Is this realistic?

[InnocentMedicalStudent]

Advertisement - Members don't see this ad

med student interested in EM here,
I know that nocturnists get a lot of flexibility but I was wondering if it is realistic to get a schedule that looks something like this: 6 consecutive night shifts and take 21 days off, so 6 on 21 off.
is an odd schedule like that that something that most hospitals/groups/whatever else would be willing to accept? or am i going to have a hard time finding something like that?
thanks
As w2 btw not locums

 

[skougess]

You could likely find that, but:
A. By night 5 you’re going to wish you ran your car into a tree.
B. That’s part-time work. Is that what you’re looking for? Will you have student loans?

 

[InnocentMedicalStudent]

You could likely find that, but:
A. By night 5 you’re going to wish you didn’t wake up in the morning.
B. That’s part-time work. Is that what you’re looking for? Will you have student loans?

hmmm i always wondered what are the max amount of consecutive shifts one could do, apparently the answer is 5.
Also no i wont have a lot of student loans, Also i think i should still be able to make good money tho

 

[trackrunner321]

There is no maximum amount of shifts one can do, but six overnights in a row would be highly unenjoyable. One of my colleagues works overnights Sun-Wed 3 weeks a month so he automatically gets one week off a month. 5 ****s a month is not even part-time. I know no attendings who work 5 shifts a month, no less anyone out of residency.

 

[RustedFox]

Nocturnist here .
Stop this. Stop this right now.

3 is max. 4 and you regret it.
5 is reckless.

I have a 4-stretch next week, but the last 2 are at a site where I will likely sleep for a few hours. I bring 3 pillows and a blanket in a big Tupperware tub. No joke. Then I have 3 days off before going on vacation.

 

[InnocentMedicalStudent]

3 is max. 4 and you regret it.
5 is reckless.

does being a nocturnist impact this? or would it be the same if you were working normal day hours. because i dont think that would make a difference for me

 

[RustedFox]

does being a nocturnist impact this? or would it be the same if you were working normal day hours. because i dont think that would make a difference for me

Listen, kid.
Everyone at your stage thinks they're "different" and (that thing) "won't impact me."

You're wrong . Whatever it is that you're thinking; you're wrong .

 

[InnocentMedicalStudent]

does being a nocturnist impact this? or would it be the same if you were working normal day hours. because i dont think that would make a difference for me

not to be disrespectful but you didnt answer the question. is the reason

3 is max. 4 and you regret it.
5 is reckless.
.

does being a nocturnist impact this? or would you be able to work longer if you were working normal day hours.

 

[InnocentMedicalStudent]

7 on 7 off was what I did for years and fairly common amongst several I know.

good to know that 3consecutive shifts isnt the absolute limit

That’s why many eventually work more straight than 3-4 so you only have to switch twice per month.

yup thats exactly my plan i dont wanna switch too often thats why i want to have as many consecutive shifts

The bigger misconceptions you have are #1 thinking it’s a reasonable or good idea to work PT right out of residency and build then maintain skills, as well as #2 that you will be receiving benefits as a PT physician.

honestly what i plan to do for the first three years out of residency is work 1.2 FTE and invest 85% of my money in SP500 then after that Ill work part time for the rest of my life, idk if that makes a difference or if I would still suffer from skill decay. Also do you no longer get malpractice insurance? What benefits do PT physicians miss out on?

 

[Pinner Doc]

med student interested in EM here,
I know that nocturnists get a lot of flexibility but I was wondering if it is realistic to get a schedule that looks something like this: 6 consecutive night shifts and take 21 days off, so 6 on 21 off.
is an odd schedule like that that something that most hospitals/groups/whatever else would be willing to accept? or am i going to have a hard time finding something like that?
thanks
As w2 btw not locums

As others have said, that’s part time work. Our full time nocturnists are more on the realm of 12-14 shifts a month.

As I see it, you’ll have two hurdles- getting hired at 6 shifts a month, and then having your pick of night shifts. To that second point, the places I have worked all have had dedicated nocturnists at an higher FTE, and those folks generally pick their night shifts first. So you’ll get the leftovers.

 

[Porfirio]

I have worked 8-10 nights shifts in a row a number of times when I was younger. You cannot permanently do that.

As for all the night docs out there, thank you for your service.

