What happens to me when I am forced to be available* for 168 hours?
✔︎ I feel like I am literally counting down the minutes**
✔︎ I treat my body like crap (stay up too late, eat total junk food/comfort food) and then feel annoyed about it
✔︎ I tend to grab my phone and zone out on Instagram or the like, with the intent of making the minutes go by more quickly. It does not feel relaxing; it feels like a numbing agent or some kind of illicit drug with potentially neurotoxic effects
✔︎ I fixate on the future
My call weeks aren’t even that bad, practically speaking. It’s the unpredictability and total loss of control (at any time if my phone rings, I have to address it; there’s a loss of freedom and choice there). During the work day, there is potential for constant interruption and sometimes it really does occur to the point of disorientation (I’ll be writing one complicated note while a nurse is calling me from the floor and someone is also standing outside my door with new patient records to review – and everyone seems to want me URGENTLY***). One might argue that these same pressures are present a) in a normal work day as many physicians and b) as a parent (!). However, it wouldn’t bother me much in 24 hour chunks.
It’s the 168 hours IN A ROW that kills me, and the possibility of getting awoken from a deep sleep every night**** (sometimes multiple times!) for 7 in a row.
The thing is . . . I am never going to find the kind of job I want without call*****, so I am going to have to learn to deal with it. Next year, it will be approximately 1/7, which means a mere 7-8 weeks out of the entire year.******
THINGS I HAVE IMPLEMENTED:
1) That extra hour of childcare! From 6p – 7p. Actually, this has helped a lot. 3 kids (including one baby) and the phone = anxiety provoking situation. I love being able to put G to bed before our nanny goes home on call nights.
2) Also strong weekend child-care coverage. So that Josh can get some work done and I can round in a non-rushed fashion and maybe even catch up on other work. Once I am done breastfeeding I could also see going to a workout class (of course, I’d have to step out if I got called, but that’s ok) on my way home from work to add a little positive ingredient to those days. There is an Orange Theory right next to our hospital and I’d like to give it a try someday — again, after weaning b/c right now I just rush home because I detest pumping and like to avoid it whenever possible.
3) Giving myself a break, particularly about getting some extra sleep or intermittent crappy eating (I’m looking at you, yesterday’s dulce de leche cheesecake). I slept in yesterday + today until 6:15. Needed it.
4) I TRY at times to find some presence in the moment and appreciate what I am doing (caring for patients, nursing G, hanging out with A&C, etc) and not fixate on when I will be interrupted. But it’s hard.
5) I watch TV instead of surfing the phone. Josh helps drag me into this and it feels like a much healthier distraction. Also, GLOW season 2 is genius.
* also pleasant, compassionate, and knowledgeable but also unfailingly evidence-based
** I admit I also sometimes feel like I am counting the days of pumping. That’s a lot of wishing life would hurry up . . .
*** The funny thing is that rarely are there ACTUAL urgent situations in my field! But the way health care is constructed, things are engineered to feel urgent (get that note done! call that family! figure out this “MAR HOLD”! review these transfer orders!) even when they are not.
**** in addition to G’s nightly snack, typically anywhere from 1 am – 3:30 am these days – and I am not complaining about that because once/night really isn’t so bad unless one is adding multiple phone calls to the mix.
***** okay that said – there are places with LESS FREQUENT call, or where there are fellows to take some of the calls away from attending. But most of those jobs come with other trade-offs, and I am really happy otherwise at my current institution.
****** I’m 80% pay but currently doing 100% call. I haven’t wanted to ruffle the feathers of my colleagues, especially right after taking a maternity leave. But someday I may ask to have this adjusted, which could save me another week!
Thanks so much for this post. I am just starting a weekend of all phone call for hospice with lots of calls day and night. I struggle to not dread my call (one weekday per week and one weekend per month). I listed to a podcast from Katrina Ubell where she talked about shifting he mindset to thinking about how call is just part of the privilege of being a doctor. I found this somewhat helpful. I also try to make the rest of my life as easy as possible. But there is definitely struggle at home when my husband describes me as “here but not here.”
I have to say anyone saying that call is a privilege probably doesn”t take a lot of call.
