Nights as an er doc

[Nevis]

I have a question for the attending Ed docs out there....
I love ER, but I hate being awake after 1a. I am a morning person and have no problems being at work by say 6a. Is it difficult to find a job that would allow an attending to not have to work say btw the hours of MN-6A? I would happily take a pay cut. I don't have any problems working until 12MN or even 1A, and I have no problems starting work as early as 5-6A. I am particularly interested in anyone with insight into the Florida ER groups.

I apologize in advance if this thread's topic has been covered else where. I did not see where any prior thread that addressed not working during just a few specific hours of a night.

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[The White Coat Investor]

I have a question for the attending Ed docs out there....
I love ER, but I hate being awake after 1a. I am a morning person and have no problems being at work by say 6a. Is it difficult to find a job that would allow an attending to not have to work say btw the hours of MN-6A? I would happily take a pay cut. I don't have any problems working until 12MN or even 1A, and I have no problems starting work as early as 5-6A. I am particularly interested in anyone with insight into the Florida ER groups.

I apologize in advance if this thread's topic has been covered else where. I did not see where any prior thread that addressed not working during just a few specific hours of a night.

3 of our 5 shifts don't work between midnight and 6 am. In my group, you can avoid the two "night" shifts but you will be paid significantly less to do so.

You will not be able to avoid night shifts in many groups, nor in medical school and residency. But if that is a bigger priority to you than say, where you live, or how much you make, I'm confident you can find a job where you don't have to work after midnight.

 

[Birdstrike]

I have a question for the attending Ed docs out there....
I love ER, but I hate being awake after 1a. I am a morning person and have no problems being at work by say 6a. Is it difficult to find a job that would allow an attending to not have to work say btw the hours of MN-6A? I would happily take a pay cut. I don't have any problems working until 12MN or even 1A, and I have no problems starting work as early as 5-6A. I am particularly interested in anyone with insight into the Florida ER groups.

I apologize in advance if this thread's topic has been covered else where. I did not see where any prior thread that addressed not working during just a few specific hours of a night.

Here's my honest opinion, as someone who originally didn't mind working shift work, but grew to dispise it. If you have any issues with sleep, think long and hard before choosing Emergency Medicine as a career. An absolute requirement of thriving as an ER doctor, as opposed to being burned out and miserable, is to be able to go on any shift at any time, and come off any shift at any time and function. You'll be expected to work any time of the day, any day of the year, period. You might have to work until 3am, go to sleep at 4am and wake up after only 3 hours of sleep on your day off to go to a meeting, play with your kids, or whatever, and not only be able to function, but be happy. Yes, you'll get a nap at some point, but that will not retroactively erase the groggy jet lagged feeling you felt all day.

You might find a job that has "night rangers", but "night rangers" sometimes get tired of doing nights, and drop out, and back on night-shift you go. That's happened to me before at one of my jobs, twice. Also, "not doing nights" doesn't mean you won't work later shifts such as 6pm-4am, 7pm-5am, etc. Shift work sleep disorder is nothing to blow off, and can chronically affect your mood and relationships.

Also, generally the vast majority of ER physicians hate nights, so going to interview at a job and saying "I'm not going to work after midnight" is a huge turn off. That means more nights for everyone else.

If you're someone who knows you won't ever mind the crazy schedule, it's no big deal. If you need to sleep when it's dark out and be awake when there's sunlight, think twice. Also, think long term. You may be in your late 20s now and single, but how are you going to feel about the same shift work when you're 38, married with kids and you don't want to work 12 hr shifts Friday, Saturday, and Sunday and be off the next four days because you won't see your kids, and when you're off, they're back in school?

I'm not telling you what you should do or not do, these are just the things I didn't think about when I was 26 and single, but had to live with later. It may not apply to you, but its something to think about. My 2 cents.

ER attending who've been out of residency more than 1 year, do you agree or disagree?

 

[WilcoWorld]

It is certainly possible to get a "no nights" job, but, as was mentioned before, you'll have to prioritize that over geography/pay/etc.

