Which medical residents have the least on-call?

[gryffindor]

I am a dental resident at a major medical center. Our residency is not one of those that is in fear of breaking the "80 hour work week" and rarely has after-hours call. There is an on-call beeper and an assigned resident has a responsiblity to answer it. Recently an administrator alluded to the fact that our residents work less hours and have less on-call than those who are medical residents and that justifies some of their policies toward our residency.

So my questions for all you medical residents is which of your colleagues have the "cushiest" residencies (mainly an 8 - 5 clinic with maybe some after clinic duty) with the least amount of on-call? I've read jokes here on SDN that getting opthalmology or derm for a consult at midnight can be a challenge. However, I'm intersted in serious answers so I can ask the corresponding residents at my hospital for their experiences here.

And does the on-call schedule for these residencies work on seniority? For example, if there is a psych/derm/whatever resident assigned to all overnight consults, etc., is it going to be the PGY2 residents rotating the on-call for the whole year as first call while the PGY 3 and 4s go home every night as second call? Or could you be PGY4 and still end up being on first call?

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[Hurricane]

Psych is pretty good. At many programs, the 3rd and 4th years are purely outpatient with no call.

 

[Ruban]

Fields with zero-minimal call: derm, rad onc, optho, path
Fields with moderate call: radiology, psych
Lots of call: all other fields

 

[deleted109597]

Fields with zero-minimal call: derm, rad onc, optho, path
Fields with moderate call: radiology, psych
Lots of call: all other fields

EM takes zero call during their EM months. Everyone takes call on offservice rotations.

 

[medgator]

Fields with zero-minimal call: derm, rad onc, optho, path
Fields with moderate call: radiology, psych
Lots of call: all other fields

Rad Onc call is home call with a beeper. You work M-F from ~8-5:30 and then take call from home after that. Working at a major academic center ensures that youll get called in every so often as a resident, but call is pretty nice in private practice.

 

[Mumpu]

There is a difference between time on call and actually being called. You can be on call for months on end in derm without missing a minute of sleepytime.

 

[Winged Scapula]

Ophtho takes call from home and in a trauma center can be called in - I have felt bad calling the Optho resident (I always got someone senior when I called, so am not sure of the schedule) but with penetrating or blunt trauma to the eye, they've got to come in and see the patient.

Still, I imagine its not nearly as often as most others.

Path does take call. I spent a month on path during my fellowship and the path residents do take call - for late cases requiring frozen sections they have to stay in house until they were needed (and sometimes some of the big surg onc cases can go way after hours) and for autopsies. Now, admittedly they aren't often coming in at 2 am, but they can spend most of the weekend doing an autopsy - first grossing and then the microscopic work.

 

[gryffindor]

Wow, I appreciate the replies. So it sounds like Derm, Rad Onc, and upper level Psych residents may have schedules similar to ours.

 

[medgator]

Wow, I appreciate the replies. So it sounds like Derm, Rad Onc, and upper level Psych residents may have schedules similar to ours.

Ive heard that at major med centers with a lot of trauma, radiology call can be brutal with late night calls from the ER regarding prelim reads on scans.

 

[8744]

Ive heard that at major med centers with a lot of trauma, radiology call can be brutal with late night calls from the ER regarding prelim reads on scans.

I have the greatest respect for radiologists but sitting in a dark office in a comfortable chair looking at pictures on a monitor is hardly my idea of brutal.

 

[Tired]

I have the greatest respect for radiologists but sitting in a dark office in a comfortable chair looking at pictures on a monitor is hardly my idea of brutal.

I don't know, imagine staying up 36hrs then being asked to play "Where's Waldo?" over and over with 100% accuracy.

Me, I'd be asleep after the 4th chest xray.

 

[sunlioness]

I'm psych and at my program we take overnight call in-house for the first two years. That can be anywhere from 3 - 6 times per month depending on how many residents are available. 3rd and 4th years we do one week per month of "back-up" call from home, in which the residents taking in-house call page us with any questions that come up. When you're doing back-up, you may have to go into the hospital if the junior resident gets swamped but that happens only very rarely. Call sucks no matter what field it's in, but I have to say we have it fairly good in psych compared to internal medicine (I was an IM intern).

