How many nights do you do?

[Janders]

Our VRADS reads are technically prelim reads and I suspect most of my group don’t know that, as they aren’t one-line wetreads, they appear and function as full reads, and often do tap specialists to do them (CTA head/neck get funneled to Neurorads; sometimes they will call you with a weird read and mention they had so-and-so the CT-left-chest-guy look at it). I find that our Vrads reads are a notch WORSE than our local daytime rads reads… and we actually discussed this in a meeting w/ radiology last week… we aren’t really sure changing to “final” reads will improve the standard they give us. The errors tend to be rushed misses by the same radiologists (I have a couple names I roll my eyes at) or really tiny stuff that probably would always cause misses if a second attending re-read the study 8hr later…

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[Janders]

As far as nights—
(1) A night is an OVERNIGHT… or at least ending past 0200. Not a shift that ends at 0030 or even 0200. You can still get up at 0800 or 1000 and function in “normal” life with those.
(2) A quarter of our shifts are overnights, thus we each work 25% nights, except we have one nocturnist currently who eats about 1/3 of the month, so we all work more like 18% nights currently. So say 2-3 shifts per month. I’ve been with the group a decade, and typically worked 3-4 night shifts for my usual compliment of 14 shifts for the vast majority of those years, as while we occasionally had nocturnists we also had long standing docs who hit 60yo and bought out of nights…

 

[TooMuchResearch]

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 complete lost cause. They don't want to hire night hawks because the money for that universally 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.

Yikes. Not our standard.

I guess technically extremity MSK MRI are wet reads overnight by the emergency body rad. But how often does that happen? Everything else is the correct person from our local rads group.

 

[TrailRun]

I guess everyone is different, but for me 5-2 or 3 is enough to mess up the next day, especially with little ones that wake me up at 6 no matter what. Even 3-12s hurt too. But I’m in my 40s, probably easier in your 20s or 30s or if you have a quiet house to sleep in

 

[turkeyjerky]

I guess everyone is different, but for me 5-2 or 3 is enough to mess up the next day, especially with little ones that wake me up at 6 no matter what. Even 3-12s hurt too. But I’m in my 40s, probably easier in your 20s or 30s or if you have a quiet house to sleep in

Sure, if your comparison is 9-5 w/ a 2 hr lunch break, a swing kinda sucks. But it's not a night. It's just not.

I've always hated 6am shifts. I never get quite enough sleep and always am too exhausted afterwards to do much, plus the shift is oftentimes slow at the beginning and gets busier at the end. But it's not a night shift either.

 

[CoolDoc1729]

Yikes. Not our standard.

I guess technically extremity MSK MRI are wet reads overnight by the emergency body rad. But how often does that happen? Everything else is the correct person from our local rads group.

My ~45k place and our freestanding ~20k place have telerad for ct, US and MRI after 2300 and on weekends, sometimes after 1400. Some of the tele people are great. Some are terrible and constantly miss things. Sometimes I call them. Hey can you add the {PE, orbital tumor, 6 consecutive rib fractures} to your report. Of course one of our radiologists is also terrible and they all miss things occasionally. I have most definitely gotten sharper at looking at imaging since moving to midnights since telerad reports can take 2 hours and I don’t like surprises lol

 

[Janders]

Sure, if your comparison is 9-5 w/ a 2 hr lunch break, a swing kinda sucks. But it's not a night. It's just not.

I've always hated 6am shifts. I never get quite enough sleep and always am too exhausted afterwards to do much, plus the shift is oftentimes slow at the beginning and gets busier at the end. But it's not a night shift either.

I actually loved the 6a-2p shift one place I moonlit at. It was my preferred shift. Leave my house at 0530am, hit the door right on time. Overnight doc technically stayed until 0700 and the overnight PA until 0800, so they got a lot tied up before signing out. Still could usually get them out “Early” but they’d go have that one tricky conversation while I saw some new things. Then an AM PA showed up at 0800, another doc at 0900, another PA at 11, another doc at noon, and finally your replacement at 2.

