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Yeah, but it beats dealing with all the nonsense during the day if your shop is the right volume
Sleep from 9a-3p, wake up and do nothing but play video games, read, eat.
Sleep from 9p-7a. #resumelife.
Does anyone else struggle with anxiety at work?
Started by han14tra
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Yeah, but it beats dealing with all the nonsense during the day if your shop is the right volume
Sleep from 9a-3p, wake up and do nothing but play video games, read, eat.
Sleep from 9p-7a. #resumelife.
They can't fill the ER slots
Flip and burn baby 🤣
I've tried a lot of stuff over the years, and unfortunately I think this is what facilitates the fastest flip, the shortest hangover, and easiest return to normal day life.
But maaan, it sucks. It's like having a hangover scheduled in advance.
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"Right volume" is key.
When I left my shift at midnight the other day, there were 50 in the WR. Mostly nonsense, willing to wait 5+ hours.
Thank god I don't do nights at this place.
I never understood this. I actually started feeling bad for some of these nonsense visits after a while. I used to moonlight at a tertiary center in a very low income area where I would show up for my fast track shift at 10a and immediately pull back 4 or 5 people who had wait times of OVER 24 HOURS. Literally, you've been here 25 hrs and 20 minutes for low back pain after an MVC. Here's your ibuprofen and some flexeril and off you go. To be fair, I also felt bad for these folks because once you cross that insane waiting threshold, it seems like you're the kind of person who is actually genuinely happy for medical advice and aren't demanding some BS. If the doc "blesses you" you legit feel better.
Andy Jagoda (my EM hero) at Elmhurst in Queens (Mt Sinai covered it) said that - "if someone is waiting 16 hours to be seen, they have a reason why they stayed, and see them."
Yes. Levitan w/ cadavers.
Also a nocturnist. I flip to nights on Thursday or Friday and I flip to days on Monday or Tuesday 3-4 times a month 🤷🏻♀️
This also holds true for farmers and Amish people the second they arrive. I don't think I've seen a single BS presentation from either of those demographics.
Never discharge an Amish kid was what my old PEM attending used to say.
Impressive. I simply can't do that. Most other EM docs can't either. Many of the nocturnists that I know don't flip completely to an early a.m. schedule either since that defeats the primary benefit that comes from having a set schedule. More often than not, they are night owls that still go to bed late and sleep late mornings on their day off. I have known a few docs like you that can flip on a dime with little to no repercussions (one was in his 60s) and you people are just built differently.
Still though..the ornery point of my post, and completely nothing personal....is that it's just slightly aggravating getting lectured by nocturnists about how regular docs should handle their circadian flips. Moreover, the whole "my body is a holy temple" philosophy to approaching EM shift work is just slightly hilarious considering that this specialty is probably killing us far faster than most poor lifestyle choices ever could.
These days I feel fatigued after working one evening shift. Perhaps this body is broken.
Yeah, that's unacceptable in my head. Un. Ac. Cept. A. Ble.
I mean 50 is a lot but there were 28 out there Saturday night for me … 18 had not gone through PIT yet .. I feel like some of the departing docs care and some are just like good luck with that $hit lol
This is so so underrated haha. I remember this feeling, couldn't pay me enough to endure it again.
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What’s your approach? I am also a fan of sleep hygiene, exercise, intentional light exposure or lack thereof. I use melatonin too sometimes and am an aggressive caffeinator which maybe gets into your “no drugs” area, but I’m curious about the specific approach that works for you.
All the advice to be a nocturnists are great but no matter how you try to game it, it is just bad for you physical/mental health especially if you have young kids.
Our private group used to pay +$60-100/hr for overnights and I told my partners back in the day that I would pay as much as they want. The nocturnist made an extra $750/shift and a full timer was alotted 3/month so it costs each doc about $2200/month which was essentially one shift.
I would gladly work an extra day/mid shift a month than 3 overnights.
If you can avoid it, avoid it. The money is not worth is esp as you get older or have young kids. With kids, no matter how you game they system, they will break it. I just never had the heart to tell my young kids to leave me alone when they got home from school at 3pm b/c I had to sleep for my overnight. Plus, when they came into the room to give me a hug, no way could I tell them not to as those hugs are precious and don't last forever.
Our private group used to pay +$60-100/hr for overnights and I told my partners back in the day that I would pay as much as they want. The nocturnist made an extra $750/shift and a full timer was alotted 3/month so it costs each doc about $2200/month which was essentially one shift.
I would gladly work an extra day/mid shift a month than 3 overnights.
If you can avoid it, avoid it. The money is not worth is esp as you get older or have young kids. With kids, no matter how you game they system, they will break it. I just never had the heart to tell my young kids to leave me alone when they got home from school at 3pm b/c I had to sleep for my overnight. Plus, when they came into the room to give me a hug, no way could I tell them not to as those hugs are precious and don't last forever.
