Who covers what services while on call in your program?

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I'm curious: who (attending, resident, PA/NP, heme/onc fellow, BMT fellow) covers what services while on call at your institution?

1. Oncology
2. Hematology
3. BMT
4. Other?

I ask because I've heard that some programs vary widely and I'm desperate for ideas. For example,
1. The heme fellow is called first for all 3 services.
2. A resident is called first (not necessarily the same resident for all 3 services).
3. A PA/NP is called first all of the time on BMT. Or interchangeably with a heme fellow.
4. The attending handles all calls directly from BMT. No PA/NPs or trainees are integrated into call duties for BMT patients.
5. Fellow is back up in case the attending doesn't answer (no judgment; I'm just quoting).
6. No attendings are on call. The fellows run the asylum.

Who does what at your program? Or, if you're out of training, who did what? What was the on call coverage workflow? You don't need to say which institution if you'd rather not, of course. Thank you.

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You need to give some more information here.

Who are you and what is your role in this program? PD? PC? Chief Fellow? First year Fellow getting your a$$ handed to you on call and just trying to figure out a way to survive?
Days? Nights? Weekends?
Consults? Inpatients on your own service? ER? Outpatient calls?
How big of an institution?
 
I'm curious: who (attending, resident, PA/NP, heme/onc fellow, BMT fellow) covers what services while on call at your institution?

1. Oncology
2. Hematology
3. BMT
4. Other?

I ask because I've heard that some programs vary widely and I'm desperate for ideas. For example,
1. The heme fellow is called first for all 3 services.
2. A resident is called first (not necessarily the same resident for all 3 services).
3. A PA/NP is called first all of the time on BMT. Or interchangeably with a heme fellow.
4. The attending handles all calls directly from BMT. No PA/NPs or trainees are integrated into call duties for BMT patients.
5. Fellow is back up in case the attending doesn't answer (no judgment; I'm just quoting).
6. No attendings are on call. The fellows run the asylum.

Who does what at your program? Or, if you're out of training, who did what? What was the on call coverage workflow? You don't need to say which institution if you'd rather not, of course. Thank you.
On overnight call, first year fellows cover weeknights. One fellow covering solid tumor, malignant heme, classical heme, SCT, and VA services. We approve or deny admissions to the malignant heme service. Used to have to do this for solid tumor as well but that got nixed. Residents staff solid tumor and malignant heme services but they are to call fellow with concerns. NP in house for non-teaching malignant heme service and SCT. But also everything goes through the fellow, even for SCT. Fellow also gets all patient calls, attendings are not called first.

First years bear the brunt of this, with about 50 overnight calls in the year.
 
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I'm curious: who (attending, resident, PA/NP, heme/onc fellow, BMT fellow) covers what services while on call at your institution?

1. Oncology
2. Hematology
3. BMT
4. Other?

I ask because I've heard that some programs vary widely and I'm desperate for ideas. For example,
1. The heme fellow is called first for all 3 services.
2. A resident is called first (not necessarily the same resident for all 3 services).
3. A PA/NP is called first all of the time on BMT. Or interchangeably with a heme fellow.
4. The attending handles all calls directly from BMT. No PA/NPs or trainees are integrated into call duties for BMT patients.
5. Fellow is back up in case the attending doesn't answer (no judgment; I'm just quoting).
6. No attendings are on call. The fellows run the asylum.

Who does what at your program? Or, if you're out of training, who did what? What was the on call coverage workflow? You don't need to say which institution if you'd rather not, of course. Thank you.
For the primary inpatient Heme and Onc services which Fellows are on an NP/PA is first call on patients during the day. At night it is a moonlighted. The Fellow on service is on “call” 24/6 for questions from these folks. How much work that is varies widely. On Acute Leukemia, it’s fairly busy as you have to (usually) come and see most of the new patients and/or review the smears. On inpatient Onc, it’s the rare Ifos neurotox page in the middle of the night, but things are otherwise cruise control
 
I'm curious: who (attending, resident, PA/NP, heme/onc fellow, BMT fellow) covers what services while on call at your institution?

1. Oncology
2. Hematology
3. BMT
4. Other?

I ask because I've heard that some programs vary widely and I'm desperate for ideas. For example,
1. The heme fellow is called first for all 3 services.
2. A resident is called first (not necessarily the same resident for all 3 services).
3. A PA/NP is called first all of the time on BMT. Or interchangeably with a heme fellow.
4. The attending handles all calls directly from BMT. No PA/NPs or trainees are integrated into call duties for BMT patients.
5. Fellow is back up in case the attending doesn't answer (no judgment; I'm just quoting).
6. No attendings are on call. The fellows run the asylum.

Who does what at your program? Or, if you're out of training, who did what? What was the on call coverage workflow? You don't need to say which institution if you'd rather not, of course. Thank you.

Daytime call (into early evening) is covered by midlevels from the respective clinics.

On call first year fellow is first call for everything overnight (onc, heme, BMT) including in-house calls and outpatient calls. As you can see, this can get hairy at times. Inpatient heme, onc, and BMT teams have overnight residents so you won't get called for admitted patients, but you do get called for new consults (however which can nearly always be triaged to daytime unless it's an acute leuk). IMO the outpatient calls overnight really should be covered by 1) moonlighter, 2) midlevel (PA/nurse hired for this purpose), 3) in-house resident since they're 95% non-urgent and involve general medical complaints like constipation, anxiety, fatigue after chemo...etc. Fellow can be second call, and attending as third call (if actually needed). Alas, with COVID affecting hospital budgets, I don't see this happening any time in the future since fellow labor is cheap free.

