12 hour shifts

[hotsoup]

Anyone have any positive experiences with 12 hour shifts? After a whole bunch of interviews, my favorite program was the one with 12 hour shifts. I loved everything else about the program, but don't know if I want to subject myself to 12s.
I want time to see my little ones and spouse, go to the gym, and have some general balance in life. I think this is going to be essentially impossible with 12s, so I am guessing I just won't put my (otherwise #1) anywhere near the top of my list.
Anyone else in this position? Or anyone do 12s and able to have some balance?
Thanks.

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[Rendar5]

I prefer 12s because I have more days off with my spouse. But that's basically it, more full days with them or more half days with them

 

[Mad Jack]

12s are a love it or hate it thing. Personally I love 12s and 16s because you work far fewer days a week. If you work 3 12s a week, you have 4 days off, during which you can spend plenty of quality time with friends and family. A busy 8 hour day basically wears me out for the remainder of that day anyway, so I might as well stretch it out a few hours longer. I'll take working 156 days a year over 260 days a year without question.

It's a personal thing though, a lot of older people I work with feel drained by 12s and can't really function if they do more than two or three in a row. Another factor is what you are doing- 8 hours in an incredibly busy environment can be soul crushing compared to 12 hours in a relaxed one. Ultimately you'll have to do what you feel suits you best.

 

[dotcb]

Personally - I HATE 12 hours shifts. I did them in residency. Will never do them as an attending. If you work in a medium to busy center, by 8-9 hours, you're fried. I can have a balanced life and do other things, like exercise and see friends, while doing 8's. Doing 12's - you have time to do your charts, go home, and come back again.

 

[Dr.CCM]

Any thoughts on how 12s affect the "learning" aspect during residency? I've heard that 8-10s are better to learn while 12s are better for attendings.

 

[dotcb]

I'd say 12's contribute to burn out, at least for me personally. I'm pretty grumpy by hour 11. This is balanced by having more days off, but I don't really like having negative feelings toward my job or patients. It wasn't worth it.

 

[dchristismi]

Honestly, if you loved everything else, I don't know that the 12 vs 10 vs 8 should be as high a factor. I worked 12s in residency, and although they are exhausting, it's doable for 3 years. Also remember that you're going to be off-service more than you realize, so you won't really be working 3 years of 12s.

I work 8s now, and wouldn't want to work 12s at my current high-acuity shop, but residency is a limited thing.

Also, the match will send you wherever you're supposed to go. At least, it did for me, although I didn't believe it at first. I ranked the program I really liked (but had one or two nagging things - like 12 hour shifts) lower than I should have... ended up there anyway, and so glad I did.

 

[Arcan57]

Anyone have any positive experiences with 12 hour shifts? After a whole bunch of interviews, my favorite program was the one with 12 hour shifts. I loved everything else about the program, but don't know if I want to subject myself to 12s.
I want time to see my little ones and spouse, go to the gym, and have some general balance in life. I think this is going to be essentially impossible with 12s, so I am guessing I just won't put my (otherwise #1) anywhere near the top of my list.
Anyone else in this position? Or anyone do 12s and able to have some balance?
Thanks.

Back in residency, the now chair of the program gave me some advice for life. I'll paraphrase it as: Take work, family, and play. You can be good at 2 of the 3 but not all 3. Residency isn't really a time for balance, and I don't think 8s vs. 12s contributes appreciably to the lack of balance. It changes greatly what you can do after a shift, but if you're on a run of 3-11s then you're not seeing family or spouse at all.

 

[Birdstrike]

One man's opinion:

A stretch of four or so,12 hour shifts in the ED is murderous. Just remember, most 12 hour shifts don't end at 12 hours, and 8 hours in the ED is like 12 doing anything else, 12 hr is more like 16 hr and so on. Also remember, the "cushy, lots-of-days-off" mythical EM schedule has those days off built in (if you are fortunate) more for recovery so you can get back to even keel, than for any "lifestyle philosophy" envisioned by the Creators of the specialty.

Again, it's just one man's 2 bit coins-, I mean 2 cents.