Personally, I think that saying "I like EM as a specialty, but I don't want to work nights" is a lot like saying "I like Surgery as a specialty, but I don't want to spend much time in the OR".

 

[Apollyon]

ER attending who've been out of residency more than 1 year, do you agree or disagree?

41, out 5 years, not married/no kids, work exclusively nights 7p-7a, 12-14 shifts/month, VERY slow ED. I have no problem with the nights, or with the days off. None.

Then again, I never get jet-lagged, either.

 

[WilcoWorld]

not married/no kids

This is huge. The less your schedule is effected by other's, the less trouble nights are. When I was single, it was no big deal. Now I'm a married father. My wife is very understanding of my sleep needs. My 1 year old? Not so much.

 

[Arcan57]

Here's my honest opinion, as someone who originally didn't mind working shift work, but grew to dispise it. If you have any issues with sleep, think long and hard before choosing Emergency Medicine as a career. An absolute requirement of thriving as an ER doctor, as opposed to being burned out and miserable, is to be able to go on any shift at any time, and come off any shift at any time and function. You'll be expected to work any time of the day, any day of the year, period. You might have to work until 3am, go to sleep at 4am and wake up after only 3 hours of sleep on your day off to go to a meeting, play with your kids, or whatever, and not only be able to function, but be happy. Yes, you'll get a nap at some point, but that will not retroactively erase the groggy jet lagged feeling you felt all day.

You might find a job that has "night rangers", but "night rangers" sometimes get tired of doing nights, and drop out, and back on night-shift you go. That's happened to me before at one of my jobs, twice. Also, "not doing nights" doesn't mean you won't work later shifts such as 6pm-4am, 7pm-5am, etc. Shift work sleep disorder is nothing to blow off, and can chronically affect your mood and relationships.

Also, generally the vast majority of ER physicians hate nights, so going to interview at a job and saying "I'm not going to work after midnight" is a huge turn off. That means more nights for everyone else.

If you're someone who knows you won't ever mind the crazy schedule, it's no big deal. If you need to sleep when it's dark out and be awake when there's sunlight, think twice. Also, think long term. You may be in your late 20s now and single, but how are you going to feel about the same shift work when you're 38, married with kids and you don't want to work 12 hr shifts Friday, Saturday, and Sunday and be off the next four days because you won't see your kids, and when you're off, they're back in school?

I'm not telling you what you should do or not do, these are just the things I didn't think about when I was 26 and single, but had to live with later. It may not apply to you, but its something to think about. My 2 cents.

ER attending who've been out of residency more than 1 year, do you agree or disagree?

Kids are a game-changer, there is no question. Prior to my first son, I slept like a baby in a completely darkened room with a good amount of white noise. I'd pull 5 hrs of sleep after the first night, and then would be good for about 6-7 hrs on subsequent nights. After he was born, my first day sleep started running ~2-3 hrs and would max out at 4-5hrs. So I started taking naps before my overnight shifts, which cut down on the time I could spend with the wife (who was working 7a-6p type days).

Now I've got two kids and the latest my overnight shifts start are 8p. Which means no nap beforehand, with +/- administrative stuff to do in the am. It's annoying but not a major problem currently. The bigger problem I have is that I've never been a disciplined eater, and the transition from days-nights and back usually results in at least one extra meal during the day of the transition. Also, I tend to snack on junk food because I become off-cycle with the rest of the family in terms of meal-time.

 

[Apollyon]

The bigger problem I have is that I've never been a disciplined eater, and the transition from days-nights and back usually results in at least one extra meal during the day of the transition. Also, I tend to snack on junk food because I become off-cycle with the rest of the family in terms of meal-time.

Before last night, I had eaten 10lbs of food over my last 3 meals (7lbs of chili and 3lbs of pasta). I tried to do the 7lbs of chili all at once, but stalled at 5lbs.

