How many nights do you do?

[TrailRun]

Was wondering how many nights people do on average... I guess I would define night as a shift that crosses midnight; so obviously 10/11p to 7a, but also 5p-2a since that's enough to through off the circadian rhythms (for me, at least). Based on some responses in a recent thread, I'm wondering how rare it actually is to have a job with no nights.

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[PianoMedic]

Was wondering how many nights people do on average... I guess I would define night as a shift that crosses midnight; so obviously 10/11p to 7a, but also 5p-2a since that's enough to through off the circadian rhythms (for me, at least). Based on some responses in a recent thread, I'm wondering how rare it actually is to have a job with no nights.

If you split the day into 12 hour shifts, that will on average give you half of needed shifts being nights. If you split it into 8 hour shifts, depending on start time, that could either be 1/3 or shifts or 2/3 of shifts ending after midnight. I think most shops have a mixture to get up to at least double coverage. I’d guess most docs average close to 40%, but that is obviously going to vary by site and how many nocturnists you have. I’m a nocturnist now, but was on the “standard” random schedule before that. Admin positions and core faculty (I’m neither) preferentially get more day shifts here. Looking at my schedule before I switched to nocturnist, I was doing close to 2/3 of my shifts crossing midnight (around 9 or 10 out of 14 or 15). Some ending at 0100, some at 0200 (we do 8s and 9s as well as 12s), but a lot of those 12s overnight. I also have trouble flipping around, so last summer I switched to nocturnist since the majority of my shifts were already nights essentially. That personally has been beneficial for me as I like having more of a set schedule, even if that schedule is somewhat crummy. I’m less moody, get more sleep, and see my kids more. But that is just my experience personally with my group and our scheduling.

 

[emperor tamarin]

At my shop there are 5/7 nights fully covered by nocturnists. Double cov at night, mostly triple during the day with a 4th swing a few days. So for the "general" pool, there are 28 shifts a week to cover, and 4 of those are night shifts.
So non nocturnists work 1/16 of their shifts at night, so 1ish a month.

We work 8s.

 

[watermanMD]

I’m learning my group is on the bigger side of average. We have some nocturnists—probably enough to cover ~40% of shifts. We staff multiple hospitals and work everywhere. Most I’ll do is 7 or 8 in a row. Averages out to a run of nights once every 2 months or so. I’d rather block them than have 2 or 3 nights a month.

 

[MechEDoc]

I work ~95% nights, usually 12 per month. It's rough, but it works with childcare / child custody.

 

[Mount Asclepius]

As the volume of the site goes up, physicians will transition from working a higher percentage of nights to swings.

Rural sites are typically 12 or 24 hour shifts at 50-100% night coverage.

Busy urban and suburban hospitals will usually see most of their volume around 10a-10p. Day and night shifts will have less coverage with most coverage placed during the busier swing hours afternoon and evening. Most EPs at these locations will usually have a mix of all 3 shift types with the majority being swing. Unless you have a higher percentage of EPs in the group that prefer swings and nights.

The only way to avoid nights is to find nocturnists to add to your group determining what amount of pay required to hire and retain them in nocturnist roles.

 

[TooMuchResearch]

We have two evening shifts that go past midnight. If you count those, which I don't, it's a lot. Otherwise it's probably 4-5 with reasonable error bars.

 

[AlmostAnMD]

Rofl

Poll is majority "nights only" so far, apparently nocturnists disproportionately come here.

I'm adding to that tally.

Being nights only and staying that way effectively cuts off all career growth. There is no meaningful position of leadership one can ever apply for and be on nights. It also sets you up to avoid leadership.

Which is good and bad, you won't be a leader but you won't see nurse admin/hospital admin either....

You just see patients until you no longer need the paycheck. Unless staffing levels improve and I begin to actually enjoy the job again loooooooooooooooooool

 

[Mount Asclepius]

Being nights only and staying that way effectively cuts off all career growth. There is no meaningful position of leadership one can ever apply for and be on nights. It also sets you up to avoid leadership.

