Abstract: TH-PO0020
Night Float Scheduling in US Nephrology Fellowship Programs: A Nationwide Survey Analysis
Session Information
- Educational Research Within and Across Disciplines
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 1000 Educational Research
Authors
- Rutowski, James Jude, University of Rochester, Rochester, New York, United States
- Ross, Daniel W., Northwell Health, New Hyde Park, New York, United States
- Yuan, Christina M., Walter Reed National Military Medical Center, Bethesda, Maryland, United States
- Moore, Catherine A., University of Rochester, Rochester, New York, United States
Background
Night float scheduling, defined by the Accreditation Council for Graduate Medical Education (ACGME) as "the episodic coverage of patients just at night," is widely adopted in internal medicine programs, improving work-life balance and patient care outcomes. However, U.S. nephrology fellowship programs have been slower to integrate night float, often retaining traditional call-from-home systems due to concerns about continuity of care and the educational experience of trainees. Given the variability in night float implementation, this study aims to systematically evaluate the prevalence, structure, and impact of night float within nephrology fellowship programs.
Methods
A nationwide survey was distributed to 151 U.S. nephrology fellowship program directors, achieving a 51% response rate (n=77). Data collected included program size, geographic distribution, and the presence of night float systems. Further questions assessed the structure of night float, including in-house versus at-home call, management of daytime responsibilities, and the perceived impact on trainee wellness, satisfaction, and recruitment.
Results
Among responding programs, 36% (n=28) reported implementing night float. Those who had night float and reported number of ACGME-approved fellows (n=27) had 10.3 fellows (SD 3.4). Those who did not have night float and reported number of ACGME-approved fellows (n=49) had 6.2 fellows (SD 2.7); p < 0.0001, unpaired t test.
Of the 28 programs with night float, 72% utilized at-home call, and 28% required in-house coverage. Additionally, 93% exempted continuity clinic attendance during night float, and 89% excluded regular didactic sessions. Reported benefits included reduced work hour violations (86%), improved trainee wellness (93%), increased trainee satisfaction (89%), and enhanced recruitment (71%). Among programs without night float (n=49), primary barriers were insufficient trainee numbers (81%), concerns about didactic attendance (57%), outpatient continuity (49%), and post-graduation transition readiness (14%).
Conclusion
Night float is present in over a third of U.S. nephrology fellowship programs, demonstrating positive impacts on work hour compliance, trainee wellness, and satisfaction. However, its adoption is limited by program size and concerns about educational continuity.