Hours in Emergency Medicine Residency vs Attending

Started by doc2be245
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doc2be245

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Hey All.

I know that an Emergency Medicine Resident will definitely be working close to 80 hours a week, but is it true that as an Attending you will have more flexible hours and be able to work less night shifts?

I'm attracted to the field and wouldn't mind doing night shifts during residency, but I would like to work during the days after residency is over.

Any input from current physicians would be very helpful.

Thanks.
 
doc2be245 said:
Hey All.

I know that an Emergency Medicine Resident will definitely be working close to 80 hours a week, but is it true that as an Attending you will have more flexible hours and be able to work less night shifts?

I'm attracted to the field and wouldn't mind doing night shifts during residency, but I would like to work during the days after residency is over.

Any input from current physicians would be very helpful.

Thanks.
Click to expand...

If you want to work just days, pick another specialty. End of story.
 
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EM residents do not work 80 hours per week. They work fewer hours per week than many other specialties, but these are much more intensive and draining hours--and far more irregular hours--than other specialties. Most of your shifts will be the dreaded evening shifts, with a door-to-door time of 3 pm - 2 am. The reason most of your shifts will be this one is because this is one coverage is needed the most, due to patient volumes.

As for night shifts after residency, it is certainly possible to find a job here or there where you can avoid it, but this would restrict your job options by 98%. Therefore, I agree with whoever said that you should consider another job if you are already concerned about this. The hours of EM are very, very irregular. Nights, weekends, and holidays.

Good luck!
 
doc2be245 said:
Hey All.

I know that an Emergency Medicine Resident will definitely be working close to 80 hours a week, but is it true that as an Attending you will have more flexible hours and be able to work less night shifts?

I'm attracted to the field and wouldn't mind doing night shifts during residency, but I would like to work during the days after residency is over.

Any input from current physicians would be very helpful.

Thanks.
Click to expand...
You won't be able to work all days... When you are in the Er you can only work 60 hours/week which doesn't include academic time and other admin bs. As an attending I'm working 140 to 160/ month. 2/3 of those are swings or nights.
 
Louisianahopefuldoc said:
I'm still in med school but I know for a fact none of the EM residents get anywhere near 80 hours a week where I'm at.
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We are limited to 60 hours a week while in the ED, that's a nationwide EM requirement.

While off service, we are subject to the rules for whatever service we are on. So if you are on a surgery rotation, you are subject to their duty hours. If you're unlucky enough to be in one of the pilot study sites for duty hour loosening, that means 100+ hours/week.

On ICU months, we still average 80+ hrs/week here.
 
The most clinical hours I ever worked was as an intern and then it was an average of 55 weekly. As a new attending 2 months out of residency I work abound 180 hours a month or 45 a week, more than most but completely of my own choosing. When I get tired I'll work less. If you're lucky enough to catch on with a group who has dedicated nocturnists then you may be able to avoid nights. Other than that, expect to work your fair share, especially as the new guy.
 
Right now I'm working 2-3 night shifts per month and 120/month overall two years out. This seems very sustainable
 
Angry Birds said:
Can you give details? I had never heard of this before... Sounds bad!
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The FIRST trial. http://www.thefirsttrial.org

Technically, still limited to 80 hrs/week with decreased time off and longer individual shifts. But, on trauma, we had a 24 day rotation, and the hours are averaged over 4 weeks. So we always worked q3 30 hour call, w 2 days off the whole rotation. But they assumed we would get days off on our surrounding blocks (before and after). Sometimes that happened, sometimes it didn't. The study sites weren't required to report the extra days of the month we weren't there, so it appeared like we got 6-7 days off a month.
 
