Can't stand overnight shifts

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ExEngineer

ExEngineer

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1. How uncommon is it to find a position where you don't have to work overnight shifts?

2. How much of a pay cut will you take if you don't take nights?
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bruh, we all would like to not work nights.

youd have to go to the middle of nowhere to get no nights.
 
GLIPGLOP said:
bruh, we all would like to not work nights.

youd have to go to the middle of nowhere to get no nights.
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Not true.
I'm one of 4 nocturnists in a group of about 25 docs in a moderate sized college town, like 120k people. I get a $40/hr differential. That's mostly funded by everyone else paying like $600/month into a pot (the hospital covers the rest).
To be honest, I should be asking more for a differential, because $40/hr barely covers the loss of RVUs that are part of my bonus since the volume at night is lower. But there's something to be said for consistent schedules and lower volumes.
That said, I'm a few years from hitting 40, so the end of my life as a nocturnists is probably near.
The point is you can find jobs that don't require nights that aren't otherwise painfully bad in some way. However, I will say that I think most EM people look down on colleagues who "can't" or "won't" do nights, so I wouldn't lead with that if you're looking for a job. I wouldn't hire you, even with nocturnists.
 
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I’m just an incoming first year EM intern, so feel free to ignore/chastise/correct my viewpoint.

I figure that aside from the small % of attendings that prefer a nocturnist schedule because of the consistent schedule (and to a lesser extent maybe for a little more money,) most ER docs, like most docs, and like pretty much anyone, don’t exactly look forward to a lifetime of screwy schedules. It’s just part of the EM world.

It’s not like there’s a secret pool of ppl that just happily think: “I’d like to work ****ty shifts for the rest of my life.” Part of EM is knowing that difficult schedules are part of the job. There’s no way around it that I can see.

For me, I just know that part of doing EM is working nights, weekends, and holidays. If that was unacceptable to me, I would have picked a different field. I thought loooooooong and hard about biting off such a difficult part of the pie before I chose to apply to EM, and really had to make sure I knew what I was trying to get into.

Again, I’m just a soon-to-be PGY1, so I likely don’t know squat about a career in EM, but when I see posts about EM applicants not wanting to work nights it concerns me. Most people don’t want to work nights, but it’s not like you close the office at 6pm in the ED.

Anyways- just my two cents. Not my intention to make fun of anyone’s conversation regarding shift scheduling - it’s a fair question.
 
My job and several others I was looking at had a group of nocturnists that picked up the majority of the night shifts. However they didn't get all of them. I have to work 1-2 overnights a month. It's WAY better than 6-7 in residency. I would prefer none, but that isn't realistic in most groups. But few is certainly possible.
 
I'm not sure if medical students just don't work overnight at most places, but I'm always surprised when I ask candidates during interviews about what they perceive as negatives of EM or why EM docs burn out, rarely do people mention the shift work. The perception I think of many students is that because EM is shift work, it should be easy. Less time in the hospital = easy. I'm not sure if its just that students rarely have to work night shifts, or if its that because they are younger, they don't experience what shift work does to you physically starting in your 30's or so.

That being said, I'm a nocturnist. But I've always been a night owl, and while I'd rather work easier hours, I MUCH MUCH MUCH prefer having one shift as opposed to the shift work sleep disorder you get with having your shifts bounce all around. .
 
I have been doing locums for the past 2 yrs. I have not worked past 10p[ for the past 4 months. I can avoid working past 10p if I want. When I do an overnight, I get compensated More.

I do some FSERs but I usually get 6-8 hrs of sleep so can't really count that.
 
I am an EM attending and found out I hated overnights about idk, halfway into intern year. My medical student rotations I did some overnights, didn't love them but I loved the field. Even the beginning of intern year wasn't too big of a deal. They did eventually get to me and by eventually I mean rather rapidly before my career really even began. No amount of preplanning and understanding the field would have changed my choice to do EM. So I just wanted to make applicants aware your feelings can change (and not just when your 50 and have been doing it for 20+ years).
 
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gamerEMdoc said:
I'm not sure if medical students just don't work overnight at most places, but I'm always surprised when I ask candidates during interviews about what they perceive as negatives of EM or why EM docs burn out, rarely do people mention the shift work. The perception I think of many students is that because EM is shift work, it should be easy. Less time in the hospital = easy. I'm not sure if its just that students rarely have to work night shifts, or if its that because they are younger, they don't experience what shift work does to you physically starting in your 30's or so.

That being said, I'm a nocturnist. But I've always been a night owl, and while I'd rather work easier hours, I MUCH MUCH MUCH prefer having one shift as opposed to the shift work sleep disorder you get with having your shifts bounce all around. .
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You don't really understand what shiftwork does to you until you live it and medical school EM rotations are a very poor preview of that life. Med students often do few night shifts, and even if they do a good amount, they are (appropriately) focused on learning as opposed to moving the department, so they don't get a very accurate view of the realities of the job.
 
