week on Thursday and initially it was hit or miss being able to get some hours of sleep, but then the last few months it was always no sleep. I would feel like a zombie for the next three days. I don't think I will ever do any overnight call ever again. It doesn't pay well enough for the stress on my body. As a matter of fact, I am not sure there would be enough money per hour to make an overnight worth it for me. ..... unless maybe it was my only job and one day per week. 😛

 

[675015]

What year are you in? Is your 24 hour call typically slammed beginning to end?

PGY2/ And it varies. Some nights I get plenty of sleep... tonight is not shaping up to be one of those nights. Just wish I didn't have to do it for 24 hours straight.

 

[Jules A]

I find it intrusive at best and exhausting at worst but can't justify turning down the extra money so I continue doing it. One of the keys is to get to know the staff and have them get accustomed to your style so they know what you will or won't do, no I will not be ordering additional subutex, as well as any diagnostics you are going to request every single time they call you with a certain presentation. If they are bothering you with insignificant things they are probably either inexperienced so you will need to educate them or messing with you because they think you are a tool in which case pizzas and soda probably wouldn't hurt.

 

[nexus73]

Call sucks. Ideally I would have no weekend call obligation, but I work on an inpatient unit and call is required. The trade off is they pay me more. Once loans are paid off, I don't see myself continuing with the current setup.

If you are at an academic center I imagine your pay sucks. I hope you're getting at least $2000 to cover the weekend, at minimum. $3000 is more appropriate, and for 24 patients, $3500-$4000 would be fair.

 

[Psychotic]

24 hour weekend call is the worst. I tolerate shorter call (12 or even 15 hour call) OK, but 24 hours, even if I am not called, or am only called once or twice, is draining.

Last night I was backup, and I still got called, of course in the dead middle of the night. The resident on call didn't answer his phone fast enough for the hospital, and they called me. It got sorted out very quickly, but damn, I hate call.

I am a resident now, and I will NOT accept a job after residency with call obligations, certainly not 24 hour call. I don't mind working weekends at all, but not on top of a full 5 day week.

 

[northernpsy]

I don't think I've ever met someone, even in other specialties, who LIKES being on call. Doesn't everyone kind of see it as a necessary evil?

My current job involves a lot of call and, yes, I am definitely not planning to keep doing this forever. It's worth it in the short term for the money I'm making at this, but the older I get the less tolerance I have for sleep deprivation and working two weeks straight.

 

[Psychotic]

I don't think I've ever met someone, even in other specialties, who LIKES being on call. Doesn't everyone kind of see it as a necessary evil?

My current job involves a lot of call and, yes, I am definitely not planning to keep doing this forever. It's worth it in the short term for the money I'm making at this, but the older I get the less tolerance I have for sleep deprivation and working two weeks straight.

Call may be "necessary" for hospital inpatient staffing, but that doesn't mean I have to like it or accept it if I can avoid it, and my goal is to avoid it.

As for the money, it isn't worth it to me. YMMV...but call screws me up and wears me down. No amount of money worth that.

 

[wolfvgang22]

Call as a "necessary evil" is what hospitals tell the indetured servants, I mean residents. There are other ways to provide care.

 

[Doctor Bagel]

I'm on call as we speak. I don't like call. I've never liked call. But I like the money from call, and I like the normal daytime structure of my inpatient job right now more than I would like the structure of an outpatient job, and call goes with the inpatient setting. Somebody has to see the patients on the weekend and someone has to be available for things that come up overnight. Call is easier as an attending than a resident, though. At my current job, we have no expectation of ever coming in after hours -- admits are done over the phone, and rapid response and the hospitalists are available in house for acute medical issues. Whereas as a resident, we had to actually work up the admits whenever they came in and see the consults whenever we were called about them whether it was clinically indicated or not.

My current call rant is that I have about zero empathy or listening capacity today, and I'm convincing anyone to do anything (because I don't want to sit and here why they're not doing it). It doesn't help that there are a lot of irritable, manic patients right now on our unit. No therapeutic alliances are being built right now. You don't want to take your meds? Fine -- talk to your doctor about it tomorrow. You think I'm Satan because I think maybe you should take meds? Sure, whatever -- see you tomorrow. I think we need a system with a better way to provide weekend coverage especially now that most admits are a week or less anyone which makes losing 2 days of good treatment pretty significant.

