24 hr shifts

[mega_colon]

So I’m thinking about signing a contract at a place that works 24h shifts. Now admittedly the hourly rate is lower than what I’m being offered in the city, but you usually get a few hours of sleep. Census is 13k with 12 hrs of APP coverage, docs average 1pph over a shift.

My question for you guys is what is a reasonable number of 24s to do in a month without getting burned out?

My urban offer is for 10x12s and this rural gig averages 6x24s.

Since the hourly rate is a bit lower I was thinking about trying to average more like 7-8x24s a month to set my finances straight. I’m concerned because this is 168-192 clinical hours a month.

Does the nature of these 24hr shifts make it easier to work more clinical hours?

---

Members don't see this ad.

 

[deleted497653]

A roundabout answer— humans are made of body and spirit (and soul etc) The body needs sleep, food and other things all which you say you would get during the 24 hours (you mentioned sleep). The spirit however might not like to be closed up in a hospital 24 hours for too many days. In other words, though it may be easy as far as work load, there is something demanding about being in a hospital 24 hours in a row. So just start with the required number of shifts and see how you handle that first before adding on two more shifts.

 

[TooMuchResearch]

I don't recommend starting off with 7-8 of those, unless you're only committing to 6 and can quickly back off. Also 13k with 12 hours of APP, I'd be pretty worried about downtime and sleep, both of which are important on a 24.

Did you do 24s in the ICU in residency? I did. Trust me, a 24 hour ED shift without downtime is worse.

 

[Airborne Flt Doc]

So I’m thinking about signing a contract at a place that works 24h shifts. Now admittedly the hourly rate is lower than what I’m being offered in the city, but you usually get a few hours of sleep. Census is 13k with 12 hrs of APP coverage, docs average 1pph over a shift.

My question for you guys is what is a reasonable number of 24s to do in a month without getting burned out?

My urban offer is for 10x12s and this rural gig averages 6x24s.

Since the hourly rate is a bit lower I was thinking about trying to average more like 7-8x24s a month to set my finances straight. I’m concerned because this is 168-192 clinical hours a month.

Does the nature of these 24hr shifts make it easier to work more clinical hours?

A few years ago I enjoyed this. I worked 8a-8p & slept about 5-7 hrs a shift 50% of the time in a slightly smaller volume ER. I slept as soon as getting to hotel/home as long as my body needed 6-8 hrs and did 8-10 shifts a month for a year while also doing the hospitalist work for 6 inpatient beds & 1-2 consults to a psych unit .

I didn’t work most weekends as there were docs who consistently worked these. Ideally, work 2x a week & it’s a pretty great gig. Hope you are getting at least $200/ hr though as this is available a lot of sites.

If it is a small hospital, there will be underlying hospital administrators/ group pressuring for admissions.

Depending on your specialty back up , you’ll have lots of transfers. Do you have competing hospitals wanting your transfers ? I never had a problem transferring due to competition. We had cardiology twice a week, Nephrology once a week & General surgery for daytime hours only since that’s when anesthesia was available.

PCPs and Specialist have the biggest voice in these small hospitals; be very nice to them.

 

[deleted109597]

We were doing 24s with 7000 volume. I would rarely get more than 2-3 hours uninterrupted.
Doing 8 a month became too much, so I quit

 

[namethatsmell]

24 hour shifts at a 13k shop with a midlevel for some support??

I’d run, not walk, away from this job...

 

[AlmostAnMD]

I did a few 24's at a similar place moonlighting during residency

good money

fewer shifts for more/similar pay

but overall pretty brutal. It was worth it for the experience but I wouldn't do it long term. You get sleep at night.....sometimes. You don't wanna be the guy that gets a subtle PE 23 hrs into your shift when you haven't slept

 

[emergentmd]

I work in a 7K volume FSER and even at 20 pts/dy it can suck with a few pts showing up between MN and 7am.

And what we get paid as owners likely is 3x what they are paying you.

 

[Groove]

Not a fan of 24/h shifts for all the reasons listed. I'd consider it for $200/hr but that's my bare minimum. The volume would have to be reliably light during night hours and I would need a pimp call room.

 

[erdoc00]

Someone is selling you a bag of **** if they are telling you that with 13k visits you can expect to sleep during your nights. That's 35 visits a day. Theres no way you're routinely getting any meanigful sleep during the night shift. Maybe 1 or 2 hours a night which will very quickly get old.

Maybe for $500 an hour and 4 shifts a month this would be a good idea.

 

[cyanide12345678]

You won't sleep much at a 13k visits a year hospital. A slow trickle of 1 patient every other hour will ensure no sleep basically.

The only place where i would personally do a 24 hour shift would be a place with less than 5k volume.

I've worked several shifts at a place with 3.5k volume and reliably slept 6-8 hours every night there during a 24, even that is not guaranteed though.

 

[Apollyon]

Wherever @Arcan57 went off to, he posted 2 or 3 years ago about a place in Texas that saw 50-60 a day, and the guys did 24s there. 60, for example, is 2.5pt/hr, for EVERY hour. I work 24s. Trust me, they suck. Our volume is 7K. I am going to get an ADA accommodation to go to 12s.

 

[CajunMedic]

The volume would have to be reliably light during night hours and I would need a pimp call room.

There's a company I've talked to that specializes in the smaller Critical Access Hospitals. They've got at least 2 sites where you can work up to a 72 and have a fully furnished house on the grounds. One of them is listed at 7200 visits/yr.

 

[thegenius]

yea still sounds miserable. Unless you were paid > 10K for that 72. Even then I don't think I would do that.

