overnight shift work

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c diddy

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hi everyone. i am finishing up my second year and am new to this forum. as far as i can tell at the moment, er seems the way to go for residency, but one thing i wonder about is the overnight shifts that er docs do in residency and beyond. for those of you having done an er elective/residency already, outside of simply not being bothered by them, were there any specific ways you dealt with flipping back and forth between daytime and nighttime shifts? how did you feel the day following the night shift? also, can anyone tell me, more or less, how many overnight shifts do residents and attendings typically do per week/month? thanks for the feedback.

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overnight shifts are awful for your health. or at least your sanity. switching between days and nights is even worse. think twice about EM (I certainly did) because this will really screw things up for you.

number of overnight shifts will vary for each hospital; attendings' hours will generally vary with things like (1) number of other attendings; (2) seniority; (3) administrative duty [means less shift work]; (4) teaching responsibilities, etc.
 
I don't have a problem with nights but I'm still in my 30s. I hear from the older guys that it gets harder. For me I need to get a good night's sleep and then a little nap in the afternoon before I start a string of nights. I find that helps a lot.
 
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Some programs work on a "progressive schedule", which means your shifts rotate on a circadian rhythm. This is how my future program works, which is one of the reasons I chose it. Basically, we do 2 day shifts, then 2 evening shifts, then 2 overnights, followed by a few days off. Apparently, someone did a study showing that it was better for your health (and sanity).

I worked on this kind of schedule during one of my 4th year rotations, and it was definately easier than the "random shift" schedule (dealt with that on at my 2nd EM rotation). Your sleep cycle adjusts, as you go through the schedule... going to sleep later and waking up later. Regardless, night shifts aren't so bad. You adjust.

As for Md_student's comment about overnights being awful for your health... I think doing the IM/surgery call thing is MUCH worse. Going 24-36hrs without sleep and being expected to care for patients is crazy! Just my humble opinion 😉
 
I'm with Scrubbs...yeah, working overnight sucks, but it is so much better to come in at 11pm and leave at 9 am than to come in at 6 am and leave the next afternoon at 6 pm.
 
I found that on my rotations as a fourth year student, I was the one with the worst schedule in the department. As a student, I was randomly assigned to shifts to try to get me to work with the PD and Dept Chair as much as possible when they were working, and then just working with the best teachers. This ended up being a lot of flipping back and forth. My advice, invest in black-out shades if you get much sun in your room so that you actually can sleep in the middle of the day. It's not so bad, though...definately beats trauma call!
 
As a resident I was on a schedule a lot like Scrubs. I thought it was great. After your second 7am to 3pm shift you didn't have to be back until 3pm the next day so you could stay out late and get some things done the next morning before work so it was almost like having a day off. Then after your second 3pm to 11pm shift you could go to bed, get up and go skiing the next day. Take an evening nap and start your first overnight shift. Again, almost like having a day off. After the second night shift I would try to stay up all day doing something fun, skiing, biking, etc... That way you got a good nights sleep and the next day you were back on a day schedule for your next day off.

As an attending I see alot of different systems. Templates like in residency only with fewer shifts, random (this seems the most painful) and even a few groups in town in which nights are done based on seniority (the older guys work no nights). I only work weekend nights-it fits my lifestyle- so I usually take a nap before my first night, sleep all day saturday, and stay up most of sunday so I can sleep sunday night and get back on a day schedule.

It works for me.
 
Scrubbs makes a good point. The circadian shift approach is pretty nice if you can find it. I worked on that when I was in med school and it really does help.

How does one find residencies that use "circadian" scheduling?
 
I didn't mind the shift work the first few years when I was single and then married without kids. Now that I'm a little older (late 30's), with a family the shift work has just become murder. The above techniques help a little but overall, for me anyways, it's become brutal.
 
And you were in your early 30s when this thread was started!

If you notice, this dude bumped not one but two 8+ year old threads, when there was yet a third one on the same topic, from 4 months ago, which he also bumped.

LOL, I didn't look at the dates. I didn't realize I was responding to the OP who is probably older and more burned out than me now! He's probably an ED directer somewhere explaining the value of 12 hr shifts and door-to-doctor times. :laugh:
 
How does one find residencies that use "circadian" scheduling?

