What is considered a "call heavy" program?

[yanks26dmb]

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I've interviewed at a few places so far and they've all required 1 Saturday and 1 Sunday a month. Some required first two years, one required first three. None have overnight call. This was the extent of the call.

Any idea how this is relative to other programs? Are working weekends pretty standard? Do some programs require no weekends? What's considered heavy? Appreciate it.

 

[wolfvgang22]

That sounds glorious. Call heavy residency is typically Q3 overnight, which means call every third night ,rain, shine, holiday, weekend, or whatever for the first 2 or 3 years. Call heavy programs will get 24 to 30 hours per overnight call.
Edit: Actually in the hospital, working the whole time, not sleeping, in charge of 100 patients with an attending available by phone who you aren't supposed to contact unless you really, really need help.

 

[yanks26dmb]

That sounds glorious. Call heavy residency is typically Q3 overnight, which means call every third night ,rain, shine, holiday, weekend, or whatever for the first 2 or 3 years. Call heavy programs will get 24 to 30 hours per overnight call.

Jeez. And here I was thinking two weekend days a month was rough. I've lived a sheltered life.

 

[twospadz]

My program requires overnight call about 4 days a month 24 +3 hrs for first 2 years. Some days can be weekend or weekday

 

[Mass Effect]

I've interviewed at a few places so far and they've all required 1 Saturday and 1 Sunday a month. Some required first two years, one required first three. None have overnight call. This was the extent of the call.

Any idea how this is relative to other programs? Are working weekends pretty standard? Do some programs require no weekends? What's considered heavy? Appreciate it.

So who covers overnights?

 

[st2205]

The challenge with comparing call is that different programs use the term call to mean many things.

Call can mean:

- Weekend rounding.
- Answering the phone from home to approve trazodone and ibuprofen.
- Home call where you handle admissions +/- the above.
- Home call where you may have to go in.
- Home call where you don’t go in.
- Being physically in the hospital overnight, working all night.
- Working a normal weekday shift, but since it’s ER consults or something, you’re technically “on call.”
- Being “on call” (i.e. admitting, covering clinic phone calls, etc.) for a brief, specified time (such as 5pm-10pm).

Then there are things that “aren’t” call but are absolutely miserable, such as working a nightfloat 70 hours per week.

The bottom line is that it’s much more important to actually define call before you start comparing anything.

 

[wolfvgang22]

The challenge with comparing call is that different programs use the term call to mean many things.

Call can mean:

- Weekend rounding.
- Answering the phone from home to approve trazodone and ibuprofen.
- Home call where you handle admissions +/- the above.
- Home call where you may have to go in.
- Home call where you don’t go in.
- Being physically in the hospital overnight, working all night.
- Working a normal weekday shift, but since it’s ER consults or something, you’re technically “on call.”
- Being “on call” (i.e. admitting, covering clinic phone calls, etc.) for a brief, specified time (such as 5pm-10pm).

Then there are things that “aren’t” call but are absolutely miserable, such as working a nightfloat 70 hours per week.

The bottom line is that it’s much more important to actually define call before you start comparing anything.

Ok. I edited what I considered heavy call above.

 

[clausewitz2]

I'd say we're pretty call-heavy but this is partially due to the fact that it is exclusively confined to the first two years.

First year:
Four weeks of night float, 70 hours per week, in two-week blocks intercalcated with a much more relaxed rotation (neurology consults); in the hospital all night, solo covering medical needs of 185 beds, doing medical H+Ps and med recs for direct admissions from elsewhere. Usually can get a couple hours' sleep per night.

3-4 weeks of overnights in psych ED with a senior resident (moonlighter) physically present. No sleep.

One black weekend, one golden weekend, and two grey weekends per month while doing our 3 months of inpatient medicine. Some of those weekends are overnights. Q3 weeks your team also does short call until 8 pm. No sleep.

Second year:

2-3 weekday 28 hour shifts for when the interns are not available for night float.

Friday and Saturday night 12 hour shifts per night float responsibilities as above, roughly one shift a month.

Saturday day shifts in psych ED flying solo, once a month

Saturday and Sunday night shifts in psych ED. 8-9 hours. Senior moonlighter always present. Very little sleep.

While on consults, 3 weeks of home call covering all emergent and urgent consults for flagship hospital and nearby womens' hospital. Not everyone understands what urgent or emergent means in this context who has the power to place consults. 2-3 calls per night, going in happens to one person once a year on average.

Also while on consults, 3-4 black weekends where you see all new consults placed between Friday 4 pm and Sunday 4 pm. Moonlighter handles f/us, transfers, commitments. Some ability to pull in folks from outlying hospitals to help if really slammed. Generally at least 14 consults in that period, record is 25.

Third and fourth year:

Nope

 

[Dharma]

I'd say we're pretty call-heavy but this is partially due to the fact that it is exclusively confined to the first two years.

First year:
Four weeks of night float, 70 hours per week, in two-week blocks intercalcated with a much more relaxed rotation (neurology consults); in the hospital all night, solo covering medical needs of 185 beds, doing medical H+Ps and med recs for direct admissions from elsewhere. Usually can get a couple hours' sleep per night.

3-4 weeks of overnights in psych ED with a senior resident (moonlighter) physically present.

One black weekend, one golden weekend, and two grey weekends per month while doing our 3 months of inpatient medicine. Some of those weekends are overnights. Q3 weeks your team also does short call until 8 pm.

You get to sleep overnight!? Lucky! 😉

 

[clausewitz2]

You get to sleep overnight!? Lucky! 😉

I was probably the last resident to be able to do this because of changes to our direct admission process. I would catch 1-2 of these per night. Recently someone had 14 in one night.

They are hiring an overnight PA to help out with this because we have had some near misses.

 

[wolfvgang22]

While heavy call did make me somewhat of a better physician, I wouldn't wish the negative health effects on anyone. It was hell and still affects me to this day.

 

[Candidate2017]

The challenge with comparing call is that different programs use the term call to mean many things.

Call can mean:

- Weekend rounding.
- Answering the phone from home to approve trazodone and ibuprofen.
- Home call where you handle admissions +/- the above.
- Home call where you may have to go in.
- Home call where you don’t go in.
- Being physically in the hospital overnight, working all night.
- Working a normal weekday shift, but since it’s ER consults or something, you’re technically “on call.”
- Being “on call” (i.e. admitting, covering clinic phone calls, etc.) for a brief, specified time (such as 5pm-10pm).

Then there are things that “aren’t” call but are absolutely miserable, such as working a nightfloat 70 hours per week.

The bottom line is that it’s much more important to actually define call before you start comparing anything.

Call is difficult for applicants to figure out for a number of reasons. There is only so much time in interviews, digging into the finer details of call can give the impression of laziness, interns who are most likely to speak candidly have no clue beyond intern year. Beyond call, programs define the length of their workday and workweek differently. 9 to 5 vs 7 to 6. 5 vs 6 days a week.

Things are also subject to change and there will be many quirks or negatives that applicants can never fully be cognizant of until they are a resident at the program. The information imbalance is the nature of having zero power. You are not an attending who can have things spelled out or modified in your contract. There is a lot of fine print that is unwritten in residency. The best you can do beyond, “How’s call?” is to look at the interns and residents to see how miserable they are and expect to be more miserable than them since the residents on lighter rotations will be ones to show up to interviews/meals. Do they look tired, sad, happy, resigned, collegial, guarded, disheveled, well-dressed, overweight, fit, pale, tanned, speak candidly when attendings are present etc? Basically do a mental status exam on the residents lol.