FWIW, I never woke up an attending overnight to staff a case other than an acute leuk, but had been woken up many times at 3 or 4 AM for constipation or anxiety :rolleyes: (...I would still probably do this over ICU overnight call though, even though I felt more like a doctor in the ICU :lol:)
 
Unsurprisingly, OP hasn't checked back in since the initial post, so unclear what precisely s/he was trying to get from this question.

But here's how my medium-szied (4-5 fellows/year) program worked it.

All fellows take call all years but in a graduated fashion, roughly 50% among the first years, 30% among the 2nd years and 20% among 3rd years.
During the day? Whoever is on for that particular service (Benign Heme, Solid Tumor, Leukemia, BMT) takes inpatient calls/consults. Leukemia and BMT have their own inpatient services with fellows and NP/PAs and calls go to whoever's "on" that day. Solid Tumor has a chemo-only inpatient service run by a PA and the solid tumor attending.

After hours (5p-8a M-Th) and weekends (5p F - 8a M) there is a fellow on call who takes all outpatient/ER/consult/transfer calls as first call. That fellow covers oncology consults and any patients on the solid tumor chemo service over the weekend. There is a moonlighter covering leukemia/BMT/solid tumor chemo overnight who does all admissions and handles all inpatient calls overnight. New acute leukemics who come in after hours (and they all do...I've never seen a new acute leuk transferred/admitted during a regular work day) need to be seen/evaluated by the fellow on call but if the moonlighter is an onc fellow, the on-call fellow doesn't need to come in.

It's kind of crappy to have to take call all 3 years, but it's manageable.

Call as a community-based attending is basically a vacation.
 
Unsurprisingly, OP hasn't checked back in since the initial post, so unclear what precisely s/he was trying to get from this question.

But here's how my medium-szied (4-5 fellows/year) program worked it.

All fellows take call all years but in a graduated fashion, roughly 50% among the first years, 30% among the 2nd years and 20% among 3rd years.
During the day? Whoever is on for that particular service (Benign Heme, Solid Tumor, Leukemia, BMT) takes inpatient calls/consults. Leukemia and BMT have their own inpatient services with fellows and NP/PAs and calls go to whoever's "on" that day. Solid Tumor has a chemo-only inpatient service run by a PA and the solid tumor attending.

After hours (5p-8a M-Th) and weekends (5p F - 8a M) there is a fellow on call who takes all outpatient/ER/consult/transfer calls as first call. That fellow covers oncology consults and any patients on the solid tumor chemo service over the weekend. There is a moonlighter covering leukemia/BMT/solid tumor chemo overnight who does all admissions and handles all inpatient calls overnight. New acute leukemics who come in after hours (and they all do...I've never seen a new acute leuk transferred/admitted during a regular work day) need to be seen/evaluated by the fellow on call but if the moonlighter is an onc fellow, the on-call fellow doesn't need to come in.

It's kind of crappy to have to take call all 3 years, but it's manageable.

Call as a community-based attending is basically a vacation.
To your last point, why is that the case? Wouldn’t the burden on an attending without fellows be greater?
 
To your last point, why is that the case? Wouldn’t the burden on an attending without fellows be greater?
I can only comment on my call experience in a group covering 15 physicians. I get an average of 2 calls a night when on call. Usually between 5:01pm and 9pm. I can count on one hand the number of times I've been woken up in the middle of the night during my last half dozen calls.
 
To your last point, why is that the case? Wouldn’t the burden on an attending without fellows be greater?
As a fellow overnight, I covered the call for dozens of attending clinics, new consults, urgent lab results that were drawn at 7AM but only got finalized at 10PM, etc.

As an attending I cover the call for my clinic and 6 partners and in theory consults for 3-4 hospitals that in the last year have not woken me up for an overnight consult. It is extremely rare that I get a page after I go to bed, and even while awake it is a "busy day" if I get 3 or 4 calls from close of clinic to the next morning. As a fellow, I would have considered that a miraculously light evening of call.
 
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As a fellow overnight, I covered the call for dozens of attending clinics, new consults, urgent lab results that were drawn at 7AM but only got finalized at 10PM, etc.

As an attending I cover the call for my clinic and 6 partners and in theory consults for 3-4 hospitals that in the last year have not woken me up for an overnight consult. It is extremely rare that I get a page after I go to bed, and even while awake it is a "busy day" if I get 3 or 4 calls from close of clinic to the next morning. As a fellow, I would have considered that a miraculously light evening of call.
This aligns with my experience as well.

As an update to my post above. I was on call last weekend. As mentioned, I cover 5 clinics, 15 docs and 7 hospitals. I got 14 total pages between 5p Friday and 8a Monday. Only 2 of those were outside the hours of 7a-7p, and only 1 of them was between 10p-6a (it was at 10:30, I had just laid down and was still wide awake). I had to see a total of 3 patients at on (of the 7) hospitals.

When I was a fellow, that would have qualified as "best weeknight call ever".
 
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