Night Shift Differential

[Mount Asclepius]

Curious what most groups are doing for night shift differential? What are your thoughts on what’s fair?

In our SDG we do ~$30-45/hour depending upon the night shift (set dollar amount per specific shift). We also do around $10-15/hour for an unpopular late swing shift. Most of the nights are covered by several dedicated nocturnists. Everyone else still though usually has to cover 1-2 nights per month.

The right shift differential in my opinion should be whatever amount it takes for everyone in a group who doesn’t want to work nights to not have to work them. In that vein, we might need to increase our differential.

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[GonnaBeADoc2222]

I think ours is in that range as well.

 

[WilcoWorld]

The right shift differential in my opinion should be whatever amount it takes for everyone in a group who doesn’t want to work nights to not have to work them. In that vein, we might need to increase our differential.

Exactly - this is precisely the sort of problem to be solved by "market forces". Because how much the nights are worth depends on how painful they are. 2.5 pph single coverage? That's gonna need to be a 2x differential for me to even consider. A shift where you often get to nap for 2 hours? Different story.

 

[Jabbed]

$55/hr, SDG

 

[emergentmd]

We did $500 for an 8 hr shift, and I think this is being underpaid. Of the 4 nocturnist we had over the 15 yrs @ our hospital - #1 Unpleasant guy who got out of medicine. #2 guy divorced, got hooked on drugs. #3 guy's wife cheated on, gained alot of weight. #4 guy did well, but after 10 yrs switched to FSER and never looked back.

No money is worth it.

 

[Groove]

Night diff is 10$/hr at our CMG with ~$270/hr for the day docs currently. We have one FT nocturnist but it doesn't really reduce our overnights that much. I've never had a CMG implement a successful shift differential where it's attracted enough FTE nocturnist. It's always taken out of the day docs pot and people get greedy near the end of negotiations. I've almost gotten there twice in my career, each time people start bickering about the few dollars/hr taken out of their day shift pay and reneged.

All things being equal, I think your 30-45/hr is plenty. That's ~70K/yr if they are working 144hr/mo. You've just got to hire people interested in doing nights which are going to be your younger docs who are in debt to their eyeballs or the career nocturnists where it fits their lifestyle. When one of your old timers retires, hire another fresh out of residency or one of the latter. Sooner or later, your younger docs get older and less interested in nights so they let the newer docs take over. That's assuming that income is fixed otherwise. If you are an RVU centric model, you'll need to do something to fix the night doc salary since volume drops off. If you guys aren't doing that then perhaps an additional diff is needed... If both day and night docs average pay is the same...then $35-45/hr should be more than enough.

 

[BoardingDoc]

We are entirely keep what you kill so our differential is set to both incentivize the night doc and also to compensate for the (generally) lower volume that you'll see at night. It's ~$100/hr

 

[p1acebo]

Wish we had a night differential (although we are currently in the talks of having one), all docs do equal amount of nights at my shop. I think $40-50 an hour more seems fair, anything less it’s not worth it. Even if the nights are slower you are having more disruption of your circadian rhythm, usually dealing with less staff at night, less resources, more liability, etc

 

[Mount Asclepius]

We did $500 for an 8 hr shift, and I think this is being underpaid. Of the 4 nocturnist we had over the 15 yrs @ our hospital - #1 Unpleasant guy who got out of medicine. #2 guy divorced, got hooked on drugs. #3 guy's wife cheated on, gained alot of weight. #4 guy did well, but after 10 yrs switched to FSER and never looked back.

No money is worth it.

I find this slightly offensive. You're implying that nocturnists are all dysfunctional? We have 5-10 nocturnists (vague for anonymity) and all are some of the best doctors in our group, most efficient, high earning and all with seemingly happy family lives.

 

[Mount Asclepius]

Volume starts to taper off overnight, but there is also decreased physician coverage as well as more motivated nursing staff. Leads to way more efficient and productive shifts at night. Our night physicians see more patients/hour than our day physicians resulting in higher compensation even before differential is factored in.

 

[GonnaBeADoc2222]

I find this slightly offensive. You're implying that nocturnists are all dysfunctional? We have 5-10 nocturnists (vague for anonymity) and all are some of the best doctors in our group, most efficient, high earning and all with seemingly happy family lives.

I think it was more so to illustrate how a nocturnal schedule has the to potential to have a deleterious effect on your physical, mental and family health, and that these risks should be well compensated for.

 

[Mount Asclepius]

I think it was more so to illustrate how emergency medicine a nocturnal schedule has the to potential to have a deleterious effect on your physical, mental and family health, and that these risks should be well compensated for.