Which is good and bad, you won't be a leader but you won't see nurse admin/hospital admin either....

All of our nocturnists are really strong physicians and it tends to be the pool our group’s leadership is drawn from.

Granted most transition to leadership and part time admin mid-end of career when they give up clinical time working fewer nights.

 

[bravotwozero]

Work minimum 5 12hr overnights a month. More if I pick up an extra shift, usually because I’m being offered a bonus.

 

[xaelia]

In our 300+ daily visit tertiary center, the last attending physician shift ends at midnight. A lot of NZ/AUS EDs don't have senior staff in the ED at night – call from home (once a month, for us).

Previously in the U.S., I've had 2-3 nights per month – UT-Houston had a couple nocturnists, Kaiser let you "sell" your night shifts within the group.

 

[MechEDoc]

In our 300+ daily visit tertiary center, the last attending physician shift ends at midnight. A lot of NZ/AUS EDs don't have senior staff in the ED at night – call from home (once a month, for us).

Previously in the U.S., I've had 2-3 nights per month – UT-Houston had a couple nocturnists, Kaiser let you "sell" your night shifts within the group.

how does the no attendings at night workout?

 

[turkeyjerky]

I strenuously object to the notion that any shift crossing midnight is a "night". Nope, nadda, get outta here.

There's an order of magnitude difference between swings and overnights in their effect on your circadian rhythm. It's like comparing a mild headache from an extra glass of wine the night before to a puking your guts out, can't get outta bed until 4 in the afternoon hangover.

 

[cyanide12345678]

6 ish 12 hour night shifts a month. Single coverage rural ER. So 50 percent 7 am to 7 pm and 50 percent 7 pm to 7 am.

Night shifts are significantly less volume and often can get a couple of hours of sleep. But some days there is a slow trickle of death where you clear the ER and discharge a person, immediately after the next person shows up. Yesterday only saw 10 but got 0 sleep. The day before saw 7 and got two 1.5 hour naps.

 

[AlmostAnMD]

Night shifts are significantly less volume and often can get a couple of hours of sleep.\

Maybe for you

At my tertiary care center we woefully understaff at night. I'll have one midlevel helping boluses of 6-8 pph, steady stream of 4 pph. Some respite as we board occasionally but not uncommon to see 40 patients in 8 hrs with one midlevel, moderate/high acuity

I've never slept there

or even tried

 

[BoardingDoc]

Maybe for you

At my tertiary care center we woefully understaff at night. I'll have one midlevel helping boluses of 6-8 pph, steady stream of 4 pph. Some respite as we board occasionally but not uncommon to see 40 patients in 8 hrs with one midlevel, moderate/high acuity

I've never slept there

or even tried

One attending and one mid-level? Seeing 40 pts in 8 hrs? This does not sound remotely safe. I remember breaking 40 patients on a 9 hr overnight when I was an attending at a local academic center but that was with a pgy 1, 2 and 3 working with me. Even then that felt brutal.

 

[CoolDoc1729]

Maybe for you

At my tertiary care center we woefully understaff at night. I'll have one midlevel helping boluses of 6-8 pph, steady stream of 4 pph. Some respite as we board occasionally but not uncommon to see 40 patients in 8 hrs with one midlevel, moderate/high acuity

I've never slept there

or even tried

My main place I’m seeing usually 25-30 between 2200 and 0600, I get 2 hours to clean up once the am Dr arrives. I’d never try to sleep lol.
Our freestanding we work 12’s so the night there is 1900-0700. I’ve seen anywhere from 10-25 there on a night. One day I saw 20 and had the place empty by 1. But I’m acclimated to nights so I couldn’t sleep anyway. I want to say I did 12 “hours” of cme, goofed around on Reddit, cleaned my car … lol. I don’t usually pickup there because I have to be there at 1900 so I don’t get to tuck my kids in, and also it is boring (~5% admit rate, minimal ambulance traffic) and I feel like I’m there for 2 days.

