At Tacoma Family Medicine, call responsibility is divided into three distinct areas: inpatient call for pediatrics and adult medicine, night float, and OB. All call is taken in the hospital.
The on-call resident team, comprised of an R1 and a senior resident, does the primary admissions to our family medicine, pediatric, and internal medicine services. Precepting for the 3 services is provided by the on call family medicine, inpatient adult, and pediatric hospitalists. This call model closely duplicates the actual practice of family medicine, allowing residents to develop and maintain both adult and pediatric skills and knowledge throughout their training.
Weekday call begins at 2:00 pm and finishes at 8:00 pm with the arrival of the night float resident. Saturday and Sunday calls are from 7:00 am to 8:30 pm.
A “backup” resident is available from home to come into the hospital as needed if the call team is overwhelmed by admissions. Medicine and pediatric patients from the TFM clinic are generally placed on the Family Medicine Service. Primary care resident physicians are expected to make “social” continuity visits to their patients on the panel when possible.
TFM’s “night float” call system has been in effect since 1989. It has recently been modified to be 7 days per week, with separate weekday (Sunday through Thursday) and weekend (Friday & Saturday) night float rotations. Night float is taken by second and third year residents and is designed to minimize resident fatigue while meeting all duty hour requirements. The night float resident takes admissions to and provides cross cover for all resident services, including internal medicine, family medicine and pediatrics. This experience is designed to encourage greater autonomy, responsibility, and decision-making skills with direct faculty support as needed. The night float schedule if from 8:00pm – 7:45am.
Given the high volume and high-risk nature of OB patients managed by TFM residents, a separate call system provides continuous coverage on the labor deck. OB call is a 24-hour call that occurs every 4th night during the OB rotation. The 4 person rotation each month consists of 2 senior level (R2 or R3) residents and 2 Rural Family Medicine fellows. Senior residents run the labor deck and participate in both vaginal and operative deliveries. Interns are paired with a fellow for call, and work from 7 am to 9 pm. Family medicine and obstetrician faculty supervision is available at all times. Residents are strongly encouraged to maintain continuity call coverage for their own obstetric patients.