Agree

 

[emergentmd]

I find this slightly offensive. You're implying that nocturnists are all dysfunctional? We have 5-10 nocturnists (vague for anonymity) and all are some of the best doctors in our group, most efficient, high earning and all with seemingly happy family lives.

Wasn't meant to be offensive at all. Its just the nature of the stress. If you read my posts, I tried to be a nocturnist for 2 months and was chronically unhappy/sleep deprived/grouchy that made for a bad household.

EM shift work def can cause some stress but if I get 5+hrs of good sleep a night, then I am happy. If I do an overnight, I get max 4 hrs and chronically tired and grouchy.

 

[EctopicFetus]

We are entirely keep what you kill so our differential is set to both incentivize the night doc and also to compensate for the (generally) lower volume that you'll see at night. It's ~$100/hr

We have multiple sites and similarly we have 1 where it is about $100/hr. Another where it is 0. Another were it is 20.
we also allow anyone who works over half their shifts at night to set their own night schedule.

 

[SeekerOfTheTree]

Wasn't meant to be offensive at all. Its just the nature of the stress. If you read my posts, I tried to be a nocturnist for 2 months and was chronically unhappy/sleep deprived/grouchy that made for a bad household.

EM shift work def can cause some stress but if I get 5+hrs of good sleep a night, then I am happy. If I do an overnight, I get max 4 hrs and chronically tired and grouchy.

I agree with this. Your likelihood of dysfunction goes up greatly. It adds alot of stressors that one might not actively notice. I have noticed it when I tried to do it and I have noticed other EM attendings that have done pure nights. It causes a slight change in people. I would love to see data on divorces for shift workers.

I just looked at the data and you are 6 times more likely to get divorced just based on a rough search. Kind of crazy.

Shift Work, Role Overload, and the Transition to Parenthood - PMC

This article examines how the work hours, work schedules, and role overload of working-class couples are related to depressive symptoms and relationship conflict across the transition to parenthood. Data are from 132 dual-earner couples interviewed ...

www.ncbi.nlm.nih.gov

 

[Mount Asclepius]

I agree with this. Your likelihood of dysfunction goes up greatly. It adds alot of stressors that one might not actively notice. I have noticed it when I tried to do it and I have noticed other EM attendings that have done pure nights. It causes a slight change in people. I would love to see data on divorces for shift workers.

I just looked at the data and you are 6 times more likely to get divorced just based on a rough search. Kind of crazy.

Shift Work, Role Overload, and the Transition to Parenthood - PMC

This article examines how the work hours, work schedules, and role overload of working-class couples are related to depressive symptoms and relationship conflict across the transition to parenthood. Data are from 132 dual-earner couples interviewed ...

www.ncbi.nlm.nih.gov

Why do we have 5-10 night docs who are all married almost all with kids throughout various stages of life? Many chose the night shift schedule because it fit their family life better. I think it depends more on the person and setup. Blanket statements aren’t universal. Night shift work doesn’t equate to dysfunction. It perhaps does if you aren’t a good sleeper, or can’t sleep during the day. Exercise cures that, not pills.

 

[VA Hopeful Dr]

Why do we have 5-10 night docs who are all married almost all with kids throughout various stages of life? Many chose the night shift schedule because it fit their family life better. I think it depends more on the person and setup. Blanket statements aren’t universal. Night shift work doesn’t equate to dysfunction. It perhaps does if you aren’t a good sleeper, or can’t sleep during the day. Exercise cures that, not pills.

Exercise can for some people just like pills can for some people.

 

[SeekerOfTheTree]

Why do we have 5-10 night docs who are all married almost all with kids throughout various stages of life? Many chose the night shift schedule because it fit their family life better. I think it depends more on the person and setup. Blanket statements aren’t universal. Night shift work doesn’t equate to dysfunction. It perhaps does if you aren’t a good sleeper, or can’t sleep during the day. Exercise cures that, not pills.

I agree anecdotes don't make for generalizations that's why I included that link. 5-10 night docs all married with 0 divorces blows the national data for divorce out the water. I am glad that you guys have some good family values in your water there that helps everyone.

There are also tons of studies that cite shift work leads to dysfunction, health issues, etc...but we don't have to consider them if we don't want to.

I workout everyday, best shape of my life. Didn't help with working nights. Exercise isn't the Viagra of sleep disorder.

 

[emergentmd]

Why do we have 5-10 night docs who are all married almost all with kids throughout various stages of life? Many chose the night shift schedule because it fit their family life better. I think it depends more on the person and setup. Blanket statements aren’t universal. Night shift work doesn’t equate to dysfunction. It perhaps does if you aren’t a good sleeper, or can’t sleep during the day. Exercise cures that, not pills.

