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Night Float/Decent Call Programs
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12-17-2021, 01:53 PM
Have been trying to track this but curious if anyone has a list/insight - what programs do a night float system, or have lighter call burdens? Not the most important thing, but does matter and sometimes hard to figure out from interviews.
12-17-2021, 03:17 PM
Your best bet for lighter call burden is to go to a larger program (~3/year). Some 1/year program PGY4/5s still take primary call...
Also consider the degree of redundancy during rounding/call and amount of mid-level/ancillary support. For example, Hopkins residents ran the list 2-3 times daily. Pitt residents have minimal inpatient mid-level support. MGH/Barrow have an in-house mid-level resident in addition to the junior + chief (this has both +/- though). It's the content of your call that matters more than the amount i.e. doing procedures & seeing interesting consults rather than preparing discharge medications and scheduling outpatient follow up. 
Definitely worth taking into account the number of call pools and number of residents. A one a year program with one hospital will result in residents taking an entire year of call minimum over the course of their time. A four a year program with two hospitals takes half a year of call potentially, etc. A four a year program with four call pools may take as much total as a one a year program, but some of that time may be of variable intensity (i.e. one hospital is very low-acuity, so home call no pages, etc).
12-18-2021, 04:02 PM
Having worked as a resident under both systems, I would prefer q2-3 24h call to night float. Night float is the devil.
12-19-2021, 03:20 PM
12-19-2021, 03:25 PM
It is part personal preference and part what you are used to. I also trained in both and much preferred night float both as a junior and as chief. IMO the problem with 24h call is you either have to stay for good cases post-call in a state where you aren't at your greatest learning potential or give them up. Now, if you go to a low intensity program where you are assigned a room while being on call, that would be different, but the culture when I trained was the call person stayed out of the OR except emergencies.
12-20-2021, 01:12 AM
(12-19-2021, 03:20 PM)Guest Wrote:(12-18-2021, 04:02 PM)Guest Wrote: Having worked as a resident under both systems, I would prefer q2-3 24h call to night float. Night float is the devil. 24h call is less taxing for sure - the caveat is that I trained at a place that is largely in compliance with the duty hour rules, meaning I'd come in at 5am and leave by 9am the next day. The biggest advantages are no handoffs - that's at least 1 wasted hour per day in my opinion, and learning to manage patients over a more clinically meaningful timescale - i.e. this patient is at high risk of deterioration in the next 10-12 hours after admission so I need to have a good management plan not just run out the clock til shift change.
12-20-2021, 11:32 PM
Night float is far superior
12-21-2021, 10:57 AM
We go through both types of call at my program depending on the hospital you're at, each has its benefits, personally i prefer the night float system.
PM handoff can be a waste of time during night float, but usually only for the intern/chief that have to do the handoff. I like that night float is less sporadic, you have a set period of time where you know you can't do anything social, you just grit your teeth and get through it. I find post call days to be a far bigger waste of time. When your post call days are protected not only are you wasting OR time being on call, but that's every 2-4 days you're at home catching up on sleep. I think there was a poster at CNS this past year which showed night float systems have significantly more OR time. And if your post call days aren't protected then you're just a zombie going through the motions, which is even worse.
12-21-2021, 11:43 AM
The opposite was actually published regarding operative time: More in a 24h call system
https://pubmed.ncbi.nlm.nih.gov/34866033/ |
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