 

[NERDY]

I wound try to find out how much after the 12 hours do residents stay, are these shifts becoming 13,14,15 hours? Also, when I was on the interview trail, I think places that did 12s might have had around 2 extra days off. However, you may have lecture/conference/etc on an "off" day. Also, I feel that the extra "days" off will just get spent catching up on sleep, life, bills, reading, etc. Chances are on ICU/OBgyn/surgery rotations, you'll be doing 12s so might as well enjoy the 8-10 hour ED shifts. Also, it is always possible that the leadership will change the shift length.

 

[deleted547339]

I wound try to find out how much after the 12 hours do residents stay, are these shifts becoming 13,14,15 hours? Also, when I was on the interview trail, I think places that did 12s might have had around 2 extra days off. However, you may have lecture/conference/etc on an "off" day. Also, I feel that the extra "days" off will just get spent catching up on sleep, life, bills, reading, etc. Chances are on ICU/OBgyn/surgery rotations, you'll be doing 12s so might as well enjoy the 8-10 hour ED shifts. Also, it is always possible that the leadership will change the shift length.

These are what we call "career-affirming" months.

 

[da8s0859q]

These are what we call "career-affirming" months.

Amen.

OP: my program has us doing 8 hour shifts, about 20-21 of them monthly in PGY-1, decreasing from there. Stay-over for charting, cleaning up, pending radiology for dispo, whatever, usually extends that to 9-9.5 hours on average. Busy hospitals. I'm exhausted when I go home but would do 12s as an attending if it were at a shop with half the volume for the reasons mentioned above.

The thought of 12 hour shifts in my current environment is painful, but that's just me. I did interview at, or know of, some places that do something like 17-18 12 hour shifts monthly for interns, and while I don't know what the culture is as far as getting them out right at the 12 hour mark, I'd rather take a couple more days a month and work several hours fewer each shift.

 

[EMdoc10]

The 12h-shift progs I interviewed at stressed that duty-hrs are taken SERIOUSLY. The attendings/PD know when your shift ends and "kick you out" if you're still lingering 0.5h after. Can any current residents attest to this?

 

[NinerNiner999]

For residency, 12 hour shifts are ideal IMO because they will give you additional study time / family/friend time on your days off. You'll maximize your exposure while you're there and learn in longer boluses, which for me at least, sticks more. You will have more time off relatively, unless the residency you choose expects you to work 20 shifts per month - which defeats the purpose.

As an attending rotating days and nights, run far away from 12 hour shifts. Far, far away. 9 hour shifts are ideal for maximizing hours and minimizing time away from your life. 15 shifts per month is 135 hours (by my math), and you still have 1/2 of the month off. Not to mention, you have time to get an extra meal or movie in with your family around your shifts. 12 hour shifts also impact Press Ganey scores because, as another poster mentioned, most people get tired around 10 hours or so. 1/6 of your clinical year will be spent tired in the ED...

Remember - Residency is a sprint, but Attending life is a marathon. Try to have a consistent schedule with lower hour shifts. The job is crazy enough - try to make your life outside of it somewhat regular...

 

[NERDY]

The 12h-shift progs I interviewed at stressed that duty-hrs are taken SERIOUSLY. The attendings/PD know when your shift ends and "kick you out" if you're still lingering 0.5h after. Can any current residents attest to this?

Even if they tell you to leave, you still have to finish your documentation and give good patient care. You may be out of the ED, but you be at home/lounge/call room finishing up the charting. Also, depending on the culture, there are some things you can and can't sign out.

 

[DrMom]

I was in a residency that only did 12 hour shifts. We rarely stayed over any significant amount of time. Residents charted on paper and our attendings dictated the official final record, so we were able to keep up on our documentation without too much difficulty. We were expected to arrive 15 mins early for a shift to get handoffs from the residents leaving. Working fewer days/month gave me more days with my family and more time available for moonlighting.

As an attending, I still work mostly 12 hour shifts (occasionally have a 9 or 10 hour shift instead). I travel a lot, so I'd rather have more days off than work shorter shifts. That said, my day-to-day quality of life is notably better when I'm doing the shorter shifts.

 

[tkim]

did 12's in residency, now 9, 10's in attending land. can't do 12's now - they would kill me.

 

[DoctorTinyCat]

I think an absolutely crucial question is how long you stay after shifts. At my residency, most shifts are ~8 hrs, but it's the norm to stay 3-4+ hours after for charting, tying up loose ends, etc. I also was adamant I didn't want to end up at a program that works 12s and feel rather disappointed that I essentially did; 12s are not conducive to family life. If the program you're considering works 12s but you can wrap up quickly, it may actually end up being a better bargain if you're working fewer shifts.

