Night Float

In my vast contemplation about the different careers in medicine, I started looking at some area IM residency programs. Several of them have…night float.

I…am not familiar with this. Can anyone fill me in on what night float is and how it works? I’m assuming that instead of having a q3 or q4 call schedule that one would just work nights for a week every so often? Obviously…you wouldn’t be on during the day that week?

One of my biggest concerns with a career in medicine centers on the relentless nature of call schedules and I imagine that night float would ease things?

Would anyone with experience mind sharing what they know or at least if the nightfloat system has provided them with a more consistent sleep/family schedule?

Thanks in advance,


Hi, Kris. I am in a peds residency that has night float coverage for the wards and NICU. It’s pretty much as you described in that residents spend one or two months a year working nights (in our case 20:00 to 08:00). The night float team also takes a 27 hour shift from Sunday to Monday morning. The day teams cover the 27 hour shifts on Fridays and Saturdays but the rest of the week they work only until 8 PM. The only Q3/4 call we have is in the PICU.

The arrangement has benefits (sleeping at home 6 nights a week) and drawbacks (continuity of care issues) but overall seems to work well.

Hope this helps.



Are you talking about residency night float or as an attending?

I did Emergency medicine, so I only have limited info…

But during residency, the senior IM residents would take a week or 2 during the month and do just straight nights in the ICUs & IM rotation. They would come in at 6 or 7 at night and get off 12 hours later. The only disadvantage is that you do not have an attending around to run something by at 2 am. Hopefully, you have a fellow or maybe an Emergency attending that you have bonded with you can touch base with in the middle of the night (and are usually up).

As an attending - they usually call it a Hospitalist. They basically take care of inpatients and usually do not have a clinic base (we had both types). They would either straight nights or mixture of days and nights. They would contract with certain FPs & IM groups and do the admission H&P & orders so that they (PVT groups) did not have to come in. Also, if the IM groups capped then they would also see those patients. They also did preop evals as well for PVT groups. They would go the pre-codes and codes on the floors.

Hope that helps,

Rachel Yealy

late reply, but…

we have night float on some rotations; day person works 7:30 a - 7 p, night works 6:30 p -8:00 a M-F

I thought I would like it better than the traditional q4 30-hr shift. I actually really dislike it. I never get used to nights, and I never sleep well during the days. I never see my boyfriend on night float b/c he has a regular work schedule. My whole life feels out of whack.

Just my personal experience.

Although it may not be good for the person ON night float, let me tell ya, it is NICE for the rest of the folks! NF takes care of all the medicine patients that do not have their team on call, so when YOU are on call you are just taking care of your new admissions and whoever else is on your team. No 1000 pages about patients on another team that you have no clue about. Also the NF person usually by day 3 knows the patients pretty well…so there is continuity of care somewhat.

Expect more & more residencies to adopt night float models vs. traditional call. The ACGME is moving towards mandating that residents not be on-duty more than 16 consecutive hours. The primary impediment to already implementing the restriction is economics - programs/institutions have so long relied upon their underpaid/overworked resident workforce to get the work done that they are not in position to loose that manpower nor to fund the battalion of mid-levels &/or physicians to pick up the slack & CMS has capped the number of slots that they will fund. Nice little pickle?