 

[AlmostAnMD]

I am (was) the closest to OPs setup. I worked part time nights, 8 shifts a month, 4 nights on, 2 off, 4 on, then rest of month off

Still hated it and left em. Lasted 5 years

 

[JacobMcCandles]

Most of our nocturnists work 5-7 in a row and have been for a while. You could probably find a group that would let you do that since it’s nights but you won’t be a very strong doc working part time straight out of residency. You’d be much, much better off (professionally and financially) if you worked hard and saved the first 10 years out.

In my personal opinion, if you’re in med school and already looking to work part time, medicine isn’t for you.

 

[bravotwozero]

As a counterpoint, I would strongly suggest you reconsider being a nocturnist and keep the number of nights to an absolute minimum. I'm fortunate enough to work in a place now that allows me to get some shuteye during nights. But before medschool, I worked nights as a security guard. During medschool, I pulled all nighters before exams. Now, I'm in a field where I can't entirely escape working nights. I'm pretty sure all of this has prematurely aged me.

 

[cyanide12345678]

med student interested in EM here,
I know that nocturnists get a lot of flexibility but I was wondering if it is realistic to get a schedule that looks something like this: 6 consecutive night shifts and take 21 days off, so 6 on 21 off.
is an odd schedule like that that something that most hospitals/groups/whatever else would be willing to accept? or am i going to have a hard time finding something like that?
thanks
As w2 btw not locums

Locums would allow that. Full time w2 with benefits will be a little unlikely with just 6 monthly shifts.

I’m 0.6 fte. I average 6.5 shifts per month right now. At 6 shifts most places will not give you benefits. I know my shop won’t

 

[bky3c]

I always preferred night shifts... aside from the fact that they occur at night... I liked the personalities of the employees the night shift attracted, I liked the fact that by the wee hours of the morning, I was usually able to clear the waiting room (have heard that's often not the case anymore), and I liked the fact that I'd never hear the click-click-click of the fancy shoes of admin coming down the hall. And sometimes, at certain critical access hospitals, I was able to get a few hours of sleep in an actual bed. NEVER count on that, though, even at the slowest ED on earth, no matter what they say during the hiring process.

There are a very small number of people whose biology agrees with night shift work, for some reason. Have you worked night shifts before? Lots of them in a row, at a job you didn't always enjoy? At a job where you didn't get a lunch break, and the work was (at least some nights) absolutely nonstop, and you sometimes/often didn't leave exactly at the end of your shift? You should do everything you can to make sure this will work for you before planning your entire career around it.

I once worked with a guy who lived halfway around the planet. He flew to this particular ED, worked 14 (12-hour) nights in a row, which was "day" for him, and then flew home without ever feeling like his schedule had been disrupted. Or at least that's what he said. So you could potentially use time zones to your advantage. (14 shifts, though, on any schedule, in any ED, is insane. I felt crusty after 3 shifts, and 5-6 was about all I could muster even if I knew I had a nice vacation right after it. Don't forget that we don't generally get paid vacation time. If you want time off, you either lose money by giving away shifts or you move your shifts around to create a gap, which means working more shifts in a row before/after vacation.)

I've worked part-time nights as a 1099 and as a locums doc, but never as a W2. Not to say that it can't happen, but I've never seen it. I had periods in my career when I patched together a full-time schedule by working part-time at several places, but it was only a) when I was trying to decide on which one to keep as a full-time job and then b) when I went to locums after quitting that full-time job in favor of more scheduling freedom on my way to early retirement. Our career can be very flexible, but only if you, as a doc, are also flexible and willing to put up with the BS that goes on at the EDs that are desperate enough to hire someone wanting to work a non-traditional schedule.

 

[alpinism]

med student interested in EM here,
I know that nocturnists get a lot of flexibility but I was wondering if it is realistic to get a schedule that looks something like this: 6 consecutive night shifts and take 21 days off, so 6 on 21 off.
is an odd schedule like that that something that most hospitals/groups/whatever else would be willing to accept? or am i going to have a hard time finding something like that?
thanks
As w2 btw not locums

So for various reasons while technically possible it would be extremely challenging to work that kind of schedule.