 

[cyanide12345678]

Maybe for you

At my tertiary care center we woefully understaff at night. I'll have one midlevel helping boluses of 6-8 pph, steady stream of 4 pph. Some respite as we board occasionally but not uncommon to see 40 patients in 8 hrs with one midlevel, moderate/high acuity

I've never slept there

or even tried

Yes. I meant my job. But i had a very clear idea of the kind of job i wanted when i switched jobs. <10k annual volume was my cut off honestly. Both my main sites have 8-9k annual volume. Some nocturnist jobs are absolutely terrible and very under staffed. Sounds like your job is one of them.

Why do we put up with these terribly staffed jobs?

Why not walk away and find something better, even if it means making less money.

 

[Rekt]

5pm/6pm swings don’t count as nights. Those are princess shifts. I can easily wake up at 9-10am and have a normal day after those shifts.

I’m full time nocturnist. I do up to 18 a month. Hustling to dump loans before the speciality crashes full speed into the ground. Double coverage. Not uncommon for us to have 30 patients check in from 8pm to midnight and have the 1-2am bolus of 10-15 pts. This is all dumped on top of whatever the day crew left us which is usually slower docs than night. No such thing as sleep here. It costs our group 50$/hr for this privilege.

I’ve done the rural sleepy shops too. I’d personally rather see 25 pts overnight than go to sleep for two hours at midnight to wake up at 230am for some drugged out hillbilly that has had chronic back pain for 6 months check in and waste my time.

 

[Groove]

Granted most transition to leadership and part time admin mid-end of career when they give up clinical time working fewer nights.

That's some serious nocturnist koolaid drinking. Whoever sold you that position needs to go work for one of the major CMGs hiring for their fire fighter positions. Let them loose on the job floor at ACEP and they are guaranteed to mop up. I've never even remotely worked at a gig where nocturnists were the super soldiers of the group and/or where FMDs or RMDs were born. It's where docs go to be left alone. They might be fast docs...but the beauty is that they don't have to be. Their metrics can suck and nobody cares because....they're nocturnists and nobody else wants the job. No c-suite watching over their shoulders. They can have better schedule control, etc.. There's a better chance to work part time +/- night differential and extra compensation. It's certainly NOT seal team 6, future leaders of America breeding ground. Your job might be an exception but I kind of doubt it.

I think you posted somewhere else about how you felt that it made you a stronger clinician because you had to read your own CTs and XRs? Are you crazy? I mean, we should all be reading our own imaging but c'mon man...that's an insane spin on the fact that you are being forced to take on incredible medicolegal risk in dispositioning patients on your watch WITHOUT final reads because your radiology group doesn't want to work at night and they have somehow convinced the hospital that it's ok to provide one standard of care for patients at 1pm and a completely different standard of care at 1a.m. It's NOT making you a stronger doc, it's making you more LIABLE and increasing your chances of lawsuit from discharging someone with a critical finding that was missed. It's widely known, even when you get wet reads from these guys at night, they are adding all the incidentalomas the following morning...pulmonary nodules, adrenal adenomas, non specific mesenteric lympadenopathy with hazy "thickened endometrium" correlate with menstrual cycle (pt is menopausal), etc.. I could go on forever.

 

[Groove]

Was wondering how many nights people do on average... I guess I would define night as a shift that crosses midnight; so obviously 10/11p to 7a, but also 5p-2a since that's enough to through off the circadian rhythms (for me, at least). Based on some responses in a recent thread, I'm wondering how rare it actually is to have a job with no nights.

I do about 6 per month in blocks which is probably the highest number I've had to pull in all my gigs save for one 10 years ago. I've averaged around 3-4 at most jobs because we've had 1-3 nocturnists. Currently we have only one nocturnist but they are part time and we're a large tertiary care academic site with multiple community EDs with triple coverage overnights at the mother hospital so any shifts filled by the part timer are barely felt.