You basically only had to hit it hard/alone for a couple hours, then fresh faces were constantly showing up and the culture was sign-out-ASAP-at-1400. I could be home by 1500 and get a workout in before my kids were home from school!

 

[emergentmd]

My ~45k place and our freestanding ~20k place have telerad for ct, US and MRI after 2300 and on weekends, sometimes after 1400. Some of the tele people are great. Some are terrible and constantly miss things. Sometimes I call them. Hey can you add the {PE, orbital tumor, 6 consecutive rib fractures} to your report. Of course one of our radiologists is also terrible and they all miss things occasionally. I have most definitely gotten sharper at looking at imaging since moving to midnights since telerad reports can take 2 hours and I don’t like surprises lol

So do radiologists ever get sued? I rarely hear of them being sued and they miss stuff ALL THE TIME.

Hey, you see air under that diaphragm?
Is that a Fracture to you?
Is that a pneumo?

 

[MechEDoc]

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?

off site reads can be final reads.

 

[emergentmd]

I have never seen a read faxed to me that stated "Prelim read". I am sure I never had a Prelim read outside of residency b/c I never had a formal read get faxed to us.

 

[Kryptocoin]

So do radiologists ever get sued? I rarely hear of them being sued and they miss stuff ALL THE TIME.

Hey, you see air under that diaphragm?
Is that a Fracture to you?
Is that a pneumo?

Prelim reads where I work are usually a one-liner: "no acute finding", right lung PTX/PNA/bronchitis etc. The next morning we get a full report. Long after the patient is discharged or admitted.

Yes, they get sued. They're ranked 9th in lawsuit. They should be ranked higher because of the volume of studies they read. But as we all know, no one hedges better than a radiologist.

 

[emergentmd]

Prelim reads where I work are usually a one-liner: "no acute finding", right lung PTX/PNA/bronchitis etc. The next morning we get a full report. Long after the patient is discharged or admitted.

Yes, they get sued. They're ranked 9th in lawsuit. They should be ranked higher because of the volume of studies they read. But as we all know, no one hedges better a radiologist.

I just can't get on board with Prelim reads b/c that takes all the liability from the Radiologist and puts its 10x on the ER.

What do you do with all the prelim reads that has nodules? There are many that you will never be able to contact.

What happens when they come back in 3 yrs with a large cancer mass and your notes shows that you could not contact them? That is just a lawsuit waiting to happen.

 

[TooMuchResearch]

I have never seen a read faxed to me that stated "Prelim read". I am sure I never had a Prelim read outside of residency b/c I never had a formal read get faxed to us.

Faxed? Wtf.

 

[emergentmd]

Faxed? Wtf.

Well, faxed was old now its all PACS.......

 

[CoolDoc1729]

Faxed? Wtf.

Ours get uploaded into PACs and also faxed

 

[Kryptocoin]

I just can't get on board with Prelim reads b/c that takes all the liability from the Radiologist and puts its 10x on the ER.

What do you do with all the prelim reads that has nodules? There are many that you will never be able to contact.

What happens when they come back in 3 yrs with a large cancer mass and your notes shows that you could not contact them? That is just a lawsuit waiting to happen.

Most, if not all, of my prelims don't mention nodules. That shows up in the full report the next day.

The hospital has a nurse that looks over the full reports each morning and if there's something significant (missed fx, nodules etc) she consults with the ER doctor on shift and then he/she decides who gets a call back or not. It's a good system and it was the result of previous lawsuit from missed injuries.

 

[xaelia]

I actually loved the 6a-2p shift one place I moonlit at. It was my preferred shift.

We had a 5a-2p, IIRC, at KPNW. Helped get the night docs out on time. Wasn't much worse than our 6a-3p, and man it was great to see that 5a guy at the end of the night because inevitably folks started piling in right around then.

