Call Lingo Explained?

[FrannieLydon]

As an incoming med student who is fairly raw with the inner workings of the healthcare system I see people talk a lot about call and often refer to it as “1 in 4 call” or “1 in 2” etc.  And then sometimes there is a distinction drawn between home call and in house call. So sometimes I’m just not exactly sure what a call schedule actually looks like when people talk about them on here. 

If anyone has some time and wants to explain the what all the lingo around call means that would be wonderful! 
 

ps: sorry if it’s like plainly obvious... just a bit unsure and have zero experience with it.

[1D7]

1 in 4 = 1 in 4 days for residents. Usually this is an average of number of call shifts/month, so you may be doing something like 4 call shifts in a span of 8 days but because it's looked at over a month, that's considered ~1 in 7. For staff it's a bit different since they are often referring to weeks, e.g. 1 in 4 weeks.

Home call vs in-house call will determine the stipend you receive for each (it's marginally more with the in-house call), how many call shifts you can receive in a block (1 in 4 for in-house vs 1 in 3 for home), and the rules governing your post-call day (you not supposed to work post-call for in-house call). The numbers I posted may be different for provinces other than ON.

For some specialties you are expected to be able to go home during home call, while for others it's in name only so you can consistently work post-call.

[FrannieLydon]

16 minutes ago, 1D7 said:

1 in 4 = 1 in 4 days for residents. Usually this is an average of number of call shifts/month, so you may be doing something like 4 call shifts in a span of 8 days but because it's looked at over a month, that's considered 1 in 4. For staff it's a bit different since they are often referring to weeks, e.g. 1 in 4 weeks.

Home call vs in-house call will determine the stipend you receive for each (it's marginally more with the in-house call), how many call shifts you can receive in a block (1 in 4 for in-house vs 1 in 3 for home), and the rules governing your post-call day (you not supposed to work post-call for in-house call). The numbers I posted may be different for provinces other than ON.

For some specialties you are expected to be able to go home during home call, while for others it's in name only so you can consistently work post-call.

This is really helpful! Is there any sort of structure in terms of what a 1in4 call would actually look like for a resident? Are the days often strung together? Or are they fairly sporadic throughout a given month? 

[1D7]

6 minutes ago, FrannieLydon said:

This is really helpful! Is there any sort of structure in terms of what a 1in4 call would actually look like for a resident? Are the days often strung together? Or are they fairly sporadic throughout a given month? 

I made a math mistake in my post above in terms of how many call shifts/month (1 in 4 looks like 7 or 8 call shifts per full block).

Friday+Sunday is a combination that happens frequently, but other than that it's fairly random, meaning it may be spaced out or may be grouped together. In terms of scheduling, you're at the mercy of whoever is making it (usually the chief residents or designated staff). Usually call switches are arranged between residents, though sometimes they will send out preliminary drafts for you to request for a switch from the scheduler directly.

[FrannieLydon]

6 minutes ago, 1D7 said:

I made a math mistake in my post above in terms of how many call shifts/month (1 in 4 looks like 7 or 8 call shifts per full block).

Friday+Sunday is a combination that happens frequently, but other than that it's fairly random, meaning it may be spaced out or may be grouped together. In terms of scheduling, you're at the mercy of whoever is making it (usually the chief residents or designated staff). Usually call switches are arranged between residents, though sometimes they will send out preliminary drafts for you to request for a switch from the scheduler directly.

Last naive question - how long is a typical

 call shift? Are they typically 24 hours? 

[1D7]

8 minutes ago, FrannieLydon said:

Last naive question - how long is a typically call shift? Are they typically 24 hours? 

For in-house call, it will be 24-26 hours (i.e. start of your day, which is around usually 7-8 to the next day around 7-8 plus handover taking 1-2 hours). On some services you will work a few more hours handling busywork, typically until noon, meaning ~28 hours. 

If you are doing home call like I said you may just continue to work, or you may get a post-call day depending on how much you worked overnight and the culture.

Rarely there may be some sort of special evening shift for some services which is also referred to as call but does not last nearly as long as a typical 24+ hr shift.

If you are doing nightfloat usually you get blocks of X hour shifts overnight.

[FrannieLydon]

Thank so much! You have been most helpful  

[Snowmen]

Home call or call that isn't as busy will tend to be grouped together more than busy, in-house call shifts (ie: internal medicine). For instance, residents in my specialty typically do home-call shifts from 17h to 8h on the next day for 3-4 straight days.

[rmorelan]

6 hours ago, FrannieLydon said:

Last naive question - how long is a typical

 call shift? Are they typically 24 hours? 

