Call Systems

[LadyRad]

Hi,
I am about to start a prelim internship in surgery, but I am not familiar with their call system. All I know is that they have a "no call" system with a month of night float. What exactly does this mean? What should I expect in terms of hours? Is it a good or bad system?
I got this position in SOAP and I did not have a chance to visit the program. I know that I should ask the ones in the program, I have tried multiple times with no success.

Thank you

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[LucidSplash]

Hi,
I am about to start a prelim internship in surgery, but I am not familiar with their call system. All I know is that they have a "no call" system with a month of night float. What exactly does this mean? What should I expect in terms of hours? Is it a good or bad system?
I got this position in SOAP and I did not have a chance to visit the program. I know that I should ask the ones in the program, I have tried multiple times with no success.

Thank you

A night float system means that instead of residents working a regular workday and then staying for overnight (call), there is a specific team that works nights, usually 6 nights on, 1 off. Some programs will do 5 nights on, 2 off. Typically these hours will be something like 6pm-8am.

If you only have one month of night float as a prelim intern, that's not bad. Some programs have 2-3 months of it for interns.

"Bad" or "good" all depends on your perspective. I hated nightfloat and so do most/all of my residency colleagues. YMMV.

 

[LadyRad]

A night float system means that instead of residents working a regular workday and then staying for overnight (call), there is a specific team that works nights, usually 6 nights on, 1 off. Some programs will do 5 nights on, 2 off. Typically these hours will be something like 6pm-8am.

If you only have one month of night float as a prelim intern, that's not bad. Some programs have 2-3 months of it for interns.

"Bad" or "good" all depends on your perspective. I hated nightfloat and so do most/all of my residency colleagues. YMMV.

Thank you so much for the information. How would the night float system work with the ICU rotation?

 

[LucidSplash]

Thank you so much for the information. How would the night float system work with the ICU rotation?

The same as described.

 

[bannie22]

Night float is the superior system. Congrats you got lucky!

 

[dr zaius]

For us the night person showed up at 6pm, meaning that even if you had a census of 2 people with nothing acute going on, clinic finished by 3pm, you still had to stay until 6pm for sign out. With the 24 hour system if you were able to finish your work with nothing pending you could theoretically sign out earlier. The trade off is that when you're on call you take over patients earlier. In my opinion the 24 hour system is better overall. You're on for 24, have a post call day, and you have the ability to sign out early if the opportunity arises.

That was how I felt on general surgery for 2 years. Now on urology we have a home call system which is every other night and every other weekend. I would much prefer a night float month to all year weeknight home call.

Just my opinion.

 

[Pir8DeacDoc]

How is your call every other night and weekend on urology? It seems a four year program (after intern year) would have more people for coverage..new program?

 

[bannie22]

Hmmm. Thats not completely accurate imo.

It is leadership dependent and at a NF you can have a census of 2. Drop the list off. And either say call with questions, text a signout, or call a signout at 6pm or whenever NF is available.

Similarly if you run a 24, even if you have nothing going on, your call guy can be stuck in OR or whatever reasons and you are still stuck.

I think leadership plays a huge role in facilitating everyones efficiency.

I do prefer NF tho. No doubt post call days are beautiful, but the physiological harm from staying awake 28 hours with maybe catnaps in between is immeasurable and undeniably bad for the body

 

[Dr.LeoSpaceman]

Night float is the superior system. Congrats you got lucky!

I'm reminded of this for about 80% of your posts.

 

[LucidSplash]

bannie reminds me of the adage "Seldom right but never in doubt."

 

[LadyRad]

Thank you all for your posts. So other than the month of NF, I should have pretty predictable hours. How is it typically for surgery internship in major academic centers? 5 am to 6-7 pm for 6 days a week or worse?

 

[deleted547339]

The best system is the one you don't have.

 

[Winged Scapula]

Thank you all for your posts. So other than the month of NF, I should have pretty predictable hours. How is it typically for surgery internship in major academic centers? 5 am to 6-7 pm for 6 days a week or worse?

