I hate taking overnight calls. It is one of the most vile responsibilities of being a doctor. In our group an anesthesiologist can volunteer to take calls for a guaranteed stipend plus income from any cases he may do during that time. So far there have been no takers.
Having to do calls is so heinous that colleagues have come up with all sorts of reasons to palm it off somebody else. There is always the suspicious excuse of calling in sick on your call day. Other people have used marital strife as an alibi. Then there is the creative use of some murky medical excuse that prevents one from working nights and weekends but doesn't prevent them from working all day on weekdays with any obvious ailments.
Why do doctors hate calls so much? While I can't speak for others, here are my reasons for loathing calls with a passion.
1. Your caseload is unpredictable. With elective surgeries I have the luxury of evaluating a patient the night before the procedure and devise an anesthetic plan. When I'm on call anything could roll into the OR with little time for preparation. It could be as simple as an appendectomy or as exhausting as a multiple gunshot wound to the chest and abdomen. This randomness creates severe anxiety and stress.
2. My income is adversely affected when I take calls. Elective surgeries are scheduled so that there is as little wasted time as possible between cases all to maximize OR utilization and profits. Some anesthesiologists are employees of their facilities and get paid by the hour. For them, a lot of sitting around time between cases doesn't doesn't affect them at all. Alas I'm not one of them. When I'm on call I am on standby for anything that might roll in through the ER that needs urgent surgical intervention. I could be on standby all night which means I can't go out to a movie,
go get a drink with friends, or travel more than thirty minutes away
from the hospital. But since I work fee for service I don't get paid if I'm not giving anesthesia to a patient.
3. The opposite problem of having too much downtime while on call is being overly busy. Sometimes being on call means running around nonstop all night trying to get cases going with surgeons breathing down my neck. Thus there can be little freedom to go to the bathroom or get something to eat. And since this is the middle of the night there isn't anybody around to give me a break for even a few minutes.
4. Call days feel endless. With a regular day I have an approximation of when I'll be able to go home. When I'm on call I may not make it home until 6:00 PM or 6:00 AM. It is a very demoralizing feeling not to know what time I'll be able to make it back. It's like indentured servitude for twenty-four days.
5. I don't sleep well when I'm on call. My sleep becomes very light. Even if I'm home in my own bed my body is tensed and ready to jump the moment my pager goes off. I get so sensitive that just rolling in bed will wake me up. As I get older it takes me longer to recover from a poor night's sleep. So I'm tired and grumpy for a few days after a bad call day. This does a disservice to my patients and my family.
6. I don't get to write as much as I'd like. Observant readers may notice that my blog entries are somewhat lumpy. Sometimes I'll have new posts virtually every day while other times I'll go AWOL for days at a time. That's usually because I'm too exhausted from a close set of call days to do any creative work. So if you're missing your favorite anesthesia blogger you can blame my call schedule.
Is there a solution for this dreaded practice? I believe it is already happening. In the near future I think fee for service will become a medical relic, like an open appendectomy. Doctors will eventually all be employees of either the government or giant hospital organizations. At that point shift work will be the norm. We'll all work hours like ER doctors. The inhumane practice of working twenty-four hours straight will no longer be tolerated under federal labor laws that protect employee work conditions. Then at that point we can listen to the grumpy old doctors complain about how good the new doctors have it compared to when they were young.