 

[TheOther]

MS2 here. If you had to speculate and throw out rough numbers, what's the pay gap between taking a job that requires the kind of call y'all are talking about and one that takes little/no call?

 

[Doctor Bagel]

MS2 here. If you had to speculate and throw out rough numbers, what's the pay gap between taking a job that requires the kind of call y'all are talking about and one that takes little/no call?

My call work adds about $50k to my annual income. Not insignificant.

 

[northernpsy]

Call may be "necessary" for hospital inpatient staffing, but that doesn't mean I have to like it or accept it if I can avoid it, and my goal is to avoid it.

As for the money, it isn't worth it to me. YMMV...but call screws me up and wears me down. No amount of money worth that.

If I sounded as if I thought you should like being on call or take a call heavy job yourself, that's definitely not what I intended. I am planning to continue taking this much call for two years max then I'm heading to greener pastures. It IS draining and I especially dislike it now that I have a child (since call means extra time away from the kiddo, more sleep deprivation and hiring a babysitter if my spouse is working when I'm on call).
I definitely agree that money isn't worth it if you feel like you're killing yourself working. I took this job knowing I wouldn't love it but also not feeling like I'd totally hate it either. I'm also very motivated to try to become debt free and put away a nice cushion for retirement. In theory I could even quit medicine altogether at that point. 😉

 

[northernpsy]

Call as a "necessary evil" is what hospitals tell the indetured servants, I mean residents. There are other ways to provide care.

What do you have in mind? Yes, residents do end up being exploited as cheap labor often. However, the hospital system I work for actually does pay us attendings a decent amount for as much as we are on call and I would expect if there was a cheaper option they would be all over it.

 

[TheOther]

My call work adds about $50k to my annual income. Not insignificant.

Definitely a hefty sum. What does your non-call salary look like, if you don't mind me asking?

 

[northernpsy]

My call work adds about $50k to my annual income. Not insignificant.

Yeah that's how it is here too. My job doesn't actually offer the option to decline to take call but it pays about $60K more than comparable jobs with little/no call in the area. Academia in this area (where the buffer of having a resident probably makes call much more tolerable) pays about 100K less than my job does. The places that pay well definitely do so for a reason.

 

[Jules A]

Call sucks. Ideally I would have no weekend call obligation, but I work on an inpatient unit and call is required. The trade off is they pay me more. Once loans are paid off, I don't see myself continuing with the current setup.

If you are at an academic center I imagine your pay sucks. I hope you're getting at least $2000 to cover the weekend, at minimum. $3000 is more appropriate, and for 24 patients, $3500-$4000 would be fair.

There are geographic variations as well as the local climate based on expectations a majority of physicians in any given area will tolerate but there is no way I'd take call for less than $3,000 a weekend if that includes having to round on Saturday and Sunday.

 

[Doctor Bagel]

Definitely a hefty sum. What does your non-call salary look like, if you don't mind me asking?

About the same as a not particularly exciting 40 hour a week job in my city. Base pay isn't different from what I'd make say working 40 hours/week in community MH. My hospital does offer extra perks over community type of work like student loan benefits ($18k/year up to $90k total -- this is essentially extra taxable income), CME money, etc.. My average day is maybe less draining than a day in a full-time employed outpatient position. 9 to 10 patients day with 1 to 2 admits (and sometimes no admits on good days).

I'd love to figure out how to make $300k doing no nights and weekends without doing cash only child.

 

[Doctor Bagel]

There are geographic variations as well as the local climate based on expectations a majority of physicians in any given area will tolerate but there is no way I'd take call for less than $3,000 a weekend if that includes having to round on Saturday and Sunday.

You're an NP, right? $3k would be on the low end in my town for a psychiatry but pretty high for an NP.

 

[Doctor Bagel]

What do you have in mind? Yes, residents do end up being exploited as cheap labor often. However, the hospital system I work for actually does pay us attendings a decent amount for as much as we are on call and I would expect if there was a cheaper option they would be all over it.

Cheaper option coming will be the future glut of NPs from all these online schools opening up every day. My town has a both a psychiatrist and NP shortage, but I suspect that'll change in 10 years at least based on all the ads I get on Facebook suggesting I get my NP degree in 2 years all online at some for profit school.

 

[Jules A]

You're an NP, right? $3k would be on the low end in my town for a psychiatry but pretty high for an NP.

Yup psychiatrists who aren't locum doing weekends make between $3,000 and $4,000 in this area.

