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Dealing with the Jet lag in EM

PoorMD

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May 3, 2005
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    Currently an MIII considering Emergency med. I have read over some of the sticky threads in EM, very useful stuff. the threads covering fatigue and burnout rates were a must read for me, because I too am afraid of some of the negative aspects.. But very, very intrigued by the positives.

    One topic that didn't get much attention was the feeling that ER docs always have jet lag from switching over to night shift again after a week of days and vice versa. Can any ER folks expand on that a bit? Do you have a system that helps you transition from the night shift period back to days? other than coffee? Is there a point in your career where you essentially own the day shift? or the night shift for that matter? I wouldn't mind working 10a-10pm four days a week and then 3 days off with my wife, then switch to 10pm-10am or whatever the next week. I expect that to be the norm for the first 10-15 years as an ER doc, but maybe the higher up attendings get a better ratio of days to nights?

    Im sorry this is turning into far more than just a jet lag discussion, but
    does anyone know anything about combined EM/Internal Med? It would be interesting to discharge a patient and tell them to "Follow up in my clinic next week" lol. just curious if anyone out there is in that track?

    liked what a lot of people said,if you keep a positive attitude and try to see the comical things in your patients, and maintain that teamwork problem solver focus, this field could be very satisfying
     
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    AmoryBlaine

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      1. Switching shifts and the crazy schedules of EM suck a$$. It is one of the negatives of the field and there is no way to put a nice spin on it. You go into a field because you like the pros and can deal with the cons -- that's all there is too it.

      2. The EM/IM "work a shift or two a week and follow up patients in your own clinic" model is the stuff of medical student dreams. I challenge anyone to name me 3 people who practice this model. The bottom line about EM/IM residencies is that they end up being 5 year EM residencies with alot of extra off service months becuase most of the grads get EM jobs.

      3. As others have said, if you are really interested in patient follow-up go into a field with patient follow-up and feel no shame! If you are very concerned about one of the cons of EM (crappy shifts) and also concerned about what most of us consider a pro (no clinic/no FU) then take a good hard look at your career options.
       

      southerndoc

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        Actually self-referrals to your own clinic may be a violation of federal anti-kickback laws. With our legal system in its current state, I wouldn't discredit this possibility at all.

        Some of us like follow-up. Instead of seeing the patient in a clinic, we call them to check up on them or we look at the charts while a patient is still admitted. I've been known to do both on countless occasions.

        Switching shifts isn't that bad. Most attendings work around 3-5 nights/month, which isn't that bad. Personally I love night shifts. I might not like it when I'm 55, but it sure as heck beats getting awakened by a pager every hour.
         

        WallowaWanderer

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          Speaking of follow up . . . I was doing outpatient neurology last week and I was hanging out in one of the brain doc's office while he was shuffling through med refills, returning phone calls, and filling out all sorts of forms. He looked up and said " you know, one nice thing about EM is you don't have to deal with any of this bullsh**. I thought that was pretty funny. I think there's some parts of follow-up that are cool (even as an EM person I can appreciate that), but a lot of it is, well, summed up in his statement. Maybe I'm just hanging around the wrong internists, but I don't see them touting "follow-up" as their favorite part of the job.

          That being said you should look into EM/IM. Just because we wouldn't choose it doens't mean you shouldn't. My impression is that the EM/IM docs who actually use both certifications work part time as a hospitalist and part time as a EM doc. Some gravitate towards one or the other, but that doesn't neccesarily mean their training was wasted. Don't let us get you down on EM/IM. We're almost all straight EM people. You need to find some EM/IM people and talk to them to get a balanced perspective.

          As far as the "jet lag" stuff, I think you just have to do a rotation and see how it affects YOU. Make sure you get enough shifts to really evaluate it. Some places will only make you do 2-3 in a month but as a resident you'll be working way more. You might find that you like working at night because of the comraderie, cool cases, funny drunk people, etc and so the jet lag might not be as big of a deal for you. On the other hand, you might be like my wife who gets up and goes to bed at exact same time every day. I think you have to like the irregular hours, or the flexibility, or the comraderie, or flourescent lights or something that makes it more than just working while everyone else is having a beer, playing with their kids, and sleeping. In summary: try before you buy.
           

          PoorMD

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            thanks for the input.

            im not that concerned about followup, I was thinking about EM/IM because it would give more flexibility in the autumn years of one's career if you chose to do less full time, more part time ER work. I come from engineering background so I am used to problem solving, less of the touchy feely peds/psych relationship stuff, so I don't care much about prolonged relationships with my patients. In engineering the basic protocall was trouble shoot and on to the next one, which seems like ER medicine all the way.

            I am not so strict about my sleep/wake cycle. I could certainly handle 3-4 nights per month, but Im wondering if you could work 2 straight months on night shift, and "earn" the next 4 months on day/evening shift? That would be best for me, I think. Coming off night float was very hard for me, so I would need several days off to get my sleep cycle back

            The only other thing that scares me about EM is the double coverage issue, i.e. morning shift, afternoon break, then evening shift. any thoughts?
             

            WallowaWanderer

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              I was thinking about EM/IM because it would give more flexibility in the autumn years.

              IMHO, straight EM gives you the perfect way to just fade away. Find a less-intense ED or urgent care, then just drop your shifts down. You can work 2 days per month in EM. I would think the least clinic days you could do would be 2/week, and your patients can still call you anytime for med refils, insurance referals, etc. What about nighttime and weekend call coverage - would you be part of a group or would you take your own night call every night? What group would want to have you just working twice per week? Would you keep up your IM board cert just for this semi-serene retirement? That's a lot of cost and time. All these issues that have been brought up before, but good ones to think about.

              I could certainly handle 3-4 nights per month, but Im wondering if you could work 2 straight months on night shift, and "earn" the next 4 months on day/evening shift?

              I've heard of some groups doing this but I think it's less common. In the situation I had heard about it was more like 1 month of nights in 12. Still, my impression from talking to folks (this is something that sounded good to me too) was that the night month is so hard that you wouldn't want to do it. But if you decide you like that, then you can probably find a way to make it happen.

              Remember that residency is about 7 nights per month and many residencies use the beloved waterfall (some variation of 2 days, 2 swings, 2 nights)

              The only other thing that scares me about EM is the double coverage issue, i.e. morning shift, afternoon break, then evening shift. any thoughts?

              When people refer to double coverage, they are reffering to 2 docs working in the department at the same time. You won't be doing any double shifts. Believe me - one will make you plenty tired.
               

              jbar

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                the best part of the 8 hour overnight is that you come home at 7am, sleep till 2PM, wake up just in time to enjoy the rest of the day, eat dinner with the wife, be somewhat productive, then head back out to work at 1030!

                Yeah, but the question is how do you switch back to normal people schedule after your last overnight of the week? I spent a few months working nights and never really figured it out. It seemed that your two choices are either just push through, be a zombie, and go to bed early, or sleep through the morning and waste the day. Either way stinks especially during ski season when the powder goes to the early bird
                 
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