Circadian disruption

[EM STUD 3000]

Can anyone comment on this; especially current EM docs who work different kinds of rotating schedules. I love EM, but worry that I won't always be able to go from days to nights and back. Thanks in advance.

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[NinerNiner999]

Not really a big deal - typically you will either be block scheduled for nights (a month of nights, or 2-3 weeks in a row), and have at least a couple of days in between a transition from nights to days. Often times, depending on the number of hours you work or the number of residents in the program (or physicians in the group), there may be an intermediate shift, that covers evenings (say 3-11pm). Not much of a big deal IMHO...

 

[edinOH]

I'd be interested to hear how some of the docs who have been in practice for a while deal with this. Sessamoid, MudPhud?

 

[ERMudPhud]

Its pretty easy for me because I only work part time. I leave the lab on Friday P.M. and take a nap, work overnight Friday night, sleep all day Saturday, work overnight Saturday, sleep a bit during the day on Sunday, then knock myself out with Benadryl Sunday night so I can be in lab Monday morning. I only do this 2 weekends per month. My wife works full time in the ED and puts all of her nights for the month (4) in a row and just stays on a night schedule for the week. Try to find a program/job that either lets you work nights as a block or has a schedule that gradually progresses from days to evenings to nights. Random nights suck. Keep in mind though that studies have shown that people who work night shifts have shorter lifespans no matter how they try to make it more physiologic.

 

[Sessamoid]

I haven't been out all that long, but I've always found it harder going back to days from nights than vice versa. Then again, I've always been a night owl since I was a child.

Most of us will tolerate night shifts less well as we get older, and I think the general trend you'll find is that the older docs in a group will either get scheduled for fewer nights or retire rich (less likely in this day and age).

Really, whether you can handle this kind of lifestyle is a question only you can answer based on what you know of yourself.

 

[EM STUD 3000]

I know I could handle it; I just don't want to have a poor quality of life because I am always tired.

It seems like the ideal situation would be longer blocks, like 2 months or so, where you have time to adjust to the switch. It supposedly takes 2 weeks to reset your clock. So even on blocks of a month of a certain shift, just when you get used to the change, you switch back.

This is my biggest concern about EM. Otherwise I think it is the best specialty for me. I read all the stuff in the Rules of the Road book about the adverse health effects of circadian disruption, and it worries me. I don't wan't to die tired!!!

 

[iwakuni_doc]

Hate to bust your bubble, but you picked the wrong profession if you don't want to mess up your sleeping patterns. Whether it's circadian shift progression like in most ED's or Q3-4 night call with most med/surg programs....your sleep is going to take a major hit. Everyone has a system that seems to be easier for them - what works for me may not work for you & that will drive what kind of specialty/practice you go into.

As for the 2 wks to adjust to a circadian shift - speaking as someone who has made more intercontinental flights over the last 1-2 years than I care to count, then gone straight into work upon arrival...yes it can be tough, but rarely will it take more than 1-2 days to become productive & functional following a major circadian shift. Feeling fully rested & comfortable with the time difference can take a week or two, but that's part of the business.

 

[DrQuinn]

Just got done doing a string of nights (6)... it wasn't that bad... 7p - 7a (12 hours) which you'll almost never do as an attending, unless you're in a smaller ED. My days were kind of shot... a few of my days I spent almost sleeping the whole day (although that might be attributed to feeling burnt out from the past 4 months of non EM rotations)... but some days I would only need 3-4 hours of sleep, so I would go see a movie during the day and go shopping (mmm Matrix on IMAX).

Everyone has their own system AND rhythm. I luckily can go a day or so without much sleep... also, Diet Mountain Dew helps.

Q, DO

 

[kungfufishing]

diet mt. dew is the best.

 

[DOrk]

One EM attending I know works a 4 on 6 off. The shifts are something like this 7a-7p, 11a-11p, 5p-1a, 10p-8a. He loves it because he gets so much time off at once. The hospital he works in is a kinda cushy community hosp, though. Some residency programs (Indiana, Rochester and probably several others) follow a similar schedule....but without as many days off.

 

[The White Coat Investor]

It sucks to have to switch night back to day....but that's the price you pay to only work 35-40 hours a week. It seems like you work more because you have some hours that are "lost" to you because you are sleeping or can't function because you need to stay up to get "back on schedule."

Every body deals with it differently, and every group has a different scheme. Some hire a couple of young guys to do most of the nights and pay them a little more. Others do blocks (4 days, then 3 days off, 4 evenings, then 3 days off, 4 nights then 3 days off etc.) And others do the circadian thing where every day its a later shift until you are working a night shift at the end.

The good news is you realize there's nothing magic about 8 am to 5 pm. You can get lots of stuff done at other times of the day. For example, I seem to get more reading done when I'm working nights because I can read after my wife goes to bed and before I go to work.

Unlike the previous posters, caffeine doesn't seem to help me much. Making sleep a priority when you can do it does help. So does planning ahead. (If you are switching evenings to nights, stay up a little later that last evening shift, then it'll be an easier transition.)