I've never found a job during my career where nobody worked nights. Which is insane considering it's probably much more the norm for a hospitalist job. Our hospitalists might need to pull 1 night per month because one of the nocturnists was sick or out of town. Why is finding a full time nocturnist so much more common for IM for nobody seems to care to do it in EM?

 

[RustedFox]

That's some serious nocturnist koolaid drinking. Whoever sold you that position needs to go work for one of the major CMGs hiring for their fire fighter positions. Let them loose on the job floor at ACEP and they are guaranteed to mop up. I've never even remotely worked at a gig where nocturnists were the super soldiers of the group and/or where FMDs or RMDs were born. It's where docs go to be left alone. They might be fast docs...but the beauty is that they don't have to be. Their metrics can suck and nobody cares because....they're nocturnists and nobody else wants the job. No c-suite watching over their shoulders. They can have better schedule control, etc.. There's a better chance to work part time +/- night differential and extra compensation. It's certainly NOT seal team 6, future leaders of America breeding ground. Your job might be an exception but I kind of doubt it.

I think you posted somewhere else about how you felt that it made you a stronger clinician because you had to read your own CTs and XRs? Are you crazy? I mean, we should all be reading our own imaging but c'mon man...that's an insane spin on the fact that you are being forced to take on incredible medicolegal risk in dispositioning patients on your watch WITHOUT final reads because your radiology group doesn't want to work at night and they have somehow convinced the hospital that it's ok to provide one standard of care for patients at 1pm and a completely different standard of care at 1a.m. It's NOT making you a stronger doc, it's making you more LIABLE and increasing your chances of lawsuit from discharging someone with a critical finding that was missed. It's widely known, even when you get wet reads from these guys at night, they are adding all the incidentalomas the following morning...pulmonary nodules, adrenal adenomas, non specific mesenteric lympadenopathy with hazy "thickened endometrium" correlate with menstrual cycle (pt is menopausal), etc.. I could go on forever.

Damn.
I hope you two continue to spar this one out.
Two of my favorite SDNers here.
It's like watching fave baseball team A play fave baseball team B.

 

[RustedFox]

5pm/6pm swings don’t count as nights. Those are princess shifts. I can easily wake up at 9-10am and have a normal day after those shifts.

I’m full time nocturnist. I do up to 18 a month. Hustling to dump loans before the speciality crashes full speed into the ground. Double coverage. Not uncommon for us to have 30 patients check in from 8pm to midnight and have the 1-2am bolus of 10-15 pts. This is all dumped on top of whatever the day crew left us which is usually slower docs than night. No such thing as sleep here. It costs our group 50$/hr for this privilege.

I’ve done the rural sleepy shops too. I’d personally rather see 25 pts overnight than go to sleep for two hours at midnight to wake up at 230am for some drugged out hillbilly that has had chronic back pain for 6 months check in and waste my time.

Hi, neighbor.
Yep. The 4 AM "Florida Man" visit.
Every time.

 

[Mount Asclepius]

That's some serious nocturnist koolaid drinking. Whoever sold you that position needs to go work for one of the major CMGs hiring for their fire fighter positions. Let them loose on the job floor at ACEP and they are guaranteed to mop up. I've never even remotely worked at a gig where nocturnists were the super soldiers of the group and/or where FMDs or RMDs were born. It's where docs go to be left alone. They might be fast docs...but the beauty is that they don't have to be. Their metrics can suck and nobody cares because....they're nocturnists and nobody else wants the job. No c-suite watching over their shoulders. They can have better schedule control, etc.. There's a better chance to work part time +/- night differential and extra compensation. It's certainly NOT seal team 6, future leaders of America breeding ground. Your job might be an exception but I kind of doubt it.

Slow down on throwing the naivety curve balls. Maybe part of the problem is that your experience is with CMGs. I'm not talking about sell out admin leadership positions with large CMGs. My comments (while not mentioned) were specific to my site. SDG partner. N=1 based upon my current long-standing position. Two of our group's Presidents were nocturnists. One of those ended up on the hospital's MEC. Two other nocturnists serving as chairs of our group's BOD. Another on our group’s BOD. For whatever reason some of the better physicians in our group are/were nocturnists. They either started that way, or became that way working nights in our environment.