 

[Arcan57]

I think an absolutely crucial question is how long you stay after shifts. At my residency, most shifts are ~8 hrs, but it's the norm to stay 3-4+ hours after for charting, tying up loose ends, etc. I also was adamant I didn't want to end up at a program that works 12s and feel rather disappointed that I essentially did; 12s are not conducive to family life. If the program you're considering works 12s but you can wrap up quickly, it may actually end up being a better bargain if you're working fewer shifts.

Out of curiosity, why is the norm 3-4 hrs after your shift? Either you're picking up patients right until the minute your shift ends, or there's some systemic flaw in the way your residency teaches work-flow.

 

[dotcb]

In my residency we did 8's. As an R2 I'd stay 3 hours after tidying up and documenting. By the time I was an R4, I would see more patients, document as I go, and leave just after sign out. You progress through residency and become much more efficient. This is how it should be. A 12 plus staying late = 15 hours. I would die.

 

[deleted547339]

How do you possibly stay that late? If I get swamped, I'll stay a little over an hour late...
Generally most people are out about 30-45mins after a shift, some are a little better at getting out on time.

Do you not check stuff out?

 

[DoctorTinyCat]

Out of curiosity, why is the norm 3-4 hrs after your shift? Either you're picking up patients right until the minute your shift ends, or there's some systemic flaw in the way your residency teaches work-flow.

A fine question and one that I am still trying to figure out as an intern. I think generally we are understaffed and there is a culture of going to see more patients rather than working on your notes as you go; sometimes seniors will go through their shift seeing 20+ pts and will have not have started notes by the end of the shift. We sign-out, but typically if your pt will be leaving in the next hour or so, it seems to be the norm to stay and complete the dispo. Plus, the attendings seem to have an expectation for exceptionally thorough MDMs in our notes. Most of us find this system pretty miserable and our trying to change the culture, but that's easier said than done.

 

[Arcan57]

A fine question and one that I am still trying to figure out as an intern. I think generally we are understaffed and there is a culture of going to see more patients rather than working on your notes as you go; sometimes seniors will go through their shift seeing 20+ pts and will have not have started notes by the end of the shift. We sign-out, but typically if your pt will be leaving in the next hour or so, it seems to be the norm to stay and complete the dispo. Plus, the attendings seem to have an expectation for exceptionally thorough MDMs in our notes. Most of us find this system pretty miserable and our trying to change the culture, but that's easier said than done.

Interns leaving late routinely is pretty common, but any program that's features seniors routinely not charting until the end of their shift is doing it's residents a disservice. It also will lead to either poor charting or "creative" charting since it is difficult to keep 20 patients straight when it comes time to document. We were always taught that you shouldn't have more than 3 undictated finished charts, or you need to dictate before you pick up the next patient.

 

[bartleby]

Twelve hour shifts will regularly turn into 13 hour shifts by the time you tie things up and sign out. Note that the emergency medicine work hour restrictions state that you cannot have a _scheduled_ shift longer than 12 hours...The ACGME doesn't care how long it actually takes you to extricate yourself at the end of a shift as long as you don't break the duty hour total for the week.

12 hr shifts are the pits if you work in a busy place. All you can do after work is veg out on the couch before passing out and getting up to do it again tomorrow. They are terrible for wellness from the standpoint of being able to eat well, exercise and have any sort of social life. You might think that you just push through during residency but it will make you sad, tired, and burnt out. Residency should be challenging, educational, and fun...Not a prison sentence

 

[carbonizedeyesockets]

Sorry for the necro-bump (is the truly necro if it was 2 years old?). An attending mentioned to me that our program switched from all 12s to mostly 8s because 12s are less efficient, which I hadn't heard before. I figured this was worth adding for anyone who might do a search on the subject.

Am J Emerg Med. 2008 Sep;26(7):789-91.
Resident productivity: does shift length matter?
Jeanmonod R1, Jeanmonod D, Ngiam R.

Abstract
BACKGROUND:
It has been established that residents are able to evaluate more patients per hour as they progress through training. However, it is unknown if shift length influences resident productivity.

