Emergency Medicine Schedule

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YeeHawWooHoo

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Hi! I am a 4th year medical student looking for advice. I love everything about emergency medicine (seeing critically ill patients alongside patients who aren't that sick, knowing a little about a bunch of different fields, navigating difficult patient interactions, etc.) but I am struggling with the schedule. I don't sleep very well during the day and I feel crazy tired switching between days and nights and even some have trouble going from later evening shifts back to days. Are there any jobs in EM that offer some regularity or will that just be impossible to find?
 
In before the flood of "avoid this field like the plague" posts. I think that topic has been hashed to death.

To actually answer your question, I would not count on finding a "regular" schedule in Emergency Medicine. This isn't to say that it doesn't exist, and it actually probably does exist more than we give it credit for, but I don't want your expectations to be set incorrectly. This job involves nights, weekends, and holidays.

That said, it's more common than not to have physicians who work exclusively nights. They actually tend to have the most "regular" schedule since they frequently get to make their own schedules, and generally parlay additional compensation and sometimes less weekend/holiday time in return for doing overnight shifts. If anybody is in a group that doesn't have dedicated nocturnists, I recommend advocating for getting whatever it takes to get them.

Even with dedicated nocturnists, I still work a couple nights every few months. It's a part of the job. Honestly, it's working evenings that's an even greater burden. Evenings (and by that I mean shifts that start in the afternoon and end in the evening; second shift) mean that your time at home and not asleep tends to be the morning to midday hours; so if you have children in school or a spouse that works, you will not see them at all. I've known physicians who became nocturnists actually to avoid working second shifts because being a nocturnist was better for their home lives.

The scheduling on our jobs is not a perk; it's the number of hours that we work that makes this lifestyle attractive.
 
Hi! I am a 4th year medical student looking for advice. I love everything about emergency medicine (seeing critically ill patients alongside patients who aren't that sick, knowing a little about a bunch of different fields, navigating difficult patient interactions, etc.) but I am struggling with the schedule. I don't sleep very well during the day and I feel crazy tired switching between days and nights and even some have trouble going from later evening shifts back to days. Are there any jobs in EM that offer some regularity or will that just be impossible to find?

No.
 
Hi! I am a 4th year medical student looking for advice. I love everything about emergency medicine (seeing critically ill patients alongside patients who aren't that sick, knowing a little about a bunch of different fields, navigating difficult patient interactions, etc.) but I am struggling with the schedule. I don't sleep very well during the day and I feel crazy tired switching between days and nights and even some have trouble going from later evening shifts back to days. Are there any jobs in EM that offer some regularity or will that just be impossible to find?

You won't do well in this field. There are zero options for traditional EM with majority 6am shifts unless you own the group.

Options:

1) Search for groups that have full time nocturnists so that it minimizes any overnights. Note...this does NOT solve your circadian disruption since you will still be working early/late swings.
2) Be a nocturnist. This would be the most common solution for people like you.
3) Part time EM combined with say....urgent care/telemedicine to keep you on majority days.

That's really about it next to doing a fellowship and launching into something completely non EM related.

All that being said, listening to you only makes me think about the world of hurt that awaits you in EM. We are a bunch of walking sleep disorders. Anybody with as much trouble sleeping as you describe should completely stick to an outpatient clinic schedule. You don't need EM, you need FM.
 
I was a nocturnist for 5 years and I can attest to the fact if you surrender to the night and just live the night life it's an easy schedule.

But as time goes on you start to see what you're missing out on by doing that. If you're single and don't have kids it's probably the best way to do EM
 
Hi! I am a 4th year medical student looking for advice. I love everything about emergency medicine (seeing critically ill patients alongside patients who aren't that sick, knowing a little about a bunch of different fields, navigating difficult patient interactions, etc.) but I am struggling with the schedule. I don't sleep very well during the day and I feel crazy tired switching between days and nights and even some have trouble going from later evening shifts back to days. Are there any jobs in EM that offer some regularity or will that just be impossible to find?
I missed the gravity of this (sleep) as a student. I’m an awful sleeper and now as an EM attending, I’m a shell of a sleep-deprived human. Tried nights—even that’s tough bc you want to be normal on your days off. Overall, juice ain’t worth the squeeze. Would skip. Too many other interesting 9a-4p things out there in the world of medicine.
 
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In before the flood of "avoid this field like the plague" posts. I think that topic has been hashed to death.

To actually answer your question, I would not count on finding a "regular" schedule in Emergency Medicine. This isn't to say that it doesn't exist, and it actually probably does exist more than we give it credit for, but I don't want your expectations to be set incorrectly. This job involves nights, weekends, and holidays.

That said, it's more common than not to have physicians who work exclusively nights. They actually tend to have the most "regular" schedule since they frequently get to make their own schedules, and generally parlay additional compensation and sometimes less weekend/holiday time in return for doing overnight shifts. If anybody is in a group that doesn't have dedicated nocturnists, I recommend advocating for getting whatever it takes to get them.

Even with dedicated nocturnists, I still work a couple nights every few months. It's a part of the job. Honestly, it's working evenings that's an even greater burden. Evenings (and by that I mean shifts that start in the afternoon and end in the evening; second shift) mean that your time at home and not asleep tends to be the morning to midday hours; so if you have children in school or a spouse that works, you will not see them at all. I've known physicians who became nocturnists actually to avoid working second shifts because being a nocturnist was better for their home lives.

