nights... seriously

[domer621]

I did a search and didn't really find any helpful threads. I'm hoping the more experienced EM docs can chime in on this. Right now, I'm fine with the day-night transition with 12 hour shifts at the ripe age of 24. How tough does it get when you're in your 40s and 50s? Do most of you end up working less nights as you gain more experience in the field?

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[Apollyon]

I'm 37 and do 1 night every week as an attending. It's fine for me, but I don't have much going on at home.

As for less overnights as you get older, that's group-dependent.

 

[deleted6669]

I work more nights than anyone else in my group. cooler stuff happens at night with less b.s. and more money can be made as we get a night differential.
flip/flopping day/nights isn't fun. I tend to work a block of nights and have a day or 2 off before returning to days.

 

[DrQuinn]

I'm only two years out, 30 years old. No problem with nights. Our most senior peeps don't do night, so their shifts are either 7a-3p or 3p-11p.

I actually don't mind nights, it tends to be a little more relaxing and a lot less loud.

Q

 

[BKN]

I did a search and didn't really find any helpful threads. I'm hoping the more experienced EM docs can chime in on this. Right now, I'm fine with the day-night transition with 12 hour shifts at the ripe age of 24. How tough does it get when you're in your 40s and 50s? Do most of you end up working less nights as you gain more experience in the field?

I'm 57 and have been doing this for 30 years. There's no question that it gets much harder.

There have been several older studies from Scandanavia documenting shift work as a major cardiac risk factor. More recent work suggests that this finding was confounded by social class status and may not have been real.

In our group we have several senior docs. We've held ourself to doing the same proportion nights as the younger guys. But since we mostly have significant administrative/teaching/research duties our number of shift and thus night shifts is lower.

p.s. another tip Most people set their sleep time back 90 minutes each time they work all night and sleep during day. So work 1 night shift at a time or no less than 3 weeks. Either reset your circadian rhythm completely or not at all. If working the 1 night shift pattern, try for 8 hours (midnight - 8). Sleep 2-3 hours before the shift and go to bed directly after for about 5-6. Then you'll be able to sleep almost at the regular time that night and won't really reset.

 

[Flopotomist]

I wonder if there are any people who prefer exclusive nights, and continue to have this preference when they are older. I am only a med student now, but MUCH prefer nights, and would LOVE to work exclusively at night. I am 33, and in my previous lives before medical school usually had swing or night shift jobs. I can't seem to get on the "day schedule" no matter how hard I try. Am I a weirdo? Will this last?

 

[deleted6669]

I wonder if there are any people who prefer exclusive nights, and continue to have this preference when they are older. I am only a med student now, but MUCH prefer nights, and would LOVE to work exclusively at night. I am 33, and in my previous lives before medical school usually had swing or night shift jobs. I can't seem to get on the "day schedule" no matter how hard I try. Am I a weirdo? Will this last?

I prefer nights. this maximizes time with my family. I work while they sleep. they go to school while I sleep. nights pay more for fewer pts/hr with a more interesting mix of pts so I can work fewer shifts than my day only colleagues for the same $.

 

[vtucci]

I'll be 32 in August and also prefer nights. The most refreshing weeks of 3rd year were my week of nights on OB and my night and overnight shifts on emergency med.

I would love to work only night shifts. I think it is the day-night-overnight transition that is more of a problem.

Are there often programs that object to having a doc work only nights or overnights (i.e., no day shifts)? I assumed that this would be more sought after in a candidate and understand that there is often a shift pay differential for the overnights.

 

[AmoryBlaine]

I wonder if there are any people who prefer exclusive nights, and continue to have this preference when they are older. I am only a med student now, but MUCH prefer nights, and would LOVE to work exclusively at night. I am 33, and in my previous lives before medical school usually had swing or night shift jobs. I can't seem to get on the "day schedule" no matter how hard I try. Am I a weirdo? Will this last?

I'll be 32 in August and also prefer nights. The most refreshing weeks of 3rd year were my week of nights on OB and my night and overnight shifts on emergency med.

I would love to work only night shifts. I think it is the day-night-overnight transition that is more of a problem.

Are there often programs that object to having a doc work only nights or overnights (i.e., no day shifts)? I assumed that this would be more sought after in a candidate and understand that there is often a shift pay differential for the overnights.

