“ ON CALL” 📟

Being 'on call' in psychiatry residency is definitely one of the most intense parts of training, but it’s also where some of the deepest learning happens. When I first started, I often wondered, "What does it mean to be 'ON CALL'?" beyond just carrying a pager. It's so much more than just covering shifts; it's about being the primary decision-maker for a wide range of acute psychiatric issues, often with limited immediate supervision. My on-call responsibilities are incredibly varied. A typical shift might involve everything from managing the Psych Emergency Room to handling urgent psych consults from other medical services, and overseeing patients on the inpatient psych unit. You’re the point person for any psych emergencies that arise in the hospital, whether it’s a patient experiencing acute psychosis, severe suicidality, or a violent outburst. For example, in the ER, you might be evaluating a patient brought in by police for an involuntary hold, trying to stabilize someone in a severe panic attack, or assessing for substance-induced psychosis. Each case is unique and demands a swift, thoughtful approach. One aspect that truly stands out is the feeling of being the 'only psychiatrist' in the entire hospital during those hours. It can be incredibly intimidating, especially early on. The weight of responsibility is immense, but it forces you to synthesize your knowledge and trust your judgment under pressure. That’s where the 'lot of learning' truly occurs. You learn to prioritize, manage multiple complex situations simultaneously, and become efficient in your assessments and interventions. I remember one shift where I had three ER consults, two inpatient emergencies, and a new admission all within an hour – it felt like juggling, but I came out of it feeling so much more capable. While you're often the face of psychiatry on the ground, it’s comforting to know that an attending is always just a phone call away. This lifeline is crucial. They might not be physically present, but their guidance and experience are invaluable for complex or uncertain cases. It’s a balance of independent practice and supervised learning, which is essential for growth. For anyone considering a career in medicine, especially psychiatry, I can't stress enough the importance of preparing for this aspect of residency. When you're going through residency interviews, make sure to ask about call schedules. Inquire about the volume of calls, the level of attending support, and the specific duties involved. Understanding the call structure can significantly impact your residency experience. From my own journey, I’d advise developing strong organizational skills, practicing quick assessments, and learning to manage stress effectively. It’s not just about clinical knowledge; it’s about resilience and self-care too. Knowing what to expect and how to prepare can make a huge difference in navigating these demanding but ultimately rewarding shifts. The experience gained during these on-call hours is irreplaceable, shaping you into a more competent and confident psychiatrist.