I"m not sure "predicable hours" is a phrase that should be used in reference to residency.

 

[bannie22]

Lol there is no prediction in general surgery.
If you predict 24/7 x 7d you might maybe not be disappointed.

 

[dr zaius]

How is your call every other night and weekend on urology? It seems a four year program (after intern year) would have more people for coverage..new program?

2 residents a year, junior residents take home call. 2/4 years are spent at other facilities.

Hmmm. Thats not completely accurate imo.

It is leadership dependent and at a NF you can have a census of 2. Drop the list off. And either say call with questions, text a signout, or call a signout at 6pm or whenever NF is available.

Similarly if you run a 24, even if you have nothing going on, your call guy can be stuck in OR or whatever reasons and you are still stuck.

I think leadership plays a huge role in facilitating everyones efficiency.

I do prefer NF tho. No doubt post call days are beautiful, but the physiological harm from staying awake 28 hours with maybe catnaps in between is immeasurable and undeniably bad for the body

So who answers the pages until sign out if you drop a list on the desk and say call with questions?

 

[bannie22]

2 residents a year, junior residents take home call. 2/4 years are spent at other facilities.



So who answers the pages until sign out if you drop a list on the desk and say call with questions?

Primary service resident who is now out of hospital.
Rarely do you need to signout to someone inhouse.
If something needs to be seen you can go back, or have someone on another service lay eyes etc

 

[LucidSplash]

Primary service resident who is now out of hospital.
Rarely do you need to signout to someone inhouse.
If something needs to be seen you can go back, or have someone on another service lay eyes etc

This wouldn't fly at my surgery program. But we've been over the fact that your purported experience varies widely from the majority of surgery residents on this board before. Our nightfloat juniors come at 6p and the day juniors needs to stay until they sign out in person. Occasionally the nightfloat junior will take the pager without signout if the day junior is in the OR but after they are done they find the nightfloat person and give formal signout.

 

[vhawk]

Where I'm at now is fairly old school and its more work than I did when I was a resident but I do think its probably best for the patients. They do a traditional night float for the interns so an intern is on 6 nights a week, they signout at 6, face to face. The night intern then makes night rounds where they do any holdover postop checks, check up on specific things, and see the patients. This may or may not be done as part of evening rounds with the senior resident on service, depending on when that occurs. This way when issues come up overnight the night intern has already met the patients at least once and has a baseline.

Then there is an in-house "chief" which is usually a PGY4 who basically is there to bounce ideas off of and see really sick patients as a buffer between the intern and the fellows/attendings. This role I think is not definitely necessary but is helpful, and this resident is responsible mostly for just taking cases back in the middle of the night, operative trauma, emergency GS, stuff like that, so mostly they just sleep in the call room and operate.

Now a lot of this is made simpler because its a pretty big program with a lot of bodies, but I think this is pretty close to an ideal setup.

 

[Winged Scapula]

Primary service resident who is now out of hospital.
Rarely do you need to signout to someone inhouse.
If something needs to be seen you can go back, or have someone on another service lay eyes etc

Not kosher in our program.

Night call person would take the pager, but the sign out happens in person when the day person is done. The only time we allowed "on the phone" sign out was Chief to Chief/senior/fellow or attending.

 

[surgonc2017]

My program does not mandate in person sign out. Sometimes people call etc.


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[dr zaius]

Primary service resident who is now out of hospital.
Rarely do you need to signout to someone inhouse.
If something needs to be seen you can go back, or have someone on another service lay eyes etc

What if someone goes into unstable afib with RVR post op? Or all of a sudden a stable floor patient starts tanking, fast? I feel like there needs to be someone in house at all times for just such occasions.

Even though we do home call our patients are still covered by the night float intern for first call who can respond/I can tell what to do while I'm driving in when things start to go south.

 

[bannie22]

What if someone goes into unstable afib with RVR post op? Or all of a sudden a stable floor patient starts tanking, fast? I feel like there needs to be someone in house at all times for just such occasions.