ExEngineer said:
1. How uncommon is it to find a position where you don't have to work overnight shifts?

2. How much of a pay cut will you take if you don't take nights?
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I'm a full time nocturnist. You will have a very hard time finding places that won't make you do at least 1-2 nights a month, which is much more tolerable as an attending compared to residency where you are expected to go from nights to days in 1 day etc.

Having said that, I find that nights are especially hard for those who: have families or kids that don't understand that you need to sleep during the day and those who have a lot of trouble transitioning from nights to days or vice versa. If you can mitigate those two issues, being nights only affords a consistent schedule, working with nursing staff that know you well because frequently they are a bunch of 3rd shifters as well, and a night differential allows you to work less for the same income. Something to think about.
 
I work all mids (3pm to 1AM) or nights (6PM to 6AM). I like being always on a night schedule, and even my days off I don't go to sleep until 3 or 4 AM. It makes the burnout much less if you can maintain the same schedule even on your days off. I'm astonished that the majority of EM still insists on transitioning people from days to nights and back given what we know about circadian disruptions and health issues. Groups need to find nocturnists who enjoy night shifts, and compensate them such that all the nights get filled.
 
When I was second year EM resident (PGY-3), there was a month where I had 7 quick turnarounds (11p-7a, then back the next day at 7a). I pointed this out to my PD, who said she didn't see a problem, and "maybe EM isn't for you". Seriously. At the end of that year, the graduating senior who had done the scheduling said out loud that I was the one that had been screwed by the schedule this academic year.
 
Apollyon said:
When I was second year EM resident (PGY-3), there was a month where I had 7 quick turnarounds (11p-7a, then back the next day at 7a). I pointed this out to my PD, who said she didn't see a problem, and "maybe EM isn't for you". Seriously. At the end of that year, the graduating senior who had done the scheduling said out loud that I was the one that had been screwed by the schedule this academic year.
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If the senior that did the schedule recognized that yours was more unfair than others, why did they continue to schedule you that way?
 
gamerEMdoc said:
If the senior that did the schedule recognized that yours was more unfair than others, why did they continue to schedule you that way?
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He said this at the end of June. As is common, the reasoning is multifactorial. One is, each month, a person just figures "it's just this month". I didn't think to have a printed out schedule (the attendings used "AmIOn", but we had something else, and I don't recall it being able to be printed, or not easily). Second, there was one classmate - we'll call her "Betty" - that was the type to turn up the heat in the conference room, when everyone else was warm, but she was the only cold one. Betty would bitch - royally - even when she had the best schedule. It was the best to sate her just to shut her up. I wasn't as politically savvy, so I could never wage an equivalent battle. Finally, we were the second class in the program - it was the first time that residents scheduled other residents. Growing up Catholic, I just figured it was my lot in life, and to "offer it up".
 
As someone who has worked nights and taken classes during the day for several years, I can’t express how thrilled I am to be starting medical school and, eventually, residency. Being on a rotating schedule would be gravy at this point. There are times I bemoan having found medicine so much later in life than is typical. However, after hearing these whippersnappers in their twenties complain about having to stay up all night, I’m happy that I took the path less traveled. It really helps to have spent time out of academia. (Not that it’s been terribly hard: my wife is awesome and also a night shifter...and we don’t have kids. Also, Apollyon sounds like he got a raw deal.) Sleep hygiene is the name of the game!
 
How common is the slightly less than full time but only working nights gig? Something like 8-10 nights a months maybe? But still being compensated roughly full time with benefits, etc.
 
This can be done, but I certainly wouldn't go into EM if working 3-5 night shifts a month for at least a decade isn't something you're willing to do. You don't have to like it, but you do have to be willing to do it.

I no longer work nights. I'm 12 years out of residency. It costs me a lot of money to not work my share of the nights. It probably works out to $80 an hour to work the day shift instead. If my share of nights is 4 a month, that works out to be something like $31K a year to work day shifts instead of overnights. If I want to avoid my share of the "lates" (i.e. 6 pm to 2 am shifts) that's another 2 shifts a month with a differential of perhaps $40 an hour, perhaps another $8K a year.

If you are an emergency doctor you will either work nights or essentially pay someone else to do them for you. If you are willing to preferentially work nights, you will be able to either make more money or work less hours and make the same money. You might not be able to do this in every location and every job you prefer, but you can do it in enough places that most people could be happy.
 
