Emergency Medicine Schedule

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

YeeHawWooHoo

New Member
Joined
Jul 26, 2025
Messages
4
Reaction score
3
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.
 
Last edited:
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.
 
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.
Really? This is literally our job. Obviously a lot of issues in there. FWIW there is a CPT code (with 0 RVUs) for this after hours care.

Prudent layperson be damned.. the insurance companies would love this as they would pay nothing. I would say its not a likely outcome because it is so flawed. I work in an RVU heavy system. IDGAF.. keep em coming.. i dont care what the complaint is. Every patient i see is money in my pocket.
 
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.
Hubris of youth.. and lack of experience. I still really really like my job. PGY-20 year right now. That being said plenty of things suck both on shift and the flow of the schedule, missing events I wish I didnt have to etc.
 
Really? This is literally our job. Obviously a lot of issues in there. FWIW there is a CPT code (with 0 RVUs) for this after hours care.

Prudent layperson be damned.. the insurance companies would love this as they would pay nothing. I would say its not a likely outcome because it is so flawed. I work in an RVU heavy system. IDGAF.. keep em coming.. i dont care what the complaint is. Every patient i see is money in my pocket.
Sure, keep them coming and charge them 3x as much. If volumes drop because people stop coming after hours then decrease the supply of EPs by shutting down all of the sub-par residencies that have sprung up. Let’s practice EM 24/7, but be the Everything Room during business hours unless they are going to pay after hours plumber rates. We don’t need to staff 4-5 physicians into the evening and double coverage overnight. We should put the extra staffing from 8a - 5p. Death to swing/evening shifts! /rant
 
Sure, keep them coming and charge them 3x as much. If volumes drop because people stop coming after hours then decrease the supply of EPs by shutting down all of the sub-par residencies that have sprung up. Let’s practice EM 24/7, but be the Everything Room during business hours unless they are going to pay after hours plumber rates. We don’t need to staff 4-5 physicians into the evening and double coverage overnight. We should put the extra staffing from 8a - 5p. Death to swing/evening shifts! /rant
Issue is the hospitals like factories are better served to have steady volume 24/7.

If at an extreme you see 200 patients from 8am-5pm and 20 patients from 5pm-8am, the physical space needed to see that many is signficant and things sit idle and empty at night. Its highly inefficient. I am always all for more money.. thats a different question i guess. sure pay more.. i dig it.. but the other stuff you mentioned i cant get behind. the dumber the complaint the less my risk, the simpler the workup usually and my hospital doesnt care about patient sat so when they want an MRI for 4 months of knee pain i just say no..
 
Issue is the hospitals like factories are better served to have steady volume 24/7.

If at an extreme you see 200 patients from 8am-5pm and 20 patients from 5pm-8am, the physical space needed to see that many is signficant and things sit idle and empty at night. It’s highly inefficient. I am always all for more money.. thats a different question i guess. sure pay more.. i dig it.. but the other stuff you mentioned i cant get behind. the dumber the complaint the less my risk, the simpler the workup usually and my hospital doesnt care about patient sat so when they want an MRI for 4 months of knee pain i just say no..
Agree, hospitals want the machine to go burrrrrrr. That being said, every business does. It’s supply/demand. McDonalds and Taco Bell will stay open 24/7 if the employee cost is cheap enough and enough people have overnight munchies. You can’t get your oil changed at 2 am because responsibility occurs during the day. I’m just upset that we are burger flippers and not even mechanics.

Big city interstates are barely used. That is if you factor in long periods of overnight, non-rush hour traffic. You sit in rush hour though and you certainly wonder why there isn’t a third, fourth, fifth, sixth lane or whatever is one more than you have. Hospitals as businesses want to stay constantly utilized with no more resources than they absolutely need. They are high end hotels. That being said they also serve a public good.

Healthcare is in odd industry that must fit societal demand and is ultimately paid for by the people to an extent one way or another, but also deals with market forces and capitalism. And capitalism goes burrrrrrr.

OP, I’d strongly caution you against EM at the end of the day if the circadian dysfunction is already a struggle for you. There aren’t many opportunities in EM where you can have a regular schedule. Ultimately, you will care more about components like your schedule and work environment than how interesting the pathology is to you.
 
Agree, hospitals want the machine to go burrrrrrr. That being said, every business does. It’s supply/demand. McDonalds and Taco Bell will stay open 24/7 if the employee cost is cheap enough and enough people have overnight munchies. You can’t get your oil changed at 2 am because responsibility occurs during the day. I’m just upset that we are burger flippers and not even mechanics.

Big city interstates are barely used. That is if you factor in long periods of overnight, non-rush hour traffic. You sit in rush hour though and you certainly wonder why there isn’t a third, fourth, fifth, sixth lane or whatever is one more than you have. Hospitals as businesses want to stay constantly utilized with no more resources than they absolutely need. They are high end hotels. That being said they also serve a public good.

Healthcare is in odd industry that must fit societal demand and is ultimately paid for by the people to an extent one way or another, but also deals with market forces and capitalism. And capitalism goes burrrrrrr.

OP, I’d strongly caution you against EM at the end of the day if the circadian dysfunction is already a struggle for you. There aren’t many opportunities in EM where you can have a regular schedule. Ultimately, you will care more about components like your schedule and work environment than how interesting the pathology is to you.
Oil changes arent done at 2 in the morning not "because responsibility occurs during the day" but because society sleeps at that time and they dont want (key word) to change their oil at 2am. Why arent bars open at 9am (mostly) cause people dont want to drink alcohol that early. That being said when football season starts plenty of bars are open that early because people want to drink on those days. Its supply/demand nothing more/less.

