Emergency Medicine and Holidays

[Serve Others]

Hello all,

So i've been lurking around some of the EM forums and i haven't seen this question asked or answered before. My question is, is there a way to get at least some holidays off throughout the fiscal year working as an EM physician? I've read from a couple of forums where people in the same group trade off shifts such as some taking all night shifts (to ease with the circadian rhythms screw up) while the others seem very grateful they get to work less night shifts or perhaps none; also others working plenty of shifts during three weeks span and then getting a week off, etc. Similarly, could EM physicians in a group schedule/work out scenarios where they work majority of holidays realistically 80% of them, so that they can get the other 20& off? Or is there just not enough EM physician staff for this to happen and they all have to be stretched too thin during holidays. Bonuses aside from working night shifts and holidays, seems like a win/win for both parties agreeing.

Appreciate the input and your time.

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[BoardingDoc]

Hello all,

So i've been lurking around some of the EM forums and i haven't seen this question asked or answered before. My question is, is there a way to get at least some holidays off throughout the fiscal year working as an EM physician? I've read from a couple of forums where people in the same group trade off shifts such as some taking all night shifts (to ease with the circadian rhythms screw up) while the others seem very grateful they get to work less night shifts or perhaps none; also others working plenty of shifts during three weeks span and then getting a week off, etc. Similarly, could EM physicians in a group schedule/work out scenarios where they work majority of holidays realistically 80% of them, so that they can get the other 20& off? Or is there just not enough EM physician staff for this to happen and they all have to be stretched too thin during holidays. Bonuses aside from working night shifts and holidays, seems like a win/win for both parties agreeing.

Appreciate the input and your time.

It entirely depends on your group, but yes, you can certainly find a group where you could, for example, get every xmas off in exchange for working every NYE, thanksgiving, 4th of july etc.

 

[Hercules]

It all depends on what holidays are important to your group. I work every other Christmas (but we set it up where each person in the group has at least 6-7 days off in a row right around Christmas). Each year that you're off for Christmas you work the Thanksgiving stretch. I live in Mobile, AL so Mardis Gras is a major holiday as well where the kids are out for the week so we tend to take turns with that one as well.


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[Brahnold Bloodaxe]

What if you absolutely don't care about working holidays and just want to make the most money possible? Can you volunteer to work the worst shift on every holiday in exchange for a massive bump in hourly rate for those shifts?

 

[Daiphon]

What if you absolutely don't care about working holidays and just want to make the most money possible? Can you volunteer to work the worst shift on every holiday in exchange for a massive bump in hourly rate for those shifts?

Volunteer? No.
Negotiate? Yes.

Former implies you're "taking one for the team;" while the latter is a variation on noctutnalism, and as such should have your benefits of doing so defined. In writing. Well before the first holiday hits.

Semper Brunneis Pallium

 

[EKGdoc]

We're a fairly large group (~60 docs, hospital employees) covering several hospitals. Also have ACGME EM residency. We have an "A" and a "B" holiday schedule block, each doc is assigned to one. We alternate years that you're expected to work 1/2 the holidays, but u get the other holidays off. The next year it's flipped which holidays are in your block. Holidays are Easter, Mem Day, July 4th, Labor Day, Thanksgiving, Christmas, and New Years. (For example, if you're on the block working Memorial Day, you'll be off July 4th block. Or if you're working Christmas, you're off New Years). People are free to trade. Nice thing is that you know years ahead which holidays you're working.

 

[The White Coat Investor]

Here's what to expect. Let's assume you work 15 shifts a month. That's half the days in any given month. Thus you work half the days in any given year. So you should expect to work half of the holidays in a given year. So maybe you work all 3 days on President's Day weekend but get MLK weekend off. You work Memorial day so you get Labor day off. You get half of Spring Break off. You get Thanksgiving or Christmas. You get July 4th or New Years Day.

You get the picture. If you expect to work half of them, that'll be about right. Want to work fewer? Work fewer shifts or pay someone else to work your shifts.

 

[Serve Others]

Thank you all for your responses, but I have a question in which you medical students, residents and physicians may better guide me. I did a bit of reading today on shifting your circadian rhythm to potentially be able to work all night shifts and sleep during the day. It seems definitely doable (I don't think I'm underestimating it) and I found plenty of helpful tips in regards to sleep hygiene and related tricks to make this "circadian rhythm shift" transition as smooth as "possible ?" and keeping it a routine. However, assuming that one can successfully shift the circadian rhythm to work all night shifts and sleep during the day and keep it a routine, are there any REAL health risks that can overtime deter physical and cognitive functions? I tried looking around online for anything suggesting a deterioration of overall health by switching (from natural) and keeping a flipped circadian rhythm but I couldn't find anything. Is it then just doable to train and adjust your circadian rhythm to what works or is necessary for your lifestyle without any significant negative health impact? Maybe some of you can point me to the right sources to look at or comment on these thoughts/share some insight from medical knowledge or experience. I greatly appreciate your input, thanks.

