Evening Surgery

[FulfilledDeer]

Advertisement - Members don't see this ad

So I have a question. I'm really not a morning person. Like...really. I can do it (worked as a teacher), but despite a lot of attempts to change myself, I've been unable to. So let's say I go into surgery and nothing changes (because if it does, no problem). Is there any way as an attending to work full time but start later?

I mean like, substantially later. Outside of trauma, can you do mostly afternoon/evening work? Overnight? Could you mainly just take call for a group? Again, I still mean working full time, I just don't have any ideas about if there are specific limitations.

 

[mbe36]

You could be a SICU attending covering overnight. Residency would be a toughy. Nobody likes the guy who can't get it together in the morning.

 

[cpants]

I would think you could easily find a job taking overnight call full time. Might even pay pretty decent too. Problem is that most people want to do elective surgery not just emergency appie, choles, and ex laps.

 

[DrBodacious]

The problem is that the OR personnel are all staffed to come in early. This includes preop nurses, or nurses & techs, anesthesia, instrument processing personnel, post op nurses etc. Cases that go after hours are limited to emergencies. You will become a morning person.

Sent from my HTC One X+ using SDN Mobile

 

[Dwindlin]

People can swat this down if it's grossly incorrect, but I think it matters also how valuable you are. There is a very busy neuro-spine attending here who hates mornings and doesn't start his cases until 5-6pm, and then operates through-out the night. Because it's my understanding he brings in a significant amount of billing for the hospital, they accommodate him.

 

[45408]

Pretty unlikely and impractical. If you ran into complications or an emergency, it would be with a skeleton crew. Your partners would all be asleep. My hospital is only staffed for emergencies at night.

 

[FulfilledDeer]

Yes, I was definitely talking about after residency. I mean, I can get up early and function, but I swear I've tried everything and my sleep schedule immediately goes back to not mornings when it can. Just musing in case things don't change.


So it looks like, unless I have major sway, not happening electively. Let's say I want to sub-specialize into something like vascular. Would full time taking call be reasonable? Also, cpants, why do people want to do elective? I mean, I can think of reasons, but what were you thinking?

 

[Winged Scapula]

So it looks like, unless I have major sway, not happening electively. Let's say I want to sub-specialize into something like vascular. Would full time taking call be reasonable?

When are you planning on seeing patients in the office? You aren't going to find too many patients and office staff who would want to come in after hours.

Also, cpants, why do people want to do elective? I mean, I can think of reasons, but what were you thinking?

Most people want some control over their schedule. Elective surgeries are much more conducive to having a regular schedule. As noted above, most ORs will not allow surgeons to do non-emergent cases after hours. IMHO the night OR staff also tends to be less motivated and less skilled than the day crews. YMMV.

 

[SLUser11]

So I have a question. I'm really not a morning person. Like...really. I can do it (worked as a teacher), but despite a lot of attempts to change myself, I've been unable to. So let's say I go into surgery and nothing changes (because if it does, no problem). Is there any way as an attending to work full time but start later?

I mean like, substantially later. Outside of trauma, can you do mostly afternoon/evening work? Overnight? Could you mainly just take call for a group? Again, I still mean working full time, I just don't have any ideas about if there are specific limitations.

Yes, you can find jobs working exclusively at night. However, you are unlikely to find a lucrative and satisfying career working only at night. The only thing you can do at night is cover emergencies and be a shift worker. All elective surgery (and clinic, etc) happens during the day, and you won't be able to change that substantially.

Truthfully, I think it's probably time to just grow up. There are plenty of doctors who aren't "morning people," but are able to make it work. The vast majority of the time, it is lifestyle-related. I sincerely doubt you have some biologic abnormality that is impossible to fix.

Please list out the things that you've tried already, and we can give amateur opinions on whether or not you've truly "tried everything." If that fails you, it's time to see a sleep medicine specialist.