 

[Arcan57]

Wherever @Arcan57 went off to, he posted 2 or 3 years ago about a place in Texas that saw 50-60 a day, and the guys did 24s there. 60, for example, is 2.5pt/hr, for EVERY hour. I work 24s. Trust me, they suck. Our volume is 7K. I am going to get an ADA accommodation to go to 12s.

That ended when we had somebody hit 70 and we dropped down to 12s, then 10s with NP coverage.

 

[Apollyon]

yea still sounds miserable. Unless you were paid > 10K for that 72. Even then I don't think I would do that.

$10k for 72 is less than $150/hr. No way.

That ended when we had somebody hit 70 and we dropped down to 12s, then 10s with NP coverage.

70 in 24 hours? Skuh-huh-roo THAT!! That's nuts!!

 

[thegenius]

$10k for 72 is less than $150/hr. No way.

70 in 24 hours? Skuh-huh-roo THAT!! That's nuts!!

OK well there you go. I can't do math.

I wouldn't do it for 20K.

 

[namethatsmell]

There's a company I've talked to that specializes in the smaller Critical Access Hospitals. They've got at least 2 sites where you can work up to a 72 and have a fully furnished house on the grounds. One of them is listed at 7200 visits/yr.

72hr shift at a 7.2k visit shop? That's a terrific way to test the limits of sleep deprivation.

Only way I'd consider that gig is if their compensation includes an own-occ DI policy w/full mental health coverage.

This setup reeks of ERx Group...if they're still in business.

 

[Tenk]

13k is WAY too high for 24 hour shifts. Once you get above 8k or so annual visits your sleep rate goes way down because the chance of always having people in the department goes way up. 100% would not sign that because you will be destroyed the next day. One 24 is only better than two 12s if you get some sleep at night and can wake up in the morning and go.

 

[TooMuchResearch]

I saw 30 once and questioned if I wanted to do it again.

$10k for 72 is less than $150/hr. No way.

70 in 24 hours? Skuh-huh-roo THAT!! That's nuts!!

 

[Apollyon]

I saw 30 once and questioned if I wanted to do it again.

I saw 29 on Labor Day (thought it was 30), with NOT the A team nursing staff, and the manager said, "that's not a lot".

 

[mega_colon]

It’s interesting how much of a hard no I’m getting from people here compared to how happy the docs seemed. Everyone claimed that less than 3 hours of sleep was unusual.

 

[TooMuchResearch]

Maybe it's a very weird arrival curve, but those numbers don't sound like a place where 3+ hours is the norm. Maybe in the dead of winter on a lucky night.

It’s interesting how much of a hard no I’m getting from people here compared to how happy the docs seemed. Everyone claimed that less than 3 hours of sleep was unusual.

 

[erdoc00]

It’s interesting how much of a hard no I’m getting from people here compared to how happy the docs seemed. Everyone claimed that less than 3 hours of sleep was unusual.

It could be that they are telling the truth and maybe the volume really doesnt come in at night at this facility. But a 13k volume is not a slow "critical access" facility where the place is empty much of the time.

My personal experience at one of these types of places is that the nights are hit or miss. Plenty of nights we had no patients for a few hours overnight. Other nights it was steady throughout the night. And even if it's not routinely "busy" over night, 1 pt every few hours overnight is all you need to make it so you cant sleep.

If it were me I'd ask to see the triage times and census numbers for a few days. I would trust that more than any "happy doctors" telling me tall tales. I think many of us here can attest that we've been fooled by this charade before.

Bottom line though is if you think you'll like the job, give it a try. I would just not go in with the expectation that you're going to be getting restful sleep each night. You're very likely going to be losing the next day in terms of needing to catch up on sleep or being jet lagged. So I would consider each 24hr shift as 2 days of work essentially. Just my opinion and experience.

 

[GeneralVeers]

Agree with erdoc00. Did exactly two of these 24 hour shifts and never again. I'm the kind of person who needs a proper bed, quiet, and no interruptions to get some sleep. My days after the shifts were destroyed due to catching up on sleep, so with the low wage it simply wasn't worth it.

 

[thegenius]

Bottom line though is if you think you'll like the job, give it a try. I would just not go in with the expectation that you're going to be getting restful sleep each night. You're very likely going to be losing the next day in terms of needing to catch up on sleep or being jet lagged. So I would consider each 24hr shift as 2 days of work essentially. Just my opinion and experience.

Well said.

For what it’s worth, I work part time at night at a hospital that sees like 60-80 pts/day depending on the season. That is 21K - 28K / year.

I have some shifts where I see 6 patients total. Some I see 15. Almost always...patients stop coming in between 2a-5a. If I’ve seen only a handful of patients that night, by 3a the ER is empty or i have a young vomiter or some low risk chest pain I’m holding onto and that’s it. I do get to get some rest and sleep for a few hours.

Most of the time though..I’m awake and finishing charts. Maybe I’ll have an hour or two with nothing to do, and I’ll play games in my phone or chat with the nurses. Overall I rarely get sleep. But it’s a calm evening.

So if you are at a place with 1/2 the volume....I can see a scenario that between 1a-6a you may not have very many patients, if any at all. However all you need is a young vomiter or some low risk chest pain....2 patients to come in overnight a few hours apart...and you get little to no sleep.

If you take the job, please go into it with the notion you are not going to get much sleep. It might be a calm evening, but you will probably be awake.

Also...it sucks to have fallen into a nice sleep....the you hear whispers of “Dr....dr....we have a new old man checking in and he’s probably septic.” You go into the room 1/2 asleep and not thinking right and it’s hard to be a good doctor in those case when your brain is foggy.