Schedule/Lifestyle of ER doctors

My neighbor works 4, 18 hours shifts a month, cause she has kids and likes to be home. I think its pretty flexible when you are an attending (she is 30) , depending on where you are.

That's a good point to bring up, though I have no clue what I want to do yet. Although medicine is something I've always found interesting, the greatest thing that is honestly holding me back are the hours, seeing that someday I may have to raise a family and whatnot.

Tippyboat said:

I can imagine that residents in ER programs probably get stuck with the worst hours/shifts, so how many overnight shifts do they usually do in a week?

As one climbs the seniority ladder as an ER doctor, after approximately how many years do you begin to work shorter shifts (how short?) and work mostly in the daytime?

Overall, what kind of schedule and shifts does an average ER doctor expect?

Thanks!

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There's always an attending or fairly senior resident on call overnight at most places -- it's not like it's ever totally turned over to the interns alone, so don't expect a nine to five job in EM, ever -- it will always be your turn to do overnight at some point in most practices. But certainly, during your early years (residency and post residency), a lot of your hours will be overnight. Expect three or four 12ish hour shifts per week at some places. Still works out to not that many hours a week.

But bear in mind that in medicine there is a disconnect between what hours you work and what hours you can actually leave -- you may end up doing a couple of hours of paperwork and clean-up of details even beyond your shift (particularly when you are still learning and less efficient). This is not specific to EM.

For example, on many rotations in med school, you will see the residents sign out at 9am after an overnight shift, but not actually get to go home until 1-2 pm post call, because there is stuff they didn't get to during the busy night. The sign outs are artificial -- something to show the policing organizations that the residents are not running afoul of the 80 hour work week. Yet at many programs, they still aren't in compliance -- just the sign out times are.

billy72583 said:

My neighbor works 4, 18 hours shifts a month, cause she has kids and likes to be home. I think its pretty flexible when you are an attending (she is 30) , depending on where you are.

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Just one shift a week?

Tippyboat said:

So basically ER doctors can begin to choose their hours after becuming an attendings?

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I think that's the draw of ER; shift-work. And you definitely do more than one shift per week. It's probably still around a 40-50 hour work week, but with a schedule to your choosing.

I know an ER doctor who work about 3 shifts a month and maybe puts in 35 hours of research in a week. If you ask me that is a pretty nice job, especially consider you are making around 200 dollars per hour.

I think you will find that the answer to your question varies by institution. For example, in our ED the attendings always work 8 hour shifts and the residents may work 8 - 12 hour shifts. Our attendings/residents are usually put on some type of schedule that has them working the same shift for an entire week (ie, always 7-3, 3-11 or 11-7) and then switching to the next shift, so that in any given week your hours are regular, but over the course of a month they are not. The attendings don't really get to pick their shifts; everyone works days and nights. But again, this likely varies depending upon where you work.

Tippyboat said:

Thanks for the info.

So basically ER doctors can begin to choose their hours after becoming an attending?

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Eh, this is kind of misleading - it REALLY depends on where you're working. Academic physicians have less clinic hours but you have other obligations. Most academic hospitals do something like 8 12 hr shifts a month or 10 10 hour shifts a month.

If you do a community ER you work more because you have no teaching or research responsibilities - most community ER docs put in 40-50hrs/week.

As far as night work - you can never really count on not working nights - so if thats your goal EM is probably not for you. ERs are almost always more busy at night so more attendings work at night than in the day which means you will almost always have to work SOME night shifts.

I'm told that if you do a subspecialty you are higher value and can sort of pick your hours to a point (and your salary). But that requires a fellowship and more years of low pay.

alwaysaangel said:

ERs are almost always more busy at night so more attendings work at night than in the day which means you will almost always have to work SOME night shifts.

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This might be true at lot of places, but not all. Nights in our ER are usually slow as molassus.

One of the most unique things about emergency medicine is its variety of job set-ups. If you go into family practice and plan to do primary care you pretty much need to be in clinic during the day at least a few days a week (probably more). If you go into surgery you will probably need at least 1-2 clinic days a week and 1-2 OR days.

Emergency jobs are all over the map but let me try to clear up a few things.

-It is pretty rare for groups to give senior members priority scheduling. Thing of how this would affect hiring into the group -- "come work for us we have a great set up but our collection of docs over the age of 60 work everying 8a-5p shift so you will do all evenings and nights." Scheduling is usually pretty democratic.

-Eighteen hours in an even moderately busy ED would be a grind. Alot of people say things like "I don't mind working when I'm at work" but try 18 hours (which would turn into 20 or 21) and then get back to me. It would take an average person an entire day to recover from a shift like this.

