Our program has fully eliminated in-house, 24-hour call. Nights are covered 365 days a year by a night float system at Zuckerberg San Francisco General and UCSF Medical Center. Night float blocks are spread evenly through the second half of the R2 year, the R3 year, and R4 year. At ZSFG, night float blocks consist of 4-5 consecutive night shifts within a 14-day rotation combined with outpatient clinics where there is 1 post-call day and 3 days off to allow for adequate rest. At UCSF Medical Center, we use a novel sleep-optimized night float system consisting of 1 day off, 2-3 evening shifts, 2-3 night shifts, and then a post call day followed by 3 days off for rest and circadian rhythm recovery.

Nights at the VA are covered by a home call system, shared between inpatient and outpatient rotators. No resident takes more than 2 nights per week, and residents are given either a half-day or full day off after home call to allow adequate rest. The VA National Telestroke Program provides acute stroke coverage overnight and on weekends at the San Francisco VA.