 

[Pox in a box]

Can you count the number of times you've needed a derm consult in the middle of the night? Probably never.

 

[Flankstripe]

I have the greatest respect for radiologists but sitting in a dark office in a comfortable chair looking at pictures on a monitor is hardly my idea of brutal.

Yes, but unfortunately that's not the entire story. Just like the ER, we are balancing numerous patients at once, often with little to no history to guide us (abdominal pain came up as the only indication for the last 10 abd/pelvis CT's I did from the ER).

Just like you guys, we are jumping from modality to modality, looking at NICU day 0 neonatal CXR's, followed by a 90 year old head CT for "weakness" followed immediately by 90 year old head MRI/MRA, then off to R/O ectopic on a pelvic ultrasound, followed by a trauma CT head/face/c-spine/chest/abdomen/pelvis. That's a LOT of anatomy and pathology to get thrown at you simultaneously.

The entire time you're dealing with this, the ER and the trauma service are breathing down your necks to get reads to dispo patients, and while all this is going on, you are covering the entire hospital by yourself. While the medicine resident might be cross-covering 50 patients, if they actually get a ward call of any significance (any kind of crumping patient, chest pain, SOB, decreased level of consciousness, fall, peritoneal signs, etc) chances are very good that an imaging test of some sort (ie. R/O PE, R/O stroke/bleed, R/O fracture, R/O abscess/perforation ) will be upcoming.

The final kicker, is that unlike the patient who rolls through the ER, and then may cycle through multiple residents before finally ending up at the surgical attending and then off to the OR, on the radiology service, you and you alone are going to take the entire hit for the error when you either undercall or overcall an imaging finding.

On the clinical service, you have lots of residents to spread the responsibility around. Most clinicians get to consult other specialties for help. We don't. We are a stopping point because we don't have anyone else who we can consult. That's tough, since you might be fielding calls from Peds, OB/GYN, Neuro, Trauma, Gen Surg, IM, etc at any one time.

Radiology on call is a lonely existence, and the knowledge that your reads at 24 hours still have to be as sharp as when you started your shift yesterday morning is very, very stressful. I knew that coming in, but just like most of clinical medicine, you can't really appreciate it fully until you are in the hot seat by yourself at 3 am.

I love radiology, but call is undoubtedly far and away the worst part of residency.

Unfortunately, it's also a necessary evil because you learn a HUGE number of practical skills, including multitasking and time management.

 

[Winged Scapula]

Another reason rads call is pretty bad at a trauma hospital (from my experience in discussing this with our residents):

our rads residents were not allowed to go home when their "shift" was over at 0700; they had to go over all studies from the night before with the attending, and dictate the final reads. They are not allowed to leave until all studies that occured during their shift were read and dictated with a final report. This often meant they were in the hospital several hours post-call. Now its not a 30 hr shift, but after being up all night, with little break from the trauma bay and ER, its exhausting.

As for sitting in a dark room, frankly I'd find that a LOT more exhausting than walking around in the bright light. I think you'd find me drooling on the PACS around 9 pm every night if I had to sit there!

 

[JR]

Ophtho resident call is very location dependent. At Hopkins, ophtho consult is the easiest to get anytime, day or night. We have a 24/7/365 open eye ER/ocular trauma center staffed by a PGY2 in-house and backed-up by a PGY3 resident from home. Our first year is very busy call-wise averaging like q3.5 all year round. I thought my 1st year ophtho call way WAY worse than my internship call. It does, however, get progressively better as you go up the ranks with PGY4 residents having to take like 1 week back up call in 7 to 8 weeks. Again, this is just my program (pretty typical for a large academic center).

Ophtho takes call from home and in a trauma center can be called in - I have felt bad calling the Optho resident (I always got someone senior when I called, so am not sure of the schedule) but with penetrating or blunt trauma to the eye, they've got to come in and see the patient.