 

[ptarmigan]

Alot of shifts end at 11pm, MN, or 1am but just remember your head might not hit the pillow for several hours after that due to tying up loose ends, charting, dictating, driving, eating once you get home etc. If you won't feel good about the swing or the overnight there won't actually be many shifts that you can do.

 

[StevieStud]

There is more to the working nights versus days issue than just the mix of shifts.

What are you willing to give up in exchange for working days & early evenings only?

Christmas? Thanksgiving Day? SuperBowl Sunday?

How about working every afternoon/evening during March Madness?

Willing to work every Saturday during the year without exception?


The sucker willing to work every Saturday, Christmas, major sporting events etc can always find him/her self a home. Might not be a fun home, but you will get a paycheck.

 

[GeneralVeers]

If you hate nights, I would suggest offering to do "swing shifts". Typically from noon or early afternoon until around midnight. These are unpopular shifts as the people with families want to be home in the evening to play with their kids and have dinner.

I do "swings" almost exclusively and find it's great. My days off aren't ruined like they would be on night shift, and I don't have to work every Saturday. My group is more than happy to give me these shifts.

 

[Lysinee]

I would like to hear from EM attendings on how they balance family with kids, and the usual shifts that are popular for doctors in this situation.

 

[leorl]

Some attendings with kids prefer night shifts so they can see their kids after school, basically go to work while the kids are sleeping, and then get to see their kids before they go to school the next day.

 

[painfan]

FWIW,
This is my 6th year of EM post residency. Things were great when it was just me and the wife. Now with 2 kids (4 and 2), a busy EM schedule is just not family friendly. Hind sight is 20/20, I went into EM to have plenty of time off.....but realized to make decent money (I know this is very relative) I need to work 16-18 shifts (9hrs avg) a month. For the last 6 years, this essentially meant that I was not home for dinner or didnt sleep in my bed about 13-14 days a month. Also was working atleast 2 full weekends a month.
I consider my self very forutnate to have a job (in this economy) and made a very good living. I have no regrets of doing EM.
With that said, my wife and I have decided that I dont want to spend my remaining 25-30 years of my medical career like this. Fortunatley, I got into an interventional pain medicine, and will be doing EM for another 9 months (plus some moonlighting during the training year).

(above is just my perspective, and by no means am I am "dissing" EM.....I think its a great field, I think EM guys/gals are extremely talented in what they have to do, and I have nothing but respect for all of my colleagues...It just isnt for me anymore.....and I am not burnt out by EM itself, but the hours/weekends!)

 

[The White Coat Investor]

FWIW,
This is my 6th year of EM post residency. Things were great when it was just me and the wife. Now with 2 kids (4 and 2), a busy EM schedule is just not family friendly. Hind sight is 20/20, I went into EM to have plenty of time off.....but realized to make decent money (I know this is very relative) I need to work 16-18 shifts (9hrs avg) a month.

I'm not sure you're reading what you're writing. You're absolutely right that "a busy EM schedule is just not family friendly." You need to get a schedule that ISN'T busy. We work 8 hour shifts in my group. This is the number of shifts people in the group worked last month:

6 shifts: 2 people
9 shifts: 1 person
10 shifts: 1 person
11 shifts: 2 people
12 shifts: 1 person
13 shifts: 1 people
14 shifts: 2 people
15 shifts: 3 people (the youngest 3 in the group)

We just passed a rule that says you can't work more than 17 a month (including moonlighting).

Even if you're working all evenings, if you're only doing 15 shifts you've got half of your evenings off to spend with the family plus the entire day on half the days in the month. That's pretty darn good.

If you can't live and be happy on $200K, $400K isn't going to magically make you happy. If you like emergency medicine, I suggest you just cut way back on your hours and adjust your lifestyle accordingly. You'd be amazed how much better life is when you work 12 shifts instead of 18.

 

[JackShephard MD]

You'd be amazed how much better life is when you work 12 shifts instead of 18.

Makes sense.