Nothing in life is black or white. Statements may appear to be blanket statements but you have to take everything in context and rarely is anything a blanket statement.

I say the government/congress is a wasteful machine of special interests that is highly inefficient and corrupt. That doesn't mean that there will be a few in Congress that will vote on their conscious rather than special interests.

I will stand by my opinion that anyone who does nights for an extended period of time will be worse off physically/mentally/socially than someone not doing nights. Obviously there will be many who can do extended nights and keep an intact "happy family" but I will go further to state that they would have had a much happier family life if they did days.

Its just facts of being opposite your spouse/kids schedule. 14 night shifts = 14 nights that you do not sleep in the same bed as you spouse. That is 14 post shift that you are sleeping while your spouse is running errands, having lunch by herself, miss taking the kids to school, picking them up, etc.

 

[GonnaBeADoc2222]

Nothing in life is black or white. Statements may appear to be blanket statements but you have to take everything in context and rarely is anything a blanket statement.

I say the government/congress is a wasteful machine of special interests that is highly inefficient and corrupt. That doesn't mean that there will be a few in Congress that will vote on their conscious rather than special interests.

I will stand by my opinion that anyone who does nights for an extended period of time will be worse off physically/mentally/socially than someone not doing nights. Obviously there will be many who can do extended nights and keep an intact "happy family" but I will go further to state that they would have had a much happier family life if they did days.

Its just facts of being opposite your spouse/kids schedule. 14 night shifts = 14 nights that you do not sleep in the same bed as you spouse. That is 14 post shift that you are sleeping while your spouse is running errands, having lunch by herself, miss taking the kids to school, picking them up, etc.

14 nights a month that your wife's boyfriend is over at the house youre paying for.

 

[emergentmd]

14 nights a month that your wife's boyfriend is over at the house youre paying for.

I have a nocturnist that this happened to. Never would have believed it but that is half the year where you are sleeping while she is "running" errands.

 

[SeekerOfTheTree]

I have a nocturnist that this happened to. Never would have believed it but that is half the year where you are sleeping while she is "running" errands.

I agree with. Tons of this already happens in the hospital but working nights creates a different environment that messes with people.

Sleep deprived doc short with his wife, annoyed can't get enough sleep. Wife wants him to do the laundry and take care of the kids, he wants to just veg on the couch because sleep is always elusive. Goes to work at night. Young nurses, clerks, techs, treat you great, laugh and joke....no responsibilities. You're the man. You slowly start to go man this isn't working between me and (insert spouse here). (Insert random hot chick here) really gets me and I have feelings for her.

Seen it happen so many times to those who go around and you think they have great marriages and are outstanding people.

I don't blame the spouses on the other end getting short end of the stick who do the same. People are fallible.

 

[Mount Asclepius]

Some people sleep great during the day. Myself being one of them. If you aren’t running a sleep debt, the night schedule and ability to work a consistent schedule is amazing. I sleep half the month while spouse is at work and kids at school. I work while they sleep. We are around each other the same amount of time before and after regardless. I have no romantic interest in 20 year old staff. My spouse has plenty of interest in my family and I. Nights don’t work for people that can’t sleep well consistently during the day. It isn’t universally true that working nights is dysfunctional though or will for sure be detrimental to your health. I’ve worked nights for years and don’t feel any worse off. I’ve personally found exercise (running) the key. It may not be the viagra for night shift work to everyone, but it is for me.

 

[LostinLift]

Yes, the differential should be balanced so that, as closely as possible, everyone who doesn't want to works nights doesn't and everyone who does is appropriately compensated. My group has a decent differential, approximately $400 per shift.

I've been doing all nights for a while now. The differential is the only reason I jumped on it but the standardized schedule is actually wonderful. Of course it's not perfect, it's somewhat unnatural for me, even though I can naturally stay up until 2-3am, but overall compared to the frequent flipping it makes more sense. I will plan to do nights as long as it continues to works for my family and my health. Once I can switch to all days and the pay-cut isn't detrimental to family/life/retirement, I will plan for that.

In terms of risk for marriage, yes nights can put you in risky situations and stress the relationship, but that is still on the individual to engage or not to engage in flirting behavior. Just like an addict who gets triggered, if you choose to start walking down that path it will only lead to disaster. Optimizing your health and healthy choices while on nights is important and actually highlights your unhealthy choices more clearly.

Eating healthy foods, not eating too close to sleep, consistent exercise, time in the sun, dedicated and protected time to sleep, time with family/friends, and time for meditation/time with God/whatever centers you become more obviously important. Working all nights has highlighted my bad habits and is helping me address these unhealthy areas and change.