Residencies with predominantly night / 3rd shift hours?

[WanderingDave]

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I'm an MSIII who is leaning toward geriatrics, and as such will probably go for an IM, FP, or Psych residency. I cut my teeth in the healthcare world working at nursing homes and hospitals as a nurse's aide, and it was here that I discovered I'm at heart a creature of the night. I absolutely love working 3rd shift.

My wife and I have settled in the greater NYC area, and this is where we intend to stay for the long run. We also plan on having a child as soon as I get my DO. Based on my previous experience working nights, I found it surprisingly amenable to a good home life. I woke up just when my wife was getting home from her job as a schoolteacher, we had a meal together and took care of any household business, then I went to work and she went to sleep. Then I came home to a quiet house, netsurfed until I got sleepy, and slept. I could see this working very well with kids -- I get up and I'm energetic and refreshed for spending some time with them after they're done with school, rather than tired after a day of work.

Is it at all realistic to find an IM or FP residency in a large metropolitan area whose hours are primarily at night (with long call going into daytime hours, obviously)? I realize that night doctoring jobs are not hard to find once I'm licensed, but could I become Batman again before then, by chance?

 

[gutonc]

I'm an MSIII who is leaning toward geriatrics, and as such will probably go for an IM, FP, or Psych residency. I cut my teeth in the healthcare world working at nursing homes and hospitals as a nurse's aide, and it was here that I discovered I'm at heart a creature of the night. I absolutely love working 3rd shift.

My wife and I have settled in the greater NYC area, and this is where we intend to stay for the long run. We also plan on having a child as soon as I get my DO. Based on my previous experience working nights, I found it surprisingly amenable to a good home life. I woke up just when my wife was getting home from her job as a schoolteacher, we had a meal together and took care of any household business, then I went to work and she went to sleep. Then I came home to a quiet house, netsurfed until I got sleepy, and slept. I could see this working very well with kids -- I get up and I'm energetic and refreshed for spending some time with them after they're done with school, rather than tired after a day of work.

Is it at all realistic to find an IM or FP residency in a large metropolitan area whose hours are primarily at night (with long call going into daytime hours, obviously)? I realize that night doctoring jobs are not hard to find once I'm licensed, but could I become Batman again before then, by chance?

In a word, No.

After intern year, FM and Psych are primarily outpatient (Psych after 2nd year actually) residencies and there aren't too many academic primary care or psych clinics open at 3am. IM residencies have more inpatient duties but somebody still has to cover the daytime and even in programs with night float (close to 100% by July 2011 when the new work hour rules come into place), it only takes 1-3 people to cover at night what 10-20 people deal with during the day so daytime personnel needs are much higher. Add on required things like subspecialty months (usually consults/clinic) and outpatient primary care, and you're likely to do 1-3 months of nights per year at the most. There's also the didactic component to think about. You'll be required to attend a certain # of morning reports, Grand Rounds, noon conferences, etc (depending on how the program is set up) which generally happen, you know, at noon and in the morning.

 

[michaelrack]

Is it at all realistic to find an IM or FP residency in a large metropolitan area whose hours are primarily at night (with long call going into daytime hours, obviously)?

no

 

[Law2Doc]

I'm an MSIII who is leaning toward geriatrics, and as such will probably go for an IM, FP, or Psych residency. I cut my teeth in the healthcare world working at nursing homes and hospitals as a nurse's aide, and it was here that I discovered I'm at heart a creature of the night. I absolutely love working 3rd shift.

My wife and I have settled in the greater NYC area, and this is where we intend to stay for the long run. We also plan on having a child as soon as I get my DO. Based on my previous experience working nights, I found it surprisingly amenable to a good home life. I woke up just when my wife was getting home from her job as a schoolteacher, we had a meal together and took care of any household business, then I went to work and she went to sleep. Then I came home to a quiet house, netsurfed until I got sleepy, and slept. I could see this working very well with kids -- I get up and I'm energetic and refreshed for spending some time with them after they're done with school, rather than tired after a day of work.