 

[arb011]

I'm not sure you're reading what you're writing. You're absolutely right that "a busy EM schedule is just not family friendly." You need to get a schedule that ISN'T busy. We work 8 hour shifts in my group. This is the number of shifts people in the group worked last month:

6 shifts: 2 people
9 shifts: 1 person
10 shifts: 1 person
11 shifts: 2 people
12 shifts: 1 person
13 shifts: 1 people
14 shifts: 2 people
15 shifts: 3 people (the youngest 3 in the group)

We just passed a rule that says you can't work more than 17 a month (including moonlighting).

Even if you're working all evenings, if you're only doing 15 shifts you've got half of your evenings off to spend with the family plus the entire day on half the days in the month. That's pretty darn good.

If you can't live and be happy on $200K, $400K isn't going to magically make you happy. If you like emergency medicine, I suggest you just cut way back on your hours and adjust your lifestyle accordingly. You'd be amazed how much better life is when you work 12 shifts instead of 18.

Thank you for writing this! I was getting very discouraged about my future as an EM doc by reading all of these posts until I read yours.

 

[Braves123]

There is more to the working nights versus days issue than just the mix of shifts.

What are you willing to give up in exchange for working days & early evenings only?

Christmas? Thanksgiving Day? SuperBowl Sunday?

How about working every afternoon/evening during March Madness?

Willing to work every Saturday during the year without exception?


The sucker willing to work every Saturday, Christmas, major sporting events etc can always find him/her self a home. Might not be a fun home, but you will get a paycheck.

Finally a competition edge for us IMGs!

 

[Birdstrike]

I'm not sure you're reading what you're writing. You're absolutely right that "a busy EM schedule is just not family friendly." You need to get a schedule that ISN'T busy. We work 8 hour shifts in my group. This is the number of shifts people in the group worked last month:

6 shifts: 2 people
9 shifts: 1 person
10 shifts: 1 person
11 shifts: 2 people
12 shifts: 1 person
13 shifts: 1 people
14 shifts: 2 people
15 shifts: 3 people (the youngest 3 in the group)

We just passed a rule that says you can't work more than 17 a month (including moonlighting).

Even if you're working all evenings, if you're only doing 15 shifts you've got half of your evenings off to spend with the family plus the entire day on half the days in the month. That's pretty darn good.

If you can't live and be happy on $200K, $400K isn't going to magically make you happy. If you like emergency medicine, I suggest you just cut way back on your hours and adjust your lifestyle accordingly. You'd be amazed how much better life is when you work 12 shifts instead of 18.

Congrats. You clearly have a 99th percentile job.

Impromptu poll: how many of you can cut your shifts from 17 per month to 8 shifts per month, just cause you want to? If so, who works your extra shifts? Do you have to pick up extra shifts if a couple of your partners want to cut back? Is your hospital admin cool with everyone cutting back 10-20% and just letting wait times go through the roof until you can hire new bodies?

 

[GeneralVeers]

My company has no "maximum" but we do have a mandatory minimum that is 108 hours or about 12 shifts. The rationale is that it's the minimum needed to pay for the generous benefits. It would be unfair for someone working 8 shifts a month to collect full benefits while someone else slaves away at 18 shifts.

 

[Arcan57]

Congrats. You clearly have a 99th percentile job.

Impromptu poll: how many of you can cut your shifts from 17 per month to 8 shifts per month, just cause you want to? If so, who works your extra shifts? Do you have to pick up extra shifts if a couple of your partners want to cut back? Is your hospital admin cool with everyone cutting back 10-20% and just letting wait times go through the roof until you can hire new bodies?

Yes, other people, spmetimes, no. We've had 4 full-time guys cut back at various times in the last 2 months, and so far we've been able to plug the holes with locums/part-timers. Which is pissing administration off since the part-timers have almost no accountability.

 

[The White Coat Investor]

Congrats. You clearly have a 99th percentile job.

Impromptu poll: how many of you can cut your shifts from 17 per month to 8 shifts per month, just cause you want to? If so, who works your extra shifts? Do you have to pick up extra shifts if a couple of your partners want to cut back? Is your hospital admin cool with everyone cutting back 10-20% and just letting wait times go through the roof until you can hire new bodies?

