question about night work

[Ttan]

I know pure CC has a huge variation in how it's worked with regard to shifts etc.

What kind of night work is required from average community ICU's? I don't mean the huge academic places where **** is always going down. How does it pan out? Is it mostly day work then you're on call with NP support at night? Is that how 7 on 7 off works? In a situation like this, are you able to stay out of the hospital at night and just come in when you need to?

Is it possible to be an intensivist and not have to shift your circadian rhythm around all the time like an ER doc?

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[jdh71]

I know pure CC has a huge variation in how it's worked with regard to shifts etc.

What kind of night work is required from average community ICU's? I don't mean the huge academic places where **** is always going down. How does it pan out? Is it mostly day work then you're on call with NP support at night? Is that how 7 on 7 off works? In a situation like this, are you able to stay out of the hospital at night and just come in when you need to?

Is it possible to be an intensivist and not have to shift your circadian rhythm around all the time like an ER doc?

I would say no.

You can find outliers jobs but in general a place busy enough to employ/need intensivist coverage for a "night shift" will be busy. Plan to work.

 

[Ttan]

I would say no.

You can find outliers jobs but in general a place busy enough to employ/need intensivist coverage for a "night shift" will be busy. Plan to work.

No no. I mean if you are strictly an intensivist (not pulm/cc) is it possible to be a day worker who takes call and the call isn't brutal enough that you actually sleep at home and just come in when needed.

An intensivist who never has to take 12 hour "night shifts," but doesn't mind being on home call.

 

[jdh71]

No no. I mean if you are strictly an intensivist (not pulm/cc) is it possible to be a day worker who takes call and the call isn't brutal enough that you actually sleep at home and just come in when needed.

An intensivist who never has to take 12 hour "night shifts," but doesn't mind being on home call.

And I answered. Anywhere busy enough to pay for a real deal intensivist to cover nights will almost surely have you working nights too.

 

[Ttan]

And I answered. Anywhere busy enough to pay for a real deal intensivist to cover nights will almost surely have you working nights too.

So it's not possible to be an intensivist who doesn't have to flip circadian rhythms around?

 

[jdh71]

So it's not possible to be an intensivist who doesn't have to flip circadian rhythms around?

In most jobs? No. Which isn't to say you might not find one but I wouldn't count on it.

 

[Ttan]

In most jobs? No. Which isn't to say you might not find one but I wouldn't count on it.

Thanks so much for the replies.

Is the amount of work at night at these community places substantial enough that you have to change your circadian rhythm to run around all night long?

Or is it an issue where when something goes down you need to be right there to address it?

 

[jdh71]

Thanks so much for the replies.

Is the amount of work at night at these community places substantial enough that you have to change your circadian rhythm to run around all night long?

Or is it an issue where when something goes down you need to be right there to address it?

These are the sickest of the sick. They need a DOCTOR. You don't treat them from your bed by phone. You need to see your patient.

 

[Ttan]

These are the sickest of the sick. They need a DOCTOR. You don't treat them from your bed by phone. You need to see your patient.

When you are on nights, do you handle it with naps at night and additional naps in the day PRN? Or do you have to switch over your rhythm to remain awake all night long?

How busy in general will it keep you going, in an average place on an average night?

 

[jdh71]

When you are on nights, do you handle it with naps at night and additional naps in the day PRN? Or do you have to switch over your rhythm to remain awake all night long?

How busy in general will it keep you going, in an average place on an average night?

3-5 admits per night depending on when they come in may have you up all night or it might not. I try and sleep at night between. I sleep long during the day. I usually do not do more than 4 nights in a row, if I do a whole 7 in a row, I've usually flipped by the end.

 

[Ttan]

3-5 admits per night depending on when they come in may have you up all night or it might not. I try and sleep at night between. I sleep long during the day. I usually do not do more than 4 nights in a row, if I do a whole 7 in a row, I've usually flipped by the end.

I see thanks for the perspective. What type of ICU and how large are you at?

 

[G-Man82]

I'm academic Anesthesiology and critical care physician, but we, along with some pulmonologists and surgeons run a teleICU that covers some community hospitals about 300 miles away within the state remotely.

There's always something happening. Admissions. Codes. And at those regional hospitals, getting lines, hemodialysis, or securing airways doesn't always happen because the in-house provider, usually EM on duty in their ED, or occasionally a surgeon can't always come right away. Surgical volume isn't high enough to warrant an in-house Anesthesiologist, who at one of the other hospitals is the one I call for lines and airways etc.