 

[DrBodacious]

I would advise you not to perseverate on this. If you can handle gen surg residency, then you can figure out what job is right for you 5 + years from now. I'm not a morning person either, but sleeping in every day isn't very rewarding. You will get out of bed if you have to, and if you like surgery, that is the most important factor. Obviously surgery is more labor intensive than medicine...

Sent from my HTC One X+ using SDN Mobile

 

[FulfilledDeer]

Whoa, whoa, whoa.


Whoa.


"Time to grow up?" Feeling a bit judgmental are we? And...assumption-y. I have seen a sleep medicine specialist. He said I have mild delayed sleep phase disorder, but neither he nor I felt the need to bother with the full workup since it's impact on my life is generally manageable and he suggested it could resolve itself. Also, not a lot you can do. I generally don't like mentioning it because for some people it's a full on disability, but for me it's much better. But you're right, maybe if I just try putting on my big boy pants....


It basically sounds like no, but I was just trying to figure out if there's a way to make life a little less painful. My question has no bearing on what field I plan on going into or anything like that, since I have come to accept that the world operates (heh, I didn't mean surgically but I'll leave it) during the day, and I can make that happen. I know that in some specialties there are possibilities, but I don't have enough exposure to the practice side of surgery to tell.

 

[Apollyon]

When I was in South Carolina, there was a guy that only took overnight and weekend call, in exchange for no office hours during the week. With 2 community hospitals seeing 40K/year each, he was not overwhelmed, but kept working. His partners were more than happy to do this.

 

[maxheadroom]

If you like surgery and want to be a surgeon, you'll find a way to practice in a way that works. And a surgical residency has a surprising way of turning night-owls into morning people. Well, that and coffee.

Honestly, there aren't many jobs in medicine where you can be a permanent 2nd/3rd shift worker besides EM. Gas and Rads both have people who work late -- most groups would probably welcome someone who offered to be the late guy.

 

[Boogie Man]

Not sure where you are in your education, but have you considered other medical careers that are mainly shiftwork? Nursing, respiratory, etc... make a decent living and a little more control over your schedule if you're looking to completely avoid mornings.

Just a question.

 

[SLUser11]

Whoa, whoa, whoa.


Whoa.

.....I have seen a sleep medicine specialist. He said I have mild delayed sleep phase disorder, but neither he nor I felt the need to bother with the full workup since it's impact on my life is generally manageable and he suggested it could resolve itself.

Keyword is mild. I agree with your doctor's conclusion: it can resolve itself.

Before you apply for disability, I think it's worth giving it a little time. Also, did you undergo any tests, or did the sleep specialist give you the diagnosis after a single office visit? I'm not teasing you anymore, but instead I'm genuinely curious. I want to make sure it's not the fibromyalgia of sleep medicine.

 

[maxheadroom]

want to make sure it's not the fibromyalgia of sleep medicine.

If you show up in my clinic with that word (we do not speak it) on your chart, I will smile and nod for five minutes and then send you to a pain specialist.

 

[FulfilledDeer]

Boogie Man: I'm actually in med school. But I definitely appreciate the thought.

SLUser11: Couple of office visits with a sleep diary (and other interventions tried and failed) but no polysomnography. I definitely didn't get the impression that this diagnosis is the fibromyalgia of sleep medicine (but you know, I could be wrong). It seemed really legitimate. The thing about my case being mild is that the delay is pretty significant, but I adapt easily, so the effect is not as large as you would assume. The main problem I have is that even if I'm exhausted for several days, come 8-ish I just become pretty awake until 3. Which just exacerbates everything.

And to be clear, I'm not suggesting I have a disability or that I would ever want (or deserve) special treatment, I was just curious what kind of flexibility exists.



Side Note: I can't stay signed into SDN...is anyone else having this issue? It's becoming really, really annoying.

 

[45408]

I don't have a sleep disorder (that I know of), and I considered myself a night owl for a while, but three years of surgery residency has done a number on my desire to stay up late. I can still sleep in something fierce, but that has to do with sleep deprivation and small children.