Firstly working 4-8 shifts each month would be considered a part time employee so you would have to find someplace that's willing to hire a part time nocturnist which can be hard since most sites want full time docs since its easier to schedule. Not only that but you would also have to find someplace that will let you work all the shifts together in one single block which can be hard since most nocturnists work short blocks of 2-4 shifts each month.

Secondly working all of those shifts in a row is miserable for most docs especially at busy sites where you might arrive on shift with 60+ patients in the waiting room and have no breaks till after 6am at which time you still have to catch up on all the charting for patients. Not only that but you will not get high quality sleep between shifts which means nearly everyone will feel terrible at the end of all of those shifts in a row which only gets worse as you get older with time.

Thirdly working that few shifts means a huge paycut with a lack of benefits such as health insurance, retirement, education, sick leave, etc... which means that it would have to be taken from your own paycheck which is thousands of dollars. I'd expect to make roughly 200K without benefits which is not a lot after taxes.

 

[alpinism]

Funny enough we have a new IHS dude who just graduated last summer and decided to work a block of 12 - 12hr nocturnist shifts each month.

The shifts are chill but he lasted less than 4 months before he was giving away his shifts for 400/hr because it was so miserable.

 

[bravotwozero]

Another thing to consider - Some of the busier EDs have that night wingman shift, with hours like 6pm-2am etc. I'm not particularly fond of these shifts, but they are much gentler on your circadian rhythm than a full on all night shift. The advantage of working at places that have these shifts, is that you will usually end up working fewer full night shifts, since some of these will have to be the night wingman shifts.

 

[Groove]

I had a new grad asking me for job advice and was inquiring about a hospital downtown that is pretty good pay and low pace. I was telling her it's a "good" gig and was about 1.7pph. She goes "Oh no...so it's slow? You mean, I'll get bored???" I don't usually get speechless but I stopped in mid sentence and just stared at her and kind of stammered out..."Uh...yeah well...um...you may feel differently in a few years than you feel now, ya know?"

 

[Janders]

Personally, I think its FINE to work 4-5 shifts in a row. You might start to get toasty by the the last one, but I don't think its disabling, and a little self-care can get you through them.

Before our group got nocturnists, I typically worked 4 overnights most months (sometimes a 5th moonlighting) and I STRONGLY preferred to block them and have 4-5 in a row. One transition.

Like many people, I like the work of overnights. I like the coworkers. I like the pace. I like the tone. As we get older, the circadian disruption catches up with most of us more and more. A bigger part is how much it can impact your civilian life, if you have typical nuclear-family-spouse-and-kids-do-work/school-weekdays-during-normal-hours.

So anyway, if your dream gig was 6 overnights in a row (and those were 8-10h nights, not 12+ hours), I would tell you that such a thing IS feasible.

I have more concern with ONLY working 6 shifts/month straight out of training, and how that will impact your "community fellowship" years (first couple years out) and your ability to earn at peak timing.

We've had ZERO issue hiring dedicated nocturnists who want to work 9-11 shifts/month, and I'm sure we could drop that to 8, but 6 would impact pay as the cost of malpractice and health insurance are FIXED and not per-shift.

 

[RustedFox]

I’m a former long time nocturnist. I.e. my life expectancy is shorter. I’m okay with that as I want to die pre-SNF.

7 on 7 off was what I did for years and fairly common amongst several I know. It’s how well you sleep during the day and limiting the number of switches that really matters. That’s why many eventually work more straight than 3-4 so you only have to switch twice per month. I know several senior nocturnists that have previously or currently work 10-14 straight so they only have to switch once per month. Not advisable though to work more than 7 straight as the night patient population can be more difficult than days, you become more irritated, your productivity declines, and it further destroys balance with your personal life.

The bigger misconceptions you have are #1 thinking it’s a reasonable or good idea to work PT right out of residency and build then maintain skills, as well as #2 that you will be receiving benefits as a PT physician.

7-on-7-off has got to be 8-hr shift lengths.

I will concede that "more than 4 is possible", but not at 12-hour shift lengths.

(Everywhere I work, it's 12-hour overnights.)

 

[Janders]

7-on-7-off has got to be 8-hr shift lengths.

I will concede that "more than 4 is possible", but not at 12-hour shift lengths.

(Everywhere I work, it's 12-hour overnights.)