OBJECTIVES:
The aim of this study is to assess whether there is a difference in second-year resident productivity as a function of shift length.

METHODS:
This is a retrospective chart review of patients evaluated in the emergency department (ED) by second-year residents in a 65,000 volume center; 9- and 12-hour shifts were included. Nine-hour shifts provide a 1-hour overlap, such that three 9-hour shifts provide 24 hours of resident coverage. Shifts on weekly conference day were excluded. A patient was determined as having been evaluated by a resident if the resident initiated care on the patient and dictated the chart. Data were analyzed using 2-tailed t test.

RESULTS:
A total of 193 nine-hour shifts and 90 twelve-hour shifts met inclusion criteria. Residents working 12-hour shifts evaluated 1.06 patients per hour, and residents working 9-hour shifts evaluated 1.15 patients per hour (95% confidence interval, 0.031-0.151). In an ED with 120 hours of resident coverage per day, this results in 10 additional patients seen by residents working 9-hour shifts. In our department with 9 ED months in the second year of residency, this results in 180 additional patient encounters per resident during that year.

CONCLUSIONS:
Shorter shift lengths appear to result in more patients evaluated per hour by second-year residents and an increase in patient encounters.

 

[deleted109597]

Yeah, it's a given.
Also, with 12s, you can't stay after, or it's a work hour violation.

 

[DeadCactus]

I don't think twelves are a deal breaker as a resident. I prefer 8's or 9's because they leave you time in the day to work-out, sleep reasonably well, eat a decent meal, and read for 10 or 15 minutes. I find being able to keep good daily habits outweighs the benefits of an extra day off. I also buy into the results of the above listed study. On a final note, 12's does not inherently even mean more days off. Different programs work different hours per month.

 

[The White Coat Investor]

I also prefer 8s.

I also agree you won't find work-life balance as a resident.

My second choice had 12s. My first choice had 9s. That was the reason one was my first choice and one was my second choice. I matched at my first choice. Later on, I had the opportunity to work 12s for a few years. I was right. I hate them.

 

[BAM!]

avoid 12 hour shifts during residency. it's not conducive to a happy life.

but as an attending, an occasional 12 hour shift is not that bad. it means extra cash. also make sure you're not seeing a high patient volume over the 12 hours.

 

[Jlaw]

My program does 12's, along with occasional shorter shifts. I don't like 12's, per se, but I would rather work 4-5 long days a week than 5-6 short days per week. Also in my experience at many different programs during 4th year, a lot of the places that work 9-10 hour shifts you spend 1-3 hours cleaning up charts after. When you work a 12 there is not much room before duty hour violations become an issue so they tend to be out right on time with charts complete.

Go to the program you like, a 12 at a place you love will be infinitely shorter than an 8 you hate. Boom.

 

[carbonizedeyesockets]

My program does 12's, along with occasional shorter shifts. I don't like 12's, per se, but I would rather work 4-5 long days a week than 5-6 short days per week. Also in my experience at many different programs during 4th year, a lot of the places that work 9-10 hour shifts you spend 1-3 hours cleaning up charts after. When you work a 12 there is not much room before duty hour violations become an issue so they tend to be out right on time with charts complete.

Go to the program you like, a 12 at a place you love will be infinitely shorter than an 8 you hate. Boom.

Still the problem remains. You work the same number of hours, but ultimately are seeing fewer patients. That is a disservice to your education. Also, the duty hour restriction doesn't apply to time needed to chart after a shift.

 

[Jlaw]

Still the problem remains. You work the same number of hours, but ultimately are seeing fewer patients. That is a disservice to your education. Also, the duty hour restriction doesn't apply to time needed to chart after a shift.

I'm pretty sure if you stay at the hospital finishing up charts and tidying things up after a shift that counts as duty hours. If you go home and chart then it doesn't count. Not totally up to speed on duty hour technicalities but that is how it was explained to me and on their website ACGME counts "administrative duties related to clinical cases" towards duty hours.

 

[FroggerMD]

12 hour shifts are pretty brutal, but doable for a few years. My program had all 12's for the first two years, then mostly 8's for the second two with 12's only on weekends and holidays. The improvement in quality of life going from 12's to 8's was palpable - work days actually allowed time for normal life things, like going to the gym or cooking or just going out for a bit. One important factor is how many 12's you do a month - my program had 18 12's intern year and 17 12's second year; another residency I looked at started with 20 12's and went down by one each year, and this was just too much for me. Additionally, as some others have mentioned above, the culture of notes/ sign-outs matters; if residents are routinely staying an hour after each shift (common in my program) to finish notes because the culture is to see as many patients as possible and not sign out little things, then you'll have a tougher time.

