EM with a circadian rhythm disorder

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Sasaro

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M4 here, thinking about applying to EM. I'm wondering how possible it would be to have a career in EM while working mostly evening shifts? I have delayed sleep-wake phase disorder, and so a big priority of mine is having a job that allows me to start work after 12pm or so. I do OK staying up all night, so night shifts would be doable too, but working afternoons/evenings (12pm-8pm, 4pm-12am, 6pm-2am, etc.) would be the ideal case scenario. There seems to be no better way to deal with my sleep disorder at this point, unfortunately, and the chronic sleep deprivation from having to be at the hospital by 6am for most of the past year has already taken a toll on my health. I ruled out gas and surgery quickly solely due to the very early starts, though I loved the OR.

So for those in EM, I'm wondering how flexible would your groups be in allowing docs to work a schedule like this? I hear that mornings are preferable for most people due to family commitments and such, and there is traditionally less demand for evening and night shifts. If there was a physician who wanted to work mostly evenings, would your group accommodate that? Or would I be better off in some different specialty that allows me to work in private practice and control my own schedule more effectively?

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If you want to work noon to 8, or 5p-1a, or nights, I think that it is highly unlikely (although not impossible) that you would not get that for which you ask. The evening is the busiest time in the ED, so, doing afternoons into evening, you would, likely, be working very hard, every shift (weekends possibly excepted, depending on the pt base where the dept is located).
 
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I also tend to be a rather extreme "owl." I naturally seem to go to bed between 3 and 4 am and wake between 11a and 12p. This was absolutely murderous during medical school and residency. I would have like 5-day periods during which I had gotten less than 15 hours total sleep, no freaking joke. I have been an attending for 14 months now, and I feel like I am finally sleeping; I am almost never sleep deprived anymore, getting 7-8 hours daily. I work pretty much all swing shifts, which works fine for this sleep schedule. Nobody fights me for these. Everybody seems to want to work the buttcrack of dawn shift (probably because that shift sucks least for reasons noted above). I would need to wake up not long after the time I prefer to go to sleep to work the buttcrack shift, so it's a no bueno for me. Get backloaded mercilessly every shift. That's the tradeoff.
 
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I also tend to be a rather extreme "owl." I naturally seem to go to bed between 3 and 4 am and wake between 11a and 12p. This was absolutely murderous during medical school and residency. I would have like 5-day periods during which I had gotten less than 15 hours total sleep, no freaking joke.

Are you me?

But in all seriousness, it's great to hear that you found a job that works for you - it gives me hope for the future. Not being able to sleep at 'normal times' is awful and I wouldn't wish it on anyone.
 
If you want to work noon to 8, or 5p-1a, or nights, I think that it is highly unlikely (although not impossible) that you would not get that for which you ask. The evening is the busiest time in the ED, so, doing afternoons into evening, you would, likely, be working very hard, every shift (weekends possibly excepted, depending on the pt base where the dept is located).

Appreciate the insight about the increased workload of evening shifts, that is something I hadn't considered in this context. How many shifts a month do you think are reasonable on a schedule like this, to avoid excessively early burnout?
 
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Totally doable. I only work 1200-2100, 1500-0000 and 2100-0600. More people want to work mornings than evening/nights in our specialty.
 
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I despise the evening shifts so if you’re in my group you can have them all. Nights are more palatable for me (and many others) because generally you get to have dinner with the family, often there’s a pay differential, and frequently there’s less patient volume and certainly less suits/admin around.
 
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I have delayed sleep-wake phase disorder, and so a big priority of mine is having a job that...
Imagine a well-oiled machine with shiny metallic gears, moving quickly, efficiently and with youthful power. Then throw in some pebbles into it. Then add some sand. As the gears slow down and start making a primitive screeching sound, throw some metal shavings and rusty bolts into them. Finally, sprinkle on some lighter fluid and like a cherry on top, add a lit match. That's your mood and sleep on EM's circadian rhythms, for the next 30 years.

None of your proposed solutions are adequately effective, practical or available. Despite well intentioned co-workers' promises to give you the shifts you want and they don't want, never ending request for this day off, that day off, Bobby's birthday, Susie's graduation, gum up your plans. The only practical and effective solution is to reduce your monthly EM shifts to as close to zero as possible. Keep in mind, you're at zero now.
 
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You still have to make it through residency which will be lots of 6AM rise time both for the ED and off service. They will not be able to make a special schedule for you.

Once you make it through you could definitely do nocturnist. The other option is to try to do a clinic based speciality where you can set your own hours say ophtho or pain or something. Or do radiology and maybe you can do telerads
 
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You still have to make it through residency which will be lots of 6AM rise time both for the ED and off service. They will not be able to make a special schedule for you.