For what it's worth, I know St. Barnabas in the Bronx puts the students on an intentionally circadian rhythm-friendly schedule in the ER. They rotate through weeks of days, evenings, overnights in that order.
 
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Ugh. I have to do my first overnight shift since Jan '10. Luckily, our group has a guy that just wants to do nights, a couple of partners that like to do 2-3/month, and a couple of pre-partners that cover the rest. Since 1 of our pre-partners just made partner, there are a few more overnights that need covering, so I am gonna have to do an overnight once every month or two. Oh the humanity🙄
 
Ugh. I have to do my first overnight shift since Jan '10. Luckily, our group has a guy that just wants to do nights, a couple of partners that like to do 2-3/month, and a couple of pre-partners that cover the rest. Since 1 of our pre-partners just made partner, there are a few more overnights that need covering, so I am gonna have to do an overnight once every month or two. Oh the humanity🙄


wow. where are you in the bay area? I'm looking for a new job. 😀
 
Ugh. I have to do my first overnight shift since Jan '10. Luckily, our group has a guy that just wants to do nights, a couple of partners that like to do 2-3/month, and a couple of pre-partners that cover the rest. Since 1 of our pre-partners just made partner, there are a few more overnights that need covering, so I am gonna have to do an overnight once every month or two. Oh the humanity🙄

You know what's better? working in a large enough group where you never, ever have to do nights, period.

We have enough guys who want to do nights only (7p-4a or 11p-8a), and 2 guys who do a more traditional day/night/evening (all shifts) schedule where the rest of us do days and evenings only (7a-4p, 9a-6p, 3p-mn, or a 10-10 triage shift).

It's nice to be contractually obligated to do ZERO nights and sleep in your own bed every night.

BTW- I'm a hospital employee, 101k vists a year tertiary care center.
 
For the people working a more "traditional" mix, how many overnights are you doing? Like a third of your shifts or something like that.
 
Statistically, unless you have docs that like working nights then you're going to do 1/3 (8 hours)-1/2 (12 hrs) of your shifts at night. We have 1 guy that does nights exclusively and I end up doing ~20% of shifts at night.
 
Statistically, unless you have docs that like working nights then you're going to do 1/3 (8 hours)-1/2 (12 hrs) of your shifts at night. We have 1 guy that does nights exclusively and I end up doing ~20% of shifts at night.

With the 12 shifts/month model. How does a typical months schedule look like?
 
With the 12 shifts/month model. How does a typical months schedule look like?

Not sure if you're assuming those 12 shifts are 8's, 10's, or 12's. Basically, in single coverage (or double coverage without overlapping shifts) ED, there are 3 (viable) ways to break the 24hrs of the day. Doing 24 hr shifts (in which case 100% of the shifts will include an overnight component), doing 12 hours shifts (in which case half of the shifts will be overnight), or doing 8 hour shifts (in which case 1/3 of shifts will be overnight).

If you're working 12 shifts/month then 6 of them are going to be overnights (under the 12hr model) or 4 of them are going to be overnights (under the 8hr model).

There are many EDs that don't staff purely for multiples of 24h worth of coverage. Peak times tend to be in the afternoon/evening and so many shops will have someone covering a "swing" shift sometime between noon and midnight. Then there shops that have overlaps in coverage (including my own) that use 9h, 10h, and 11h shifts in some configuration depending on patient volume over the day. These shops are going to have the majority of their physician hours during peak times, and will usually skimp on overnight coverage (and early morning) due to a drop in patient volume that occurs in most shops between midnight and 2am.

We have five 10-11 hr shifts with start times of 7a, 9a, 11a, 6p, and 9p.
I do 13-16 shifts a month and will typically work 3-4 6p or 9p shifts/month. The guy that does our schedule tends to group your nights into 1-2 blocks, with very few/no isolated nights. Usually there will be two days off after the block, although occasionally we do get stuck with a DOMA.