-ER docs work shifts, and they get paid by the hour. Conceivably you could work 8 hours a week but then you would be getting a small fraction of your POTENTIAL salary. EM is well compensated but not so well compensated that you are going to be living the high life working one shift a week.

-The lifestyle is what the lifestyle is. It's impossible to say that it is "better" than fields like Gas, IM, Peds, FP etc because that is such a value judgement. If you go into EM you will work fewer hours than a pediatrician and you will not be on call. You will also probably be in the hospital at 10am on Christmas morning while you family is at home opening presents.


At the end of the day lifestyle should be a distant second to your interests. I personally like EM alot but there are things about it that I wish I didn't have to deal with. If you go into a field largely for reasons of hours and salary then prepare to be miserable and depressed 5 years out of residency.

mmmcdowe said:

When you live in the middle of nowhere in the very very far north and there's pile of snow on the ground most days, you don't get many people in the ED at night unless they REALLY need it.

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Says the pre-med student to the resident....

Seriously, most EDs in the US are not in the middle of nowhere in the very very far north, which makes your statement not-applicable to the majority of EDs. And, although I can only speak for the ED that I worked in, which was in the south in the middle of suburbia, people will come into the ED at 3am for all sorts of things, including a pain that's been bothering them for months.

"Sir, did the pain get worse tonight?"
"No"
"Did the pain change at all tonight?"
"No"
"So why did you come to the ED in the middle of the night?"
"Well, I just thought it was time to get it checked out"

diosa428 said:

Says the pre-med student to the resident....

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not just any resident either, perhaps one of the best medical bloggers ive read.

AmoryBlaine said:

-It is pretty rare for groups to give senior members priority scheduling. Thing of how this would affect hiring into the group -- "come work for us we have a great set up but our collection of docs over the age of 60 work everying 8a-5p shift so you will do all evenings and nights." Scheduling is usually pretty democratic.

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This is pretty much the opposite with the group that I work with (not as an MD, obviously). When someone new is hired to the group, part of their contract is that for the first 2 years, they only get night shifts (11p-7a). After that, they go into the regular scheduling mix, but our most senior docs only work minimal nights (although they do end up with some).

All the attending ER docs at my work work 12-15 shifts a month, 12 hour days. They work all shifts: day, mids, and nights. The older docs (15+ years) work about 9 shifts a month, 12 hr days. All these Drs, including the veterans, are full-time. They usually group a bunch of shifts in a row (4-6 shifts), then have like 4-7 days off in between. Not too bad for 290k/year...

In the busy NorCal county ER I volunteered at, the ER docs worked 3 12s a week and brought in approx. 200k a year. I think mix of day/night weekends. Not sure how seniority played into things. The 2 doctors I talked to were in their thirties or forties.

<I can imagine that residents in ER programs probably get stuck with the worst hours/shifts, so how many overnight shifts do they usually do in a week?>

Actually, ER residents have some of the shortest/cushiest hours of any type of residency. This is because they don't work >12 hours at a stretch in the ER, and they have a stricter limit on the hours/week they can work. I think it's 50 or 60 (for residents) maximum per week. For other specialties like internal medicine or surgery, it's a maximum of 80hrs/week on average, and a lot of the time these residents do work the 80 (sometimes a little more). ER is basically shift work, so no patients to follow longitudinally and less paperwork, though there still is some.

As far as what hours you'll work as an attending, that really will vary a lot according to your practice setting. You can probably assume some nights will be required, unless you work in a doc in the box or can negotiate yourself only day shifts (but would probably not count on definitely being able to do that).

As far as the $50-100/hour someone quoted above, that is definitely low. I get $80-100/hour at a VA for working in the ER there, for 8-15 hours at a time. That is for a nontrauma ER and I'm an internist. ER docs generally make more per hour.

As far as whether the ER is busy at night vs. not, that depends a lot on the particular ER. The ones that are not trauma centers will tend to be quieter at night, plus probably the ones in the far north in some rural area during winter at night (not many patients will get out @night unless they are really, really sick b/c it's hard to drive in the ice and snow and cold, etc.).

This has been briefly mentioned above, and its clearly stated in Panda's articles (read them btw)... but for my fellow pre-meds, don't be blinded by the low hours/no call aspect to Emergency Medicine.

12 hours of work in an ED, juggling many patients simultaneously at a very fast pace, especially when it can be more like 13-14, is long and hard work. Again, pre-med here, but this is what I've learned from those in the field. Please lets just not forget that part because some of the posts here on SDN seem to glorify the specialty for its "easier hours."

tdittyx2x3 said:

This has been briefly mentioned above, and its clearly stated in Panda's articles (read them btw)... but for my fellow pre-meds, don't be blinded by the low hours/no call aspect to Emergency Medicine.