Yea, a great job in a group very focused on lifestyle. We'd love to have wait times going through the roof. We almost never have a wait. If we had sufficient patients we'd hire more docs and add more shifts. It isn't very hard to find people willing to work here as you might imagine.

As far as cutting back on shifts, you can't do it all of a sudden unless others want the shifts. But gradually, over time, no problema. For example, several docs want to work 3 or 4 fewer shifts in the summer months. It turned out a couple of us wanted some more shifts, but not enough, so those docs only got to cut back 1 or 2 shifts.

 

[The White Coat Investor]

My company has no "maximum" but we do have a mandatory minimum that is 108 hours or about 12 shifts. The rationale is that it's the minimum needed to pay for the generous benefits. It would be unfair for someone working 8 shifts a month to collect full benefits while someone else slaves away at 18 shifts.

We pay for our own benefits. One nice thing is that if you work 3/4 or 1/2 time you get a break on your malpractice.

 

[wobit]

Circling the topic back, as a resident with two young kids I find that though I love the pace of the second shift (3p to midnight) while I'm at work, the overnight shift fits my family better. After second shift I get home and need some time to unwind, rehydrate, refuel, but then the kids invariably wake me up at dawn which has arrived too soon. I end up helping get them ready for daycare and have a crappy interrupted daytime nap before heading back in, feeling like I had no useful time off. After an overnight shift I get home, kiss the babies on their way out the door, sleep blissfully while they're at daycare and then wake at 4, we all have social time together including dinner and cozy putting the kids to bed before I go back to work.

Clearly it's an issue that requires some planning, but so far my husband and kids are happier with me during the rotations I'm in the department, following EM style schedules.

Some of it's personality. I need a certain amount of alone time to recharge and I was utterly miserable as a full-time stay at home parent near the end of my generous maternity leave in med school. EM and it's hopscotch-ey time off fits that nicely.

 

[Jack is Back]

It seems like most of the criticism are based upon the group you're in and the schedule you have.

If you find an excellent schedule/group that doesn't force you to work a ton of shifts, then I think a lot of the burned out or frustrated EP would decrease.

 

[gutonc]

It seems like most of the criticism are based upon the group you're in and the schedule you have.

If you find an excellent schedule/group that doesn't force you to work a ton of shifts, then I think a lot of the burned out or frustrated EP would decrease.

Unsurprisingly, a job where you don't work too many hours and get paid a lot for each of the hours that you work is better than a job where you do work a lot of hours and get paid less for each of those hours.

I'm going to go out on a limb and state that this is a universal truth throughout the working world.

 

[Jack is Back]

Unsurprisingly, a job where you don't work too many hours and get paid a lot for each of the hours that you work is better than a job where you do work a lot of hours and get paid less for each of those hours.

I'm going to go out on a limb and state that this is a universal truth throughout the working world.

 

[endo]

I am 4 years out of residency and have been working exclusively nights the entire time. Nights seem to work quite well for family life with kids in school. You do give up a little in the quality of sleep dept and have to be careful to try and sleep as late as you can during the day -- it's very easy to wake up after only 4hrs and have difficulty getting back to sleep. You get to spend much more time with the kiddos because you wake up when they're getting out of school.

The problem with swings is you never see your kids. The problem with the early morning shifts is everyone wants to work 'em and you end up getting a lot of swings anyway, since there are more of them. Nights also make your schedule more predictable -- if you have activities in the afternoon you do weekly, you can count on being off to do them, working or not.

Other benefits -- night shifts where I am are slightly longer which means you can work less shifts/mo. Plus there is a stipend. Plus, most often I am seeing significantly less patients per hour and earning more than day workers. I get hammered for 4 hours at the beginning of the shift, but then things usually die out.

Cons: jet-lag, hard to trade-out shifts (cuz you work the crappy ones), no real family breakfasts, I go to sleep before the kiddos are awake

I'm not sure how long I will be able to do nights, but it works well for me now (mid 30s).