Once you make it through you could definitely do nocturnist. The other option is to try to do a clinic based speciality where you can set your own hours say ophtho or pain or something. Or do radiology and maybe you can do telerads

On the ED months, they did actually allow us to request evenings/nights, and I would mostly work those, but being residency, the stupid didactics/journal clubs, etc. always messed up whatever schedule you were on.
 
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You still have to make it through residency which will be lots of 6AM rise time both for the ED and off service. They will not be able to make a special schedule for you.

Once you make it through you could definitely do nocturnist. The other option is to try to do a clinic based speciality where you can set your own hours say ophtho or pain or something. Or do radiology and maybe you can do telerads

Yes, I am dreading residency a little for that reason, but it's a finite amount of time so I will survive. The other specialty I'm considering is actually psych (strange, I know), which would give the option of private practice and setting my own schedule without having to do additional fellowships.
 
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You're letting this "diagnosis" go to your head Delayed sleep phase disorder is about as real as 99% of people's self diagnosed "bipolar disorder". It is essentially just poor sleep habits. Get off your phone, no TV, no caffeine, pop a melatonin, etc. Any residency won't care about your issue.
 
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I also tend to be a rather extreme "owl." I naturally seem to go to bed between 3 and 4 am and wake between 11a and 12p. This was absolutely murderous during medical school and residency. I would have like 5-day periods during which I had gotten less than 15 hours total sleep, no freaking joke. I have been an attending for 14 months now, and I feel like I am finally sleeping; I am almost never sleep deprived anymore, getting 7-8 hours daily. I work pretty much all swing shifts, which works fine for this sleep schedule. Nobody fights me for these. Everybody seems to want to work the buttcrack of dawn shift (probably because that shift sucks least for reasons noted above). I would need to wake up not long after the time I prefer to go to sleep to work the buttcrack shift, so it's a no bueno for me. Get backloaded mercilessly every shift. That's the tradeoff.

I'm assuming you don't have kids. I used to be like this, but when you have a wife/kids in the mix, that type of schedule will go out the window fast. Can't expect the wife to deal with the kids all morning all the time while I sleep in.
 
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I'm assuming you don't have kids. I used to be like this, but when you have a wife/kids in the mix, that type of schedule will go out the window fast. Can't expect the wife to deal with the kids all morning all the time while I sleep in.
Yep. Same here. The crazy, anytime schedule was just fine when I could sleep any time or place I wanted. Throw kids and family in the mix and all of a sudden you've got to be awake, alert, happy and emotionally available on the rest of the world's schedule. It's get real jarring, real quick, and never stops being so.
 
I'm assuming you don't have kids. I used to be like this, but when you have a wife/kids in the mix, that type of schedule will go out the window fast. Can't expect the wife to deal with the kids all morning all the time while I sleep in.

I am child-free. Seems like a great time to be so, too.
 
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You aren't going to have any problem finding a job if you want to work only evenings/nights. I'm very similar, I really struggle with bouncing my shifts around or working during the day. I only work overnights.

Your only struggle may be residency. Not only are you going to have to work a variety of different shifts, but you also are going to rotate on services like the ICU and Trauma where it is likely that you'll have to be at the hospital pretty early.
 
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You're letting this "diagnosis" go to your head Delayed sleep phase disorder is about as real as 99% of people's self diagnosed "bipolar disorder". It is essentially just poor sleep habits. Get off your phone, no TV, no caffeine, pop a melatonin, etc. Any residency won't care about your issue.

Legitimately can't tell if you're trying to make a very poor attempt at humor, or if you're actually arrogant enough to make such asinine assumptions about all strangers who make the mistake of sharing their personal health issues with you. Do you also tell all your bipolar patients to 'get off the phone, drink less caffeine, and stop being manic for God's sake'? Maybe try telling your next depressed SA patient "Just cheer up man! Have you tried thinking more positively?" Or perhaps your next fibromyalgia patient just needs to hear that 'everyone feels aches and pains, just a normal part of getting older, stop trying to be special'.

Not that it's any of your business, but I have been diagnosed and treated by more than one sleep specialist, so you may kindly f*** right off. I do feel very badly for your patients, though, if that's how you treat everyone who has a condition you don't 'believe' in.
 