I chatted with one of the docs up at St. Paul's in Vancouver awhile ago – they are straight RVU up there, it's fascinating. But, they also have a strong night-shift differential to their RVUs as part of their set-up – he was telling me it's easy to make more in a 10p-4a night shift as a typical 8a-4p day.

 

[JacobMcCandles]

I just can't get on board with Prelim reads b/c that takes all the liability from the Radiologist and puts its 10x on the ER.

What do you do with all the prelim reads that has nodules? There are many that you will never be able to contact.

What happens when they come back in 3 yrs with a large cancer mass and your notes shows that you could not contact them? That is just a lawsuit waiting to happen.

Anyone who gives knowingly false contact information should lose their ability to sue because they couldn’t be contacted.

 

[PianoMedic]

Most, if not all, of my prelims don't mention nodules. That shows up in the full report the next day.

The hospital has a nurse that looks over the full reports each morning and if there's something significant (missed fx, nodules etc) she consults with the ER doctor on shift and then he/she decides who gets a call back or not. It's a good system and it was the result of previous lawsuit from missed injuries.

One of my two shops uses a nighthawk group to give reads overnight. They aren’t called prelim reads, get faxed to us. All are overread by our in house rad in the morning, and that rad reviews the nighthawk read after they finish their read. If there is any discrepancy they think is significant, they call the ED physician or the ED charge RN and discuss directly with us. If it’s a nodule, they call the charge RN to call the patient back. If it’s a major finding (like a missed appy, or missed active arterial bleeding which I’ve gotten both calls) then they talk with the ED physician. I read all my own films now after having some major misses from the nighthawk group, and I call them if I think they missed something egregious. Our other issue is that company is super slow. If we wait more than two hours for a read, we can call our in house rad to read from home now. That is a recent concession from them for patient care as we’re getting backed up in the waiting room overnight now.

 

[RustedFox]

HEY RADIOLOGISTS:

You already can work from home doing reads.
Get to work overnights.
Hire some crews. Train them right.
Get a grip.

 

[HoosierdaddyO]

Considering this thread is about working nights I have a question for the hive:

Would you be ok working at a hospital that is otherwise amazing (govt VA job)… where patient population is awesome, supportive staff, obviously federal benefits and good salary, with the kicker of not having to work a single night. It sounds too good to be true but they exist. The only kicker is the fear of skill atropy in lieu of all the other amazing things about the job. Ie rarely place central lines, maybe 2 intubations a year etc. level of acuity is on the softer side of things but def not urgent care.

Could you knowingly let your skills atrophy just 5 years out of residency for that golden goose egg of a job??

 

[xaelia]

Considering this thread is about working nights I have a question for the hive:

Would you be ok working at a hospital that is otherwise amazing (govt VA job)… where patient population is awesome, supportive staff, obviously federal benefits and good salary, with the kicker of not having to work a single night. It sounds too good to be true but they exist. The only kicker is the fear of skill atropy in lieu of all the other amazing things about the job. Ie rarely place central lines, maybe 2 intubations a year etc. level of acuity is on the softer side of things but def not urgent care.

Could you knowingly let your skills atrophy just 5 years out of residency for that golden goose egg of a job??

Yes.

Trick being if you *do* decide to switch jobs, they may want some sort of procedure logs and it could be problematic.

 

[TooMuchResearch]

Considering this thread is about working nights I have a question for the hive:

Would you be ok working at a hospital that is otherwise amazing (govt VA job)… where patient population is awesome, supportive staff, obviously federal benefits and good salary, with the kicker of not having to work a single night. It sounds too good to be true but they exist. The only kicker is the fear of skill atropy in lieu of all the other amazing things about the job. Ie rarely place central lines, maybe 2 intubations a year etc. level of acuity is on the softer side of things but def not urgent care.