An Intensivist presence, or at least an NP/PA trained to place lines and intubate, would make the care at that hospital so much better.


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[engineeredout]

An Intensivist presence, or at least an NP/PA trained to place lines and intubate, would make the care at that hospital so much better.

Is the issue at those hospitals that they can't afford an intensivist or that they can't find one?

Or the volume doesn't warrant it?

 

[sluggs]

38 bed community ICU. Week of days, week off. Week of nights week off. Our group takes the 16-18 sickest plus night admits. Nights are busy.
Week of nights = WORK 7p-7a. gym 730 am-8:30 am (or straight home to bed). 1 ambien, 2 melatonin, 1 black Russian, 7 hours sleep. Repeat x7!

 

[NRAI2001]

38 bed community ICU. Week of days, week off. Week of nights week off. Our group takes the 16-18 sickest plus night admits. Nights are busy.
Week of nights = WORK 7p-7a. gym 730 am-8:30 am (or straight home to bed). 1 ambien, 2 melatonin, 1 black Russian, 7 hours sleep. Repeat x7!

With the week on and week off model (similar to hospitalists) what is a reasonable compensation/pay? I ve been trying to get a general idea about this but its hard to get an answer? I don't need specifics but what is considered average?

 

[G-Man82]

Is the issue at those hospitals that they can't afford an intensivist or that they can't find one?

Or the volume doesn't warrant it?

I'm not really sure. The volume seems ok. At the one where I call my Anesthesia colleagues for ICU procedures, the unit is run by IM Hospitalists who call a CCM consult, which right now is PP Pulm/CCM. That hospital just announced its asking us (the academic service) to staff the ICU. So that will change. It will be a mixture of anesthesiologists and pulmonologists in the unit during the day time with teleICU coverage at night with NP/PA service to do the admits ("staffed" by the TeleICU attending) and procedures at night.

The other one? A community / regional hospital. I know they're having trouble finding intensivists. The level of care there is below what I'm used to. I think the teleICU presence actually improves the care of those patients, but it drives me nuts that I, at 200 miles distance over videophone, catch and fix a ton of their BS. It's good for those patients but it doesn't give me a good impression of the way community hospitals handle their ICUs.


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[engineeredout]

I'm not really sure. The volume seems ok. At the one where I call my Anesthesia colleagues for ICU procedures, the unit is run by IM Hospitalists who call a CCM consult, which right now is PP Pulm/CCM. That hospital just announced its asking us (the academic service) to staff the ICU. So that will change. It will be a mixture of anesthesiologists and pulmonologists in the unit during the day time with teleICU coverage at night with NP/PA service to do the admits ("staffed" by the TeleICU attending) and procedures at night.

The other one? A community / regional hospital. I know they're having trouble finding intensivists. The level of care there is below what I'm used to. I think the teleICU presence actually improves the care of those patients, but it drives me nuts that I, at 200 miles distance over videophone, catch and fix a ton of their BS. It's good for those patients but it doesn't give me a good impression of the way community hospitals handle their ICUs.


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I'm curious about how the tele ICU works. Are you a standby consultant for if they have any particular issues/patients to discuss that they don't feel like they can handle? Do you go over all admissions with the mid levels you mentioned who are doing them? It isn't going through full rounds on all the patients right?

Are you paid a flat rate for being available or do you get paid per call/per minute? Do you do this from home?

Sorry for all the questions, I'm just very curious about this. I have a rudimentary understanding of the teleER doctor but didn't know this even existed until recently

 

[G-Man82]

I'm curious about how the tele ICU works. Are you a standby consultant for if they have any particular issues/patients to discuss that they don't feel like they can handle? Do you go over all admissions with the mid levels you mentioned who are doing them? It isn't going through full rounds on all the patients right?

Are you paid a flat rate for being available or do you get paid per call/per minute? Do you do this from home?

Sorry for all the questions, I'm just very curious about this. I have a rudimentary understanding of the teleER doctor but didn't know this even existed until recently

New admits - the midlevel calls me if I haven't already seen the patient. My note is very brief. Essentially I am to help put out fires.

I'm salaried in academics, so doesn't matter how many calls I get from the in-house staff.

I triage the patients and usually if the in-house attending needs to go in, it's because I called them and said that SHTF and their presence is needed. When I'm the in-house attending, I sign out to the teleICU and that saves me a ton of phone calls at night unless I need to go in.


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