Couple questions about call as an attending.
How often do attendings have to come in when on call? How does this vary with pediatrics?
Does the type of call or the cases seen on call vary based on subspecialty (pediatrics excluded)? For example, will a functional neurosurgeon be expected to cover trauma/etc?
Does call coverage vary based on how research prolific someone is? I noticed this trend when looking at my departments call schedule.
Thank you
Everyone takes call. This will heavily depend on your environment. Large departments spread out call more. Some have attendings cover satellite hospitals. Some have fellows take a lot of primary attending call. Some break up call to cranial and spine. Most have completely separate vascular and peds call but smaller programs may not. Private practice people likely take more call (assuming their group is smaller than an academic center). I have never heard of “functional call” and most functional people need to justify their salary with spine volume.
All academic centers (with some exceptions) are trauma centers so yes they take trauma call. Some people are X% research and take call accordingly. More senior people take less call because their elective practices are enough to have their cases.
So long story short there are trends that are very generalizable but ultimately the answer is going to boil down to “depends on the environment”…
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Peds tends to have relatively fewer emergent cases simply because there are less kids. That being said, 60% of peds neurosurgery is non-elective (i.e tumors walking into ED), so taking call as a junior attending is critical until you've built up your practice and name.
Highly variable as others have already said. I personally take call a week at a time, on average once a month. It's usually cranial only and covers both the university hospital where I primarily operate and a smaller more community-like hospital within our system. The latter is pretty low volume. I get very little trauma as that all gets diverted to our Level I where I don't take call.
depends, I've done every other week call for general/endo with no trauma. It's tolerable Endo/stroke can be busy. It really depends on your ED/IM colleagues and if they call you about the end plate fracture at 2am or if they are cool and call at a reasonable hour In the morning. Most consults are non emergent and can be dealt with in the morning and a good ED/IM group will understand that you are not awake and will let you know about that stuff in the morning. What can changes call and how annoying it can be is if you are a referral center. Even without trauma there are a lot of calls for transfers or recs for.... to be honest, non sense that should just go to clinic. Most of the time it's dealt with NP/PA questions and those are always the 2am question that makes call the most annoying thing on earth. Being at a busy trauma center and busy stroke center makes call every other week a bit rough especially if you have a partner out of town and you do a 10-14d stretch.
This is actually an interesting topic, and one that graduating residents should be paying attention to. Call responsibility can be nuanced.
A lot of factors can play into whether call is beneficial or not. A major factor is whether or not you are paid extra for additional call. Another is how surgically productive call days are, and whether or not you are paid for surgical productivity. Another factor is how busy your elective clinic surgical volume is.
Myself, for example, I cover 3 different hospitals. One is a major quaternary center, one is a smaller mid-size hospital, and one is a small community hospital. My elective clinic surgery caseload is very busy. I am also paid on an RVU basis.
Now, the smaller community hospital call is not surgically productive (meaning not many good cases come thru on any given call night). However, I get paid per call night for the small community hospital, and the burden during call is not onerous, so I’m happy to do it, and I do it frequently, often 7-10 days per month. The call pay alone generates close to half a million dollars per year for me (not counting my main RVU based compensation), so this call is very valuable to me.
The mid-sized hospital does not pay me extra, and truthfully not much surgical volume comes thru it. Additionally, I get a fair amount of consult calls through this place from outlying areas, but they rarely translate to surgeries, and they keep me up frequently at night. So I do not like covering this place.
Lastly, the quaternary center does not pay me extra, and the call is very busy. However, I have residents here to field most of the burden, and I almost always get at least one, often two, surgical cases out of every night of call, which translates to a lot of RVUs, and therefore a lot of money for me. Obviously, I’m very happy to cover this place.
The wild card is my very busy elective practice. During trauma season, when I’m getting surgical cases constantly thru the busy large center, it can def prolong my days sometimes when I’m having to add at the end of the day (or at the beginning). I sometimes do have to cancel elective cases, but fortunately I’ve only had to do that about 2-3 times in the past year.