GeneralVeers said:
I work all mids (3pm to 1AM) or nights (6PM to 6AM). I like being always on a night schedule, and even my days off I don't go to sleep until 3 or 4 AM. It makes the burnout much less if you can maintain the same schedule even on your days off. I'm astonished that the majority of EM still insists on transitioning people from days to nights and back given what we know about circadian disruptions and health issues. Groups need to find nocturnists who enjoy night shifts, and compensate them such that all the nights get filled.
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It's interesting to me how often ER switches from day to night shifts. Hospitalists and nurses also work nights, but at all the hospitals I trained at the nurses would go months at a time on a night schedule before shifting to days, and the hospitalists usually had at least several weeks if one kindkof scheduke at a time before switching. ER seems uniquely comfortable with the idea of switching back and forth half a dozen times in a month.
 
We do those quick turnarounds all the time. It's not my biggest issue with scheduling.
 
miacomet said:
We do those quick turnarounds all the time. It's not my biggest issue with scheduling.
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Seriously? I'm pretty resilient (and more than @Birdstrike , no offense, buddy), and I still feel like I've been beaten with a rubber hose. You must be young (er). If you want to be drilled by quick turnarounds, that can be arranged. I'm 47, and I do it, but, I don't dig it.
 
Groove said:
"I just want to work 6 hours a day, 2.5 days a week with no overnights and 0.8pph, IS EM FOR ME??!!"
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Stop bashing my job. 🙂 That literally is what I want out of EM. Almost. Honestly, it's 8 hours a day, no overnights, 2 days a week, and perhaps 1.3 pph (but would love to boost the volume.) Granted, it took 12 years out of residency to get to that and I have a second job/business that consumes more time (and generates more income), but I just want to point out that sort of gig isn't impossible, just rare.
 
Apollyon said:
Seriously? I'm pretty resilient (and more than @Birdstrike , no offense, buddy), and I still feel like I've been beaten with a rubber hose. You must be young (er). If you want to be drilled by quick turnarounds, that can be arranged. I'm 47, and I do it, but, I don't dig it.
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I don't like it, but I think that I'm so bad at nights that I don't really ever adjust and so I swing back to days. Having to do nights kills me- the quick turnaround sucks, but it's a secondary issue.

As to sweet jobs in Utah, USACS is coming for them, hard.
 
Perrotfish said:
It's interesting to me how often ER switches from day to night shifts. Hospitalists and nurses also work nights, but at all the hospitals I trained at the nurses would go months at a time on a night schedule before shifting to days, and the hospitalists usually had at least several weeks if one kindkof scheduke at a time before switching. ER seems uniquely comfortable with the idea of switching back and forth half a dozen times in a month.
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I've never understood why we don't do the same thing in EM. I can't see much of a downside other than different volume/RVUs at certain times of the day.
 
enalli said:
I've never understood why we don't do the same thing in EM. I can't see much of a downside other than different volume/RVUs at certain times of the day.
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Some people like myself just can't sleep during the day, so doing more than 2-3 nights a month is impossible. I could not do a FT night gig for months.

The nurses that work nights choose to work nights. It's different.
 
MS4 here on 1st EM rotation of 4 total; I'm not really enjoying my night shifts but I think that relates more to a need to be crisp and functional enough during "recovery days" to study for a shelf exam as well as not really working with core EM residency faculty and more so with staff who aren't interested in working with students. Keeping an open mind about it knowing that pressures when not at work will be different to that as an attending than as a student. See a lot of cool stuff at night
 
Apollyon said:
Seriously? I'm pretty resilient (and more than @Birdstrike , no offense, buddy), and I still feel like I've been beaten with a rubber hose. You must be young (er). If you want to be drilled by quick turnarounds, that can be arranged. I'm 47, and I do it, but, I don't dig it.
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I'm not offended. You're more resilient. I'm okay with that.
 
Perrotfish said:
It's interesting to me how often ER switches from day to night shifts. Hospitalists and nurses also work nights, but at all the hospitals I trained at the nurses would go months at a time on a night schedule before shifting to days, and the hospitalists usually had at least several weeks if one kindkof scheduke at a time before switching. ER seems uniquely comfortable with the idea of switching back and forth half a dozen times in a month.
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Most people just don't want to do this. They like to have some day shifts so they can have some semblance of a normal life. Also, the nature of the job and pace in the ED is such that working a week in a row is brutal and unbearable for many (any shift, but nights much more so) the other issue is that the need to fill the swing shifts are not conducisve to block scheduling
 
I understand the needs of the scheduling service, but as someone else who took the scenic route into medical school (and worked a lot of nights along the way), I'd much rather do a month of nights followed by a month of days. The switch between a day and night shift tends to cost you an additional day off with trying to sleep your way between them (for example working Monday day, Tuesday day, and Wednesday night also costs you your Thursday).

