At-Home vs. In-Home Calls: How Residency Programs Decide Which Option Is Best

Variables in Residency Call Success

Making coverage fit in with the workflow of the specific program is an important variable in success.

“The type of call that works best depends on the program,” Dr. Gray said. “How many residents share the call schedule, how many services are covered, and how busy call really is, are all important considerations. Busy tertiary hospitals with [a] high volume of operative patients and a large inpatient service are potentially different from a smaller hospital where the service covered is smaller.”

Dr. Gray explained that at Harvard, residents cover several different hospitals, including an otolaryngology subspecialty hospital with an otolaryngology-specific emergency room. “Because of this, our residents are needed quite frequently in the hospital, and call is generally busy, so they need to be immediately available in the hospital.”

Type and Locations of Hospitals Covered

The needs of general tertiary hospitals or hospitals with geographic concentration may accommodate an in-home model. Consolidation may change this situation going forward, so programs should review their systems every few years. Busy hospitals may want to put a resident in each. In situations where the resident fields only a call or two a night, one resident may be able to cover more than one hospital from home.

“I think as we go further into academic hospitals buying other providers in their community, there are going to be more programs that cover more than one hospital and a greater geographic region,” said Cristina Cabrera-Muffly, MD, associate residency program director in the department of otolaryngology-head and neck surgery at the University of Colorado Anschutz Medical Campus. “During my residency, we covered five hospitals and home call was a requirement. Another program had only one hospital they had to staff, so in-hospital call was a good fit.”

As a resident, my goal is to see as many patients and cases as I can. Sometimes there are no calls overnight and other times very interesting ones come through. I don’t miss good operative cases having to sit out a post-call day. —Hannah Kavookjian, MD

Number of Residents

The number of available residents should also be taken into account. The more bodies are available, the less each individual has to take call.

“One of the concerns about residents going home post call is missing the clinical or operative experience they would have been exposed to that day,” Dr. Gray said. “If you have a program with a small number of residents, it makes the call burden higher, and with each post call day, the residents miss a large part of the clinical experience of that rotation.”