Could you knowingly let your skills atrophy just 5 years out of residency for that golden goose egg of a job??

Yes.

 

[bravotwozero]

Considering this thread is about working nights I have a question for the hive:

Would you be ok working at a hospital that is otherwise amazing (govt VA job)… where patient population is awesome, supportive staff, obviously federal benefits and good salary, with the kicker of not having to work a single night. It sounds too good to be true but they exist. The only kicker is the fear of skill atropy in lieu of all the other amazing things about the job. Ie rarely place central lines, maybe 2 intubations a year etc. level of acuity is on the softer side of things but def not urgent care.

Could you knowingly let your skills atrophy just 5 years out of residency for that golden goose egg of a job??

I’d consider taking the job once I’m at coast fire or something.

That said, you’ll work a lot more hours at the VA to be considered full time.

 

[Eigenvector1]

HEY RADIOLOGISTS:

You already can work from home doing reads.
Get to work overnights.
Hire some crews. Train them right.
Get a grip.

Most big radiology practices have dedicated in-house nighthawk radiologists on a 7on/14off schedule and provide final reads.

Only the small 5-10 person rad groups ship out studies to telerad groups for prelim or final reports. These groups will never be able to afford 3 dedicated night rads to fully staff nights. There is not enough work to justify in house staffing in this setting.

 

[Eigenvector1]

Most big radiology practices have dedicated in-house nighthawk radiologists on a 7on/14off schedule and provide final reads.

Only the small 5-10 person rad groups ship out studies to telerad groups for prelim or final reports. These groups will never be able to afford 3 dedicated night rads to fully staff nights. There is not enough work to justify in house staffing in this setting.

BTW, if the overnight telerad reads are not up to snuff, you all should definitely insist on looking around for a better telerad group.

 

[BulgeDaTwine]

The problem is that at my hospital in the never-ending pursuit of trying to please the unpleaseable, my overlords have decided that it is only acceptable to try and staff for the peaks and valleys of patient census. Which in theory sounds smart except that the true acuity-measured things have an equal distribution - the census is higher during the evening and nights because primary care in this community is so worthless, or unable to be accessed, or they don't bother (or they need a freaking work note for work off tomorrow)

So we have a full 4/8 of our shifts that cross midnight (this is bad enough) and as a result of the administrators in our group getting only days on high volume, reimburSment days (Mondays, Tuesdays), I work about 66% of my shifts that cross midnight (even worse).

Yeah. It fracking sucks.

 

[GassYous]

The problem is that at my hospital in the never-ending pursuit of trying to please the unpleaseable, my overlords have decided that it is only acceptable to try and staff for the peaks and valleys of patient census. Which in theory sounds smart except that the true acuity-measured things have an equal distribution - the census is higher during the evening and nights because primary care in this community is so worthless, or unable to be accessed, or they don't bother (or they need a freaking work note for work off tomorrow)

So we have a full 4/8 of our shifts that cross midnight (this is bad enough) and as a result of the administrators in our group getting only days on high volume, reimburSment days (Mondays, Tuesdays), I work about 66% of my shifts that cross midnight (even worse).

Yeah. It fracking sucks.

It's like they're trying to burn you out

 

[chudat]

HEY RADIOLOGISTS:

You already can work from home doing reads.
Get to work overnights.
Hire some crews. Train them right.
Get a grip.

radiologists do work overnights

radiologists started working from home cause of covid

rads residency is 5+1yrs vs EM 3yrs....rads dont churn out crazy volume of docs

 

[Fox800]

Since going PRN, I haven't worked a night shift in nine months. I typically work shifts that end at 5 PM, 11 PM, or 1 AM.

It's been life changing having a normal sleep schedule again.

 

[miacomet]

Yikes. Not our standard.

I guess technically extremity MSK MRI are wet reads overnight by the emergency body rad. But how often does that happen? Everything else is the correct person from our local rads group.

Attending reads 24/7