P.s. for the sake of "REAL" health risks I'd respectfully prefer that being out of phase with regular day working people (especially during days off) would not be considered as health risk.

 

[deleted547339]

What's a holiday?

 

[Birdstrike]

As an Emergency physician, you will work about 1/3 to 1/2 of all weekend and holidays, your entire career. There's almost no way around it.
The same goes for the circadian rhythm disturbances. There's ways to tweek it slightly, to make it a little harder or a little less hard on yourself, but there's essentially no way around the essential problem if you are working general emergency medicine. Anyone that tells you anything else, is likely trying to recruit you into the specialty, hire you into a job by making promises they can't keep, blowing smoke up your colon or just has no clue what they're talking about. They'll probably tell you about the dermatologist that doesn't have to see skin or the surgeon who never had to do surgery.

 

[gutonc]

Thank you all for your responses, but I have a question in which you medical students, residents and physicians may better guide me. I did a bit of reading today on shifting your circadian rhythm to potentially be able to work all night shifts and sleep during the day. It seems definitely doable (I don't think I'm underestimating it) and I found plenty of helpful tips in regards to sleep hygiene and related tricks to make this "circadian rhythm shift" transition as smooth as "possible ?" and keeping it a routine. However, assuming that one can successfully shift the circadian rhythm to work all night shifts and sleep during the day and keep it a routine, are there any REAL health risks that can overtime deter physical and cognitive functions? I tried looking around online for anything suggesting a deterioration of overall health by switching (from natural) and keeping a flipped circadian rhythm but I couldn't find anything. Is it then just doable to train and adjust your circadian rhythm to what works or is necessary for your lifestyle without any significant negative health impact? Maybe some of you can point me to the right sources to look at or comment on these thoughts/share some insight from medical knowledge or experience. I greatly appreciate your input, thanks.

P.s. for the sake of "REAL" health risks I'd respectfully prefer that being out of phase with regular day working people (especially during days off) would not be considered as health risk.

I'm just going to leave this here.

 

[BoardingDoc]

I'm just going to leave this here.

A link to a medscape login page?

EDIT: NM, just spent the 2 min necessary to create an account using made up details.

 

[Serve Others]

ok so how realistic is taking one nap during any (swing, day, night, 8hr, 12hr, etc) ER shift? I'm talking about ~20min. Is this doable? Like probably inside the ER is not likely but maybe going to your car and take 20? Do you get a break during a shift for that matter?

 

[Serve Others]

As an Emergency physician, you will work about 1/3 to 1/2 of all weekend and holidays, your entire career. There's almost no way around it.
The same goes for the circadian rhythm disturbances. There's ways to tweek it slightly, to make it a little harder or a little less hard on yourself, but there's essentially no way around the essential problem if you are working general emergency medicine. Anyone that tells you anything else, is likely trying to recruit you into the specialty, hire you into a job by making promises they can't keep, blowing smoke up your colon or just has no clue what they're talking about. They'll probably tell you about the dermatologist that doesn't have to see skin or the surgeon who never had to do surgery.

I'm just going to leave this here.

ok so how realistic is taking one nap during any (swing, day, night, 8hr, 12hr, etc) ER shift? I'm talking about ~20min. Is this doable? Like probably inside the ER is not likely but maybe going to your car and take 20? Do you get a break during a shift for that matter?

 

[Makati2008]

ok so how realistic is taking one nap during any (swing, day, night, 8hr, 12hr, etc) ER shift? I'm talking about ~20min. Is this doable? Like probably inside the ER is not likely but maybe going to your car and take 20? Do you get a break during a shift for that matter?

Lol. It's er and volume dependent. Residency it is highly unlikely you will ever get to nap during a ED shift


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[BoardingDoc]

ok so how realistic is taking one nap during any (swing, day, night, 8hr, 12hr, etc) ER shift? I'm talking about ~20min. Is this doable? Like probably inside the ER is not likely but maybe going to your car and take 20? Do you get a break during a shift for that matter?

If you work in a super low volume shop or are working 24h shifts this is probably doable. If you're working in an average to busy shop this will not happen. As Makati said above, you will not nap during an ED shift during residency.