I think you posted somewhere else about how you felt that it made you a stronger clinician because you had to read your own CTs and XRs? Are you crazy? I mean, we should all be reading our own imaging but c'mon man...that's an insane spin on the fact that you are being forced to take on incredible medicolegal risk in dispositioning patients on your watch WITHOUT final reads because your radiology group doesn't want to work at night and they have somehow convinced the hospital that it's ok to provide one standard of care for patients at 1pm and a completely different standard of care at 1a.m. It's NOT making you a stronger doc, it's making you more LIABLE and increasing your chances of lawsuit from discharging someone with a critical finding that was missed. It's widely known, even when you get wet reads from these guys at night, they are adding all the incidentalomas the following morning...pulmonary nodules, adrenal adenomas, non specific mesenteric lympadenopathy with hazy "thickened endometrium" correlate with menstrual cycle (pt is menopausal), etc.. I could go on forever.

Many EM jobs don't have the luxury of final CT reads prior to dispositioning patients. You really think most places have 24/7 in house Radiology? I've caught many findings missed by preliminary reads for patients that I was suspicious had pathology. One Radiologist once told me, "You have a huge advantage reading your own films when you can touch the patient and I can't." An experienced EP often knows when an X-ray is going to show a fracture and a head CT is going to be normal. I look at my own imaging as I don't always trust our overnight send out Radiology service. It's not realistic to keep patients until the morning for final reads. Trust me, we've had the fight pushing for 24/7 in house Radiologists. They flat out said to hospital leadership, "We went into Radiology not to do nights." It's a hard sell on our part to the hospital CEO who also doesn't want to work nights. You also specifically tell patients at discharge to followup with their PCPs as final radiology reads might contain incidentalomas that importantly need ongoing monitoring or further evaluation.

The standard of care at 1 AM is absolutely different than 1 PM. Hospital resources are not the same. I'd argue that's part of the point why working nights can make you better. You don't have as many people in house. It's not reasonable to wake up consultants for every little thing in the middle of the night. You do take on more medicolegal risk. You have to be on your A game. Again, as I previously prefaced, you can be an All-World EP no matter what time of the day you work. Many are. At our shop, those that work nights on average as a group are a little more efficient and a little stronger than those that work days.

 

[AlmostAnMD]

One attending and one mid-level? Seeing 40 pts in 8 hrs? This does not sound remotely safe. I remember breaking 40 patients on a 9 hr overnight when I was an attending at a local academic center but that was with a pgy 1, 2 and 3 working with me. Even then that felt brutal.

There's another attending. But they see their own volume independent of my own so I don't count them.

If it doesn't sound safe, I painted the picture accurately. Family reasons keep me here, mortgage keeps me employed.

Glad someone else called out the leadership BS. I concede at that posters specific shop....maybe? But definitely for me nights is where careers go to die. Which, again, I doubt I'm long term in this anyway so it doesn't bother me. But the assertion that leaders are picked from nights is wrong, and any student or resident reading this needs to understand that.

I am a human shield of liability. I'm okay with that because I know that's what I am and don't intend to do this for another 20 years. It would depress me if I were delusional enough to believe otherwise.

Edit: for clarity i am in SDG

 

[BoardingDoc]

Hi, neighbor.
Yep. The 4 AM "Florida Man" visit.
Every time.

I got about 30 min of sleep on my overnight last night. Was woken up to see a 23 yr old girl who had gotten into an argument with someone over the phone, agreed to meet up in person to "settle things" and then was unhappily surprised when the other party pulled out a knife and slashed the back of her hand. Several sutures and a comment about "not bringing fists to a knife fight" (she didn't like that one) and I was fully unable to get back to sleep.

 

[Mount Asclepius]

One addition for clarity. If your primary goal is administration or leadership, then working nights isn’t the key factor in getting there. That’s a whole separate discussion.