 

[TooMuchResearch]

I'm pretty sure if you stay at the hospital finishing up charts and tidying things up after a shift that counts as duty hours. If you go home and chart then it doesn't count. Not totally up to speed on duty hour technicalities but that is how it was explained to me and on their website ACGME counts "administrative duties related to clinical cases" towards duty hours.

Hours worked at home are still hours worked. It's up to you if you log them.

 

[Druggernaut]

Still the problem remains. You work the same number of hours, but ultimately are seeing fewer patients. That is a disservice to your education. Also, the duty hour restriction doesn't apply to time needed to chart after a shift.

I'm not so sure you're seeing fewer patients doing 12's. I haven't seen the study myself, but one program claimed it's been shown you see more patients at 12 hour places since you are spending more of your shift dealing with new patients rather than signouts and have to sign out fewer patients.

I do 12's, and while 8's are better, I'm not willing to work 20+ days a month that would be required here if we were to make the switch. If I could do the same number of shifts with 8's like some places do, I probably would, since those places still produce competent physicians.

 

[Hercules]

I'm not so sure you're seeing fewer patients doing 12's. I haven't seen the study myself, but one program claimed it's been shown you see more patients at 12 hour places since you are spending more of your shift dealing with new patients rather than signouts and have to sign out fewer patients.

The program that said that is flat out wrong. If all other variables are equal you see fewer patients per hour on 12 hour shifts. This is true in both residency and as an attending. When you come into a shift unencumbered you can plow through a ton of patients. Many physicians will see 1/3 to 1/4 of their patients in the first hour of their shift. You have to start slowing down as results come back, dispos get made, consultants call, etc.

You can use this fact to improve coverage without increasing hours. Instead of 3 twelves you can do 4 eights or nines and wind up seeing patients faster because you have 4 separate points in the day where you add a fresh provider. Plus shorter shifts are more lifestyle friendly for everyone who has a family and isn't traveling long distances to their shift.


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[alpinism]

I personally think we should go to 6 hour shifts.

That way you can see even more patients and have even more learning opportunities!

7 x 6hrs per week = sounds like the perfect schedule.

 

[Jlaw]

Hours worked at home are still hours worked. It's up to you if you log them.

No, they aren't.

 

[TooMuchResearch]

No, they aren't.

They count per ACGME:

Duty hours are the amount of time resident and fellow physicians spend on clinical experience and education in their specialty or subspecialty after completion of medical school.

“Clinical experience and education” depicts the nature of these hours, which includes all clinical and academic activities related to a program. This includes patient care (both inpatient and outpatient); administrative duties relative to patient care; the provision for transfer of patient care; time spent in-house during call activities; and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the education site.

 

[Fox800]

I'm pretty sure if you stay at the hospital finishing up charts and tidying things up after a shift that counts as duty hours. If you go home and chart then it doesn't count. Not totally up to speed on duty hour technicalities but that is how it was explained to me and on their website ACGME counts "administrative duties related to clinical cases" towards duty hours.

That's how it was explained to me, too.

 

[wonderbread12]

don't do 12s, you are so exhausted by hours 10-12 not to mention the time you spend afterwards catching up on charts you ignore to get through patients

I see the most at the first 4 or so hours of a shift and then things slow down predictably

 

[Cerberus]

As an Attending I prefer 12s because I work fewer days and it makes travelling much easier if I want a block of dates off. As a resident I would avoid a purely 12 hour program if all other things were equal. 12 hrs in the ED can be a real beating. If you are doing it 2-3 times a week it isn't bad but if it's 4-5 days and you are coming in for conference days it is too much.

 

[deleted109597]

A Cerb sighting!

 

[deleted77919]

…

 

[Cerberus]

A Cerb sighting!

Ever since this Pokemon Go thing came out, poor old Cerberus has had to keep a low profile. It's demeaning to have these millenial 20 somethings and children throwing "poke balls" at the THE one and only Three Headed Hellhound of Hades