My hours back in residency ranged from 160-220 monthly in the ED (decreased each year slightly), occasional 100+ hour weeks on different surgical or ICU rotations, and the occasional fluff rotation that was less than 40 hours a week, usually an elective or some other nonsense. As an attending I work between 90-120, average 108/mo, with another 40 hours of admin time monthly. Still work nights, ~4 a month.
 
goodoldalky said:
My hours back in residency ranged from 160-220 monthly in the ED (decreased each year slightly), occasional 100+ hour weeks on different surgical or ICU rotations, and the occasional fluff rotation that was less than 40 hours a week, usually an elective or some other nonsense. As an attending I work between 90-120, average 108/mo, with another 40 hours of admin time monthly. Still work nights, ~4 a month.
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That sounds reasonable to me. 4 nights a month is very doable. I just don't want to be stuck doing 3 overnights a week.
 
Figure about 1/3 of your shifts are nights and 1/3 are afternoons. This includes weekends (1/2 of your weekends and holidays will have shifts). If you want these off you will have to pay significantly. If you don't mind that lifestyle, fantastic. If that's not your cup of tea, you have been warned.


Sent from my iPhone using Tapatalk
 
56-63 hrs per month in the ED, another 52 hours of paid admin each month.

I also have some income from other sources and side projects I use to defray not working my clinical target of ~125 per month (if I don't get there, I just get a pro-rated reduction in my monthly salary).

This sort of arrangement is by far the rarity in EM.
 
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I'm a first year attending. We averaged 55 hours/week in residency while in the ED. If we were on service (peds, ob, ICU, etc) it was 70-80 hours/week + conferences, journal club, etc.

I'm now in the 140-160 hours/mo club which is 16 or so shifts/mo.
 
Dr. Bruce Banner said:
So... although I love EM... I can't handle working on nights... so no EM for me?
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As has been alluded to above, yeah, you can work no nights as an attending. It's just going to close doors to about 98% of the jobs out there. I work in a major metro area and I can't think of a single group that would be willing to hire someone who refused to work nights, even if they offered to take a pay cut.
 
doc2be245 said:
Hey All.

I know that an Emergency Medicine Resident will definitely be working close to 80 hours a week, but is it true that as an Attending you will have more flexible hours and be able to work less night shifts?

I'm attracted to the field and wouldn't mind doing night shifts during residency, but I would like to work during the days after residency is over.

Any input from current physicians would be very helpful.

Thanks.
Click to expand...

Like most of life, it depends.

As an intern in the ED. I worked 22 9s a month plus 4-5 mornings of didactics. As a junior 21 shifts and a senior 20. Outside the ED it was usually very close 80 hours/week.

In the military, I often worked 15 12s a month plus several more days of "stuff."

Currently I work 12 8s plus one morning a month of meetings. By summer, I'll be working 8 8s. That's considered 3/4 time and 1/2 time respectively.

You can do the math.

As far as nights, that's trickier. It is possible. I worked a mix of days and nights for my first ten years out of residency. I no longer work nights, but it was an expensive decision.
 
I work 120-190 hours/month. Way more than most of my group, but trying to get out of debt so willing to put in the time.
 
No way to do EM other than locums or per diem and not do nights. I do per diem and work weekend swing shifts mostly and am finishing a fellowship. EM is an awesome field minus the constant circadian rhythm disruptions. Honestly when I work most of the time I don't even feel like its work. That being said when I was working like a resident I def did and was pretty burnt out.
 
doc2be245 said:
Hey All.

I know that an Emergency Medicine Resident will definitely be working close to 80 hours a week, but is it true that as an Attending you will have more flexible hours and be able to work less night shifts?

I'm attracted to the field and wouldn't mind doing night shifts during residency, but I would like to work during the days after residency is over.

Any input from current physicians would be very helpful.

Thanks.
Click to expand...


find another specialty, unless you just work at an urgent care you can't avoid nights as an ED attending.
 
swamprat said:
No way to do EM other than locums or per diem and not do nights. I do per diem and work weekend swing shifts mostly and am finishing a fellowship. EM is an awesome field minus the constant circadian rhythm disruptions. Honestly when I work most of the time I don't even feel like its work. That being said when I was working like a resident I def did and was pretty burnt out.
Click to expand...


In general yes you must do nights.