100% agree. 12s are different beasts. 9hr shift means you have time to run some errands, workout a solid hour, eat with family... SOMETHING. 12hr overnights, especially with ANY commute, and you are just getting through!

 

[Apollyon]

The things is what @Mount Asclepius said - no matter how "super" you think you are, night shifts kill. They take literal years off your life. You are NOT different. You are human.

 

[Apollyon]

Some will pull it off, but it’s not typical.

Respectfully, I have to disagree. There was a study of night shift workers in Europe, Sweden, maybe, that they followed for 10 years, then 20 years. As @NotAProgDirector said, they didn't get to 30, possibly due to all the test subjects being dead.

It's MUCH less than "not typical".

 

[dozitgetchahi]

So for various reasons while technically possible it would be extremely challenging to work that kind of schedule.

Firstly working 4-8 shifts each month would be considered a part time employee so you would have to find someplace that's willing to hire a part time nocturnist which can be hard since most sites want full time docs since its easier to schedule. Not only that but you would also have to find someplace that will let you work all the shifts together in one single block which can be hard since most nocturnists work short blocks of 2-4 shifts each month.

Secondly working all of those shifts in a row is miserable for most docs especially at busy sites where you might arrive on shift with 60+ patients in the waiting room and have no breaks till after 6am at which time you still have to catch up on all the charting for patients. Not only that but you will not get high quality sleep between shifts which means nearly everyone will feel terrible at the end of all of those shifts in a row which only gets worse as you get older with time.

Thirdly working that few shifts means a huge paycut with a lack of benefits such as health insurance, retirement, education, sick leave, etc... which means that it would have to be taken from your own paycheck which is thousands of dollars. I'd expect to make roughly 200K without benefits which is not a lot after taxes.

All the above.

Now I’m a rheumatologist who hasn’t had to work a night shift/call shift since residency. But…even as an IM resident, night shifts sucked ass. We had to do two week blocks of them, with one day off 7 days in. It was generally awful, and you could feel your mental clarity and energy levels declining with each shift. When we did our month of EM during IM residency, the night shifts were somehow even worse.

I can’t imagine doing a schedule that over and over again for the rest of your life. Not to mention that you’d be fully inverting your sleep schedule at least once a month. This is harder than it sounds, and IMO is even worse for your health (and makes you feel worse) than simply staying inverted and working nights continuously (which, as discussed above, is already a well established way to shorten your lifespan and increase your risk for cancer and heart disease).

 

[InnocentMedicalStudent]

Respectfully, I have to disagree. There was a study of night shift workers in Europe, Sweden, maybe, that they followed for 10 years, then 20 years. As @NotAProgDirector said, they didn't get to 30, possibly due to all the test subjects being dead.

It's MUCH less than "not typical".

bruh wtf. How old were these night shift workers?

 

[Apollyon]

bruh wtf. How old were these night shift workers?

No matter where you start, after 20 years, you're middle aged.

 

[Apollyon]

https://www.bmj.com/content/345/bmj.e4800

This is just a place to start.

 

[bky3c]

78 sounds good to be 6 feet under

This isn't directed at you so much as to others who might be reading. You're entitled to your own opinion/desires, of course. But it makes me sad to see people say things like this.

78 is the average age of my parents, and neither of them is ready to hang it up. They live independently (with stairs! and dogs!) in the house where I grew up, and they're active and enjoying life. When I met my husband, he said he never wanted to retire. Now he's happily looking at just another 5 years (non-medical field). I volunteer at a nursing home, and the residents there are clearly sad when someone dies. No one says, "Well, at least he had a nice long life." That's something only young people say. These people aren't even capable of living independently, and yet they're still enjoying life, laughing with their friends over coffee, etc.

It's all relative. I think it's important to keep this in mind when career planning, personal finance planning, etc. In terms of "how long do I want to live," what seems "old" to us now probably wont' seem so old when we get there.

 

[Groove]

Meanwhile my 78 year old neighbor continues to kick my ass in road biking. Dude has such weird genetics. Bikes 20-30 miles 5x a week. Then I'll be peering up from my WOW at a 78 yo on a stretcher that looks like he/she is 90 and a complete comorbidity train wreck. Some people get dealt all the right cards...or wrong ones for that matter.

 

[Janders]

It’s not that you can’t still have a decent life at that age. It’s just not a guarantee.