Even though we do home call our patients are still covered by the night float intern for first call who can respond/I can tell what to do while I'm driving in when things start to go south.

you would think that. but when u go into practice you will note that many subspecialty services do not have inhouse physician.
even in residency an ent primary patient had to be stabilized by surgery while their attending made his way into the hospital...

in your situation, just call whoever your colleague resident is in house and have them check it out
or call cards
or ask the nurse to call cards

not like your intern really knows waht to do with unstable afib with rvr right? lol

 

[ThoracicGuy]

you would think that. but when u go into practice you will note that many subspecialty services do not have inhouse physician.
even in residency an ent primary patient had to be stabilized by surgery while their attending made his way into the hospital...

in your situation, just call whoever your colleague resident is in house and have them check it out
or call cards
or ask the nurse to call cards

not like your intern really knows waht to do with unstable afib with rvr right? lol

I don't think that any resident is going to want to go check out your podiatry patients for you...

As for other specialties, if someone is coding, sure, general surgery can step in and help out. Calling them to go check out a patient because you don't want to come in? You wouldn't get to do that very much before you are either refused or the general surgery attendings would have a talk with the other specialty attendings. General Surgery residents do not exist to be anyone else's eyes and ears in the hospital. They have too much else to do.

And call cards? Or even just have the nurse call cardiology? As a trainee, that's just really lazy and really poor doctoring.

 

[Wordead]

you would think that. but when u go into practice you will note that many subspecialty services do not have inhouse physician.
even in residency an ent primary patient had to be stabilized by surgery while their attending made his way into the hospital...

in your situation, just call whoever your colleague resident is in house and have them check it out
or call cards
or ask the nurse to call cards

not like your intern really knows waht to do with unstable afib with rvr right? lol

Lol what the ****

 

[VisionaryTics]

Lol what the ****

I'm going to start using this.

"Uh, I'm not in-house. Please call general surgery with any and all issues related to ENT patients. "

 

[TraumaLlamaMD]

I got called once about a legitimately bleeding foot on a post-op podiatry patient - thinking the nurse was confused, I paged the podiatry resident myself to clear things up. Can you believe he tried to pull a "sorry I'm out of the hospital for a few hours, can you take care of it?"

The nurses are still talking about the dressing-down he got from me (and his attending, from my program director).

 

[cpants]

Definitely depends on your hospital and its size, but you are almost never going to have in house subspecialists (ENT, urology, etc). It's very rare for the few patients we have in house to be crashing, but if so, we head in and if the nurses need help they call a rapid response team. It's common in private practice/community hospitals for subspecialists to mostly serve as a consult service for the hospitalists anyway, so they are taking primary call. We even have them consult on most of our inpatients -- managing blood sugar, PRN meds, etc.

 

[WinslowPringle]

I'm at a program with pretty minimal sign out. Nights cover OR, lines, new consults, and depending on the level, trauma. If a patient goes south, the at-home resident gets the page, calls the attending and the in-house night resident. The at-home resident gives report then and the in-house resident will take over for the night. Works out pretty well over all.

 

[vhawk]

I mean, you guys do it and presumably patients arent dying left and right, so its probably mostly just my reaction to things that are different than how I trained, but that just seems like an absolutely terrible system for everyone involved.

 

[Jolie South]

In my program, people aren't mandated to stay in house until sign out. We do have a general surgery designated call service, ICU service, and trauma service with day shift and night shift that is in house 24 hours. BUT when you aren't on one of those services you are still expected to take care of your own patients and answer pages until 6 pm sign out. If you leave early, you are coming back to take care of people if the need arises. But generally, we don't leave the hospital if people are unstable. But when I am on a colorectal service with all rocks, for example, I don't make my juniors stay until 6, we might leave at 4 pm.

I don't think patient care is negatively affected and I would rather do a week or two weeks of nights straight than do 28h shifts.