Is it at all realistic to find an IM or FP residency in a large metropolitan area whose hours are primarily at night (with long call going into daytime hours, obviously)? I realize that night doctoring jobs are not hard to find once I'm licensed, but could I become Batman again before then, by chance?

My experience is that if you make it known to your chiefs that you are amenable to additional blocks of night float, they probably will give you a larger helping. But I would suggest that your schedule isn't going to be as amenable to a good homelife as you might think -- you are picturing something with much better hours. A typical night float schedule for an intern might start at 5pm, and typically will run until somewhere around 7am. But you may not be able to leave at 7am -- you might be needed to help round on the patients, or might be locked into mandatory morning lecture, or clinic hours (up until the maximum 16 hours in a row now permitted). So for example you might have to leave your house at 4:30 pm to be there at 5pm, so no "having a meal together" with your spouse. Then you might be running around putting out fires and be on your feet all night until the team relieves you at 7am. Then you might be stuck there another 1-2 hours, and get home, exhausted, at about 9am. So you eat breakfast and climb into bed by 9:30. Get 6 hours of sleep, that puts you at 3:30pm. But remember, you leave the house again at 4:30. So you have a half hour to get ready, wolf down some "lunch" and have your couple of minutes of home life. There will be no tending of household business, very little playing with the kids with this schedule. Your spouse will be someone you briefly pass on the way out the door each day. A lot of us liked night float because you got a lot of independence, and in the wee hours of the night things sometimes (but not always) were a bit slower than during the daylight hours. But on the flip side, you pretty much don't see your family because your hours don't really overlap.

 

[turquoiseblue]

if you do a residency with nightfloat, you will see the night hours daily for only 1-2 months in the year. if you do a residency with regular call hours, such as q4 q3, etc, you will see the night time more frequently--every few days, and you will be on call all day that day so it wont be just an overnighter, it will be an all day-er too. take your pick!

have you ever thought about going into sleep medicine? i think they work predominantly at night.

 

[peppy]

There are EM attendings who do only night shifts, but in residency even EM residents will work all different shifts and you may not see your family that much.
Of course, many programs across the specialties will be changing their schedules next year due to new work hour requirements, but I still don't think there will be any primarily nocturnal residencies.
Really, if you want to have the most time with your family, your best bet is probably to just try to find the programs with the lowest amount of call and lowest service demands. There are some psych programs where the hours are 8am-5pm most of the time with little call. That's probably the best you can hope for. For example, if I recall correctly the Psych program at University of Rochester in NY has no *overnight* call at all but does have their residents take "short call" until midnight about once a week.

 

[core0]

If you do medicine you can pick up a nocturnist job as a hospitalist pretty easily. Still have to do the daylight hours during residency though.

 

[Winged Scapula]

Agree with the others.

This is a pretty unrealistic plan for residency. If there is one word to describe most residencies, especially internship, it is unpredictability. As noted, FP is mostly outpatient and even residencies with night "shifts" will require that you do some daytime work.

Once you've finished you can design your career however you like it, although again, FM is not really conducive to a night career unless you can find a hospitalist position.

 

[SoCuteMD]

If you do medicine you can pick up a nocturnist job as a hospitalist pretty easily. Still have to do the daylight hours during residency though.

I don't know what it's like other places, but the overnight hospitalists at my program's hospital work 6p-6a. Still not conducive to much of a family life post-residency. Of course, they only work 3 nights a week, but still. Probably explains why most of them are grads of our residency program in between residency and fellowship.

 

[danielmd06]

have you ever thought about going into sleep medicine? i think they work predominantly at night.

This is completely wrong! First, sleep medicine is a fellowship...not a residency. The OP would still be required to complete a residency prior to applying for SM. Secondly, we work during the day (not night) reading PSG's, MSLT's, MWT's, and in seeing patients in daytime clinics. I believe you're thinking of the sleep laboratory, in which patients spend the night (sleeping) as their polysomnograms are recorded.

We take night-call to cover the sleep labs, but otherwise work exclusively during daylight hours.