I will add in some fields they can be longer - under PARO they can be up to noon on the post call day I believe as an example . There is a lot of balance with this stuff - outside of surgery at many places (which is its own animal even though it officially falls under the rules ha ), the more tough the call shift is the less likely they are to force you to stick around until the max allocated amount of time. Similarly the official 1 in 4 max call is also rarely actually used and usually at least not for long. you can create in your mind horrible scenarios of max call, max call length, and then add on their special extra call shifts they can add in an emergency...... You can in theory do all that but in reality if you did for any length of time people would start crashing - residency is LONG - you need some kind of sustainable system. 

also we tend to be merciful on med students. I mean we know you are new to this, not even getting paid, and if something comes up really late it is usually faster for the resident to do it than have them wait until you do it and then go over it. Just general guidelines. 

 

[bearded frog]

Call depends on specialty and what specific things you're doing. For instance I do ward call and NICU call but their different hours. The specific requirements for call frequency will be dictated by your provincial contract.

[DocBrown9]

For most surgical things, post call days are not a guarantee... You may be given one or you may just work through it. It's not uncommon for surgical residents to work 2 days in a row with only 2ish hours of sleep. 

[ellorie]

So many reasons I became a psychiatrist.  Out by 10 am post call, and that only because we hand over at 8:30 or 9 like merciful people who like to not show up to work at the crack of dawn.

[rmorelan]

11 hours ago, ellorie said:

So many reasons I became a psychiatrist.  Out by 10 am post call, and that only because we hand over at 8:30 or 9 like merciful people who like to not show up to work at the crack of dawn.

uh....morning people. 

crack of dawn is when I often go to bed

ha it is amazing how much of the hospital runs on traditions based around surgery - they go to the OR early so people can still not eat and drink overnight, not actually suffer from that, and then go to the OR. Thus you have to round first so surgery rounds early. Since they have to coordinate with other services we are often there early as well.  

silly surgeons....messing it up for the rest of us 

[rmorelan]

12 hours ago, DocBrown9 said:

For most surgical things, post call days are not a guarantee... You may be given one or you may just work through it. It's not uncommon for surgical residents to work 2 days in a row with only 2ish hours of sleep. 

yeah - unofficially and in practical terms that often occurs. Technically you can still insist on going home (ha - although I have seen it) - they cannot actually schedule you for anything that day (for one thing there is then a record of you breaking union rules then). 

[m_jacob_45]

If you are on a surgical rotation and are not interested in surgery as a medical student, you can definitely take those post call days (at least at my school). 

[DocBrown9]

On 8/18/2020 at 10:22 AM, rmorelan said:

yeah - unofficially and in practical terms that often occurs. Technically you can still insist on going home (ha - although I have seen it) - they cannot actually schedule you for anything that day (for one thing there is then a record of you breaking union rules then). 

Ya officially you can definately do it and off service residents for sure get post call days. It's a much bigger gamble to do it for your home program... The culture of surgery is that post call days are gifts and not expectations. Because most surgical services run on a team based service, often times residents are needed to cover ORs or clinics so insisting on post call for your home program is looked down upon.

 

On 8/18/2020 at 2:40 PM, m_jacob_45 said:

If you are on a surgical rotation and are not interested in surgery as a medical student, you can definitely take those post call days (at least at my school). 

If you aren't interested in surgery you could literally just sleep throughout the entire day and most people wouldn't notice. 

[1D7]

1 hour ago, DocBrown9 said:

If you aren't interested in surgery you could literally just sleep throughout the entire day and most people wouldn't notice. 

Depends on the school. At my medical school and residency (different institutions) students help round & do consults. Someone late or missing for a while would definitely be noticed and it would affect their evaluation... enough absences would definitely affect someone's ability to pass the rotation.

[rmorelan]

13 hours ago, 1D7 said:

Depends on the school. At my medical school and residency (different institutions) students help round & do consults. Someone late or missing for a while would definitely be noticed and it would affect their evaluation... enough absences would definitely affect someone's ability to pass the rotation.

ha yeah that wouldn't work at the school I went to med school. Each institution has a local flavour, and obviously you need to learn the local rules.

[m_jacob_45]

18 hours ago, 1D7 said:

Depends on the school. At my medical school and residency (different institutions) students help round & do consults. Someone late or missing for a while would definitely be noticed and it would affect their evaluation... enough absences would definitely affect someone's ability to pass the rotation.

Yes this is the same as my school as well. 

[JohnGrisham]

On 8/18/2020 at 11:40 AM, m_jacob_45 said:

If you are on a surgical rotation and are not interested in surgery as a medical student, you can definitely take those post call days (at least at my school). 

No medical student is being forced to stay post-call.  Anyone who is, should be telling their admin asap, and that will be addressed swiftly. Canadian schools are pretty strict about this, and most attendings know better than to keep medical students post-call. There really is zero reason any medical student should be staying post call - residents and attendings can handle literally anything a medical student is "needed" to do.