Whats GI call like as a fellow?

[nolayup]

I believe I will be on call 2 weekends a month from what I gather. Any advice on what to expect? In my residency program, we are on call Q3 days and basically accept from 7-7.

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[cabergoline2]

Depends . After hours you ll get some pages on half the days. But it's rather uncommon to actually have to go an see a patient or scope at night. Usually we go in for food impaction , variceal bleed or severe upper gi bleed that needs emergent scope or very rarely cholangitis needing urgent ercp. If you are paged after midnight it might be reasonable (depending upon availability , hospital politics , attending preference) to schedule even these cases as first case in morning.

Weekend most places won't expect you to round on all follow ups..the fellow will sign out patients you need to physically see (typically bad bleeders or complex sick ibd patients , even in my large tertiary center it amounts to 7-8 f/ups on a weekend or less). you may cross cover liver/advance endscopy list in places.. there will be stabler patients awaiting scopes as well. you may be asked to make sure monday scopes are npo/labs/inr etc is fine in some places... in some places you won't get a ton of routine consults on weekend. other places you will be slammed . that usually depends on work culture and how good/bad primary teams are.. all in all it's not that bad...definitely better lifestyle than cards fellowship or any surgical residency...

 

[rd31]

I believe I will be on call 2 weekends a month from what I gather. Any advice on what to expect? In my residency program, we are on call Q3 days and basically accept from 7-7.

Depends on institution. If your hospital is a major oncology and/or cardiology center, you will have many weekend consults. All of these patients are bleeding. All of the time. And if not, they have dysphagia and/or colitis.

Our call (at the main hospital) is pretty terrible. An average weekend includes 15-25 new consults and 1-4 urgent procedures (not including ERCPs that fellows don't do). And it's not easy to arrange/coordinate procedures on weekends (have to call/beg endo nurses to come in, arrange transport, may need to book an OR room if it's beyond the weekend hours of the endo nurses, etc. Or it's an ICU case and you drag the cart up there). And it's just you and 1 attending. Often go home at 8-10 PM both weekend days and may have to come back in overnight as well. We also get all of the outpatient pages on weekends. Inevitably, after you finish your last travel case late Sunday night, some 90 year old who has no business getting colonoscopies will page you at 3 AM Monday morning with bowel prep issues or will ask you to walk them through how to use an enema. Infinitely worse than residency where you actually have a pre-defined "shift." Not really a thing in GI fellowship.

 

[Scope guy]

huge variability between programs and more importantly "culture of the hospital".

Old patient consult after hours(for something for not so critical like chronic blood loss anemia with hb of 6, diarrhea and shock, diverticular bleed Hb 12 on full dose anticoagulant): attending be like, patient is old, would be good idea to eyeball tonight.

Young patient consult after hours: patient is young, see them tonight.

In essential, you are the eyes of the attending. They don't come in to see patients after hours unless they need to be scoped. but they will expect you to see them so no other service raises issue.

All I can tell is it gets better after few calls.

 

[1Cor1557]

Depends on institution. If your hospital is a major oncology and/or cardiology center, you will have many weekend consults. All of these patients are bleeding. All of the time. And if not, they have dysphagia and/or colitis.

Our call (at the main hospital) is pretty terrible. An average weekend includes 15-25 new consults and 1-4 urgent procedures (not including ERCPs that fellows don't do). And it's not easy to arrange/coordinate procedures on weekends (have to call/beg endo nurses to come in, arrange transport, may need to book an OR room if it's beyond the weekend hours of the endo nurses, etc. Or it's an ICU case and you drag the cart up there). And it's just you and 1 attending. Often go home at 8-10 PM both weekend days and may have to come back in overnight as well. We also get all of the outpatient pages on weekends. Inevitably after you finish your last travel case late Sunday night, some 90 year old who has no business getting colonoscopies will page you at 3 AM Monday morning with bowel prep issues or will ask you to walk them through how to use an enema. Infinitely worse than residency where you actually have a pre-defined "shift." Not really a thing in GI fellowship.

^^^^^^^

 

[cabergoline2]

while weekend can get intense , we only have to do 15-25 weekends in the whole fellowship (depending upon program).. there are definitely moments when it gets worse than an average IM residency... but overall I feel it's not that bad ...some blocks ( in our place advance endo block which is also an amazing learning block , has impossible hours. but we have ton of elective and research time that is not so bad).. also blocks like IBD and motility are pretty light..So i'd say in 3 years expect around 12 months to be busy... 4-5 months to be average busy ..and rest of the time is practically a vacation...
most programs tend to be front loaded...so after first year things are usually downhill...and third year is basically a vacation + grab as many EUS/ERCP as you can...

 

[hemosuccus]

I believe I will be on call 2 weekends a month from what I gather. Any advice on what to expect? In my residency program, we are on call Q3 days and basically accept from 7-7.

Above responses are gold, nothing to add, just came to ask, when you say 7 to 7, please tell me you mean 7 am to 7 am and not 7 am to 7 pm because if that is what you define 'call' I think theres a 'back in my day' re-examination of call about to happen...