What is overnight call actually like (internal medicine)

[Coltuna]

Hey y'all,

In the thick of things here with interviews and just having trouble wrapping my head around how some of these places have 24 hour call every X days in addition to night-float while others have strictly a night-float system. Maybe I'm soft, but how are y'all doing 24 hour call every 4 days... Is it structured in such a way that you're able to get some sleep? Or are you just walking around the hospital completely zombified? Maybe I'm interpreting these schedules wrong but a program with just a night float system seems 100000000X better with regards to QOL. What am I missing?

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[deleted1100659]

I mean im a psychiatrist and in my residency we had a year where we had both 2 months of 12 hour night float and 24 hour call shifts. Generally very little if any sleep on the 24 hour calls. You just learn to adapt it is what it is

 

[thumbz]

Hey y'all,

In the thick of things here with interviews and just having trouble wrapping my head around how some of these places have 24 hour call every X days in addition to night-float while others have strictly a night-float system. Maybe I'm soft, but how are y'all doing 24 hour call every 4 days... Is it structured in such a way that you're able to get some sleep? Or are you just walking around the hospital completely zombified? Maybe I'm interpreting these schedules wrong but a program with just a night float system seems 100000000X better with regards to QOL. What am I missing?

On your 24's you'll sleep very little if it's a decent sized program (if the teams are routinely >80% of caps don't expect to sleep).

So night float may allow for a better quality of life, but not always. Example from my residency (5 years ago, when 24 hour calls were outlawed): night float was 6 nights on, 1 night off, 5 on, 2 off, then repeat. It sucked, and I have a hard time sleeping during the day which didn't help. Because we did this on top of wards we did 6 blocks of wards, 2 blocks of night float. In a 24 hour call system, you'd skip the 2 blocks of night misery in exchange for q4 misery. Which is better depends on your personal perspective and what works for you. I passed out after my 24's in the ICU and slept no problem during the day.

Notably, 24's may suck but they do have a place in training IMHO. I take 72 hour call shifts now as an attending and 24's help teach you how to think reflexively when you're exhausted.

 

[Maximus2020]

As an intern, I did 30-hour call q4 on 3 or 4 separate 1-month rotations. On other rotations, I did night float 4-5 days straight for 12 hours.

Looking back, hard to say which was worse. Either is brutal and I am thankful I only suffered that hell for 1 year. Dealing with nurse pages for insulin dose adjustments, sleep aids, or lab critical values is only some of the fun that awaits.

What you do beyond those pages is highly variable and dependent on the program/hospital. On some rotations, it was praying I wouldn't get a fifth admit page in the last 10 minutes before admits went to the next team. I slept the whole time on a few occasions. Other times, no rest for 30 hours. I learned a lot and I loved the few times I felt valuable/doing true medicine. Stay strong.

 

[seeinghowitgoes]

My program has both. Overall q4 24 is probably worse, but I personally found doing for short periods (2 weeks at a time) is doable (certainly wouldn’t not apply to a program because they have like 4 weeks of call throughout 3 years, but also would definitely not go to a program that has like 3 months of call every year).

Day 1 is precall so you’re out by 1pm, day 2 call so there for 28 hrs (leave by 10a the next day), day 3 is that post call day (so leaving at 10am or so and going home to sleep or whatever), day 4 often times your either off or have another short call day so out by 1 pm (then back to precall). Most call days you may get an average of 2 hrs of sleep. In this schedule, other than your call day, you actually can get out pretty early, the call day is killer.

Nightfloat is more of a grind - admit and cross cover dozens of patients you can’t possibly know well. You certainly learn reflexes like how to manage urgent situations and how to prioritize (we often get 50+ pages and 4+ admits a night - knowing when you have to run to see a patient vs when they can wait and you can finish an admission is a skill). I think it’s pretty tough. Some programs make it easier and you have like two people covering a list so you can split work or one admits and one cross covers - those are likely easier. Overall though nights in general are just tough. Much easier to be a nocturnist - you generally cover fewer patients and admit fewer patients than residents are responsible for while getting paid more.

 

[ciestar]

Night float >>>>>> “24” hour call (always ends up 28 and or breaking acgme rules)

Anyone who thinks otherwise hasnt done both or is clinically insane

Guess I am clinically insane. I hated night float.

I have a 24 hour call like once a month at most (yes, ends up being a 28 if on call saturday), but otherwise it’s an overnight call (still gonna be 24 hours long, but no rounding). My program puts us on overnight call at most once a week on certain rotations plus sometimes a weekend. We also get a post-call day off sooo. I dont think i have it that bad tbh

I will say I am also FM but have also taken call with IM.

 

[sloop]

I’m a psychiatrist but I also did IM night float and ICU nights in intern year. I never did IM call per se.

ICU nights were terrible. I hated those.

Normal night float was fine. At least at my program, there were four night float house officers. There was a rotation such that, on any given night, one of the residents was off, two of the three residents were admitting and covered their own services, and the remaining resident did not admit but covered their service and cross-covered the off resident’s service. Admitting nights were annoying, and you didn’t get much sleep. Non-admitting nights were pretty decent. I probably could have slept but because it was night float I had switched my schedule so I rarely bothered. I often put my feet up in a call room and watched Netflix, though.

I also tend to like the hospital at night, though. Even as a psych resident, I kind of enjoyed overnight ED shifts. Overnight, you’re basically purely a doctor. You have to deal with a lot less of the annoying dispo/SW nonsense. Also, the people you work with at night are generally pretty chill.

 

[Prehealth1011]

One of the most important questions you should ask:

Do night residents have to stay back in the morning and present overnight admissions to attendings or can you sign them out to the residents?

This can easily add 2-3h in the morning, more if you have an a hole attending. I don’t recall anyone asking this last year in my interview trail

 

[Prehealth1011]

Nightfloat is more of a grind - admit and cross cover dozens of patients you can’t possibly know well. You certainly learn reflexes like how to manage urgent situations and how to prioritize (we often get 50+ pages and 4+ admits a night - knowing when you have to run to see a patient vs when they can wait and you can finish an admission is a skill). I think it’s pretty tough. Some programs make it easier and you have like two people covering a list so you can split work or one admits and one cross covers - those are likely easier. Overall though nights in general are just tough. Much easier to be a nocturnist - you generally cover fewer patients and admit fewer patients than residents are responsible for while getting paid more.

Is the bolded true?

I’m one of the weirdos that love nights. I don’t mind cross covers at night, but a nocturnist job where you’re only doing admissions doesn’t sound horrible to me

 

[seeinghowitgoes]

Is the bolded true?

I’m one of the weirdos that love nights. I don’t mind cross covers at night, but a nocturnist job where you’re only doing admissions doesn’t sound horrible to me

Having just interviewed for hospitalist jobs, I can confirm the bolded is true. Some jobs are admit only, the jobs that also involve cross-cover you cross cover way less patients than resident services.

Only disclaimer is I’m in a relatively large city and the institutions are more academic - I’m sure there are some community hospitals where maybe it’s different.

 

[Banco]

Night float is so much better; your body adjusts and it becomes like a routine; 5-6 nights on with 1-2 days off for 2 months of the year is much better than yearly Q4 call.