 

[SLUser11]

I don't have a sleep disorder (that I know of), and I considered myself a night owl for a while, but three years of surgery residency has done a number on my desire to stay up late. I can still sleep in something fierce, but that has to do with sleep deprivation and small children.

For years, I had a hard time falling asleep, and I would routinely toss and turn for hours, stay up until 3-4am, etc. The best cure for me was improved sleep hygiene, which is extremely important, and a heavy dose of exhaustion.

Surgical residency is a wonderful cure for these sorts of things. You fall asleep a lot easier when you are in chronic sleep debt.

 

[LucidSplash]

For years, I had a hard time falling asleep, and I would routinely toss and turn for hours, stay up until 3-4am, etc. The best cure for me was improved sleep hygiene, which is extremely important, and a heavy dose of exhaustion.

Surgical residency is a wonderful cure for these sorts of things. You fall asleep a lot easier when you are in chronic sleep debt.

Agreed. Prior to residency, I could fall asleep in minutes, provided I had a horizontal surface and a dark room. I could never sleep on planes or anywhere but lying down. I once flew to Malawi (approximately 24-30 hour flight) and slept perhaps 2 hours the entire time - and the 2 hours was after an Ambien.

Fast forward to surgery residency and just the other day one of the TICU nurses complimented my ability to fall asleep in a chair in the middle of the unit. On planes, I am asleep within moments of fastening my seatbelt and typically wake up when the wheels touch ground.

 

[droliver]

The problem with your preference for evening starts is related to staffing issues. It's difficult to find evening OR staff and maintain the schedule busy enough to make it financially sustainable for the institution. It's the same reason why many hospitals do not do elective cases on Saturday or Sunday. Scheduling becomes difficult, and you end up getting buried with overtime.

 

[Textbookversion]

Why not just do IM or EM if your sleep schedule is so important? Very easy to find a job that will let you do all nights or swing shift in those fields. Like very very easy and they'll even pay you more for it most of the time.

 

[FulfilledDeer]

Why not just do IM or EM if your sleep schedule is so important? Very easy to find a job that will let you do all nights or swing shift in those fields. Like very very easy and they'll even pay you more for it most of the time.

Yeah, I've considered those. Again, the sleeping thing is not a make or break thing, I was just trying to get a sense of the....lay of the land. No specialty is without its problems.

 

[thedrjojo]

depends on how late as well you want to start. The colorectal guys at my joint usually don't show up until at least 10-11am, and most of the time their scheduled major cases are for like between noon and 2pm...

 

[Buzz Me]

Boogie Man: I'm actually in med school. But I definitely appreciate the thought.

It's still very early in your training. You're finishing up your M1 year, right?

When you start rotating through the busier clinical rotations (especially Gen Surg), you may surprise yourself that you're ACTUALLY a morning person (or can become one). It also helps if you find something you're really interested and passionate about.

I always considered myself a night owl...still do, to some degree, but have gradually adapted to being able to wake up very early, day after day, due to residency and fellowship. But that's only because I really enjoy what I do.

 

[SLUser11]

depends on how late as well you want to start. The colorectal guys at my joint usually don't show up until at least 10-11am, and most of the time their scheduled major cases are for like between noon and 2pm...

Well, are you sure their day starts at 10am, or are they just somewhere else doing work?

For colorectal surgery, clinic is a large part of your practice, so some surgeons have to do clinic in the morning and surgery in the afternoon. Other people do scopes in the morning, or outpatient anorectal surgeries in the morning. You can't really schedule a big case first, then small cases afterward, because if the big case goes long it screws a lot of people over.

 

[FulfilledDeer]

It's still very early in your training. You're finishing up your M1 year, right?

When you start rotating through the busier clinical rotations (especially Gen Surg), you may surprise yourself that you're ACTUALLY a morning person (or can become one). It also helps if you find something you're really interested and passionate about.

