By Request: What does “CALL” mean?
I’ve written a lot about call over the years – perhaps sometimes to my detriment. Not everyone likes to acknowledge the reality that doctors get tired and are still expected to work through sleep deprivation. Things have definitely improved over the years, don’t get me wrong! My colleagues tell me stories of having to come in during the night to admit patients, and doctors that trained before I did worked 100-hr weeks while mine were limited to “just” 80! And now, it’s fairly easy to find a pediatric training program with no 24+ hr shifts – I really did work 30 hours in a row on the regular between 2007 – 2010, with anywhere from 0 to a few hours of sleep each time.
And it was TERRIBLE.
Thankfully, that is not what call looks like for me now. Now this is NOT a generalizable post. Every single specialty has a different system for call, and between institutions, things can differ markedly as well. For example, when I was in fellowship I often took “first call” as a fellow (basically the 3 years AFTER residency but before independent practice). Many nights I’d be able to handle things and not have to wake up the supervising doctor, even though they were technically taking call.
That sounds nice, doesn’t it? But we don’t have fellows where I work so I never got to experience what that was like from the attending (supervising doctor) perspective!
Anyway. The version of call that I do looks like this:
- Call starts Monday at 8 AM and last until the following Monday at 8 AM. You do a full week at a time.
- In my specialty, you are expected to see outpatients on your call days, but with a reduced schedule – only ~30-40% of normal volume. Usually they are scheduled in the afternoon because the morning is reserved for hospital based work.
- You see patients in the hospital daily. These include: patients on your own team (usually those with new diabetes diagnoses), new consults, and consults that are being followed. In my specialty, one cool thing is that I get to be all over the hospital, from the adolescent psych units, to the NICU/PICU, to the regular floors. I really like this aspect of it as I get to know tons of people and it’s just nice to have the variety.
- In terms of numbers it varies! I might get 0 consults in a day and just have 2 follow ups, or I might get 5 new consults and have 6 follow ups. Those are both pretty extreme. As I noted, I am not in a high volume specialty. (Or a highly paid one . . . in part for that reason, I guess!)
- Overnight, I am responsible for any emergent calls for the specialty. These come from the hospital AND form our outpatients, who have access to an emergency line. They will reach a triage person who will then send a message via the secure texting app, EpicChat. Then I call back (trust me, this is much better than being jarred out of sleep by a ringing phone – plus you can look at patient labs/info first).
- THANKFULLY, this volume is not terribly high. During my January call week, I got 1-2 calls every night (usually 1) and it felt pretty tiring by the end, but that is higher than average. I’d say average is more like one middle-of-the-night call 4-5 nights of the week and maybe one night with 2+ calls. Most are from patients fairly new to diabetes who have a concern at night. Sometimes a parent will call to see if we think they need to go to the emergency room for something. 97% people for very understandable reasons. The other 3% can be challenging but I continue to work on attitude about that.
- I do not have any NP / PA that helps with notes or anything, BUT we have an awesome diabetes education team that does a ton to make life easier on call weeks. (Obviously I do things other than diabetes, but the inpatient stuff is usually pretty diabetes-heavy.)
- Weekends I just have to do the inpatient and phone portion- no outpatient work. This usually involves a trip to the hospitals for a few hours. Very rarely I’ll have to spend all day or not go at all!
Currently, I have these call weeks just 6 weeks/year, which is ~60% of my colleagues who each take 9-10. Every once in a while we share call with a physician who is in our group but at a location far enough away that he isn’t in the regular rotation. He covers the nights/weekends. This is rare though (like one week a year).
I do tend to sleep really lightly when on call (like I have one ear open?) and am absolutely exhausted by the end. It takes me a few days to fully recover.
I wish we could switch to a system where we swap nights back and forth (or even just Tues / Thurs) because to me it’s the 7 nights in a row of unreliable rest that makes it tough, but this idea has not been popular with my colleagues.
The absolute hardest time to take call was when I had a baby that nursed at night – I was chronically exhausted and handling wakeups for work in addition to wakeups to feed a baby was just horrendous. I do not know how I got through that and I’m glad it’s over.
Shown above: old school pager. Thankfully we don’t use these anymore though I think some places actually still do!
Side note: I loved the recent Mom Hour episode on Rethinking Instagram (summary: both hosts are over it)
18 Comments
For contrast, I am an adult endocrinologist. I used to see patients in the hospital but now my hospital has an endocrine hospitalist who supervises all in-patient care and a fellow who takes the inpatient calls at night. So now I have it pretty easy!