That being said, I'd rather work days and nights together than work 7 days (or nights) in a row like the hospitalist schedule. I used to work that schedule too and its awful.
 
All my colleagues always ask me, "I don't know how you work all nights". Anytime I have to wake up at 6am or when I walk into the ED during the day when there is a million people around, I always say, "I don't know how anyone works dayshift".

Lol. I guess in the perfect world, you match a few people like me with a handful of the daytime people, and you have a perfect system where no one bounces from shift to shift.
 
As others have mentioned, I personally enjoy night shifts. Extended blocks of them are the best. I just did two overnight shifts immediately followed by a 7am shift tomorrow. Made myself wake up early in order to be able to go to sleep tonight so I can wake up early tomorrow - the transition blows.
 
Perfect Hair Day said:
MS4 here on 1st EM rotation of 4 total; I'm not really enjoying my night shifts but I think that relates more to a need to be crisp and functional enough during "recovery days" to study for a shelf exam as well as not really working with core EM residency faculty and more so with staff who aren't interested in working with students. Keeping an open mind about it knowing that pressures when not at work will be different to that as an attending than as a student. See a lot of cool stuff at night
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That's a lot of rationalizing. Things will only get worse as a resident before getting (a tiny bit) better as an attending. Nights are at their most benign during medical school. You don't have to love nights to work in EM (just tolerate them), so you may still be ok, but I wouldn't assume that you will magically start liking them after medical school.
 
gamerEMdoc said:
All my colleagues always ask me, "I don't know how you work all nights". Anytime I have to wake up at 6am or when I walk into the ED during the day when there is a million people around, I always say, "I don't know how anyone works dayshift".

Lol. I guess in the perfect world, you match a few people like me with a handful of the daytime people, and you have a perfect system where no one bounces from shift to shift.
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What are your normal night shift hours. Is it a 7pm to 2 am kind of thing or a 10 pm to 6 am kind of thing?
 
Steve_Zissou said:
What are your normal night shift hours. Is it a 7pm to 2 am kind of thing or a 10 pm to 6 am kind of thing?
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I worked the 6p-3a exclusively for about 4 years. Now I'm only doing 10p-7a exclusively. I actually like the 10p shift better.
 
That 6p-3a shift totally blows IMO. If you usually commute against traffic, you'll be going with traffic at this time, just as the wife/kids are getting home, and come home at a totally odd hour. You still get some circadian disruptions (though admittedly not as severe), and don't get the night differential, even though you're working a good part of the night. If you have this shift at your shop, you won't get to escape it even with dedicated nocturnists on board.

Worst of all worlds.
 
Steve_Zissou said:
Really? I figured 6p-3a would be a better gig lifestyle/family wise?
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I hated it towards the end. First, it was always coming in at the peak busy time. Second, I'd be going in right after eating dinner and always started feeling lethargic. With the 10p, if I wake up at noon for whatever reason and only get a few hours of sleep, I can get up, do some stuff during the day and take a nap after dinner before my shift (basically split sleeping, which is actually a very good strategy). But if I sleep until 3pm or so, then I can get off and have a solid 7 hours before my shift to do whatever I want. The other advantage of the 10p is, at least there is some slow nights, and when that happens I can get admin stuff done. That almost NEVER happened on a 6p. And in my group, anyone who works all 10p (I'm the only one) gets to make their own schedule. So I basically dictate exactly what days I want to work. It's a nice little added benefit. All in all, Ive found the circadian disruption less with working the 10p (thanks to the occasional nap before shifts) much better than working the 6p-3a.
 
I work only swing shifts and 2-3 nights per month. Swings are anywhere from 2p-11p and 5p-1a. Works great for me because there is no traffic going in or coming home. I'm there when it's busy and it makes the shift fly by. It's easy to shift to nights and back because it's only a few hours difference. Most of our group dislikes the swing shift, so our scheduler pretty much lets me off any time I ask.
 
24GaugeEJ said:
As someone who has worked nights and taken classes during the day for several years, I can’t express how thrilled I am to be starting medical school and, eventually, residency. Being on a rotating schedule would be gravy at this point. There are times I bemoan having found medicine so much later in life than is typical. However, after hearing these whippersnappers in their twenties complain about having to stay up all night, I’m happy that I took the path less traveled. It really helps to have spent time out of academia. (Not that it’s been terribly hard: my wife is awesome and also a night shifter...and we don’t have kids. Also, Apollyon sounds like he got a raw deal.) Sleep hygiene is the name of the game!
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omg me.
 
Our group has as many people looking to buy nights for the differential as there are those looking to sell them (for the cost of the differential).

Works out well enough.

Now I work 1 or 2 a month. Also helps one of our "overnights" is 7:30p to 4:30a.
 
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