Still, I imagine its not nearly as often as most others.

Path does take call. I spent a month on path during my fellowship and the path residents do take call - for late cases requiring frozen sections they have to stay in house until they were needed (and sometimes some of the big surg onc cases can go way after hours) and for autopsies. Now, admittedly they aren't often coming in at 2 am, but they can spend most of the weekend doing an autopsy - first grossing and then the microscopic work.

 

[prominence]

pm&r has a very minimal call schedule. Most of it is home call.

 

[sunlioness]

Can you count the number of times you've needed a derm consult in the middle of the night? Probably never.

Once, actually. To r/o Steven-Johnson's. And boy was it a bitch getting one.

 

[Proton Dense]

I can tell you we are often closing in on the 80 hour rule at our instituition, much to the shagrin (and surprise) of the hospital. I work much more as a rads resident than I did as a medicine intern. This is not a blanket statement, just my personal experience.

The call is very different as well. I am constantly on the phone talking to residents and doctors, then rushing off to perform procedures (lumbar punctures, central lines- yes we place these). There is rarely any downtime- and sleep? Forget it.

 

[Amgen1]

I would agree with the above . . . . Radiology call at any major trauma center can be very stressful/labor intensive; those guys are definitely earning their keep . . . . also as stated above all of the surgical subspecialties ie optho, ent, OMFS, urology, etc can work relatively hard on call at any trauma center (and it is usually an upper level who come in) . . . .

My vote would be for derm or PM&R having the easiest call.

 

[gryffindor]

Sunlioness mentioned getting a consult to rule out Steven-Johnson at midnight constituted a derm "emergency."

What about PM&R? What would be a midnight emergency in this field? And what are their daytime hours/responsibilites like?

 

[Tired]

What about PM&R? What would be a midnight emergency in this field?

Totally random guess:

"Yes Doctor, the patient suffered a traumatic cord transection at C7 three weeks ago, AND JUST NOW REALIZED IT!"

 

[medicineman1]

many programs PGY2-4 zero over night call. many programs function with 3 weekends off per month off, with one weekend per month responsibility of weekend rounding. Honestly- its almost unbelievable how cruiser it is! Much different than prelim medicine intern year with Q3 overnight call in the ICU.

 

[DarksideAllstar]

Once, actually. To r/o Steven-Johnson's. And boy was it a bitch getting one.

I was at a Golden State Warriors basketball game with a path attending who got called away at 9 pm on a Friday for a frozen section to r/o TEN.

 

[Finally M3]

Sunlioness mentioned getting a consult to rule out Steven-Johnson at midnight constituted a derm "emergency."

What about PM&R? What would be a midnight emergency in this field? And what are their daytime hours/responsibilites like?

Depends on what you are covering. If you are covering the clinic pager, it's generally post-procedure questions (varying from take some Tylenol, call me in the morning, to goto the ED, do not pass go, do not collect $200 to r/o abscess/hematoma, etc.).

If you are covering the inpatient unit, call is generally mild, but you can have some sick folk that need to be evaluated and/or gotten the heck off the rehab floor. (Generally, if they are sick enough to need a monitored bed, they are too sick to participate in therapy, and thus out they go).

Finally, there are institution-specific stuff, like our place and baclofen pumps. I've been called in to rule out malfunctioning pumps (twice) and had to perform a pump refill in the ED due to patient having symptoms of baclofen withdrawal. Good times!

PGY4 year; no call Two more calls left this academic year

 

[PDT4CNV]

Fields with zero-minimal call: derm, rad onc, optho, path
Fields with moderate call: radiology, psych
Lots of call: all other fields

Ophthalmology call is not as cush as many perceive.

My first year of ophthalmology, I was over the 80 hour work week at least 1 week out of 4 per month. We were in house for night call and usually saw 15-30 patients a night including consults at any of 5 different hospitals we had to cover. I was busier than most residents in other specialties. My all time high was 41 patients in one night of call. I would agree with JR, I was way WAY busier on 1st year ophtho call than I was on internal medicine call as an intern.