As a result my call is only for the patients in our practice when the office is closed. We take call in 2 week blocks and I might get anywhere from 2-6 calls a week. They are mostly patients who need refills of medications on the weekend. Other calls include diabetic emergencies and patient concerned about side effects from medications.
PS the picture of the pager is giving me PTSD
For additional contrast, at my old institution, I used to take call as a peds genetic counselor (this meant that I took consults since there are few genetic emergencies – I was only ‘on’ during regular daytime working hours and answered pages for a week at a time; no overnights). The vast majority of consults came from the NICU. Totally different than your situation but the one thing I will point out that drove us (the genetic counselors) crazy is that OUR outpatient clinic load was not reduced!!! The MDs DID reduce their outpatient clinic load when on call, but we didn’t get to – which meant that being on consults + normal clinic schedule was so very hard and really did require like a week of catchup at work. But no overnight call so I guess I can’t complain too much =) My current institution now has a designated genetic counselor who does the inpatient consults (rather than a rotation amongst all the GC staff) so I think that helps keep everyone’s workload fairly steady and avoids the double-teaming of consults+regular clinic.
I really love hearing how all these systems operate differently within different specialties/jobs/institutions. Thanks for sharing!
That is tough!! I would hate it if I had full outpatient volume on call weeks. It would be so bad for the inpatients – they need attention and time!
Q4 or q3 28h here and it is BRUTAL (IM, probably one of the handful of all call programs left in the country). I guess it’s good training, I think? I don’t know. I know that my eating and exercise habits are terrible and I’m learning to let go of that (with 3 months left). I don’t even want to know what my labs are on call…
So excited to do ID next year, our volume is high, but I don’t have to sleep in a gross call room ever again!
SO SO HARD. ID will be so much better (but probably still lot of night wakeups bc I myself remember having to page the ID fellow a lot as a resident!!)
Thank you for your detailed explanation! I’ve (thankfully) had very little interaction with hospitals and never thought about how the specialist you need supports you when needed. It does seem stressful! And the unpredictability would be the hardest part. Never knowing when my infant would wake up was more stressful than the waking up part!
Oof, that sounds intense. I’d be so paranoid about sleeping through. Does the text reliably wake you up?
Yes. I put it on the loudest setting. (If you miss it eventually they will call but that almost never happens)
Canadian trained here! We did 28h q4 and honestly think I was so sleep deprived during those phases that it was harder to learn and integrate knowledge. Now, as a mom of 2 toddlers, I still feel the effects of sleep deprivation. It is a real issue!! I wish we had better systems (nocturnists, higher volume of providers to spread out the call?)
Thank you for sharing that! As someone outside the medical world, it’s nice to understand what it looks like when you say you are on call. Do you change any of your planning habits during a call week? I work at a school for students with special needs and I have a walkie to respond to emergency behavior support needs. Somedays the walkie is quieter and other days it is not stop. I am still working out how to plan my days effectively when the walkie determines what my day looks like. I’m developing some strategies that work but they are constantly evolving!
I just plan to do . . . a lot less. Basically just call stuff and anything else is like “if there happens to be time.” Like this post yesterday!
So fascinating to read! Your point about not sleeping as deeply resonates so much with me. When my husband is on call, his sleep suffers too. You have to be “on” 24 hours a day, and your brain knows it, so it’s impossible to turn it off!
I am in awe that you took call while nursing. Wow. That sounds so draining and tough, and you DID IT.
Being a physician seems to be so much more of a calling rather than a job, because you devote so much of yourself to the work.
ooh, that gets sticky. Personally, I still consider it a job. A very very important job with meaning and consequences but a job nonetheless, not my identity, not my purpose for existing. etc.
Family medicine physician here and fun fact – I have that very pager pictured in my bedside table! I recently switched to having the nurses just call me when I’m on call (also on call this week!) but like 2 months ago I was still using that ancient pager.
I’m an outpatient primary care doc and our call is super chill – 24 h for 1 week at a time – maybe 5-6 weeks/year. It’s just phone call, never have to go in, though still have our (very busy) clinics all week. Essentially all of our calls come from our institution’s nurse line after they’ve triaged patients or critical labs etc. Very low volume – anywhere from a couple calls per day (usually in the evenings) to no calls all week. The hardest part for me is remembering to have my phone on me all the time!
I’m curious—do you wake up to Josh’s cell going off when he is on call? And does he wake up to yours?
A little, but then the other person goes right back to sleep. But I don’t feel sleep deprived when he has call or anything!
Thanks for the explanation! It does sound hard- seven nights in a row of inconsistent sleep. And I can see how you’d be sleeping really lightly, knowing you could get a text at any time. I’m glad it’s only six weeks out of the year, so you have time to fully recover each time. Being a doctor is not easy!!!