Thank you for writing this, and particularly at a time when I needed the idea reinforced that being on call means you need to make adjustments to survive. My first on-call starts 14th August (!) and as the advanced trainee/fellow we do one in four weeks on. In addition to this my hospital has put me on ward cover for general paeds every 2nd week even though the previous trainees fought very hard to remove themselves as it was just too much with such frequent on-call. I”ve been feeling guilty about making a fuss and asking why it”s changed for me but reading your post is the kick up the backside I needed to be more assertive.
Is your hospital married to the week at a time system? It sounds like you all round on call, which may make it the only way, but a week at a time is a Lot! I hate my call nights, be besides Fri-Sun (Mon AM really) weekends, they are all single nights. I also look at my 60 year old colleagues and wonder how they are still doing it.
Hi, Curious to hear your final thoughts about ‘The Awakened Family’…Perhaps a post re: any takeaways you are planning to implement if you thought it was a worthwhile read would be AWESOME! I started reading it but it seemed a little too "woo-woo’ and I wasn’t able to get into it…I was also dealing with a newborn, low on sleep etc etc so probably not in the best mindset to receive it:)
As a new mom, I like hearing about the parenting books that you are reading in your book club..there are so many out there…curious how you pick the books..
being on "call" means that you do your regular work week responsibilities as well as being the one they call for emergencies?
i’m not a physician and I am unsure if any of your normal responsibilities lessen when you are on call.
good question 🙂
So, I have a fairly normal work day but with less predictability – I see some outpatients but not a full schedule, and have consults/rounding to do which is going to really vary from week to week in intensity.
Then, I have to answer calls at night, both to manage the inpatients (which I don’t mind) and to take calls from the parents at home (which I . . hate. I know it’s important but it’s just terribly unfun.)
also, no matter how many calls I get, I have full duties the next day. This is different from some shift workers who are either ‘on’ or ‘off’. Their shifts are much more intense but I have a bad call night and am still busy in hospital (or with outpts) the next day, it can be painful.
I”m a 2nd year peds endo fellow with 1 child and reading this makes me feel so much better that I”m not alone! I wish I had realized that, as much as I hated 28h of not sleeping in the hospital in residency, home call with little kids is in some ways harder. I long for post-call days again.
Also, I totally get not wanting to ruffle feathers by decreasing call, but could you maybe re-negotiate pay? Like maybe you get 83% full salary instead of 80? If you”re going to take the call, might as well be appropriately compensated, since you are really working more than 80% of what your 100% colleagues are working.
well, not sure that 1-2 extra weeks per year (because 80% of 8 weeks is 6.4 weeks) warrants much of a pay increase!
Perhaps I’ll just try to do fewer major holidays or something. That would be good enough for me . . . or try to make sure I get 7 call weeks next year while some providers have 8 because no way to divide it exactly equally. There’s the 20% right there!
Home call (even with no postcall day) is still way better than 30 hr shifts. I am truly traumatized from that phase of my life and am so glad it is over. I wish I had a fellow to take some of these calls though! Ha!
Yes – you need to adjust something with the 100% call situation – either reduce call or increase pay!
Yeah, I prefer in house call for all the reasons you mentioned. There are few things worse than being woken up in the middle of the night for work, times 1,000,000 if you end up having to go in. Unfortunately my clinical life will likely involve some form of in house call for my entire career, at least 1x per week but perhaps as much as q4 depending on the job (those are typically home call though, and with no post call day, which is doubly wretched. Where I worked for residency, people who had protected time for research or who worked part time typically also had the same amount of call and mandatory overtime as the full time clinical people. Well kept secret, it was.
I should have said at least once every other week.
I hate call and am thankful to have chosen a field with few nights (psych). Most of the bs I deal with at night is honestly no big deal but bc it’s night I find it infuriating. During the day I don’t mind dumb questions that have easy answers. One of my post residency goals is a job without mandatory call. All of my call as a resident is in house which is easier in some ways in that childcare is mandatory for the duration. I’ve been known to do 10-15 min barre online workouts in the call room which I found helpful for sanity. I have 3 kids similar to yours in ages and feel like I’m too old and too tired to be woken up by anyone other than the baby. I hope the rest of your week is ok.
I don’t really want to take call forever. Like, I really don’t want to answer these phone calls when I’m 60. Maybe we’ll have better solutions by then!
(Shared nighttime nursing service for diabetics nationwide would be FREAKING. AMAZING.)