As a senior resident, I come in for surgery. And by the way, there are emergent surgeries other than trauma related injuries.

So, if you consult your ophtho resident at night time, you should think twice about whether it needs to be addressed that evening. Pink eye and corneal abrasions are within the scope of practice of an ER doctor. Just because you don't see ophthalmology residents on the inpatient wards doesn't mean they are at home sleeping.

 

[Tired]

My first year of ophthalmology, I was over the 80 hour work week at least 1 week out of 4 per month. We were in house for night call and usually saw 15-30 patients a night including consults at any of 5 different hospitals we had to cover. I was busier than most residents in other specialties. My all time high was 41 patients in one night of call. I would agree with JR, I was way WAY busier on 1st year ophtho call than I was on internal medicine call as an intern.

I'm confused. You were seeing that many patients as the consultant on an Ophtho service? Or you were on a surgical service and just happened to be an Ophtho intern?

In my minimal experience, I have seen maybe a half dozen Ophtho consults at night, and have never had a service I was on order it. Let's see, glaucoma, orbital/globe trauma, retinal detachment . . . what the hell else would you see emergently? 41 patients in a night with eye emergencies? Staggering.

 

[DrDawg]

By far the lightest load. I have heard of programs in PM&R going on probation for working to FEW hours. The one time I tried to talk with the PM&R team at our hospital was a saturday, and I was directed to their attending before I could even tell him that his pt was now febrile and neutrapenic.

 

[guttata]

I'm confused. You were seeing that many patients as the consultant on an Ophtho service? Or you were on a surgical service and just happened to be an Ophtho intern?

In my minimal experience, I have seen maybe a half dozen Ophtho consults at night, and have never had a service I was on order it. Let's see, glaucoma, orbital/globe trauma, retinal detachment . . . what the hell else would you see emergently? 41 patients in a night with eye emergencies? Staggering.

I'm a different program than the original poster, but....

There is a large distinction between true ocular emergencies and consults we receive. This will vary among programs. Let's see, at a level one trauma center, we get consulted on all orbital fractures even without globe involvment, most red eye/painful eye (including some viral conjunctivitis), eyelid/facial lacerations, open globes, periocular swelling (ie, "I can't evaluate the eye because there is so much swelling"), corneal ulcers, rule out non-accidental trauma, rule out bilateral acute angle glaucoma, retinal detachments (heck, any flashing lights or decrease vision), presbyopia, rule out Wilson's disease, rule out papilledema (suspected IIH), ALL facial burns, post-op corneal abrasions, HIV+ rule out CMV, etc. etc. (at that was in the last 2-3 weeks).

The true emergencies: open (or FB in) globe, bad corneal ulcer, macula on retinal detachment, acute closure glaucoma, retrobulbar hemorrhage with high high pressure plus a few others... but, it's so easy to consult opto, opthal, optho, optomology, optamology, (ophthalmology folks) when there is an eye resident always on call.

But, I'm not bitter, it beats 4 hour rounding

 

[hans19]

Fields with zero-minimal call: derm, rad onc, optho, path
Fields with moderate call: radiology, psych
Lots of call: all other fields

< Zero call : Medical Genetics, Occupational medicine, Aerospace medicine.

 

[doctawife]

< Zero call : Medical Genetics, Occupational medicine, Aerospace medicine.

I actually had to call genetics at 3am in the PICU once because my new patient had some weird mitochondrial disorder and was trying to die of sepsis. My attending insisted on checking with genetics to make sure there wasn't anything special we could do for the child.

There wasn't and the child died. Kiddo died on my day off.

I've also seen genetics called in during the wee hours to the NICU. So those guys do take call. Home call, true, but call.

 

[Patholo-gyst]

In my Path program we are ON CALL a lot, but we are rarely called to come in during that time. Frequently we are called but can handle the issue over the phone. In the past four years of my residency, I have had to come in fifteen times during weekends to do frozens/autopsies and have been called to handle something over the phone about twice as many times. I am 'on call' every third night on most of my rotations, however. This makes it look like I have more 'after hours' work than I really do.

