Macleans article on residents' salary

[Ian Wong]

Are any of the residents reading this working in a system that has a "night float" resident?

My radiology residency in the US was on night float. Truly awesome. Way better than taking traditional call in my opinion. You come in at 5-6 pm and leave at 8 am. Do this for a week straight. It still adds up to a lot of hours, but you get consistent sleep. It's substantially better than traditional call where you are working 24 hours straight.

 

I think things are trickier in clinical specialties where you have a lot more handoffs and followup. Still, count me fully in favour of night float.

 

Ian

[UBCmed09]

For the UBC anesthesia program, call while on your home service (ie anesthesia only) would be night float I guess (not familiar with that term). We get a pre-call day, go in at btwn 5-7pm depending on hospital and then go home around 7-8am in the morning and have a postcall day. Very reasonable and a nice treat when you have a rare quiet night.

 

Cheers,

UBCmed09

[apache]

that sounds quite fair to me

 

My radiology residency in the US was on night float. Truly awesome. Way better than taking traditional call in my opinion. You come in at 5-6 pm and leave at 8 am. Do this for a week straight. It still adds up to a lot of hours, but you get consistent sleep. It's substantially better than traditional call where you are working 24 hours straight.

 

I think things are trickier in clinical specialties where you have a lot more handoffs and followup. Still, count me fully in favour of night float.

 

Ian

[Lactic Folly]

Interestingly, the experience of most of our residents has been more in line with the article's findings - that night float is worse for well-being.

 

Compare a traditional call for me:

Monday - work 8 am to 8 am. Feel crappy at 5 am. Go home Tuesday morning, sleep ~6h until 3 pm. Get up, enjoy rest of afternoon and evening (like getting off work early!). Go to bed at a regular hour, sleep all night. Go back to work the next day, a little off but otherwise refreshed enough to do call again on Wednesday.

 

Versus a split call:

Monday: sleep in, get up around 10 a.m. Do call all night, still feeling crappy at 5 a.m despite having slept in. Leave in the morning - BUT - since one has to be back in the afternoon, there are significantly fewer hours for travel, changing clothes, showering, and eating, in addition to sleeping - at most getting those 6 hours of catch-up, daytime sleep before having to go back to the hospital.

Tuesday afternoon: go back to work, not fully recovered. If this were a regular postcall day, I would be tired enough to go to bed again at 11 pm. But being on call tonight, I stay up working. Feel even worse at 5 a.m. Go home the next morning, with again only ~6 hrs to recover before going back..

 

Granted, I've only done this for 3 days in a row, max. By the 3rd day I did feel my internal clock begin to shift to that of a graveyard worker, and thought about trying a whole week of night float. But I suspect that I would be spending most of that week in the hospital to minimize travel time, crashing in the swing rooms in between shifts... and even after only 3 days of nights, it took me the same amount of time to shift back to daytime hours, which was more disruptive to my productivity than traditional call.

[A-Stark]

That's been my experience with emerg shifts so far too. I came off neurosurg hours to 4 days of 2-9pm shifts which was tremendously disruptive to my productivity. While it was nice to get up sometime after 5:15, I ended up getting going around 10 or later, puttering around the rest of the morning into the afternoon, and then working straight out for 7 hours with minimal break time and getting home at 9:30 or later. I soon figured out that I'd much rather start early(ish) and benefit from the odd day being done early afternoon - with post-call days - than putter away my day or morning and end up with annoying late evening or overnight shifts. At least when on call, there's usually time when there isn't another patient to see or anything to do at all.

[Ian Wong]

The thing is that you need to be disciplined enough to get home ASAP and go to sleep. This also implies that you need to be able to sleep on demand (ie. get home after your 6 pm - 8 am shift and be fast asleep at 9 am), which isn't possible for everyone.

 

But, what it allows you to do is never work more than 14-15 hours straight. Which is flat out awesome. As well, in our program, you would then have 5-6 months without ANY overnight call (because you've done so much night call in one burst). Which is similarly awesome.

 

For me, that's huge. Depending on how busy your call nights are, night float may not make a lot of sense if you can grab a consistent 2-3 hours of sleep a night during regular call shifts. In that scenario, getting your post-call afternoon off is almost like getting half a day off for free.

 

In radiology call, definitely in the US, and I suspect at many/most Canadian programs as well, you don't generally get a chance to see the call room at all. There's ALWAYS at least one clinical specialty getting hammered each night, and their imaging is going to be hammering you concurrently.

 

Ian

[Lactic Folly]

I think this is what makes our program's call great - as long as everyone does their share over the course of the year, they are free to trade/split/combine their shifts with other like-minded residents - 12 hr or 24 hr, spread out over the year or concentrated.

 

For me, the constant activity means that 24 hrs passes very quickly, so it's less of a burden to stay the remaining hours than to come back another day. I tend to move in slo-mo post call, so closely spaced shifts aren't ideal for me. As well, 24 hr shifts are either weekends or holidays, where staff help dictate studies during the daytime.

 

I agree it's very nice to be able to concentrate call during times in the year that are more favourable for one's schedule. I'd just want to keep up some baseline amount of call (?1 every 2 weeks) so as not to have that rusty feeling when I've been off for a long time (or doing mammo) and traumas start rolling in the first night back..