There are many hospitals or groups however that have dedicated night docs, in those cases, you many not have any or very few nights
 
DSM_302.0 said:
Controlling for experience, etc, do the nocturnists get paid more than those who refuse to work overnight?
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Yes, almost every nocturnist gets a night differential of $20-40 more per hour. In some groups you can also negotiate a higher salary to just do nights
 
The White Coat Investor said:
Nope. Many small democratic groups or even CMG associated groups have dedicated nocturnists, allowing the other members of the group to work days/evenings only.
Click to expand...
29% of our group shifts are nights though, we'd need about a third of us (assuming 12 nights/month which is the max I'd be willing to do as a nocturnist) doing nights to cover this. Luckily, we have rural sites included with some slow nights. Overall I think it's a good mix as the slower shifts outside our mother ship are good for the soul, as in the soul doesn't get crushed by acuity and volume all day every day.
 
DSM_302.0 said:
Controlling for experience, etc, do the nocturnists get paid more than those who refuse to work overnight?
Click to expand...

Yes. They even can get paid more than those who don’t refuse to work nights but who just aren’t nocturnists.

Also I don’t think you get paid differently in our field based on experience. Maybe some new grads get shafted based on lack of knowing any better, but yeah, don’t think experience matters. There are however partner tracks which require a certain number of years (usually around two) at the same place in order to make partner.
 
TooMuchResearch said:
29% of our group shifts are nights though, we'd need about a third of us (assuming 12 nights/month which is the max I'd be willing to do as a nocturnist) doing nights to cover this. Luckily, we have rural sites included with some slow nights. Overall I think it's a good mix as the slower shifts outside our mother ship are good for the soul, as in the soul doesn't get crushed by acuity and volume all day every day.
Click to expand...

How much of your income are you willing to give up to not work nights? If that answer is 1/3, you can find emergency docs willing to work those nights for you. If that answer is less than 1/3, plan to work nights.
 
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fahimaz7 said:
I'm a first year attending. We averaged 55 hours/week in residency while in the ED. If we were on service (peds, ob, ICU, etc) it was 70-80 hours/week + conferences, journal club, etc.

I'm now in the 140-160 hours/mo club which is 16 or so shifts/mo.
Click to expand...

Nights vs days? What part of the country? Admin/teaching time?
 
The White Coat Investor said:
How much of your income are you willing to give up to not work nights? If that answer is 1/3, you can find emergency docs willing to work those nights for you. If that answer is less than 1/3, plan to work nights.
Click to expand...

In my shop, in a tough, tough market, it's some nights until you are 60, end of story.
 
slurpy15 said:
In my shop, in a tough, tough market, it's some nights until you are 60, end of story.
Click to expand...

I am in a touch market too and I didn't do a night for 15 yrs. Swing shifts til 2-3 am, but never a true overnight. But those wingman shifts were just as bad as overnight.
 
slurpy15 said:
In my shop, in a tough, tough market, it's some nights until you are 60, end of story.
Click to expand...
Really? Surely there is some version of your future in which someone or a couple people might want to do straight nights... just because it isn't now doesn't mean it won't be. Our group only has one nocturnist right now and a couple people that prefer them but don't do them exclusively.
 
TooMuchResearch said:
Really? Surely there is some version of your future in which someone or a couple people might want to do straight nights... just because it isn't now doesn't mean it won't be. Our group only has one nocturnist right now and a couple people that prefer them but don't do them exclusively.
Click to expand...

Exactly. Talk to the other docs and I bet it could be worked out.
 
The White Coat Investor said:
Exactly. Talk to the other docs and I bet it could be worked out.
Click to expand...
Our only scheduling rule is the other docs have to approve it, so it just really needs to benefit everyone somehow. Our night doc covers the group's least favorite night shift every week unless on vacation. We have one that only works weekends. You know, stuff we'd prefer not to do anyway but works better for their schedule. There is no financial incentive as a non-partner to take on just nights or weekends so I haven't looked into it much, yet.
 
chillaxbro said:
How many shifts per week or month is normal for an attending?
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It varies. First off, you should know that different ER's have different shift lengths, and this determines how many shifts per week (or month). Generally, shifts are either 8, 9, 10, or 12 hours long. You can even find some rural hospitals that have 24 hour shifts, but this is rare. In general, the busier the hospital, the shorter the shift (i.e. on the 8 hour side).