 

[Hamhock]

Yeah - but, Jack: he's right.

HH

 

[Jack is Back]

Yeah - but, Jack: he's right.

HH

Ok - and, HH: sounds good. [Thanks;]*'

JIB
(initials added to eliminate the ambiguity of who posted this message)

 

[fenixwbp]

So, another question I've been wondering along these lines:

I realize this differs between groups, but how much scheduling priority are docs willing to work nights only given? For me its not so much working nights that sucks, its the transitions. If were offered a job working only nights and could block them together, so I only have to transition once/month I would probably jump on it.

Say 12 night shifts with 1-2 nights off thrown in, then transition to days for two "off" weeks. rinse repeat.

How realistic is that? I would think a lot of groups jump at the chance to take on someone to work all nights, even if it means giving scheduling priority. Seems pretty win-win.

 

[GeneralVeers]

Say 12 night shifts with 1-2 nights off thrown in, then transition to days for two "off" weeks. rinse repeat.

How realistic is that? I would think a lot of groups jump at the chance to take on someone to work all nights, even if it means giving scheduling priority. Seems pretty win-win.

In general if you want to work all nights, you could probably pick a job at most groups in the country. As for doing a month of nights, then a month of days, I've never heard of this being done. The problem with transitioning back and forth is that you'd need a core group of doctors willing to do this and work all nights for a month. Many people with families don't want to work nights at all, much less do an entire month of nights.

 

[fenixwbp]

In general if you want to work all nights, you could probably pick a job at most groups in the country. As for doing a month of nights, then a month of days, I've never heard of this being done. The problem with transitioning back and forth is that you'd need a core group of doctors willing to do this and work all nights for a month. Many people with families don't want to work nights at all, much less do an entire month of nights.

That's not quite what I meant. My question is about the distribution of shifts over a given month, if one is willing to work all nights. In my hypothetical job. I'm working, say 12 night shifts per month. The question is can I block these together (Ex: 6 nights, 2 off, 6 nights, then 14 off), versus the more typical erratic ER schedule (Ex: 3 nights, 4 off, 2 nights, 4 off, 4 nights, 2 off, 3 nights, 6 off).

I guess the question really comes down to are most ER groups desperate enough for night only docs, that they'll give them significant scheduling priority.


VV Thanks for the Reply.

 

[GeneralVeers]

That's not quite what I meant. My question is about the distribution of shifts over a given month, if one is willing to work all nights. In my hypothetical job. I'm working, say 12 night shifts per month. The question is can I block these together work (Ex: 6 nights, 2 off, 6 nights, then 14 off), versus the more typical erratic ER schedule (Ex: 3 nights, 4 off, 2 nights, 4 off, 4 nights, 2 off, 3 nights, 6 off).

I guess the question really comes down to are most ER groups desperate enough for night only docs, that they'll give them significant scheduling priority.

Yes. A good scheduler should block your night shifts as much as possible to avoid the transitions. I work anywhere from zero to four night shifts per month. When I work the four shifts they are always grouped together with a couple of days off afterwards.

 

[Lysinee]

How realistic is it to find a job where you only work 12 12 hour shifts per month at a hospital group? The total would be 144 hours every month.

 

[deleted65604]

How realistic is it to find a job where you only work 12 12 hour shifts per month at a hospital group? The total would be 144 hours every month.

That is a very common schedule for a small, single-coverage ER- half days, half nights. I just finished a job where that was my schedule for three years, until they ran off one of the 5 ER docs in my group, so we had to work 15 12's for 6 months. I remember complaining to someone about how much I had been working, and they figured out, that I was averaging 40-45 hours a week. They looked at me like I was a big weany. I had to defend myself and explain how hard it was to recover from nights, but I left the conversation a little chagrined at just how spoiled I've become in my old age.