I made my initial comment that you can end up in leadership despite working nights in response to another post saying you couldn’t.

 

[emergentmd]

Man, you guys are making my Job when I was still working at the hospital seems so Unicorn.

14 shifts a month, 8 hr shifts, Never did nights (had 2 full time nocturnists), Did one 6p-2a a month (one guy loved the 6p shift), Had 24 hr rad support, had a starbucks/hot sandwich shop in house til 11pm for free, avg about 2.25pph in the 15 yrs before I left. I knew I had a sweet job.

No way is the 6p-2a an overnight. I came home and slept by 3-4am, woke up at 9-10 and felt great.

What some of you guys are describing are my locums gig which I did a decent amount of nights but I was getting paid $5-800/hr which were 12 hrs so 6 shifts/mo was equal to my SDG gig.

No way could I do 14, 12 hr shifts overnight seeing 3pph. I prob was the fastest in my group and not way could I do it. I bow to you superior EM docs.

 

[xaelia]

how does the no attendings at night workout?

If it weren't working, it wouldn't be happening.

I suspect folks on-call get called or called in once or twice a month. Occasionally the board is wrecked and the night team stays late (for after-midnight overtime rates).

I'm sure there are "misses" and "delays", but the big stuff gets picked up.

 

[JacobMcCandles]

Many EM jobs don't have the luxury of final CT reads prior to dispositioning patients.

Many? Really? That’s a bomb waiting to explode.

 

[cyanide12345678]

Many? Really? That’s a bomb waiting to explode.

I doubt it’s Many. I’ve worked in some tiny ERs - literally one that was a 4 bed shop with 3k annual volume. Even they had 24/7 CT reads by a radiologist.

Plain films you were on your own after hours though.

 

[Mount Asclepius]

I doubt it’s Many. I’ve worked in some tiny ERs - literally one that was a 4 bed shop with 3k annual volume. Even they had 24/7 CT reads by a radiologist.

Plain films you were on your own after hours though.

You had a Radiologist in house 24/7 somewhere with 3K volume. I seriously doubt that.

We’re not talking preliminary reads by an off site Radiology service, but official final reads. You guys do realize that right?

 

[Dr Mantis Toboggan]

You had a Radiologist in house 24/7 somewhere with 3K volume. I seriously doubt that.

We’re not talking preliminary reads by an off site Radiology service, but official final reads. You guys do realize that right?

Probably part of a big health system where the films were sent to the mother ship.

 

[JacobMcCandles]

You had a Radiologist in house 24/7 somewhere with 3K volume. I seriously doubt that.

We’re not talking preliminary reads by an off site Radiology service, but official final reads. You guys do realize that right?

I was mistaken. Your post made it seem like you had to read your own CTs for dispo. Overnight radiology services like Nighthawk, etc. generally blow but they’re much, much better at reading CTs than me.

 

[cyanide12345678]

You had a Radiologist in house 24/7 somewhere with 3K volume. I seriously doubt that.

We’re not talking preliminary reads by an off site Radiology service, but official final reads. You guys do realize that right?

Final reads. But not in house. Who needs in house radiology?

 

[Mount Asclepius]

Final reads. But not in house. Who needs in house radiology?

That’s who delivers final reads.

Your site must either be part of a health system where a connected bigger shop is providing an overnight final read, or else is so small that it can’t afford a Radiologist sending everything out for a final read.

Many medium sized places depend on cheaper preliminary reads overnight until Radiology shows up in the morning overreading them providing a final read.

It sounds like you weren’t aware of the distinction between preliminary and final reads.

 

[Apollyon]

Ouch! Unnecessary snark, there.

 

[Mount Asclepius]

Ouch! Unnecessary snark, there.

Yeah, you’re probably right. Got too nice of a long day off ahead today to start it off with snark.

 

[BoardingDoc]

That’s who delivers final reads.

Your site must either be part of a health system where a connected bigger shop is providing an overnight final read, or else is so small that it can’t afford a Radiologist sending everything out for a final read.