It’s very much a devil in the details situation.

I imagine enjoying my late 70s and 80s even if my ambulatory status is weak and I have orthopedic pain, as long as my mind is sharp. I can imagine accepting some suffering for a few more months on this rock.

Alternatively I can imagine multiple scenarios where punching out early is a preferred option.

 

[dozitgetchahi]

Meanwhile my 78 year old neighbor continues to kick my ass in road biking. Dude has such weird genetics. Bikes 20-30 miles 5x a week. Then I'll be peering up from my WOW at a 78 yo on a stretcher that looks like he/she is 90 and a complete comorbidity train wreck. Some people get dealt all the right cards...or wrong ones for that matter.

Choices matter too.

Genes are part of it, but from my vantage point as an OP rheumatologist, I can tell you that the vast majority of debilitated patients I encounter got there by consistently making poor choices throughout their lives.

Smoking 1ppd, carrying 50-100 extra pounds for decades, no exercise for years, drinking to excess etc are incredibly effective ways to age way beyond your years. It’s fairly uncommon to find someone who “did everything right” yet ends up in that state. It’s much, much more common to find people who did everything wrong, and then expect you to fix it.

 

[NotAProgDirector]

Respectfully, I have to disagree. There was a study of night shift workers in Europe, Sweden, maybe, that they followed for 10 years, then 20 years. As @NotAProgDirector said, they didn't get to 30, possibly due to all the test subjects being dead.

It's MUCH less than "not typical".

I believe I have been mis-tagged in this thread.

I used to tell my graduating residents that we only teach 50% of what you really need to know in residency. The next 25% you learn in the first 6 months of your full time job. The last 25% comes over the next 5 years or so. Then, you start your inevitable decline.

Planning to work part time to start is an enormous challenge. There's still so much to learn, and as mentioned many places may be leery about hiring you as such -- although if they are desperate, they will do anything. Benefits also an issue, and you may end up with the "worst" shifts.

I think there's some confusion in the thread around night shifts -- ED nights vs HM nights. Both can be challenging. Will be very site specific -- could be crazy busy, or super chill. We have a few noc's who like to work 10 in a row if possible. I agree with others that it's often not sustainable, but can be done when you're younger. Most residencies now limit nights to no more than 6, and many have voluntarily made it less. Some people are very circadian sensitive, others can switch from days to nights to days with no problem at all.

To the OP: You have contradictory statements in the thread. Mention 6 nights / 21 off, but also that you want to overload your schedule at 1.2 FTE. As already mentioned, 1.0 FTE is likely to be 14 shifts in HM, probably 12 or so in EM. Nights in HM will either pay more, or be a smaller number (again probably about 12). Only you can decide whether that intensity of schedule works for you.

 

[Groove]

C'mon....am I the only one that has ever thought about it?! I've long suspected @NotAProgDirector was a computer program WAY before AI came around. Those answers are too perfect man! I KNOW you're the MCP!

 

[Apollyon]

I believe I have been mis-tagged in this thread.

I used to tell my graduating residents that we only teach 50% of what you really need to know in residency. The next 25% you learn in the first 6 months of your full time job. The last 25% comes over the next 5 years or so. Then, you start your inevitable decline.

Planning to work part time to start is an enormous challenge. There's still so much to learn, and as mentioned many places may be leery about hiring you as such -- although if they are desperate, they will do anything. Benefits also an issue, and you may end up with the "worst" shifts.

I think there's some confusion in the thread around night shifts -- ED nights vs HM nights. Both can be challenging. Will be very site specific -- could be crazy busy, or super chill. We have a few noc's who like to work 10 in a row if possible. I agree with others that it's often not sustainable, but can be done when you're younger. Most residencies now limit nights to no more than 6, and many have voluntarily made it less. Some people are very circadian sensitive, others can switch from days to nights to days with no problem at all.

To the OP: You have contradictory statements in the thread. Mention 6 nights / 21 off, but also that you want to overload your schedule at 1.2 FTE. As already mentioned, 1.0 FTE is likely to be 14 shifts in HM, probably 12 or so in EM. Nights in HM will either pay more, or be a smaller number (again probably about 12). Only you can decide whether that intensity of schedule works for you.

No, you talked about it about 20 years ago in another forum on this site.

