Is it possible to have only daytime shifts in emergency medicine?

[deleted1095841]

I know there will be plenty of night shifts during residency, but I am wondering if after becoming an attending, I would have more flexibility about when I take shifts. I would be willing to work 6 or 7 days a week to avoid the night shift. I find that I don't do well after staying up all night or shifting my sleep schedule around too much (headaches, tiredness).

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[mvenus929]

Probably not as a junior attending. As a senior attending, maybe. I had a PEM attending during residency who only worked the 7a-3p shift, but he did so by making lots of trades and paying others to take night shifts for him. He was also among the most senior in the group.

 

[LunaOri]

Maybe if you work in urgent care, but ED is 24 hours and it’s likely that you (especially as a junior attending) will be expected to work your share of night shifts.

 

[DOVinciRobot]

Not until you are the senior partner. New attendings get the crap shifts from what I’ve seen.

 

[deleted1095841]

Thank you for the honest and direct responses. Does this vary depending on whether you are an attending in academics or private practice?

 

[DOVinciRobot]

Thank you for the honest and direct responses. Does this vary depending on whether you are an attending in academics or private practice?

No.

 

[Tenk]

Yeah you can, right out of residency, but depends on the gig. Many groups have dedicated nocturnists who make more via a night differential. This means you work far fewer or no nights.

That being said, if you can’t stomach nights, do not go into emergency medicine. Nothing is guaranteed and you still have to do a ton of nights in residency.

 

[Tenk]

Not until you are the senior partner. New attendings get the crap shifts from what I’ve seen.

Maybe in academics but the real world doesn’t work like that.

 

[Redpancreas]

Keep in mind that seniority is a common principle in all fields.

 

[Redpancreas]

Yeah you can, right out of residency, but depends on the gig. Many groups have dedicated nocturnists who make more via a night differential. This means you work far fewer or no nights.

That being said, if you can’t stomach nights, do not go into emergency medicine. Nothing is guaranteed and you still have to do a ton of nights in residency.

So newbies get treated equally to those with seniority? That doesn't sound like the real world to me.

 

[DOVinciRobot]

Maybe in academics but the real world doesn’t work like that.

I have seen it play out with the many EM residents (now attendings in various gigs) my wife and I are good friends with. Maybe it’s not all like that, but I don’t know a single new grad who was able to get out of nights.

 

[Redpancreas]

I have seen it play out with the many EM residents (now attendings in various gigs) my wife and I are good friends with. Maybe it’s not all like that, but I don’t know a single new grad who was able to get out of nights.

Yeah I mean @Tenk would know from personal experience better than either of us I suppose.

 

[mrbreakfast]

When I was in med school considering EM, I was told by multiple people that if I wasn't OK with swinging shifts for most of my career, I shouldn't do EM.

I will say that you get used to a lot. In med school the idea of a 24-hour shift seemed awful - the single 24 I worked in med school was a nightmare. Working one about once a week as a junior resident changed that from a nightmare into a minor inconvenience.

 

[Tenk]

I have seen it play out with the many EM residents (now attendings in various gigs) my wife and I are good friends with. Maybe it’s not all like that, but I don’t know a single new grad who was able to get out of nights.

It just depends on the job. I have about three friends I went to residency with whose groups have dedicated nocturnists who work no nights. I have seen tons of locums who only work days.

My point is the jobs are 100% out there and not ultra rare unicorn status. I still don’t think EM is a good field for people who don’t like nights though. Too big of a gamble on finding the right job versus any job especially in today’s market.

 

[ortnakas]

Theoretically possible, but unlikely as an early attending in EM.

 

[collegestud2013]

Possible if you can find a place that has dedicated nocturnists. However, be prepared to take a pay cut as the nocturnists will expect a higher hourly rate and the money to compensate that pay differential will likely come out of the pay of the day attendings. Also with the saturated EM job market (that's going to get worse in the near future with more and more EM residencies popping up and more reliance on midlevels) I wouldn't even recommend EM to any med student now that has decent grades/scores to do something else.

 

[Gambino.]

Place I worked at prior to med school had nocturnists but doctors still had 1-2 overnights a month and swing shifts are commonplace (4p-3a, etc). If you have a hatred for night shifts a different (clinical) speciality is probably for the best. The market is also horrible so GL trying to negotiate something like that at the moment/near future.

 

[CyrilFiggis]

So your original question shows that you really don’t understand the EM structure. Your attending contact is for a certain number of hours/year. Typically between 1440-1550 hours per year which is 12-15 shifts per month at 8-10 hours per shift (some places still do 12 hour shifts, but this is falling out of favor).

if you’re a nocturnist, you typically get credited more for overnight hours. If you’re academic, your institution may buy down your hours for your research or academic responsibilities. All this is to say, you won’t work 6 days a week unless you’re trying to get ahead on hours for vacation, paternity/maternity leave, etc. And all schedules are circadian so you are given time to recover after nights. Plus, nights are the most fun, that’s when the good cases come in.

 

[EKGdoc]

Only way of getting out of nights in EM is having full night staffing by nocturnists, or if your group has a policy of letting you age/longevity out. Lots of swing shifts even if nights mostly covered. Don’t do EM if you can’t tolerate nights or late PM shifts. Been doing EM > 30 years and still love it but it’s not always easy from a schedule/ circadian rhythm standpoint. (Our group does have a policy allowing you out of nights after certain combination of age plus years of experience).