For the last 3 months, I've been working an average of 10 9-hour shifts a month. Yes, you heard that right, I'm averaging less than 25 hours a week. My wife just had a kid and I needed a rest after working 160 hours a month for a few months. Having worked 90 hours a month for a few months, I actually have some amount of compassion leaking back into my soul. It has made me really lazy though, and my wife says I need to work more. Maybe I'll work a few more shifts a month...maybe.

 

[GeneralVeers]

That is a very common schedule for a small, single-coverage ER, half days, half nights. I just finished a job where that was my schedule for three years, until they ran off one of the 5 ER docs in my group, so we had to work 15 12's for 6 months.

Agreed. My group has a number of small(ish) contracts where the docs work 12 hour shifts. It would be very easy to work 12 shifts per month.

 

[Jack is Back]

That is a very common schedule for a small, single-coverage ER- half days, half nights. I just finished a job where that was my schedule for three years, until they ran off one of the 5 ER docs in my group, so we had to work 15 12's for 6 months. I remember complaining to someone about how much I had been working, and they figured out, that I was averaging 40-45 hours a week. They looked at me like I was a big weany. I had to defend myself and explain how hard it was to recover from nights, but I left the conversation a little chagrined at just how spoiled I've become in my old age.

For the last 3 months, I've been working an average of 10 9-hour shifts a month. Yes, you heard that right, I'm averaging less than 25 hours a week. My wife just had a kid and I needed a rest after working 160 hours a month for a few months. Having worked 90 hours a month for a few months, I actually have some amount of compassion leaking back into my soul. It has made me really lazy though, and my wife says I need to work more. Maybe I'll work a few more shifts a month...maybe.

Sounds good to me. Gotta have some balance in life, maybe 25 a week is too little but there are also other things to do with time.

It seems like you can still make a good living at ~30 hrs a week.

 

[Pinner Doc]

Sounds good to me. Gotta have some balance in life, maybe 25 a week is too little but there are also other things to do with time.

It seems like you can still make a good living at ~30 hrs a week.

I'm working 12 8 hour shifts per month. But I'm also studying for boards and training for a marathon, so I feel perpetually busy. It will be nice to have those behind me next month.

I'm also going to pick up a couple of shifts at the local VA, for a total of 14 shifts/month between the two jobs.

 

[Birdstrike]

.

 

[The White Coat Investor]

Due to the intensity of the work, combined with the mental, physical and emotional toll the circadian rythm transitions take on a person, 40 hours per week is the ED is like 60 or more doing anything else. It just is. Having worked many "normal jobs" before Medicine, and a non-EM specialty now, I know this to be undeniable; for myself anyways.

People that don't practice EM just don't get it. It's just a tough specialty. Some people are cut out for it, some aren't.

In my opinion, for EM to "grow up" as a specialty, there should be monthly hour maximums, as well as minimums, patients per hour maximums as well as minumums, mandatory four day breaks after nights before going to days, maximum shift lengths (8 or 9 hr, not 11 or 12), mandatory time and a half for nights/weekends/holidays, mandatory clockwise shift progression (never counter clockwise), and seniority in scheduling.

There should also be formal recognition, in writing, by ACEP and ABEM that failure to follow these policies causes many EM physicians to develop an illness cause Shift Work Sleep Disorder. There needs to be mandatory tracking of the percentage of EM physicians reporting feelings of burnout as well as screening for, and tracking of, EM physicians who have Shift Work Sleep disorder. Groups that have a rate higher than average should be held accountable by reporting these rates to ACEP and ABEM and having to show what they're doing to fix the problem. Those groups that don't should have to compensate their employees/members for failure to follow such guidelines, for what is and should be treated as a work related illness.

With all the obsessing on patient satisfaction and Press Gainey surveys, directing some of these resources to EM physician job satisfaction would be money well spent.

Uhhh.......I disagree. You need to watch out for yourself and your partners. We don't need big brother looking in. Time and a half? From who? You gonna pay yourself time and a half? Guess where that money comes from?

 

[Birdstrike]

.