Generally, ER doctor's work in the range of 120-160 hours/month.
So, if you're working 8 hour shifts, then it's 15 shifts/month on the lower end, and 20 shifts/mo on the higher end (which is suicide in my opinion).
On the other hand, if you are working 12 hour shifts, then it's 10 shifts/month on the lower end, and 14 shifts/month on the higher end.
You can even work five or six 24-hour shifts per month, and have the rest of the month off.

In reality, you can work as much or as little as you want: most of us get paid per hour of work. So, figure out how much you want your yearly salary to be, then divide by your hourly rate. That's how many hours you need to do in the year to reach your goal salary. Just divide that by 12, and that's how many hours you need to work per month. It's quite simple.

Note: To be on staff you usually have a minimum number of shifts required per month. You can, however, avoid this by being per-diem, IC, locums, etc etc, all of which would allow you to work even fewer shifts if you wanted to. However, generally it's tough to keep a gig unless you commit to a certain number of shifts per month.

Also, keep in mind that on their "off" days, many ER doctors pick up extra shifts at other hospitals, work in urgent cares, or do other stuff.

There is tons of flexibility in EM, which is quite nice.
 
Last edited:
The White Coat Investor said:
How much of your income are you willing to give up to not work nights? If that answer is 1/3, you can find emergency docs willing to work those nights for you. If that answer is less than 1/3, plan to work nights.
Click to expand...

2/3 of the average EM salary of 350K (according to Medscape which I know is not necessarily accurate but let's use it to compare apples) is 233K, AKA essentially the same as the average Peds (212)/FM (219)/ IM (230), and that's with working lots of evenings. Granted you would work less hours overall maybe, but quite a few FM docs work 4.5 days 8-5 (or even 5 days 8-5) which is vastly superior hours wise to 12/12s or 15-20 8s mostly afternoon/evening shifts.

So if we med students love EM for it's own sake we should go into it. But if one were tempted by the money/appearance of low hours and also refused to do nights you would be in essentially the same boat as FM/IM to get out of nights. In fact you would be working 15-20 8s with 2/3s of your shifts in the afternoon/evening as compared with 20 8s from 8-5 (or really 18 8s if you only work 4.5 days a week) in FM.

I'm sure many EM docs would hate working outpatient primary care, but I'm just working out in writing that if you refuse to do nights the pay is nearly the same but the hours are better in FM time-of-day wise (with added time for call or paperwork if you have call or aren't getting your charting done in the office of course).

From what I've seen so far (finishing 1st year of med school) I love EM, and I worked nights through college and actually like them, plus I would greatly prefer fewer longer shifts (12/12s) over more shorter shifts like 16-20 8s or the FM 8-5 schedule. I also like FM though and want to see if the logic holds that the extra 1/3 in pay that EM makes over FM goes away without working nights, and that students shouldn't be tempted into EM by the money if they then will just take a pay-cut back to primary care levels to get out of nights. Thanks!
 
ShenandoahDoc said:
2/3 of the average EM salary of 350K (according to Medscape which I know is not necessarily accurate but let's use it to compare apples) is 233K, AKA essentially the same as the average Peds (212)/FM (219)/ IM (230), and that's with working lots of evenings. Granted you would work less hours overall maybe, but quite a few FM docs work 4.5 days 8-5 (or even 5 days 8-5) which is vastly superior hours wise to 12/12s or 15-20 8s mostly afternoon/evening shifts.

So if we med students love EM for it's own sake we should go into it. But if one were tempted by the money/appearance of low hours and also refused to do nights you would be in essentially the same boat as FM/IM to get out of nights. In fact you would be working 15-20 8s with 2/3s of your shifts in the afternoon/evening as compared with 20 8s from 8-5 (or really 18 8s if you only work 4.5 days a week) in FM.