To the OP.. Maximal flexibility comes from working the shifts no one else wants to work. Many groups (dare I say any group) would let you set your schedule if you worked nights only. Similarly If you opted to only work evenings or only weekends you may get a lot of runway.

At a prior job there was a doc who worked 20 years working Sat,Sun,Monday night every week other than when the doc went on vacation. That doc had a set schedule. If the goal is M-F banker hours there is a 0% chance you will get that at even the most desperate craphole ED.
 
I don’t know one practicing physician that has ever said, “I love navigating difficult patient interactions”. With that said, EM has been very good to me and my family. Scheduling has downsides and upsides. I could never go back to working set hours. You’ll get a lot of negative viewpoints around here. I’d wager many went into the wrong specialty. I’d also wager that some would complain no matter what specialty they went into. You’ll find that some of the biggest gripes you see for EM are, at its core, present in a lot of other industries. One day EM may not be worth it but nobody knows when that happens. I could make the argument that flooding the market with poorly trained grads only makes my job more secure. Specialties seem to be somewhat cyclical and it’s a fool’s errand trying to predict it.
 
Most of what the OP currently loves about EM are things that you will come to hate about EM.
There's a theory I first heard on Esther Perel's podcast that the things that attract you to your partner are the things that you end up resenting. Loving someone's free spirit turning into frustration over irresponsibility, feelings of security becoming resentment over intrusiveness, etc. I'm not convinced this is bang on for relationships between people but it's pretty damn accurate for EM.
 
There's a theory I first heard on Esther Perel's podcast that the things that attract you to your partner are the things that you end up resenting. Loving someone's free spirit turning into frustration over irresponsibility, feelings of security becoming resentment over intrusiveness, etc. I'm not convinced this is bang on for relationships between people but it's pretty damn accurate for EM.
True. I can’t stand how hot my wife is.
 
I don’t know one practicing physician that has ever said, “I love navigating difficult patient interactions”. With that said, EM has been very good to me and my family. Scheduling has downsides and upsides. I could never go back to working set hours. You’ll get a lot of negative viewpoints around here. I’d wager many went into the wrong specialty. I’d also wager that some would complain no matter what specialty they went into. You’ll find that some of the biggest gripes you see for EM are, at its core, present in a lot of other industries. One day EM may not be worth it but nobody knows when that happens. I could make the argument that flooding the market with poorly trained grads only makes my job more secure. Specialties seem to be somewhat cyclical and it’s a fool’s errand trying to predict it.

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.
 
Yeah i wasn't gonna say anything but since you did I'll disagree too.

I too was scared to go back to regular hours...but in years of busy EM I forgot that 99.9% of jobs on earth aren't that busy. I'm definitely gonna get a good two hour nap in today. Few meetings here and there and a couple p2ps

My weight has dropped 20 lbs without even trying since leaving EM. Infinite benefits to regular day schedules.
 
Yeah i wasn't gonna say anything but since you did I'll disagree too.

I too was scared to go back to regular hours...but in years of busy EM I forgot that 99.9% of jobs on earth aren't that busy. I'm definitely gonna get a good two hour nap in today. Few meetings here and there and a couple p2ps

My weight has dropped 20 lbs without even trying since leaving EM. Infinite benefits to regular day schedules.

What was the birdstrike EM hourly formula? 1 hour practicing as EM is 2x any other specialty (with the exception of radiology where every working hour is like taking a step exam)?
 
Yeah i wasn't gonna say anything but since you did I'll disagree too.

I too was scared to go back to regular hours...but in years of busy EM I forgot that 99.9% of jobs on earth aren't that busy. I'm definitely gonna get a good two hour nap in today. Few meetings here and there and a couple p2ps

My weight has dropped 20 lbs without even trying since leaving EM. Infinite benefits to regular day schedules.
I’m the opposite. I’ve never been in better shape. Everyone is different but I’m happy for those that prefer a set schedule and get it.
 
What was the birdstrike EM hourly formula? 1 hour practicing as EM is 2x any other specialty (with the exception of radiology where every working hour is like taking a step exam)?

I'm pretty sure the multiplier is 1.5, but I can be wrong .
 
I've been a Nocturnist for 4 years now.
I'm going to attempt a strange experiment either in December or January...I'm going to ask for a one-month "break" from being a Nocturnist. This means I'll be just like any other doc and give up the perk of "pick your nights".

I'll let you guys know how I feel about it.
 
I've been a Nocturnist for 4 years now.
I'm going to attempt a strange experiment either in December or January...I'm going to ask for a one-month "break" from being a Nocturnist. This means I'll be just like any other doc and give up the perk of "pick your nights".

I'll let you guys know how I feel about it.
If you were a cop, I'd worry about you eating your gun.
 
I've been a Nocturnist for 4 years now.
I'm going to attempt a strange experiment either in December or January...I'm going to ask for a one-month "break" from being a Nocturnist. This means I'll be just like any other doc and give up the perk of "pick your nights".

I'll let you guys know how I feel about it.

good luck doc!!
 
I've been a Nocturnist for 4 years now.
I'm going to attempt a strange experiment either in December or January...I'm going to ask for a one-month "break" from being a Nocturnist. This means I'll be just like any other doc and give up the perk of "pick your nights".

I'll let you guys know how I feel about it.

I needed at least 3 months of a regular schedule to fully shake the fog of nocturnist life, and before things returned to a near-normal
 
Top