 

[Coastie]

OB/GYN, hands down.

It isn't call if you're there all the time.

I am a dental resident at a major medical center. Our residency is not one of those that is in fear of breaking the "80 hour work week" and rarely has after-hours call. There is an on-call beeper and an assigned resident has a responsiblity to answer it. Recently an administrator alluded to the fact that our residents work less hours and have less on-call than those who are medical residents and that justifies some of their policies toward our residency.

So my questions for all you medical residents is which of your colleagues have the "cushiest" residencies (mainly an 8 - 5 clinic with maybe some after clinic duty) with the least amount of on-call? I've read jokes here on SDN that getting opthalmology or derm for a consult at midnight can be a challenge. However, I'm intersted in serious answers so I can ask the corresponding residents at my hospital for their experiences here.

And does the on-call schedule for these residencies work on seniority? For example, if there is a psych/derm/whatever resident assigned to all overnight consults, etc., is it going to be the PGY2 residents rotating the on-call for the whole year as first call while the PGY 3 and 4s go home every night as second call? Or could you be PGY4 and still end up being on first call?

 

[kungfufishing]

I'm a different program than the original poster, but....

There is a large distinction between true ocular emergencies and consults we receive. This will vary among programs. Let's see, at a level one trauma center, we get consulted on all orbital fractures even without globe involvment, most red eye/painful eye (including some viral conjunctivitis), eyelid/facial lacerations, open globes, periocular swelling (ie, "I can't evaluate the eye because there is so much swelling"), corneal ulcers, rule out non-accidental trauma, rule out bilateral acute angle glaucoma, retinal detachments (heck, any flashing lights or decrease vision), presbyopia, rule out Wilson's disease, rule out papilledema (suspected IIH), ALL facial burns, post-op corneal abrasions, HIV+ rule out CMV, etc. etc. (at that was in the last 2-3 weeks).

The true emergencies: open (or FB in) globe, bad corneal ulcer, macula on retinal detachment, acute closure glaucoma, retrobulbar hemorrhage with high high pressure plus a few others... but, it's so easy to consult opto, opthal, optho, optomology, optamology, (ophthalmology folks) when there is an eye resident always on call.

But, I'm not bitter, it beats 4 hour rounding

But as an Ophthalmologist you SHOULD be consulted for many of the scenarios in your first list. In hindsight, if it turns out that their problem is relatively benign, great, but in order to make that distinction sometimes you need it from the mouth of an eye doctor. Especially when it comes to preservation of vision, I think that overcalling and thus occasionally over consulting is the safest thing to do for the patient. Viral conjunctivitis, "bilateral" acute glaucoma, or non orbital facial fractures, maybe not, but equivocal retinal detachments etc. should be seen by you guys.

 

[gryffindor]

Thanks to everyone for your replies! If it comes down to it, I will find the PM&R and Derm residents at our hospital to find out about their call schedules and to prove our point.

 

[guttata]

But as an Ophthalmologist you SHOULD be consulted for many of the scenarios in your first list. In hindsight, if it turns out that their problem is relatively benign, great, but in order to make that distinction sometimes you need it from the mouth of an eye doctor. Especially when it comes to preservation of vision, I think that overcalling and thus occasionally over consulting is the safest thing to do for the patient. Viral conjunctivitis, "bilateral" acute glaucoma, or non orbital facial fractures, maybe not, but equivocal retinal detachments etc. should be seen by you guys.

I am not going to argue about our call, because it is a lot easier than many other specialties. My point is that our call is busier than what most people think.

I do not mind overcalling if they do an appropriate work-up (basic things like a pen light exam and vision check, motility if they are concerned for entrapped muscles). But, often, the ED will just dump any eye problem patients on our service. Yes, we are the experts, but there are certain problems within the realm of ER docs. I cannot tell you how many times we have been consulted on "decreased vision." When I ask what's the visual acuity, they haven't even checked. This makes it impossible to triage.