Is this realistic?

[bravotwozero]

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I've had this thought where I want a hologram version of me to go and entertain patients with their nonsense while I eff off and actually get important things done.

a la floating head doc from Scrubs - that's what immediately popped into my head when I read this

 

[emergentmd]

Working 4+ overnight in a busy place eventually makes you insane. Work 10 overnights at a slow/sleepy ER where you get 4-6 hrs of sleep is not terrible.

I remember trying to be a nocturnist with kids and it was the worse of both worlds. Single without responsibilities very doable. having Kids is insane.

 

[InnocentMedicalStudent]

CCM is probably the ideal setup for 7-14 in a row. Most ICU patients are 🪨 s. I remember from my rotations it'd take me 2-3 days to feel comfortable with the list and then it was on cruise control rest of the week. It was a lot of babysitting with small incremental changes and a couple new admits a day. Little to no discharge planning- if they could cross their legs they can go to the floor. A code every couple days to keep things exciting but that's about it. Some of the most competent nurses in the world who can pretty much manage their own patients and only bother you for real stuff. Rounds took 30-40 minutes for 12 bed icu. If youre daytime, rest of the day was procedures or family updates. Night time was 100% Netflix or sleep between admits and codes. If I were CCM I would honestly not do any less than 7 in a row.

how are job opportunties for EM CCM ? I heard they prefer anesthesiologists or pulmonologists but idk im just a med student
Is the pay lower?

 

[InnocentMedicalStudent]

Im EM/CCM - with CCM I can easily do 14 in a row and my record is 21 in a row. For me with EM after night #5 I’m ready to drive off a cliff.

nice, longevity is something that i like

 

[TooMuchResearch]

My guess is that somebody asking what the absolute minimum they can work to get benefits at this point likely doesn’t have a partner mindset. Now, if it were someone that had already been a partner for 15-20 years then I get that.

We have a number of partners that work our minimum requirement.

 

[JacobMcCandles]

We have a number of partners that work our minimum requirement.

Us too, however, all the ones working the minimum have been partners for quite a while. I don't think we've ever had anyone become partner and then automatically go down to the minimum hours, at least since I've been with my current group. A partner putting in the work and then working the minimum is different than somebody who hasn't even joined the group asking what the least amount they can work for benefits is.

 

[Arcan57]

what do you think is the minimum amount of shifts that most places would still give you benifits?

VA gives benefits at 1/8FTE. Problem of course is that nobody's hired at 1/8 FTE so you can't get that job off the jump.

 

[thegenius]

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

No, unless it's a chitty job.

You will probably be asked to work 10-12 shifts/month.

Just remember most nocturnists positions that are full time are usually FT. Not PT.

 

[thegenius]

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

I work with someone who does 12 of 14 nights in a row then takes a month off. That person is just drained by shift #6.

Not sure how that person does that, and not sure a good job is done either.

 

[thegenius]

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.

This

Can't work 6 of 30 and pick all 6 of those as well, unless locums.

 

[Apollyon]

No, unless it's a chitty job.

You will probably be asked to work 10-12 shifts/month.

Just remember most nocturnists positions that are full time are usually FT. Not PT.

Kinda the same thing, brother!

 

[cyanide12345678]

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.

Same. High net worth has increasingly made going to work harder. I mean i keep telling my wife…. Why am i doing this when i don’t have to?!?!?! According to her i can’t just sit home and do nothing because apparently that’s a terrible example to set for my 6 and 3 year old girls 😂

So now i guess im apparently working so my kids can understand work ethic?

 

[cyanide12345678]

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.

Will report back but a VA career should solve for 2, 3, 4, 7, 8.

Technically 9 too, what’s more fair and transparent than being able to look up any federal employees salary. But obviously it’s not the most $$$/hour gig out there.

 

[Bittersteel]

Will report back but a VA career should solve for 2, 3, 4, 7, 8.

Technically 9 too, what’s more fair and transparent than being able to look up any federal employees salary. But obviously it’s not the most $$$/hour gig out there.

Doubt the VA solves for 8 and 9

 

[cyanide12345678]

Doubt the VA solves for 8 and 9

I mean it is transparent. You can’t argue that one. I can literally look up any person’s income that works for the federal government.

Also i think a fair amount of clinical autonomy happens if you no longer practice out of fear of being sued. A lot of my medicine right now is cover my a** medicine. I think Sovereign immunity and especially once i have permanent status after 2 years (first two years are provisional at the VA), will likely give me the license to practice however i want. After 2 years, you basically can’t be fired and can’t be sued.

Yet to be seen. Haven’t worked a single shift there yet.

 

[Bittersteel]

I mean it is transparent. You can’t argue that one. I can literally look up any person’s income that works for the federal government.

Also i think a fair amount of clinical autonomy happens if you no longer practice out of fear of being sued. A lot of my medicine right now is cover my a** medicine. I think Sovereign immunity and especially once i have permanent status after 2 years (first two years are provisional at the VA), will likely give me the license to practice however i want. After 2 years, you basically can’t be fired and can’t be sued.

Yet to be seen. Haven’t worked a single shift there yet.

Transparent doesnt mean fair.

You can get transparently fuqed.