 

[Jules A]

Cheaper option coming will be the future glut of NPs from all these online schools opening up every day. My town has a both a psychiatrist and NP shortage, but I suspect that'll change in 10 years at least based on all the ads I get on Facebook suggesting I get my NP degree in 2 years all online at some for profit school.

OP sorry for the hijack but yes it will be problematic in light of the trend of schools, including the big names, to encourage nursing students to continue in school with no requirement to practice as a RN before becoming a NP. Not only do many have zero nursing experience most have no psych experience so I'm anticipating the results will be disastrous as the numbers which have doubled in the last ten years are predicted quadruple in the next ten. The original intent of what in my opinion is the woefully brief and inadequate NP education was to capitalize on years of nursing experience which has somehow been forgotten. Many NPs also have no business savvy and will work for whatever someone offers them. It is pathetic and will drive all our wages down. I can't believe the AMA or other physicians organizations haven't latched on this and screamed bloody murder.

 

[Merovinge]

I can't believe the AMA or other physicians organizations haven't latched on this and screamed bloody murder.

They have to some degree but then it evokes the mighty doctor casting shade onto NPs/PAs so they can get back to taking their helicopter onto their yacht and drive their hydroplane Ferrari into the sunset.

 

[Doctor Bagel]

OP sorry for the hijack but yes it will be problematic in light of the trend of schools, including the big names, to encourage nursing students to continue in school with no requirement to practice as a RN before becoming a NP. Not only do many have zero nursing experience most have no psych experience so I'm anticipating the results will be disastrous as the numbers which have doubled in the last ten years are predicted quadruple in the next ten. The original intent of what in my opinion is the woefully brief and inadequate NP education was to capitalize on years of nursing experience which has somehow been forgotten. Many NPs also have no business savvy and will work for whatever someone offers them. It is pathetic and will drive all our wages down. I can't believe the AMA or other physicians organizations haven't latched on this and screamed bloody murder.

I have no clue what the AMA does or if any of it is help for physicians. They spend a lot of money mailing me statements for due labeled as "overdue" even though I'm not a member and haven't been since my first year of medical school when I got a free book in exchange for joining. Anyway, I feel my blood boiling when Facebook tells me how I can become an NP in 2 years at Grand Canyon University without ever leaving my house. You'd think the NPs out there already would be fighting the cheapening of their training too. The greed of educational institutions will never cease to amaze me. My psych NP coworkers tell me there's already a glut of FNPs.

On greed, though, we physicians created a shortage for a reason (OK maybe we overshot it with psych) but still. Being able to demand good pay for screwing up your life by working all weekend and getting woken up in the middle of the night is a good thing. Again, I'm post call and subsequently irritable.

 

[Jules A]

I have no clue what the AMA does or if any of it is help for physicians. They spend a lot of money mailing me statements for due labeled as "overdue" even though I'm not a member and haven't been since my first year of medical school when I got a free book in exchange for joining. Anyway, I feel my blood boiling when Facebook tells me how I can become an NP in 2 years at Grand Canyon University without ever leaving my house. You'd think the NPs out there already would be fighting the cheapening of their training too. The greed of educational institutions will never cease to amaze me. My psych NP coworkers tell me there's already a glut of FNPs.

On greed, though, we physicians created a shortage for a reason (OK maybe we overshot it with psych) but still. Being able to demand good pay for screwing up your life by working all weekend and getting woken up in the middle of the night is a good thing. Again, I'm post call and subsequently irritable.

Lol same here post call but your irritability isn't a result of being exhausted, this has become a cluster. The NP admission criteria, or lack thereof, at present is a joke which won't be funny when in upcoming years patient care and my exceptional wages are suffering. Unfortunately many NPs are so focused on posturing in the face of physicians that they not only miss what I feel is the single most valuable relationship they can nurture but they also get caught up in pissing matches over things that are insignificant. I believe much of this is due to a largely female dominated field which brings a host of problems such as the demand for mommy friendly schedules, lack of business savvy regarding contract negotiations and also the ever prevalent martyr syndrome which seems to justify doing menial tasks for menial pay in the name of providing" holistic care". In my opinion if the education was better NPs wouldn't need to be so reliant on being sweet and holding hands because their clinical acumen would speak for itself. There is a small faction of NPs who are attempting to challenge the lax criteria for NP school which in many cases is simply the ability to pay tuition. Fighting universities is difficult and this isn't just the shady online ads you see on TV these are also the old world brick and mortar institutions who have found a great avenue for getting 6 years of tuition instead of 4 out of the low hanging fruit already enrolled.