Many medium sized places depend on cheaper preliminary reads overnight until Radiology shows up in the morning overreading them providing a final read.

It sounds like you weren’t aware of the distinction between preliminary and final reads.

Fwiw you dont need in house rads for final reads. Most telerad services offer a final read service as well. I've never worked somewhere that uses it but I know it's an option.

 

[Mount Asclepius]

Fwiw you dont need in house rads for final reads. Most telerad services offer a final read service as well. I've never worked somewhere that uses it but I know it's an option.

Yep. Radiology groups are reluctant to give up that billing. They’d prefer to pay for cheaper prelim reads so they don’t have to work nights. They then bill themselves for the final reads working during the day.

 

[emergentmd]

That’s who delivers final reads.

Your site must either be part of a health system where a connected bigger shop is providing an overnight final read, or else is so small that it can’t afford a Radiologist sending everything out for a final read.

Many medium sized places depend on cheaper preliminary reads overnight until Radiology shows up in the morning overreading them providing a final read.

It sounds like you weren’t aware of the distinction between preliminary and final reads.

I don't understand this. What are prelim reads? The only time I dealt with prelim reads before a final read was during residency.

Since being an attending and 22 yrs, I have always had 24 hr real time board certified CT + Xray reads. All major city ERs had then and typically overnight was sent to a central area in the city. In outlying places, BFE Volume 10K, I had real time remote reads. My FSERs have real time Rad reads.

I never D/C a pt other than a head CT before a final. I D/C pt all the time on Xray reads b/c I am about as good as a radiologist for what I need plus I can always call pts back.

But in no way am I D/C a pt with a CT abd/chest without a final read.

 

[Mount Asclepius]

I don't understand this. What are prelim reads? The only time I dealt with prelim reads before a final read was during residency.

Since being an attending and 22 yrs, I have always had 24 hr real time board certified CT + Xray reads. All major city ERs had then and typically overnight was sent to a central area in the city. In outlying places, BFE Volume 10K, I had real time remote reads. My FSERs have real time Rad reads.

I never D/C a pt other than a head CT before a final. I D/C pt all the time on Xray reads b/c I am about as good as a radiologist for what I need plus I can always call pts back.

But in no way am I D/C a pt with a CT abd/chest without a final read.

Non X-ray imaging is read by Radiologists remotely primarily to evaluate for critical findings providing a preliminary read for overnight studies. They bill at a lower rate since they aren’t a comprehensive final read. Have seen it done at multiple non-training facilities. Seems usually at places not quite big enough to have a 24/7 Radiology group, but bigger than places that can’t afford an in house Radiologist or Radiology group.

It’s a way for Radiologists to have their cake and eat it too. No nights, yet still get a decent amount of the imaging billing overnight.

Perhaps someone in the Radiology world can weigh in with better clarity regarding the frequency and distribution of preliminary Radiology read use. @Taurus?

 

[CliveStaples]

When I worked in the community, I worked mostly nights.

I am at less than 1 night shift per month now thanks to having dedicated nocturnists. Most months I work no night shifts, and occasionally I'll work 2-3 in a row (maybe 3 months a year). I am glad that they're bundled together every few months, as opposed to working one night per month. I am hoping starting this summer our increased night coverage will take me down to zero for good.

This job is infinitely better without the night shifts. Yes, weekends and holidays still hurt, but I'd take it this way than the reverse (more nights but no weekends or holidays).

 

[RustedFox]

Non X-ray imaging is read by Radiologists remotely primarily to evaluate for critical findings providing a preliminary read for overnight studies. They bill at a lower rate since they aren’t a comprehensive final read. Have seen it done at multiple non-training facilities. Seems usually at places not quite big enough to have a 24/7 Radiology group, but bigger than places that can’t afford an in house Radiologist or Radiology group.

It’s a way for Radiologists to have their cake and eat it too. No nights, yet still get a decent amount of the imaging billing overnight.