I always considered myself a night owl...still do, to some degree, but have gradually adapted to being able to wake up very early, day after day, due to residency and fellowship. But that's only because I really enjoy what I do.

You know....I totally agree. Not about the becoming a morning person thing necessarily, but about enjoying what you do.

Thanks, I needed that.

 

[45408]

Well, are you sure their day starts at 10am, or are they just somewhere else doing work?

For colorectal surgery, clinic is a large part of your practice, so some surgeons have to do clinic in the morning and surgery in the afternoon. Other people do scopes in the morning, or outpatient anorectal surgeries in the morning. You can't really schedule a big case first, then small cases afterward, because if the big case goes long it screws a lot of people over.

Which sucks, because I'm much much much more in the mood to tackle some big whack at 8am than 4pm.

 

[Buzz Me]

Which sucks, because I'm much much much more in the mood to tackle some big whack at 8am than 4pm.

Yeah, but nothing is worse than finishing a big case at 4 pm knowing you have a bunch of little cases left. With the post-3 pm turnover times (that go from 20 min --> 30 min --> 45 min --> 1 hr), that day is seems endless.

But starting a big case at 2 pm knowing once you're done your day is over? Sweet.

 

[likes pizza]

you'll never get through 5 years of residency if you like to sleep in. all the other points are totally irrelevant

 

[dpmd]

you'll never get through 5 years of residency if you like to sleep in. all the other points are totally irrelevant

That is a bunch of crap. Liking to sleep in is not the same thing as being unable to get up and do your work. You can get used to whatever crazy schedules get thrown at you during residency, then look for a job that will work better for your particular preferences. You may not find your dream job, but there are a lot of different options out there with schedules that are nothing like residency.

 

[dpmd]

Yeah, but nothing is worse than finishing a big case at 4 pm knowing you have a bunch of little cases left. With the post-3 pm turnover times (that go from 20 min --> 30 min --> 45 min --> 1 hr), that day is seems endless.

But starting a big case at 2 pm knowing once you're done your day is over? Sweet.

Even more sweet is starting a small case at 2 (or even earlier) and knowing that after you are done your day is over, or having your big case as the only case of the day (preferably on the day the OR starts an hour later due to their staff meeting).

 

[LucidSplash]

That is a bunch of crap. Liking to sleep in is not the same thing as being unable to get up and do your work. You can get used to whatever crazy schedules get thrown at you during residency, then look for a job that will work better for your particular preferences. You may not find your dream job, but there are a lot of different options out there with schedules that are nothing like residency.

Agreed. I "like" to sleep in and did so both days this weekend (of course now that means like 9am nowadays). But that doesn't mean I'm not able to get up before 5 during the week.

 

[45408]

Agreed. I "like" to sleep in and did so both days this weekend (of course now that means like 9am nowadays). But that doesn't mean I'm not able to get up before 5 during the week.

Love sleeping in. It's one of life's great pleasures. Waking up early isn't really that hard any more either though.

 

[dpmd]

I love sleep in general. I didn't always get it at the time I wanted it, but I would say I probably still averaged about 8 hrs of sleep a night (which means, yes, I often slept for 16 hrs or more post call). I often chose sleep over studying and hanging out with my husband during residency (probably the only thing I didn't sacrifice for sleep was eating, but that was mostly because being hungry would make it harder to sleep).

 

[FulfilledDeer]

I love sleep in general. I didn't always get it at the time I wanted it, but I would say I probably still averaged about 8 hrs of sleep a night (which means, yes, I often slept for 16 hrs or more post call). I often chose sleep over studying and hanging out with my husband during residency (probably the only thing I didn't sacrifice for sleep was eating, but that was mostly because being hungry would make it harder to sleep).

In a bizarre coincidence, I awoke yesterday after 4 hours of sleep solely due to hunger. Went right back to bed after I ate. But those 10 minutes...those were wonderful. Fulfilling one need, knowing another will be met soon....beautiful.

 

[Buzz Me]

I find I can't really sleep in these days...7:30 am is about the latest it gets.