As for getting a break, no there is no protected time where you can say "I'm going to take my break." If the dept is quiet, you can typically sit down and eat something but you will frequently (during residency anyway) go your entire shift without eating/drinking/urinating because of how busy you are.

 

[Birdstrike]

ok so how realistic is taking one nap during any (swing, day, night, 8hr, 12hr, etc) ER shift? I'm talking about ~20min. Is this doable? Like probably inside the ER is not likely but maybe going to your car and take 20? Do you get a break during a shift for that matter?

Like others have said, probably never during residency and as an attending only at very low volume places, in the middle of the night. Most jobs, though, this is closer to "never" and you're constantly busy. Remember, most EDs have more business than they need, ie, overwhelmed, not hurting for business.

As far as day shifts and swing shifts, they tend to be at least steady busy pretty much everywhere. Any ED where people are asleep on day or swing shifts probably is shut down to to lack of business, like any other place of business.

I wouldn't factor in ever being able to sleep on a shift. If it happens, on an occasional night shift at a small ED, then consider yourself lucky.

 

[Jelgava]

Totally depends on your group. Our group schedules us on blocks of shifts during the holidays (so that you might work one whole block but be off the entire other block).

 

[GeneralVeers]

I always take a break to eat. Even if the department is busy. If I'm hungry, and my energy is low, my ability to work is going to suffer. Thus a 10-15 minute break every 3-4 hours is mandatory.

 

[Hercules]

I always take a break to eat. Even if the department is busy. If I'm hungry, and my energy is low, my ability to work is going to suffer. Thus a 10-15 minute break every 3-4 hours is mandatory.

Same here. I can see 3+ pph and still have time to eat. Food is mandatory for me. There's always a break in the flow at some point where you can eat. Always.


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[Angry Birds]

ok so how realistic is taking one nap during any (swing, day, night, 8hr, 12hr, etc) ER shift? I'm talking about ~20min. Is this doable? Like probably inside the ER is not likely but maybe going to your car and take 20? Do you get a break during a shift for that matter?

I worked 24's at a dinky hospital and only got ~2-4 hours of sleep a night. So yeah, unless it's 24 hour shifts, no way you can take a nap.

Also, ER really messes up sleep schedule and I would say that I am now a really bad sleeper, currently taking Melatonin to go to sleep and Benadryl the night before a shift... Although I'll have to rethink this strategy since I will no longer being working 24's.

 

[Tungsten5]

Does anyone do shifts that slowly cycle? That is, first is 8 am, next 12, next is 4, next is 8 pm etc to allow slow changes to circadian rhythm? Is this even possible?

 

[shoal]

Does anyone do shifts that slowly cycle? That is, first is 8 am, next 12, next is 4, next is 8 pm etc to allow slow changes to circadian rhythm? Is this even possible?

yes that shouls be what your group attempts to do. makes for much happier and easier time

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[Angry Birds]

yes that shouls be what your group attempts to do. makes for much happier and easier time

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I guess the problem is always all the requests and the desire for flexibility.

 

[GTP]

Hey for those who exclusively do locums for like 300 an hour, cant you choose to work 6-8 shifts a month that happen to never fall on a holiday?

 

[WalkingCorpse]

Hey for those who exclusively do locums for like 300 an hour, cant you choose to work 6-8 shifts a month that happen to never fall on a holiday?

Probably doable, but I caution anyone who thinks they can totally avoid all holidays. Or on the flip side you could decide to work Christmas-New Years for ridiculous pay because no on else wants to work, and take a nice a vacation in January. Locums can be great if you find the right situation that works for you.


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[emergentmd]

Hey for those who exclusively do locums for like 300 an hour, cant you choose to work 6-8 shifts a month that happen to never fall on a holiday?

If you do locums, You can avoid weekends, holiday, nights if you like. You may not make as much, not get as many shifts you like. If you only work 6 shifts a month, this is very doable.

 

[GTP]

If you do locums, You can avoid weekends, holiday, nights if you like. You may not make as much, not get as many shifts you like. If you only work 6 shifts a month, this is very doable.

I could even do 8-10 shifts a month. Half can be nights or weekends i dont care. And there are certain holidays i dont care about (presidents day). But i dont wanna work 4th july weekend, Thanksgiving, new yr or valentine's day if i can help it lol. Those seem to be the only times i dont want to work. Im still a 2nd yr resident. I hope i can find my dream locum

 

[Brahnold Bloodaxe]

If you are doing locums, can you make significantly more on a hourly basis if you are willing to work all weekends and all holidays that happen to fall in a given month? So for example, if an average EM doc working 15 12s makes 400k, would somebody working locums doing 15 12s including 8 weekend 12s make significantly more?