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Legitimately can't tell if you're trying to make a very poor attempt at humor, or if you're actually arrogant enough to make such asinine assumptions about all strangers who make the mistake of sharing their personal health issues with you. Do you also tell all your bipolar patients to 'get off the phone, drink less caffeine, and stop being manic for God's sake'? Maybe try telling your next depressed SA patient "Just cheer up man! Have you tried thinking more positively?" Or perhaps your next fibromyalgia patient just needs to hear that 'everyone feels aches and pains, just a normal part of getting older, stop trying to be special'.

Not that it's any of your business, but I have been diagnosed and treated by more than one sleep specialist, so you may kindly f*** right off. I do feel very badly for your patients, though, if that's how you treat everyone who has a condition you don't 'believe' in.

Lol boy oh boy are you going to be overwhelmed in residency if you're going to sit down and have a heart to heart with all your fibro patients. You might actually want to wait until you even have a single clue what medicine is like before romanticizing it or you're going to be really sad about your therapeutic talks to your fibro patients getting 1/10s on your PGs because you failed to give them Dilaudid.

Also, just because someone has a diagnosis doesn't mean an actual physician really diagnosed it and not Google (i.e. bipolar) or that it's even real (fibro, interstitial cystitis, non epileptic seizures, non DM/surgery related gastroparesis, CRPS, non monoclonal mastocytosis) etc. Etc.

You should probably do psych.
 
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You should probably do psych.

Lol boy oh boy indeed. If I do, feel free to call me up in a couple years and maybe I can pencil you in for an eval. You sound burned out as hell.
 
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Agree that you won’t have a problem finding a job that allows you to work only afternoons and nights. Nocturnists are worth their weight in gold. I’m just commenting here because I think the diagnosis you mentioned is interesting and shows the evolution of sleep medicine. “Delayed sleep wake phase disorder” used to just be called night owls. It’s good you’re thinking about how this affects your life and your career. When it comes time to negotiate a contract, remember that most people don’t want to work late afternoon (“swing shifts”) and especially overnights and your preference is especially valuable to a group.
 
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OP def belongs in psych. Plus, you can do sleep medicine on the side. Something arguably close to your heart. All of us have sleep disorders to some degree, btw. Yours sounds relatively mild compared to some of us. No shame in psych. The field is on fire these days.
 
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Lol boy oh boy indeed. If I do, feel free to call me up in a couple years and maybe I can pencil you in for an eval. You sound burned out as hell.

I try to do my best to practice Emergency Medicine the way that you described. It's difficult, but not impossible.
 
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You just called 65% of Emergency Physicians crazy and in need of mental help.

Ooof talk about a straw man. C'mon dude, you're better than this. I chose to call him/her "burned out", instead of "angry", "bitter", "immature" "needlessly aggressive", etc etc - because I tried to interpret his provocation with an attempt at understanding. Maybe he's projecting his frustration about his own chronically untreated sleep problems due to the rough schedule at his residency, or maybe he had a bad day. Or maybe he's just a jerk who likes to troll posts that are asking for advice, I don't know and frankly don't care. In social psychology, this is called the fundamental attribution error.

Also, if you think that everyone who can benefit from some therapy is "crazy", then that's a whole other bag of worms I'm not even going to touch here lol.
 
Anyhow, I very much appreciate all the helpful responses to my original question. Sounds like in many groups, people have no issues working an evening schedule for the majority of the time, which is what I was hoping to hear. Thanks all.
 
This thread is turning into one of those reasons why people deactivate their SDN accounts.
 
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Ooof talk about a straw man. C'mon dude, you're better than this. I chose to call him/her "burned out", instead of "angry", "bitter", "immature" "needlessly aggressive", etc etc - because I tried to interpret his provocation with an attempt at understanding. Maybe he's projecting his frustration about his own chronically untreated sleep problems due to the rough schedule at his residency, or maybe he had a bad day. Or maybe he's just a jerk who likes to troll posts that are asking for advice, I don't know and frankly don't care. In social psychology, this is called the fundamental attribution error.

Also, if you think that everyone who can benefit from some therapy is "crazy", then that's a whole other bag of worms I'm not even going to touch here lol.
:troll:
 
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Ooof talk about a straw man. C'mon dude, you're better than this. I chose to call him/her "burned out", instead of "angry", "bitter", "immature" "needlessly aggressive", etc etc - because I tried to interpret his provocation with an attempt at understanding.

so you may kindly f*** right off. I do feel very badly for your patients, though

Yes, very understanding.

I'm not saying I agree with Rekt, but the above and the rest of your response exudes an unfortunate combination of naivete and condescension.
 
in our group - the newbies have to work exclusively nights as generally few people actually enjoy nights in the ED (I choose to work them as a Rph) - I don't know about how they prefer evenings
 
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