Seeing as how you are both medical students I don't think enjoying nights makes you a "weirdo" but I do doubt that it will last for an entire career.

32 is still young, it impossible to know how working nights will affect you in 10-20 years.

If by "programs" you mean residency programs then my guess would be no. Maybe certain groups would be looking for a night person but some of the attendings would have to speak to that.

 

[spyderdoc]

Our group is lucky. We have a guy that just wants to do all nights. So that makes it so we each do 1 night shift/mo for most months, and an occasional month with 2....Can't complain one bit!

 

[Ed Bob]

Long-time lurker here...
I'm an MS3 starting to think about specialties. EM seems like an appealing field to me in many ways, but I'm a little unsure about what working shifts might do to me over the long run. I am well aware that the schedules of many or all specialities are not ideal, but I think its hard to grasp what shift work really feels like without doing it for a while.

please forgive my ignorance, but a couple of questions...

1) I've seen several papers suggesting that working nights and shift work leads to higher rates of depression, heart disease, and cancer. Some early studies suggested that shift work was as dangerous as smoking a pack of cigarettes per day. I've also seen studies suggesting that some of these studies are full of confounding and that the link between shift work and disease is not strong. Any thought or comments would be appreciated. Do you feel that shift work wears on your health, the health of your older colleagues?

2) What percentage of all shifts are day vs night. Ie three doctors work during day but only one at night. Do you need less doctors at night or does the staffing have to be pretty even? In a given month, how many night shifts do you have to work?

Thanks

 

[diphenyl]

I'm 3 years out and I much prefer nights. In fact it's a rare occasion where I work mornings. Our shifts are 10 hrs starting at 9 or 10 pm. I may nap for 1-2 hrs before a shift, go to work, go right to bed until 4 or 5 pm. It does get draining after a while. I like to cluster them together 4-5 in a row then have 3 off. I love it at night, sometimes we just get slammed especially around 1 am and 5 am. 5 am seems to be the STEMI hour. I prefer the night hours; you don't have much competition for the interesting patients, some of the BS complaints die down.

 

[The White Coat Investor]

Hate nights? Only join a group with a big night differential or a couple of nighthawks. At my place, all the nights but 1-4 a month are covered by 2 docs.

 

[southerndoc]

I work 50% nights (by choice). My ED is pretty weird -- it's actually busier during the night than during the day.

 

[vtucci]

I wonder if there are any people who prefer exclusive nights, and continue to have this preference when they are older. I am only a med student now, but MUCH prefer nights, and would LOVE to work exclusively at night. I am 33, and in my previous lives before medical school usually had swing or night shift jobs. I can't seem to get on the "day schedule" no matter how hard I try. Am I a weirdo? Will this last?

Amory- certainly 32 and 33y.o. are not the same as our colleague BKN at 57 but I would submit it is still very different than the OP's 24years for our circadian rhythms. The switching is what kills most of us.

I prefer working exclusively nights and feel much better when I do so (regardless of number of hours- i.e., I would rather work a 12 hour night shift 12-12 or 7p-7a than 8 hour day 7a-3p). As many docs have families including residents, anyone ever heard of a resident volunteering to work nights only? Would they ever let you do that in residency? I am sure most people would rather work days but I say keep me on night indefinitely (even on off-service rotations I would be cool with that).

 

[Powdermonkey]

But would working all nights put you at a disadvantage to the number of patients you see, or the amount of teaching that would be available for you to take in?

 

[wkv2101]

I'm thinking about EM, but I really don't like working nights. I know there are some jobs where you can avoid them.
Can you trade to get nights off? Could I switch two of my nights for three of someone else's day shift? I'd be more than happy to work an extra 8 hour day shift to avoid the night shifts.
Thx

 

[Jeff698]

I'm 40 and in my first year out of residency.

Nights suck. I do 12 hour shifts (which, BTW, also suck) and the turn around is painful.

If I have a long string of nights, I switch over after about the third shift and am OK until I have to switch again. It's the switch that hurts.

I'm lucky in that our small group of 5 has 2 docs that prefer nights and volunteer to take the majority of them. I'l do about 4-5 nights out of 12-14 shifts a month.

I was a paramedic in my younger days and don't remember having this much trouble with nights. Granted, I was younger and the shifts were different, as was the job. I'd like to be able to say it was just a different job instead of age but I suspect time is having an effect that will only get larger.