The scheduling on our jobs is not a perk; it's the number of hours that we work that makes this lifestyle attractive.

Agreed overall especially about the fact that in EM the regular schedule is to not have a regular schedule.

I will add that having previously worked as a nocturnist while you can often choose your own schedule and work only certain nights I still would not count that as having a regular schedule. Generally speaking unless you're basically a hermit without a life outside work you'll basically still need to switch back to days between working shifts. Everyone else is on a day schedule and if you want to spend time with friends that means being awake in the daytime for birthdays and weddings or even playing sports. You can't take a vacation and be awake from 8PM to 8AM.
 
All that being said, listening to you only makes me think about the world of hurt that awaits you in EM. We are a bunch of walking sleep disorders.
One of my friends who I hadn't seen in several months recently told me that I looked younger.

I said something to the extent of "yeah man. I've been jetlagged for 10 years. It finally stopped."
 
Hi! I am a 4th year medical student looking for advice. I love everything about emergency medicine (seeing critically ill patients alongside patients who aren't that sick, knowing a little about a bunch of different fields, navigating difficult patient interactions, etc.) but I am struggling with the schedule. I don't sleep very well during the day and I feel crazy tired switching between days and nights and even some have trouble going from later evening shifts back to days. Are there any jobs in EM that offer some regularity or will that just be impossible to find?

You won't find them coming out of residency. In fact, you'll probably be asked to work a few more nights than the average full time doc as part of your "buy in".

there are a handful of places where you can buy out of them, and if you find it, then that's fine.

ER is 24/7/365 work. You can't work 16/5/290.
 
In before the flood of "avoid this field like the plague" posts. I think that topic has been hashed to death.

I know. This is a sad board. People can't even answer a straight forward question without bagging their own line of work.
 
Hi! I am a 4th year medical student looking for advice. I love everything about emergency medicine (seeing critically ill patients alongside patients who aren't that sick, knowing a little about a bunch of different fields, navigating difficult patient interactions, etc.) but I am struggling with the schedule. I don't sleep very well during the day and I feel crazy tired switching between days and nights and even some have trouble going from later evening shifts back to days. Are there any jobs in EM that offer some regularity or will that just be impossible to find?

You might be able to find it if you're willing to string together enough locums / prn gigs to get it done, but this is likely not a great place to start your career. I had a job w no nights, but still have swing shifts, which tbh I find just as bad .
 
We as society need to get past on demand medicine. If you want non-emergent healthcare between the hours of 5 pm - 8 am you need to pay a premium. You can’t get your oil changed during that time. You don’t need evaluation of your chronic back pain or 3 days of abdominal pain with diarrhea during those hours. EMTALA needs revision. We need national medicolegal reform. Not holding my breath, nor do I think it’s the likely outcome, but it would help in many ways.
 
We as society need to get past on demand medicine. If you want non-emergent healthcare between the hours of 5 pm - 8 am you need to pay a premium. You can’t get your oil changed during that time. You don’t need evaluation of your chronic back pain or 3 days of abdominal pain with diarrhea during those hours. EMTALA needs revision. We need national medicolegal reform. Not holding my breath, nor do I think it’s the likely outcome, but it would help in many ways.

Do you feel better now, bro?
 
Find a functional group in attendinghood and it isn’t that bad.

I work 3-4 nights shifts a month (at 180ish total hrs/month). That’s not bad.

Plenty of other specialties have to occasionally work during the witching hours. My anesthesiologist neighbor just pulled a string of them.
 
Hi! I am a 4th year medical student looking for advice. I love everything about emergency medicine (seeing critically ill patients alongside patients who aren't that sick, knowing a little about a bunch of different fields, navigating difficult patient interactions, etc.) but I am struggling with the schedule. I don't sleep very well during the day and I feel crazy tired switching between days and nights and even some have trouble going from later evening shifts back to days. Are there any jobs in EM that offer some regularity or will that just be impossible to find?
Love _everything_ about emergency medicine? Lord help me. You need to take those goggles off. Even if you like EM I can’t believe that statement. Just stop it.
 
Most of what the OP currently loves about EM are things that you will come to hate about EM. Find a specialty that is procedural with the least chance of getting wiped out by AI, can be run as a cash business, brings in a lot of money for the hospital so they can f_ck with you the least amount possible, and is something where call is minimal. Good luck!
 
You won't do well in this field. There are zero options for traditional EM with majority 6am shifts unless you own the group.

Options:

1) Search for groups that have full time nocturnists so that it minimizes any overnights. Note...this does NOT solve your circadian disruption since you will still be working early/late swings.
2) Be a nocturnist. This would be the most common solution for people like you.
3) Part time EM combined with say....urgent care/telemedicine to keep you on majority days.

That's really about it next to doing a fellowship and launching into something completely non EM related.

All that being said, listening to you only makes me think about the world of hurt that awaits you in EM. We are a bunch of walking sleep disorders. Anybody with as much trouble sleeping as you describe should completely stick to an outpatient clinic schedule. You don't need EM, you need FM.
I am experiencing that world of hurt on nights rn. I havent been this sleepy since surgery. I think I might switch lol.
 
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