This is just my personal experience. I was told it was better for the family to work nights. Work when kids asleep, up when kids home from school. I am an easy sleeper and can sleep almost anywhere so thought I would give it a try.
The did this for 3 months and it was mentally/physically draining. I came home and we had a black out media room. I would sleep but body just work up tired after 4-5 hrs. Too awake to go back, but still tired. Got up, did some stuff with kids, and +/- nap before work.
I just could not get any prolonged sleep and was hyper tired/grouchy for close to 3 months. I didn't feel I gained much quality family time b/c I was not mentally presents.
PLUS there is something to be said with sharing a bed with your wife.
Excellent point. I might be sensitive to B blockers. I was straight stupefied.
This has been the debate at my program lately. We’ve got a big peds hospital - level 4 NICU, Pedi trauma, pedi transplant that does everything including cardiac and multiviscerals. Kids are sick as hell, and the Peds ED is run by EM residents with no fellows.
Even with all that seniors graduate with a couple pedi tubes each max. Kids just don’t need intubation that much, especially with the advent of HFNC.
We could do a NICU month, but is it really educationally worth pulling a resident from the ER so they can trend sodiums for a month in the NICU just to get a couple extra tubes?
I trained 20+ yrs ago at a PH program (either 1st or 2nd busiest in the country at the time). We have an Adult ER, Psych ER, OB ER, and a Pedi ER. Residents in probably every specialty.
I got zero Pedi tubes. When sick kids came, the attendings/Pedi EM were protective and never let us close to a Pedi Kids. Pedi Tubes don't really scare me. Use the right size, and do your best.
Even in my 20+ attending career, I have done Zero Pedi tubes. Still do not scare me.
I got zero Pedi tubes. When sick kids came, the attendings/Pedi EM were protective and never let us close to a Pedi Kids. Pedi Tubes don't really scare me. Use the right size, and do your best.
Even in my 20+ attending career, I have done Zero Pedi tubes. Still do not scare me.
Yeah, but coffee tastes good
[insert Travolta Pulp Fiction gif]
But sleeping pills? No thanks. I'm plenty tired to sleep after a night shift, and I would be worried about still being zonked on shift if I took a sleeping pill for my pre-shift nap.
I'll use melatonin to facilitate a flip back to day shifts, but only occasionally.
Wow. I've done a bunch. Thank goodness for the Broselow tape and RTs who know vent settings. But I've worked places that are 50% kids, probably not usual.
Yea I thought NICU was worth it on the whole. We probably doubled or more the whole volume of peds resuscitations and tubes in the rest of residency during that one month. One bright side is we shared the unit with peds residents. They took more of the boring medical management cases and EM would get most of the airway and resuscitation type stuff. There’s also some other interesting things to learn there like neonatal abstinence syndrome. Plus other rare but important procedures such as umbilical lines, LPs, and a few residents got chest tubes. One important factor is our unit didn’t have any NICU fellows who would otherwise steal a lot of procedures.
I did the past 2.5 years doing M-W/M-Th nights alternating every week. Every weekend off. I had a 1:10 min drive both ways. . The job was tough. 25-30/night with lots of high acuity and trauma. Great people to work with, no pushback, all boarded ED docs that I love working with, ED pharmacists that I would trust to run a critical patient, trauma surgeons in house that trust us so it's tough but easy if you get what I'm saying. I'm fine flipping. Did the stay up until 2am on monday morning, get the kids to school at 7. Play golf or whatever until noon and sleep until 4. Last morning of the shift sleep from 9a-2p. Then get a good sleep that night and flip for the weekend. I figured I could work day shift and see my kids less because I would leave before they're up and get home after they're in bed. That was mostly the case. Idk if it had a real psychological toll on me because I've always been an Eyore in a sense. Started working a new job half of the month with a 9min drive and 10 hour shifts with many daytime shifts. To be determined which is better. The new job is boring and poorly run so a whole new set of headaches. Incredibly difficult to admit, nursing staff doesn't take anything seriously, etc... Overall I learned a lot on nights and became a much better doc because of it I think. It gave me the backbone I didn't have. I definitely wouldn't say it was a dream though.
