On-Call By Specialty

[EliteAssassin23]

Hi everyone, I am a second year engineering student that is considering medicine as a career, but I am worried about the sacrifices that I have to make when it comes to work-life balance. From what you know, on average, how much are physicians on-call for each specialty? How does this vary from being in a hospital vs. being in a community-based clinic? How much freedom do you get in choosing your schedule when you are a physician in each setting? Thanks

[futureGP]

I heard max 1 in 4 nights (incl. weekends)

 

Generally, academic hospitals are busier than community hospitals.

 

Surgical specialties are harsh on-call during residency and afterwards. The better ones are urology and ENT (for attending physicians). I'm not too sure about residency.

 

Internal medicine is pretty busy during residency years. Medicine subspecialties differ depending on which one it is. Cardio tends to be very heavy on-call, while endocrinology tends to be very light. After residency, it really depends on what you do. Interventional cardiologists work on-call on many days doing PCIs on MI patients. Endocrinologists can work in the community mostly dealing with out-patients.

 

FM's residency on-call depends on which rotation you're on (IM, obs/gyn, surgery tend to be busy, psych and FM are 9-5).

 

Psych residency + staff has minimal on-call -- usually 9-5.

 

Anesthesiology - residency + staff are always on-call but you'd better find more information on that on the other subforum here.

 

Pathology -- 9-5, minimal call. great lifestyle

[NLengr]

I heard max 1 in 4 nights (incl. weekends)

 

Generally, academic hospitals are busier than community hospitals.

 

Surgical specialties are harsh on-call during residency and afterwards. The better ones are urology and ENT (for attending physicians). I'm not too sure about residency.

 

Internal medicine is pretty busy during residency years. Medicine subspecialties differ depending on which one it is. Cardio tends to be very heavy on-call, while endocrinology tends to be very light. After residency, it really depends on what you do. Interventional cardiologists work on-call on many days doing PCIs on MI patients. Endocrinologists can work in the community mostly dealing with out-patients.

 

FM's residency on-call depends on which rotation you're on (IM, obs/gyn, surgery tend to be busy, psych and FM are 9-5).

 

Psych residency + staff has minimal on-call -- usually 9-5.

 

Anesthesiology - residency + staff are always on-call but you'd better find more information on that on the other subforum here.

 

Pathology -- 9-5, minimal call. great lifestyle

 

Actually for surgical specialties the best are opthomology and Plastics by far. ENT is pretty good too. Urology can actually be rather busy compared to the previous three (lots of septic stones to deal with). Gen Surg and Ortho are the busiest. Vascular is crap cause the outcomes are terrible for emergent stuff. Ditto for neurosurg. I don't know about cardiac because I have had very little exposure.

 

If I had to pick a lifestyle surgical specialty, it would be plastics. Interesting, creative stuff and most of the overnight stuff (hand injuries etc.) can be seen in clinic within a week or two without serious consequences.

 

I once called rheumatology on call at 11 pm for some advice about a med they had started that afternoon. The guy was surprised to get a call, so I assume they havean awesome lifestyle.

 

As for how much on call you will do as a staff, it's hugely variable on the size of your division and how busy call is. I know staff who are on call a couple nights a months and a couple weekends a year, and I know staff who do 1:2 call because they hardly ever get called.

[silverwhale9]

I cannot verify the accuracy of this, and although it says they surveyed a lot of people only a small sample size is shown, but I found the career profiles section interesting to read - it gives hours they work per week, hours on call per week, etc. for different specialties.

http://medical-residency.ca/files/canadian-medical-residency-guide.pdf

[rogerroger]

Hi everyone, I am a second year engineering student that is considering medicine as a career, but I am worried about the sacrifices that I have to make when it comes to work-life balance. From what you know, on average, how much are physicians on-call for each specialty? How does this vary from being in a hospital vs. being in a community-based clinic? How much freedom do you get in choosing your schedule when you are a physician in each setting? Thanks

 

 

Good job looking into this prior to getting into Medicine. I certainly did not explore this aspect of the job as completely as I should have.

 

There is such variability in hours, even within specialities, and between centres that it really hard to answer this question in a straight forward manner. It would take looking into the specialities that interest you and probably also looking at where you want to end up practising.

 

Luckily, med school gives you a pretty decent glimpse into the hours many physicians are pulling. During clerkship you will experience being on call every four days during surgery or medicine, you will experience the 9-5 life style of many family docs and you will find out how your body copes with shift work during emerg.

 

An interesting thing tends to happen during clerkship. Many people, myself included, change pretty radically the speciality they are pursuing. I would even go as far as to say that maybe even as high as 50% of people switch up. This can be for numerous reasons. But a big one in my opinion is lifestyle expectations and only until clerkship do most wrap their heads around this aspect of the job. This certainly was my experience.

[EliteAssassin23]

Thanks for the great insights! Definitely a lot of good points about the different specialties and learning during the rotations. Do you guys know from experience about how much practicing physicians actually are on call (after residency)? Any practicing physicians/residents willing to comment would be greatly appreciated!

[NLengr]

It's completely dependent on specialty and location.

 

Generally it'll be 1:n, where n is the number of specialists in the local group. So say you work in a community hospital with 3 other ENT docs, you will probably be 1:4 call. It'll probably be broken up so everyone does one weekday night, plus one weekend a month. If you are in a major academic center where there are 12 of you in a single hospital, you may only do 1:12.

 

That being said, call can vary wildly. In a small community center, as say a general surgeon, 1:3 might be very tolerable. Call might be very quiet. You may only go in 25% of the time you are on call. If you are at a major community center or academic center, call may be very busy and you go in 100% of the time you are on call.

 

Some specialties are busier on call than others. Ortho, Gen Surg, General Internal, Cardiology all tend to be busy. Endocrine, Rheumatology etc. not very much.

 

So, as you can see, it's very hard to give solid numbers.

[Med0123]

And there's a major difference between being on-call and having a senior resident manage all the small problems and not having residents

 

Fortunately, nurses/ER MDs tend to be more selective and use their judgement before calling et waking up the MD if there are no residents available on site.

 

Radiology-calls may be busy, especially in a big ER/trauma center, but they can read ct-scans from home

 

Oh and critical care medicine... they are on call 24h a day, 7 days straight for most of them, and not the easy call-type (*cough* rhumato/endocrino *cough*). In USA they started to modify this situation by making shifts (2 or 3 a day) just like in Emergency Medicine