 

[cyanide12345678]

It’s no secret that i am burned out.

There are two main reasons for my burn out.

1) circadian rhythm disruptions from switching between nights and days - it is legit hard to flip flop around. Not to mention the disruption on your health. Night shift is linked to hypertension, diabetes, heart disease, stroke, obesity and early death. It is easier to think this is something you can do when you’re in your 20s. I thought the same - my default always was sleeping at 5-6 am for years. But once you have a family and kids, everything changes.

2) boluses of patients. It must be really nice having a schedule where patients come in every 20 minutes. But no…you can have 10 people check in 20 minutes on some days. Most places you are on your own during a night shift after a certain time. Depending on how busy the place is, but you might be dealing with boluses by yourself at nights.

 

[Groove]

It’s no secret that i am burned out.

There are two main reasons for my burn out.

1) circadian rhythm disruptions from switching between nights and days - it is legit hard to flip flop around. Not to mention the disruption on your health. Night shift is linked to hypertension, diabetes, heart disease, stroke, obesity and early death. It is easier to think this is something you can do when you’re in your 20s. I thought the same - my default always was slapping at 5-6 am for years. But once you have a family and kids, everything changes.

2) boluses of patients. It must be really nice having a schedule where patients come in every 20 minutes. But no…you can have 10 people check in 20 minutes on some days. Most places you are on your own during a night shift after a certain time. Depending on how busy the place is, but you might be dealing with boluses by yourself at nights.

I think you're late 30s near 40 if I recall. I was feeling bad other day for only being 50 and finally admitting to myself that I'm so burned out that I'm too far gone at this point. AI seemed to think it was very telling that I spent a few months off, was recharged only to jump back into the fray for a month or so and boom...right back at burnout. It said something about moral wounding or something to that effect. I was curious why some people can go to their 60s in EM and do just fine and others can barely make it out of residency. Ultimately, it said none of that is important. What's important is that the person is suffering from it and there could be multiple reasons that go into it and some people deal with it way sooner than others for no fault of their own.

It didn't think dropping my shifts significantly would make any difference. I've given it an inordinate amount of thought lately and have finally come to the conclusion that giving up bedside EM is simply what's right "for me". I think @Birdstrike has always been inspiring in that I can remember him being one of the first in tackling this issue years back (at least that I can remember on this forum) and ultimately coming to the same conclusion and mustering up the courage to completely change career vectors. I'm kind of at the same point and am charging full speed towards telemedicine.

What's your plan? I know you've got lots of irons in the fire with your entrepreneurial stuff so do you plan to transition to that or other ventures full time? Part time EM while you feel out other stuff? Give up clinical EM entirely? Have you thought of telemedicine?

 

[Janders]

^^^ This is a good description of burnout and EM. In a way, it reminds me of TBI... bad cases are obvious, moderate cases are more subtle, and recovery/response to repeated stimuli is VERY individual and can be a bit unpredictable.

Personally I'm about 1/3 admin, and cutting back shifts seems to help me keep it at bay. But I totally get that cutting to less time or half time isn't the right solution for everyone. @cyanide12345678 weren't you going to transition to the VA? That seems like SUCH a shift in practice patterns that it may fix some of the underlying causes/issues...

 

[bky3c]

It didn't think dropping my shifts significantly would make any difference.

That was true in my experience. If someone is really working way too many shifts, then dropping some can be helpful. But going from way too many shifts down to full time and then down to part time didn't do it for me. I just continued to dread the few shifts I did have. Getting OUT was what actually helped. I hope telemedicine ends up being the right answer for you.

 

[AlmostAnMD]

samesies

I went to 8 shifts/month and just hated my life for 1/3 of the month instead of 1/2

Only felt better when I was done done done

 

[Groove]

That was true in my experience. If someone is really working way too many shifts, then dropping some can be helpful. But going from way too many shifts down to full time and then down to part time didn't do it for me. I just continued to dread the few shifts I did have. Getting OUT was what actually helped. I hope telemedicine ends up being the right answer for you.

Thanks man. What did you end up getting into? I know @AlmostAnMD went into UM but what about you?