Take care,
Jeff

 

[Midwest Medic]

I am 30 and this is my first year out of residency. I hate nights. Luckily the group that I am in has 2 guys who do only nights at one of our hospitals. I do have to work an occasional night at the other place though, and usually do 2 or 3 in a row when I do them. I don't find it that hard right now to switch between the two, but it definitely was easier in internship to do them...

 

[roja]

Depends on the person. I am 36. I have ALWAYS hated nights. I have friends in thier 20's who hate nights. I am much more rigid about how I approach nights to make it not so bad. No job is perfect...

I have friends between 30-50 who are just night people and love it.

 

[turtle md]

I'm thinking about EM, but I really don't like working nights. I know there are some jobs where you can avoid them.
Can you trade to get nights off? Could I switch two of my nights for three of someone else's day shift? I'd be more than happy to work an extra 8 hour day shift to avoid the night shifts.
Thx

I'll swap with you...

 

[wkv2101]

Thanks turtle, I want to join your group after residency
What about urgent care centers? I hear they are often staffed by ER docs and it doesn't seem like they are open at night. Would that be a way to avoid nights?

 

[howelljolly]

I worked nights for two years straight when I was a medic (six 8-hour shifts every week), in my early 20s. I never fully adjusted to it. Now as a med student, I don't adjust to nights well either. I think I need sunlight.

 

[3rdJob]

I second many of the opinions here. I'm 45, and actively like nights. Way cooler stuff comes in on a night shift. It also fits in with the family schedule in a more convenient fashion. When I'm working the family is asleep, when I'm asleep, they're at school. When they get home, I'm up and get to spend a few hours (and usually have dinner) with them, Works well for me. AND.... your colleagues will LOVE you if you want to exclusively do nights like some folks in my group do. I however, do not exclusively do nights as it can be more difficult to trade shifts.

 

[howelljolly]

Thanks turtle, I want to join your group after residency
What about urgent care centers? I hear they are often staffed by ER docs and it doesn't seem like they are open at night. Would that be a way to avoid nights?

Yes, but it would also be a way to avoid getting paid

 

[bartleby]

The number of night shifts you're expected to do is highly variable between groups. I am assigned only four nights per academic quarter. Two of our docs prefer doing nights, so I am usually able to trade away another two nights. I usually do the two nights which are left over in a block in order to minimize my day night transitions.

In my opinion, a good deal of your comfort with nights relates to your innate schedule preferences (night owls versus morning larks). Very few of the people I know in EM who are up and raring to go at seven am (even when it's a day off) are fans of working the night shift. Based on my own preferences, I would much rather work evenings than days as a consequence.

I enjoy working nights, and find the nurses and tech who work third shift to some of the most entertaining people, but with academic duties that happen on a daytime schedule, it is very difficult to work nights and keep up.

 

[Kasey]

I'm personally curious about the # of night shifts during residency. I was under the impression (from the places I've rotated through) that in most programs roughly 1/3 of your shifts were night (basically a 1/3 days, 1/3 mids, 1/3 nights schedule) but a program I interviewed at last week has fully 1/2 of the shifts as night shifts. Is this common?

 

[bartleby]

It depends. If a program does 12 hour shifts, then 1/2 will be overnights. If you do 8-9 hour shifts typically 1/3 will be nights unless there is a gap in coverage which causes a change in this distribution.

a program I interviewed at last week has fully 1/2 of the shifts as night shifts. Is this common?

 

[xaelia]

Our shift coverage matches patient volume; most of our shifts will be afternoon, evening, or late evening shifts. I think it works out to about 1/5th being that ghostwalker 10pm to 8am shift.

 

[tonem]

I agree with most of what's been said so far. I'm 44 and work nights exclusively. I think most groups tend to love having people willing to work all overnights because it makes life easier for everyone else. There is usually some form of compensation associated with it as well...either more pay, less hours, or the ability to make your own schedule.

 

[wkv2101]

"It depends. If a program does 12 hour shifts, then 1/2 will be overnight."
Is this true when one is an attending? In most groups?
I only ask b/c in my ER rotation the 12 hour shifts for attendings were 7a-7p, 11am-11pm and 7p-7a. I assumed they were on 1 in 3 nights, but never really asked.