Perhaps someone in the Radiology world can weigh in with better clarity regarding the frequency and distribution of preliminary Radiology read use. @Taurus?

The whole "preliminary read" thing is bogus.
Does a GI doc do "preliminary scopes"?
Do we do "preliminary EKG interpretation"?

 

[GonnaBeADoc2222]

If you're seeing 3pph at night and being paid < $500 / hr youre getting shafted.

Dispoing CTs wothout at least a prelim read is insane.

 

[BoardingDoc]

The whole "preliminary read" thing is bogus.
Does a GI doc do "preliminary scopes"?
Do we do "preliminary EKG interpretation"?

Yeah, it's legit a scam.

 

[TooMuchResearch]

That's some serious nocturnist koolaid drinking. Whoever sold you that position needs to go work for one of the major CMGs hiring for their fire fighter positions. Let them loose on the job floor at ACEP and they are guaranteed to mop up. I've never even remotely worked at a gig where nocturnists were the super soldiers of the group and/or where FMDs or RMDs were born. It's where docs go to be left alone. They might be fast docs...but the beauty is that they don't have to be. Their metrics can suck and nobody cares because....they're nocturnists and nobody else wants the job. No c-suite watching over their shoulders. They can have better schedule control, etc.. There's a better chance to work part time +/- night differential and extra compensation. It's certainly NOT seal team 6, future leaders of America breeding ground. Your job might be an exception but I kind of doubt it.

I think you posted somewhere else about how you felt that it made you a stronger clinician because you had to read your own CTs and XRs? Are you crazy? I mean, we should all be reading our own imaging but c'mon man...that's an insane spin on the fact that you are being forced to take on incredible medicolegal risk in dispositioning patients on your watch WITHOUT final reads because your radiology group doesn't want to work at night and they have somehow convinced the hospital that it's ok to provide one standard of care for patients at 1pm and a completely different standard of care at 1a.m. It's NOT making you a stronger doc, it's making you more LIABLE and increasing your chances of lawsuit from discharging someone with a critical finding that was missed. It's widely known, even when you get wet reads from these guys at night, they are adding all the incidentalomas the following morning...pulmonary nodules, adrenal adenomas, non specific mesenteric lympadenopathy with hazy "thickened endometrium" correlate with menstrual cycle (pt is menopausal), etc.. I could go on forever.

I wouldn't take a job without 24 hour reads from sub specialty rads.

 

[TooMuchResearch]

You had a Radiologist in house 24/7 somewhere with 3K volume. I seriously doubt that.

We’re not talking preliminary reads by an off site Radiology service, but official final reads. You guys do realize that right?

Even at our rural sites we have the same sub specialty radiology reads 24 hours/day. They aren't necessarily on site. I don't need a neuro rad sitting in the rural facility, I just need them reading and available. At night they read from home or their office in the city, but the reads come in and I can call them anytime.

 

[emergentmd]

Again, what is a prelim read? If a Boarded radiologist are doing the read, then why even do a prelim? Can't take that much more time to just click on a canned normal read.


Every big hospital I worked at had an in house radiologist 9-5pm. Other times sent to central location in City.
Small rural places/FSERs, they get sent to telerad group. I always had 24hr access to the reading radiologist by phone.

I for sure would Never work at a place without 24 hr U/S, CT, or Radiologist. They could not pay me enough.

But they are always final reads. I don't understand the advantages other than alittle time doing a prelim then having another rad do a final. Seems like double the work.

 

[Groove]

I wouldn't take a job without 24 hour reads from sub specialty rads.

It's actually a lot more common than you think and is almost a regional standard of care in my area. Every hospital in this area (11) gets (at best) a wet read by a radiology resident and/or wet reads by attendings in a private group, all of which are over read for a final read at 7am

I tried to fight it when I was involved with admin but it was a completely lost cause. They don't want to hire a nighthawk service because the money for that usually comes out of the coffers used to pay the radiology group and they want to be able to bill for the overnight reads the following morning. It's disgusting really. Huge liability risk.