 

[Jules A]

They have to some degree but then it evokes the mighty doctor casting shade onto NPs/PAs so they can get back to taking their helicopter onto their yacht and drive their hydroplane Ferrari into the sunset.

I know and its unfortunate however I also haven't seen any physician group target the relatively new lack of RN experience in admission criteria as schools push them from undergraduate to prescribing. Instead it seems the MDs focus is on blocking already practicing NPs from things like suboxone or medical cannabis which often aren't successful anyway. It would be more productive to focus on the lack of required nursing experience coupled with no mandatory fellowships after so few clinical hours which would at the least slow the onslaught of new NPs and also hopefully increase the quality.

 

[Merovinge]

I know and its unfortunate however I also haven't seen any physician group target the relatively new lack of RN experience in admission criteria as schools push them from undergraduate to prescribing. Instead it seems the MDs focus is on blocking already practicing NPs from things like suboxone or medical cannabis which often aren't successful anyway. It would be more productive to focus on the lack of required nursing experience coupled with no mandatory fellowships after so few clinical hours which would at the least slow the onslaught of new NPs and also hopefully increase the quality.

We in psychiatry face even more problems than most with the RxPsychology laws being pushed by big money lobbying efforts. The way this battle was won in Illinois was to amend the bill into saying they can in fact prescribe but only if they complete the clinical equivalents of NPs/PAs. Thus to even have a chance at stopping RxP we have to accept the significantly lessened clinical standards of mid-levels as being adequate for clinical/provider practice.

I complete agree that mandatory fellowships would be ideal but I think at this point that's a lost cause. As healthcare costs go up, there will continue to be pressure to find lower cost solutions and since privately owned companies make up a huge chunk of the costs and "need" to continue to make a profit one of the easy spots to squeeze is provider costs (despite it being 10% of the total cost of care at best).

 

[Jules A]

I complete agree that mandatory fellowships would be ideal but I think at this point that's a lost cause. As healthcare costs go up, there will continue to be pressure to find lower cost solutions and since privately owned companies make up a huge chunk of the costs and "need" to continue to make a profit one of the easy spots to squeeze is provider costs (despite it being 10% of the total cost of care at best).

Blocking new grads with no required RN experience seems like a no-brainer to me. I would think relatively easy to address if brought to public light. This might force a mandatory fellowship requirement if the schools want to continue to ride this cash cow. This movement is relatively new and worth looking at before it becomes an established practice. The assertion that second rate care is better than none sounds rather smug and the lukewarm nursing research showing similar outcomes were based on experienced nurses becoming NPs, no?

 

[whopper]

Hated it-Having worked in 2 universities being on call usually amounted to several calls a day/night. Better residents would try to hold off on the BS ones and try to clump them all together. Also if you got a good resident that you know is good you don't have to put too much thought process into it.

I never held it against residents based on lack of experience, but here's what I hated to the degree where it started ticking me off.
1) Okay someone's going to think I'm racist. When a resident barely spoke English and they called me and I could barely understand them, have to ask them to repeat themselves and by the time I thought I knew what the resident was talking about what would've been a 3 minute talk was a 30 minute Hell (and only 5 more cases to discuss!) This was at one particular program. I got no problem with someone not speaking English but someone's poor grasp of the language should be a factor in their ability to be a practicing physician. I also didn't mind it if the person didn't speak English well but after time went by it improved. I knew a few very good residents where by the end of their first year their English was decent but some of them just never improved.
2) BS calls. About half of them are BS especially from other departments.
3) Calls where another doctor from an ER tries to send me their patient and they barely give us any information so while I ask for it to be given I'm waiting on the phone literally about 10 minutes (sometimes 30) in the middle of the night. Geez get this all tallied up before you even call me. I never hung up on them but I didn't feel I would've been out of line if I did.

 

[Doctor Bagel]

SDN is now also showing me ads about how I can become an NP. At Grand Canyon University no less!!

 

[Shikima]

SDN is now also showing me ads about how I can become an NP. At Grand Canyon University no less!!

Better money, less student loans.

 

[milesed]

My first job out of training had tons of call required. I never knew how bad it was until our group pulled out of inpt work completely. My life away from work is mine again. I'd gladly give up the extra $$ in exchange for better quality of life.