12 hours of work in an ED, juggling many patients simultaneously at a very fast pace, especially when it can be more like 13-14, is long and hard work. Again, pre-med here, but this is what I've learned from those in the field. Please lets just not forget that part because some of the posts here on SDN seem to glorify the specialty for its "easier hours."

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Yes, but most ED docs don't work 12 hour shifts 5-6 days a week. They work 3 or 4 days a week.

tdittyx2x3 said:

This has been briefly mentioned above, and its clearly stated in Panda's articles (read them btw)... but for my fellow pre-meds, don't be blinded by the low hours/no call aspect to Emergency Medicine.

12 hours of work in an ED, juggling many patients simultaneously at a very fast pace, especially when it can be more like 13-14, is long and hard work. Again, pre-med here, but this is what I've learned from those in the field. Please lets just not forget that part because some of the posts here on SDN seem to glorify the specialty for its "easier hours."

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1. A good point which I would emphasize to my pre-med colleagues and I will add a few more.

2. Before you decide that EM is a great field based on the low hours/no call you really owe it yourself to do a formal rotation in a busy ED. And you owe it to yourself to take the whole month into account. Doing one shift where you might get to sew a lac, see a trauma, watch a resuscitation is going to be awesome -- but so would a day on the Peds floor if you happened to have a bunch of cool patients -- so would a day on Gen Surg if your attending asked you to do some real assisting (it happens). While EM can be exciting, someone has to pick up the third 25 year old with vaginal discharge of the hour rolling in at 3am when all of your friends are asleep.

3. Med students get all hung up on certain aspects of EM while ignoring others. A lot of people will tell you "I don't mind working when I'm at work" but then some of these people will be checking facebook and waiting for someone else to pick up vag bleeder #3.

4. You gotta be fast. If you're not fast, get fast. If you can't get fast, pick another field. If you still try to do EM your fellow residents will hate you and when you eventually get a job you will be the person everyone hates to follow.

5. Lifestyle wise EM is definitely better than Surgery or Ob, probably about equal to general internal medicine or an easy subspecialty like Endo, but nowhere near a field like Derm or Radiology. This assumes that you don't mind working nights for the rest of your life.

I work in an ER, and the doctors have great schedules. Typically working as many, or as few days as they like. The shifts are 12 hours, but I think that's pretty standard. Some only work a few days a week. Plus, you don't have to worry about being on call when you aren't at the hospital. Which is a huge bonus if you intend to have a family.

Panda Bear said:

Are you kidding? 3 to 5 AM are the drug-seeker witching hours.They know were still busy with the last of the evening rush, the waiting room is not that full, and we are tired and may be craving an easy disposition

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That's what I was thinking when I read the previous post haha. I don't work in a hospital, but a pharmacy, and it's freakin scary to work the graveyard shift! Lots of patients p/w signs of addiction and rx's for lortab and the like. We get these during the day too, but in the middle of the night, it's probably 10x as bad.

Usually the most senior attendings get the choice shifts. In private practice groups will hire younger "night doctors" so that everyone else can work fewer nights. Other groups share nights equally among everyone, it varies by group.

Regarding EM as a "lifestyle" specialty--it is for some people and not for others. Some find that the near random schedule, never knowing what day it is, the exhaustion of a long shift, really throws them off and makes them unhappy, even with plenty of days off. With some regularity, a busy 12 hour shift can turn even the most calm and collected person into a miserable wreck, needing an entire day to recover physically and mentally.

Aidan said:

That's what I was thinking when I read the previous post haha. I don't work in a hospital, but a pharmacy, and it's freakin scary to work the graveyard shift! Lots of patients p/w signs of addiction and rx's for lortab and the like. We get these during the day too, but in the middle of the night, it's probably 10x as bad.

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Oh come on. They just ran out and were hurting so bad they couldn't sleep!

The only consistently slow times I noticed during my short stent in the ED were around meal times, but never when you actually have time to eat. People are SO sick they have to go see a doctor....after their sandwich. This excludes the homeless that show up with chest pain at 6 a.m. to get breakfast.

Tippyboat said:

Thanks for the info.

So basically ER doctors can begin to choose their hours after becoming an attending?

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Darkshooter326 said:

Originally Posted by Tippyboat
So basically ER doctors can begin to choose their hours after becuming an attendings?


I think that's the draw of ER; shift-work. And you definitely do more than one shift per week. It's probably still around a 40-50 hour work week, but with a schedule to your choosing.

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Tippyboat said:

Darkshooter326, how come your quote of my question contains spelling mistakes the original sentence didn't have?

haha I don't even know how that's possible unless you rewrote it.

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This is gold.