I'm realizing exactly what you said. I'm now working 50 hours less per month than I used to a couple years ago but it hasn't made any difference at all and I suspect cutting the extra 40 more this fall won't change anything either. I have zero telemedicine experience but it seems like something that would be a welcome relieve to clinical EM work even if a bit on the boring/monotonous side. The way I see it....I NEED a little boredom and monotony and set scheduling at this point in my life. As soon as the light rays align with the telemedicine credentialing/hiring, I'll probably put in my full notice and maybe take a month or 2 off in between the work.

 

[cyanide12345678]

I think you're late 30s near 40 if I recall. I was feeling bad other day for only being 50 and finally admitting to myself that I'm so burned out that I'm too far gone at this point. AI seemed to think it was very telling that I spent a few months off, was recharged only to jump back into the fray for a month or so and boom...right back at burnout. It said something about moral wounding or something to that effect. I was curious why some people can go to their 60s in EM and do just fine and others can barely make it out of residency. Ultimately, it said none of that is important. What's important is that the person is suffering from it and there could be multiple reasons that go into it and some people deal with it way sooner than others for no fault of their own.

It didn't think dropping my shifts significantly would make any difference. I've given it an inordinate amount of thought lately and have finally come to the conclusion that giving up bedside EM is simply what's right "for me". I think @Birdstrike has always been inspiring in that I can remember him being one of the first in tackling this issue years back (at least that I can remember on this forum) and ultimately coming to the same conclusion and mustering up the courage to completely change career vectors. I'm kind of at the same point and am charging full speed towards telemedicine.

What's your plan? I know you've got lots of irons in the fire with your entrepreneurial stuff so do you plan to transition to that or other ventures full time? Part time EM while you feel out other stuff? Give up clinical EM entirely? Have you thought of telemedicine?

The current last ditch effort to salvage my career in EM is to see if the grass is truly greener on the other side.

September 21st is my VA start date. It fixes a lot of issues - or so i think So far. If it’s indeed the promised land where everyone is really happy then maybe i can squeeze out 10 more years - that’s the minimum i need to hit pension.

Problems that i believe the VA solves:

1) night shifts. They have dedicated nocturnist. You’re kind of going to do 3 nights every quarter - so 1 short stretch of circadian disruption in 3 months vs right now where I’m doing 3-4 every month.

2) large patient boluses and that dreaded feeling of being behind - i won’t be the solo doc. In fact, will have up to 4-5 people on at the same time during peak hours.

3) lawsuit risk. I’ve been named in one lawsuit and was dismissed. I don’t want to go through that again. VA fixes that.

4) being stuck in very unsafe and bad situations. When I’m out in the boonies with no back ups and crap happens and there’s no helicopter, man….. it is hard and stressful. The dread of being in those situations is probably worse than those actual situations. My VA has a level 1 trauma center across the street, bad stuff would go there. It also has the state’s largest pediatric referral center 2-3 blocks away.

5) no ob or sick sick sick kids. I mean rarely it’s possible, but it’s really just unlikely to happen. It’s hard when it’s just you and no picu or ob in the hospital.

So yeah…. This will be the first time since residency i will work at a place that is not single coverage, not rural, and for a change that has back ups, specialists and resources while still being very reasonable pph and staffing.

Is the grass truly going to be greener on the other side? Who knows. Plan B is 6 monthly shifts as locums.

Plan C is to do what my wife does - i had a job offer from them, but they weren’t willing to match my wife’s 60:40 split on medical director fees and wanted 55:45. I didn’t sign that contract.

 

[cyanide12345678]

Thanks man. What did you end up getting into? I know @AlmostAnMD went into UM but what about you?

I'm realizing exactly what you said. I'm now working 50 hours less per month than I used to a couple years ago but it hasn't made any difference at all and I suspect cutting the extra 40 more this fall won't change anything either. I have zero telemedicine experience but it seems like something that would be a welcome relieve to clinical EM work even if a bit on the boring/monotonous side. The way I see it....I NEED a little boredom and monotony and set scheduling at this point in my life. As soon as the light rays align with the telemedicine credentialing/hiring, I'll probably put in my full notice and maybe take a month or 2 off in between the work.

View attachment 421717

Though honestly right now I’m averaging 6.5 monthly shifts at my w2 and 2 at my 1099.

So 8-9 monthly shifts. Honestly I’m decently satisfied with the set up currently. It’s a decent life and i can’t complain.