I'm sure many EM docs would hate working outpatient primary care, but I'm just working out in writing that if you refuse to do nights the pay is nearly the same but the hours are better in FM time-of-day wise (with added time for call or paperwork if you have call or aren't getting your charting done in the office of course).

From what I've seen so far (finishing 1st year of med school) I love EM, and I worked nights through college and actually like them, plus I would greatly prefer fewer longer shifts (12/12s) over more shorter shifts like 16-20 8s or the FM 8-5 schedule. I also like FM though and want to see if the logic holds that the extra 1/3 in pay that EM makes over FM goes away without working nights, and that students shouldn't be tempted into EM by the money if they then will just take a pay-cut back to primary care levels to get out of nights. Thanks!
Click to expand...
The only problem is you are assuming EM doctors work a lot more than they do. Most jobs are 120 hours per month full time (depending on where you are of course) up to 144. Working 160 hours a month as an EM physician is on the extreme high end, in no way normal, so pretty much no one is working 20 8's on average.

Working 9 hours a day 4.5 days a week works out to over 160 hours per month, so the low end of family medicine is significantly more hours than the high average for EM. So you might be making about the same on paper as a FM physician, but per hours worked, EM still earns you significantly more, even if you take a 1/3 pay cut for working no nights.

Now that isn't to say that going into EM expecting to work 0 nights is a realistic option, simply that the comparison you note above doesn't tell the whole picture.
 
theseeker4 said:
The only problem is you are assuming EM doctors work a lot more than they do. Most jobs are 120 hours per month full time (depending on where you are of course) up to 144. Working 160 hours a month as an EM physician is on the extreme high end, in no way normal, so pretty much no one is working 20 8's on average.

Working 9 hours a day 4.5 days a week works out to over 160 hours per month, so the low end of family medicine is significantly more hours than the high average for EM. So you might be making about the same on paper as a FM physician, but per hours worked, EM still earns you significantly more, even if you take a 1/3 pay cut for working no nights.

Now that isn't to say that going into EM expecting to work 0 nights is a realistic option, simply that the comparison you note above doesn't tell the whole picture.
Click to expand...


Sorry, I was just using the number Angry Birds said above of 15-20 8 hour shifts. you're right the hourly is better in EM, plus there's the additional benefit of doing fewer, longer shifts if you like doing 10/12 hour shifts in EM. My mental calculation out loud was just making the point that minus a significant differential for nights the hourly isn't that different, at least not if you could psychologically adjust it for working 9-5 vs mostly afternoon/evening.

FM: 219,000. Hours: 4.5*9 (9 vs 8 assuming they work through lunch, which they'd have to if they're done with paperwork and leaving at 5). *50 (let's say 2 weeks of vacation).
Hours: 4.5*9*50 = 2025. 219,000/2025= $108/hour

Theoretical EM doc who decides he can't stand nights and pays a 1/3 differential: 350K * 2/3 = 233,000/ (120*12) = $162/hour

$162 is much better than $108, but even hypothetically without nights this still has the majority of your shifts as afternoon/evening shifts including up until 2 or 3 AM, and many weekends and holidays. At one of my old jobs as a lifeguard I used to make double time on minor holidays and triple time on major holidays. A 9PM-6AM overnight job I worked in college made 1.5* the day rate of the same job. EM makes much better money hourly, and it's really 350K/ (120*12) = $243/hour. My point in doing this exercise is that if you decided you wouldn't work the nights and only work the other odd hours of EM (which I know couldn't or wouldn't often happen) the pay is a difference of $108 for 8-5 vs $162 for a majority of late shifts. Personally I like overnight and longer shifts and more intensity for less shifts vs a slower pace with more shifts. However having a spouse who works 8-5 I might be willing to take that paycut, (at least if I didn't mind/like odd shifts and nights).

All of this to convince me that if I choose EM it should be because I love it, not because of the money.
 
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