But I'd advise you (if you're interested in EM) to do an EM rotation where you work overnights as part of the mix since: 1) you'll have to work overnights in residency and 2) not working nights as an attending is going to tremendously limit your options about where you practice. On the other hand, if you love nights then you can usually dictate what schedule you work (no weekends or working the same 3-4 shifts every week).
 
watch out - you'll probably have to take a "pre-partner" job :meanie:

Meh, not so bad. Up to 6 overnights (usually 4-5) per month for 2 yrs, then partnership with obligation as described as above. Every single one of us in our group have done it and somehow survived. At this moment, we have a full group with only 1 pre-partner and a part-timer (who want to be FT when we have opening). We are a pretty good group and treat our "pre-partners" very well. We all do 12-15 eight hour shifts/mo. One of a very few single hospital truly democratic, open book FFS groups in Cali, esp in SF . Practically NO turn-over besides a couple of part-timers that have come and gone. I truly feel lucky to have landed such a great gig. 👍
 
Not sure if you're assuming those 12 shifts are 8's, 10's, or 12's. Basically, in single coverage (or double coverage without overlapping shifts) ED, there are 3 (viable) ways to break the 24hrs of the day. Doing 24 hr shifts (in which case 100% of the shifts will include an overnight component), doing 12 hours shifts (in which case half of the shifts will be overnight), or doing 8 hour shifts (in which case 1/3 of shifts will be overnight).

If you're working 12 shifts/month then 6 of them are going to be overnights (under the 12hr model) or 4 of them are going to be overnights (under the 8hr model).

There are many EDs that don't staff purely for multiples of 24h worth of coverage. Peak times tend to be in the afternoon/evening and so many shops will have someone covering a "swing" shift sometime between noon and midnight. Then there shops that have overlaps in coverage (including my own) that use 9h, 10h, and 11h shifts in some configuration depending on patient volume over the day. These shops are going to have the majority of their physician hours during peak times, and will usually skimp on overnight coverage (and early morning) due to a drop in patient volume that occurs in most shops between midnight and 2am.

We have five 10-11 hr shifts with start times of 7a, 9a, 11a, 6p, and 9p.
I do 13-16 shifts a month and will typically work 3-4 6p or 9p shifts/month. The guy that does our schedule tends to group your nights into 1-2 blocks, with very few/no isolated nights. Usually there will be two days off after the block, although occasionally we do get stuck with a DOMA.

But I'd advise you (if you're interested in EM) to do an EM rotation where you work overnights as part of the mix since: 1) you'll have to work overnights in residency and 2) not working nights as an attending is going to tremendously limit your options about where you practice. On the other hand, if you love nights then you can usually dictate what schedule you work (no weekends or working the same 3-4 shifts every week).

Very useful info, thank you. I plan on doing a few EM rotations. Both are 18 12 hour shifts in a month. Should be tough, but I am looking forward to it. I wish I didn't waste my 3rd elective on radiology :laugh:
 
Meh, not so bad. Up to 6 overnights (usually 4-5) per month for 2 yrs, then partnership with obligation as described as above. Every single one of us in our group have done it and somehow survived. At this moment, we have a full group with only 1 pre-partner and a part-timer (who want to be FT when we have opening). We are a pretty good group and treat our "pre-partners" very well. We all do 12-15 eight hour shifts/mo. One of a very few single hospital truly democratic, open book FFS groups in Cali, esp in SF . Practically NO turn-over besides a couple of part-timers that have come and gone. I truly feel lucky to have landed such a great gig. 👍

I was only poking fun. I agree that there are some great set ups where the buy in is clearly worth the cost, so long as one can commit to the job for the duration. It sounds like you've got one of those. If I'm ever looking for a private job in your area I'd most likely be sending you a PM.😉
 
Meh, not so bad. Up to 6 overnights (usually 4-5) per month for 2 yrs, then partnership with obligation as described as above. Every single one of us in our group have done it and somehow survived. At this moment, we have a full group with only 1 pre-partner and a part-timer (who want to be FT when we have opening). We are a pretty good group and treat our "pre-partners" very well. We all do 12-15 eight hour shifts/mo. One of a very few single hospital truly democratic, open book FFS groups in Cali, esp in SF . Practically NO turn-over besides a couple of part-timers that have come and gone. I truly feel lucky to have landed such a great gig. 👍
👍
 
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