If the VA doesn’t help the burn out, then I’ll just settle with 250k income and 6 monthly shifts and do locums.

 

[cyanide12345678]

^^^ This is a good description of burnout and EM. In a way, it reminds me of TBI... bad cases are obvious, moderate cases are more subtle, and recovery/response to repeated stimuli is VERY individual and can be a bit unpredictable.

Personally I'm about 1/3 admin, and cutting back shifts seems to help me keep it at bay. But I totally get that cutting to less time or half time isn't the right solution for everyone. @cyanide12345678 weren't you going to transition to the VA? That seems like SUCH a shift in practice patterns that it may fix some of the underlying causes/issues...

Yes i am. 6 month notice ending in 3 months lol. Starting end of September officially. Hopefully it fixes things.

 

[Birdstrike]

It’s no secret that i am burned out.

I think @Birdstrike has always been inspiring in that I can remember him being one of the first in tackling this issue years back

The burnout is real. But I think with many of us, it goes far beyond burnout. I think many of us have very real, clinical, PTSD. We don't admit it to ourselves because we've been conditioned to feel it's a personal failure, which it's not. It's a systems failure. The EM Machine blames us for the meat grinder it's created and refuses to take responsibility for reforming it or for the damage it's caused.

My evidence of my ED-PTSD is my book. The book is my documentation of it. The horror. The haunting, that wouldn't leave me. Even after I left EM, these scenarios would blast into my consciousness and I'd have to write about them. In some cases it would hit me while driving and I'd have to pull over and write thousands of words, expelling the memories from my brain. This was months, years after I left EM. The writing process allowed me to move past it. It allowed the wounds to scar over. But they're still there. The majority have it. Only a minority admit it to themselves. One study showed prevalence is 15%. I think it's much higher as self reported survey responses can be biased by underreporting.

The burnout from the circadian rhythm poisoning and the sense of helplessness and lack of control is the poison in the water we swim in and drink from. The PTSD is what's lurking under the dark, murky water.

There is hope, though. The first step is to leave the Emergency Department. The allergen must be removed. As impossible as it seems to do so, it's not. The secret is to commit to doing it and admitting to oneself you need to. Finding out how is the adventure, the field of lava rocks to be crawled over. On the other side is hope and healing and a good life.

We made a decision to do a tour of duty in the ED. No one said it had to last forever.

I can't tell you the joy, exuberance and sense of a weight being lifted, when I got that phone call that released me from this burden.

 

[skougess]

As an attending 4 years out, I’m realizing the biggest problem with EM longevity is that the only thing really keeping me coming back is the high pay/shift. And every month as my net worth grows, the marginal value of that next paycheck gets smaller and smaller.

You get to a place pretty quickly in your EM career where you don’t NEED the high pay/shift that EM offers, so you just start to look at the shifts for the misery that they are instead of the cash cow. Im hardly as wealthy as others on this board and I’m already feeling it, which scares me for the future when my net worth truly grows to something substantial.

 

[Birdstrike]

I still think Emergency Physicians need to construct and pass an Emergency Physician's Bill of Rights.

1. The Right to a Capped Shift Length & Hours Worked
2. The Right to Safe Patient-Per-Hour Ratios
3. The Right to Age-Adjusted Scheduling
4. The Right to Meaningful Liability Reform
5. The Right to Administrative Minimalism & Support
6. The Right to Be Free from Consultant Abuse
7. The Right to Protection from Patient Violence and Abuse
8. The Right to Autonomy Over Clinical Decisions
9. The Right to Fair and Transparent Compensation
10. The Right to Mental Health Support Without Career Consequences

EPs should demand and enforce this as a group, collectively. These rights should be non-negotiable, inalienable. No Rights, no Work.

 

[AlmostAnMD]

Great idea

Unfortunately that would work against ACEP's puppetmasters and will never be supported because almost all of those would drive down revenue, the only god PE worships

What's interesting about going from EM to UM is that it always felt like the only thing that matters is money in medicine, so when I cut out the middleman and exclusively deal with just money issues life felt more congruent

 

[Birdstrike]

Great idea

Unfortunately that would work against ACEP's puppetmasters and will never be supported because almost all of those would drive down revenue, the only god PE worships

No Rights, No Work. My boycott started in 2011 and continues to this day.