Emergency Medicine Schedule

[Birdstrike]

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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?

If you’re prone to chronic circadian rhythm dysthymia, Emergency Medicine is not for you. It will only get worse with each successive year you age. It took me too long to admit this to myself. I finally learned before it was too late.

Shift work is a poison to you (and me). You’re allergic to this poison. No amount of taking it less or at different times or chased with ambien or adderal are going to make this poison healthy for you (or me). It will always be as toxic as it ever was.

EM is dead. We have killed it.

 

[dchristismi]

Once I "retired" to a regular doctoring kind of gig (inpatient hospice, but I set my own hours, round on my patients and take super cush call) and my circadian whack sorted out, wow, geez. How the heck did I do that? How do YOU guys do that? Rhetorical question. I know exactly how you do it. You wander around jetlagged as hell all the time without the benefit of just having been cavorting around Bangkok. Now when I travel and I get that feeling I am SO thankful I don't live like that anymore.

OP, the jetlag is real. And it's constant. Take it into consideration. I ended my EM career as a nocturnist, but it's a challenging way to start off.

Also, have you thought about hospice and palliative care? Plenty of complex family stuff. Granted, the procedures are lacking, but the procedures are only fun when you're in training. Trust us.

 

[GatorCHOMPions]

I agree with everything you've said here, but need to call you out on the "I could never go back to working hours."

I would have said the same thing in deep in the middle of my attending stint, because yes there were lots of upsides to the typical EM schedule.

But now that I'm sleeping and waking up at the same exact time every single day, including the weekends, I would NEVER go back to the erratic EM scheduling, even with consistent blocks of same-time shifts. The mood, health, physical, and other benefits are WILD. There's no comparison, it's not even close.

I think a lot of ER docs have to simply accept and learn to love the erratic schedule, but we should be honest that it's not in line with how a human should live, and it's a net negative, regardless of how much cognitive dissonance you have to swallow to learn to love it.

One big reason EM is underpaid. Should be national average $300/hour, probably even $350.

 

[AlmostAnMD]

One big reason EM is underpaid. Should be national average $300/hour, probably even $350.

Poor lobbying is 80% the reason

I think the only group worse than us is air traffic controllers

 

[EctopicFetus]

Came here to say exactly this.

The ED schedule flip flopping isn’t all that troublesome when you do 11x 9hr shifts a month and only 1 is a true overnight bc nocturnists.

The ED schedule flip flopping is terrible when you do 14-15x 9hr shifts with 2-3 overnights and try to do admin meetings in the AM 3-4 days a week and 2 evenings a month.

YMMV.

I totally agree. I have it worked out now where I work about 1000-1200 hours a year. I havent done an overnight in forever, most of my shifts are done before 7pm. Its doable but it takes time and you arent gonna get there right out of residency. I will say working less is a miracle. I am glad I hustled early in my attendinghood so that i hit coastFI early and suddenly the options expanded. Even with unexpected expenses it just didnt matter. Makes work enjoyable. I have been out 15+ years and still genuinely enjoy going to work. I think not needing to work and good pay for a job I find straightforward is key to my happiness and willingness to continue.

 

[Apollyon]

Poor lobbying is 80% the reason

I think the only group worse than us is air traffic controllers

But, also, ATCs get scheduled breaks.

 

[cyanide12345678]

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?

Only nocturnist jobs offer regularity.

If you find a job with nocturnist already, you might do less nights as well. But as a general rule, you are otherwise guaranteed circadian rhythm disruptions in emergency medicine.

 

[GatorCHOMPions]

Kind of related to the other active advice thread, but academia can be a path to schedule control. In a past life I considered this route. I know a few people less than 10 years out of training who are working well under 100 hours per month clinically and have certain protected days for admin time for their "niche". They still work a few nights and evenings per month, though. The end game is getting into a Chair/VC or Dean/VD type role by the time you're 50. Those guys never work nights (or weekends) and do like a shift per week max.

 

[JacobMcCandles]

The end game is getting into a Chair/VC or Dean/VD type role by the time you're 50. Those guys never work nights (or weekends) and do like a shift per week max.

But then you're nose deep into the politics of it all and you're basically stuck playing that game which there's nothing more soul sucking in my opinion.

 

[HemorrhagicShock]

But then you're nose deep into the politics of it all and you're basically stuck playing that game which there's nothing more soul sucking in my opinion.

Exactly.

Administration or academics are their own forms of jail and not exactly the "escape" they're made out to be. In fact for most physicians and the type of people that become physicians, they're a form of hell.

I knew people who took the academic route in EM and they complain constantly about meetings, research/project deadlines, "publish or perish," along with the clinical and professional liability of dealing with resident decisions, resident documentation, and resident attitudes.

I don't know why you'd add that stress to an already stressful job, all for less pay. It makes the days off turn into 100% DOMAs.

 

[GatorCHOMPions]

Exactly.

Administration or academics are their own forms of jail and not exactly the "escape" they're made out to be. In fact for most physicians and the type of people that become physicians, they're a form of hell.

I knew people who took the academic route in EM and they complain constantly about meetings, research/project deadlines, "publish or perish," along with the clinical and professional liability of dealing with resident decisions, resident documentation, and resident attitudes.

I don't know why you'd add that stress to an already stressful job, all for less pay. It makes the days off turn into 100% DOMAs.

To each their own. I know two guys pretty well and they're very happy.

 

[Jabbed]

To each their own. I know two guys pretty well and they're very happy.

Similar to the maxim “Don’t do EM because you want a cush schedule”, I wouldn’t do admin/academics solely for the goal of reducing your workload.

 

[EctopicFetus]

Similar to the maxim “Don’t do EM because you want a cush schedule”, I wouldn’t do admin/academics solely for the goal of reducing your workload.

It’s just different. I work a fair number of clinical hours and do admin. They are both great and suck for different reasons. You have to know yourself. I think if the goal is to”easier” or more freedom you will be disappointed. I am “off” today but have had 3 phone calls and about an hour of emails. When all you do is work clinically that just doesnt happen.

 

[Apollyon]

had 3 phone calls and about an hour of emails.

This just made me think of that meme: "This meeting could have been an email. This email could have been a fist fight."

 

[Major]

Only nocturnist jobs offer regularity.

If you find a job with nocturnist already, you might do less nights as well. But as a general rule, you are otherwise guaranteed circadian rhythm disruptions in emergency medicine.

I switched to being nocturnist and have complete control of my schedule. I care more about having control over my schedule than the pay increase. Much happier.