Yeah nights are definitely not for everyone. If I get out on time I do a quick workout (gym or brisk walk outside if weather permits) I get home, try to sleep from like 9-5 so everyone is working/at school/at church anyway. Get up by 5, shower, make dinner, clean up, hang out with kids and Mr C. I drink a travel mug of coffee and try to finish it on the 30 minute commute in; then no more caffeine. I don’t drink at all (it’s just not my thing). This has been the schedule we’ve followed for 8 years now. I work weekends mostly so during the midweek I switch back to days and basically am a stay at home mom (the other moms at preschool dropoff just realized I work at all this week)
Those of us who are night creatures are happy to take the nights and appreciate the $$$ 😉
I had around 10 ped tubes during residency, mostly during the general anesthesia month. In 11 years’ practice I have intubated a 5 month old traumatic arrest, a 2 Year old status asthmatic, a 6 year old status epi and a 15 year old severe poly trauma at my community hospital two miles from the {peds hospital level 4 nicu facility level 1 trauma}center. All of them were much easier than I expected, and on par with the easiest adult airways. I think getting access and keeping the nurses from losing their minds is the bigger issue tbh
Just curious, as someone who always preferred nights for many of the reasons outlined in other posts, even though I'm very much an early bird and a terrible day sleeper. I'm aware of the studies that say shift work is terrible for your health, but do you (or anyone else here) happen to know whether they looked at how well the study participants slept during the day? It would be really interesting to know if general lack of sleep was the problem or if it's truly due to disruption of the circadian rhythm.
I don't mind nights unless it's at a busy site where I'm up ALL night. Then, F that. My nights shifts start out a bit busy but then thinned out at midnight. I routinely get 3hrs of sleep.
Underserved communities are usually the worst places to work nights since the uninsured, druggies and medicaid patients utilize the ER at all hours of the night.
Underserved communities are usually the worst places to work nights since the uninsured, druggies and medicaid patients utilize the ER at all hours of the night.
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This isn't necessarily a question for SDGs. I understand they would be more flexible, but they are pretty hard to find in my area, if at all.
You’re mistaken if you think an SDG will give you days. If anything you’re more likely to do more nights as you’ll actually have people that have been at an SDG for 15-20 years and they aren’t about to take your night shifts.
Money talks for most people, as the other poster just implied. So I don't think I'm mistaken.
But let's just forget the whole SDG thing. CMG only. Anyone with experience?
I didn't know this was a possibility until I started New Job 2 months ago.
I was in a hospital employed group where I paid about $20k per year for no nights. I would do a couple of shifts per month that ended at 2a. Night shifts are brutal at this place with typically taking the whole night to get the WR cleared out. I’ve never worked a shop where it’s possible to sleep at night. My current rural job is in a prison and nursing home industry area (cheap labor) so get a steady stream from those places all night.
I had one gig once years ago where you might get a few hours of sleep. I worked a lot of nights by the end of my EM days (*prepandemic.)
Freestanding. Sweet setup.
And then one night I actually was asleep and a crashing, bradycardic 99% LAD STEMI came in by private vehicle at 5am.
Took me a full minute to wake up and grasp what the nurse was yelling.
Couldn't get the STEMI cardiologists on the phone, couldn't get the cath lab activated, it was a cluster nightmare. Ended up calling the ER at the mothership and giving them the heads up that I was lights-and-sirening a disaster their way.
She lived and did well, but it ruined the place for me.
And even though I did occasionally get nights where I could lie down, I never managed to sleep-sleep there again.
I was not an inherently anxious person, but I was after that night.
(And FWIW, I got a ton of pedi airways in training, thanks to a single solid pedi anesthesia attending who made me really learn. I bagged a kid through a whole cardiac procedure. I tubed a bunch of kids... one three times while he yelled "do not intubate the toes!" and yanked the tube back out when I went too deep. It was safe, controlled and made me rock steady because at that hospital, we saw every Make-A-Wish kid who got sick on their Disney trip.)
But I am also old, and do not envy you all on the "other side."
(Of both medicine, and at the beginnings of your careers.)
Freestanding. Sweet setup.
And then one night I actually was asleep and a crashing, bradycardic 99% LAD STEMI came in by private vehicle at 5am.
Took me a full minute to wake up and grasp what the nurse was yelling.
Couldn't get the STEMI cardiologists on the phone, couldn't get the cath lab activated, it was a cluster nightmare. Ended up calling the ER at the mothership and giving them the heads up that I was lights-and-sirening a disaster their way.
She lived and did well, but it ruined the place for me.
And even though I did occasionally get nights where I could lie down, I never managed to sleep-sleep there again.
I was not an inherently anxious person, but I was after that night.
(And FWIW, I got a ton of pedi airways in training, thanks to a single solid pedi anesthesia attending who made me really learn. I bagged a kid through a whole cardiac procedure. I tubed a bunch of kids... one three times while he yelled "do not intubate the toes!" and yanked the tube back out when I went too deep. It was safe, controlled and made me rock steady because at that hospital, we saw every Make-A-Wish kid who got sick on their Disney trip.)
But I am also old, and do not envy you all on the "other side."
(Of both medicine, and at the beginnings of your careers.)
These are the most desirable shifts of all. I guess you might be able to find a group that would allow it IF you took a big financial hit but my guess is your best bet is to do some prn stuff and only pick up day shifts. You might get a shift or two a month but you won’t get a full schedule.
If you find a desperate place they will likely put in the contract to work only days. If its a more desirable, they likely will not but you can always do it.
Depending on the site 500/nt will typically do it.