 

[Jack is Back]

Time and a half from...yes, "each other". The is the same pot of money that night diffs come from. It's not a crazy, or impossible idea. No, it's not a money growing tree. The money comes from the pot from which you pay yourselves. This is how the rest of the world does it. A young single guy might pick up some extra holiday shifts for extr $ so, imagine this, someone with a family gets the day off.

ACEP and ABEM aren't Big Brother (government). They are organizations that represent, and are run by, Emergency Physicians. They are "yourself and your partners". They should work for you, not against you. It wouldn't be insane, for such an organization to acknowledge that there are certain occupational hazards of their field, ie, burnout, Shift Work Sleep Disorder.

Do I suggest a ban on working more than "X" number of hours per month? No. Officially published recommendations? Yes!

You say, "Uh...I disagree", but it seems I'm preaching to the choir since you posted above that your group works 8 hour shift and puts a max of 17 shifts! This needs to be the rule, not the exception. So, it seems you have the luxury of being able to disagree. Unfortunately, there's a lot of groups out there that could care less if someone feels burned out, or has Shift Work Sleep Disorder over "X" number of hours per month. If they need to put you on 200 hr per month indefinitely to get their wait times down to to an arbitrarily chosen number for no reason other than capturing more dollars from non-emergent patients, they will.

These are just some suggestions from a guy who used to be on the inside, but is now "on the outside looking in.". The view is a lot different from outside the fish bowl.

I don't see how ACEP publishing a recommendation would change anything. These matters should be handled independently (group by group or @ an academic center) and even if there was a recommendation, groups are still going to do what they want.

 

[EctopicFetus]

I think some guidelines would be fine. I believe AAEM has a written standard for partnership. That being 1 year. If it isnt written it was told to me by the AAEM president when he came to speak to my residency.

My group is a private community job and we do a few things like mentioned above.

1) We have a night differential
2) We pay 2x on the 5 major holidays (Thanksgiving, Xmas eve, Xmas, NYE, NYD)
3) We have 3 weeks paid vacation every year.

While the money all comes out of the same pot it leads to some improvement in our satisfaction. If I commit to 150 hours a month there are 3 months a year where I will work about ~110 and make the same. Its a nice little break.

The reason ACEP and AAEM cant/wont do this is because if someone works over it could be held agains them in a malpractice case.

 

[EctopicFetus]

FWIW regarding nights. My group has 8 dedicated night docs.. the non night docs only get passed 1-3 nights a month among the 30+ of them which is about 1-2 nights per yr.

 

[Birdstrike]

.

 

[The White Coat Investor]

I don't have a problem with a group deciding to pay a weekend differential, a holiday differential, or a night differential. I prefer to think my ACEP dues are going to weightier matters such as lobbying. We can figure out how to run a group on our own.

For example, the guy who gets the paid vacation. There's really no difference between someone who gets paid $20K every month even though he only works 110 hours 3 months a year and someone who gets paid $22K a month for 9 months a year and then $14K 3 months a year except one of them doesn't know how to budget on an annual basis.

 

[The White Coat Investor]

If they need to put you on 200 hr per month indefinitely to get their wait times down to to an arbitrarily chosen number for no reason other than capturing more dollars from non-emergent patients, they will.

I had a job like this once. They kept sending me to the Middle East too. I decided I didn't want a job like that, so, at the first opportunity, I left. If emergency docs don't join groups like this, groups like this won't have contracts and will cease to exist.

But I don't need ACEP telling me that working 200 hours a month is a bad idea.

 

[manny99]

Can anyone comment on working 24 hr shifts in a rural location?

 

[GeneralVeers]

Can anyone comment on working 24 hr shifts in a rural location?

Can be a pretty nice gig as long as the volume isn't too high. There's a "rural" hospital near our main sites that some of our guys moonlight at. They typically see 15-20 patients in a 24 hour period and usually get a good night's sleep. It will never pay as well as 8-12 hour shifts in a busy ED, but you can work only 6-8 shifts per month and get your hours in.