Psychiatry Residency that is healthy

[rhondabear]

Now I am revisiting this thread as a pgy-4, my thoughts are:

Random call nights of call on top of regular daytime hours is stupid and disrupts wellness.

Scheduled "night float" weeks or months (with days off) can be great for independent learning and working through vidja game backlogs during slow shifts.

What about Random call nights FROM HOME? Or is that still pretty bad?

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[myPsychAlt]

Scheduled "night float" weeks or months (with days off) can be great for independent learning and working through vidja game backlogs during slow shifts.

During my last ever night float week as a PG3 I once completed Zelda: Link's Awakening in a single sitting. Now in hindsight I should have done this during the day rather than stay awake through the night where my pager only went off once in the entire 12 hour shift, but oh well...life experience.

But honestly, I don't trust any resident to be competent if he/she is coming out of residency without doing a good amount of independent in-house call, and it's not like there's availability to do that during the daytime M-F. Call is when you learn to think independently. Doing it with an attending the next room over just isn't the same. For me especially having a really front-loaded call schedule was the best thing for me. It got my confidence up to speed quickly because I had to deal with all kinds of random **** on my own in the middle of the night. In truth I wish the program where I'm faculty at had the interns do more call sooner.

 

[Taddy Mason]

During my last ever night float week as a PG3 I once completed Zelda: Link's Awakening in a single sitting....

Meh, A Link to the Past would be more impressive.

 

[meow1985]

What about Random call nights FROM HOME? Or is that still pretty bad?

In my residency, we do all 3 - night float, 24 hour in-house call and night call in addition to regular clinic hours, and night call from home where you mostly take emergency line phone calls. Which type is most predominant depends on your year. I definitely have to say that 24 hour call is the worst, and in-house call is far and away easiest. Also, I have been doing in-house call from home and seeing inpatients via video in light of covid-19 is a lot easier than being in house. I think it's because you can relax better during downtime.

Unfortunately, we had a couple old guard attendings who grumbled about how not working for 72 hours straight disrupts patient care by forcing handoffs and that's where the ball gets dropped; also they said "well anywhere you work as an attending you will take night call in addition to your daytime duties and not get a post call day, so..." I agree with... some of that. Patients' health problems do not respect business hours, and can happen at any time, day or night. Most practices have some sort of turn-taking system for covering after hours issues; very few farm it out to independent contractors or simply give people emergency resources and leave it at that. Residents do as a policy have post call days, but attendings do not - though if I were running a group practice I *would* make a post-call day policy. However, attendings mostly do call from home, and see above that.

Overall, I agree with OP, 24 hour backbreaking work - which call can be; it's really feast or famine - even with a post-call day is unhelpful and disruptive to say the least. It can take a huge toll when you do it every week for a year. I've had colleagues develop both mental health and physical problems as a result, which resolved when they stopped working that schedule. Even night float can mess with you and make you depressed and sluggish for the week or month that you don't see the sun. However, there's something to be said for "hard bootcamp, easy war." If you make it through a year of weekly 24 hour call, you know your skills are at a high enough level to get the job done even in context of extreme stress and x-factors that practice and life will throw at you. For instance: some people compare call to having little kids.

 

[FlowRate]

What about Random call nights FROM HOME? Or is that still pretty bad?

Par for the course at most psych residencies. The degree to which it's bothersome is highly variable. At Emory, it sounded terrible (frequently being called back in to the hospital), at our program, we're rarely called in (pre-covid) and might get 3-10 calls overnight (usually most of them are before midnight) from residents seeking advice or permission to discharge a patient.

 

[clozareal]

I think more than just having long call shifts or night float is the quality of patient care during those call shifts. Are you covering the ED, psych unit, and medical floors? If so, what is the volume like (number of inpatient psych patients, number of consults per night on the floor and ED, if there's a dedicated psych emergency unit or if you are the only psychiatrist in the ED, etc). It's worthless to be on call for 24 hours to only have one page about something insignificant. What's healthy is being busy enough to learn and feel slightly to moderately uncomfortable, but not to the point of feeling overwhelmed or completely crushed.

Given that our residency has us do call at several different sites, I've noticed a stark difference in not only how busy it is, but also the culture of staffing patients with attendings. Some hospital locations allow for more autonomy and others more handholding, a mix feels safe for patient care and level of training. What's healthy is feeling like you're well supported and can ask for backup if **** hits the fan, but also feeling like you have enough autonomy to not always have to call faculty backup.

What I've noticed now as a senior resident is that the call that I dreaded and seemed tough earlier in my training is actually much easier now due to increased confidence in both evaluation skills, management strategies, and psychopharm knowledge. Call is actually easier, consults are faster, and there's more sleep to be had on nights despite being the same number of hours or similar number of pages as earlier in my training.

 

[Monocles]

What about Random call nights FROM HOME? Or is that still pretty bad?

Depends. If home call is truly done appropriately (ex: being paged only for patient status changes, or true MD level decision making questions) then it can be good. However if you are being paged at 3 am by bored nurses "just wondering why patient X is on derpstatin instead of herpstatin", disrupting yours and your bed partner's sleep, then it is terrible.

 

[ridethecliche]

At this point in my training, I think not physically being there for call would be an issue. I just don't think I've been exposed to enough patients and pathology as a PGY-1 to be able to make a truly educated decision without evaluating a patient myself.

At my institution, we have to call attendings on overnight call if someone is being discharged after initial eval. Those conversations are illuminating. I think they add a ton to my training.