 

[45408]

My experience is that if you make it known to your chiefs that you are amenable to additional blocks of night float, they probably will give you a larger helping. But I would suggest that your schedule isn't going to be as amenable to a good homelife as you might think -- you are picturing something with much better hours. A typical night float schedule for an intern might start at 5pm, and typically will run until somewhere around 7am. But you may not be able to leave at 7am -- you might be needed to help round on the patients, or might be locked into mandatory morning lecture, or clinic hours (up until the maximum 16 hours in a row now permitted). So for example you might have to leave your house at 4:30 pm to be there at 5pm, so no "having a meal together" with your spouse. Then you might be running around putting out fires and be on your feet all night until the team relieves you at 7am. Then you might be stuck there another 1-2 hours, and get home, exhausted, at about 9am. So you eat breakfast and climb into bed by 9:30. Get 6 hours of sleep, that puts you at 3:30pm. But remember, you leave the house again at 4:30. So you have a half hour to get ready, wolf down some "lunch" and have your couple of minutes of home life. There will be no tending of household business, very little playing with the kids with this schedule. Your spouse will be someone you briefly pass on the way out the door each day. A lot of us liked night float because you got a lot of independence, and in the wee hours of the night things sometimes (but not always) were a bit slower than during the daylight hours. But on the flip side, you pretty much don't see your family because your hours don't really overlap.

I get more tired reading your descriptions of how horrible life will be as a resident than I actually do as a surgery resident.

 

[Law2Doc]

I get more tired reading your descriptions of how horrible life will be as a resident than I actually do as a surgery resident.

I don't think I ever suggested life was horrible in the quoted post. I actually said "A lot of us liked night float..."

But I did suggest that OP was being naive in thinking that night float was a few chill hours late at night and then home to websurf and have a nice early evening with the spouse. I stand by that assertion.

 

[45408]

I don't think I ever suggested life was horrible in the quoted post. I actually said "A lot of us liked night float..."

But I did suggest that OP was being naive in thinking that night float was a few chill hours late at night and then home to websurf and have a nice early evening with the spouse. I stand by that assertion.

Here:

Then you might be running around putting out fires and be on your feet all night until the team relieves you at 7am. Then you might be stuck there another 1-2 hours, and get home, exhausted, at about 9am.

Putting out fires = ordering Benadryl, morphine, and the occasional EKG?

Get 6 hours of sleep, that puts you at 3:30pm. But remember, you leave the house again at 4:30. So you have a half hour to get ready, wolf down some "lunch" and have your couple of minutes of home life. There will be no tending of household business, very little playing with the kids with this schedule. Your spouse will be someone you briefly pass on the way out the door each day.

Telling him that as a resident, he'll have half an hour of free time and see his wife as he walks out the door? Yeah, that's what I'm talking about.

 

[Law2Doc]

Here:

Putting out fires = ordering Benadryl, morphine, and the occasional EKG?


Telling him that as a resident, he'll have half an hour of free time and see his wife as he walks out the door? Yeah, that's what I'm talking about.

Have you done night float? The schedule is pretty much as I've described. A lot less overlapping time with family than you have during day shifts. Not much more to say about it.

And by putting out fires, I mean patients circling the drain, not stupid "can this patient have a Tylenol" calls. You will have nights where folks aren't cooperating and staying alive, and you spend the night running from one room to the next, your pager going off hourly. We all have those nights.

But I didn't say any of this was horrible. It just is what it is. I actually said a lot of us kind of liked aspects of it. Horrible is apparently your own conclusion. I did, however say OP's notions of how it is going to pan out in terms of time for other things are wrong, and I stand by that.

 

[45408]

Have you done night float? The schedule is pretty much as I've described. A lot less overlapping time with family than you have during day shifts. Not much more to say about it.

No, we have in-house call, and since it's surgery, there are no "clinic" months. Unless you're working 98-116 hours/week (7*14 or 7*16) on night float, you've grossly exaggerated to this guy what kind of hours he would be doing on night float.

And by putting out fires, I mean patients circling the drain, not stupid "can this patient have a Tylenol" calls. You will have nights where folks aren't cooperating and staying alive, and you spend the night running from one room to the next, your pager going off hourly. We all have those nights.

Sure, it happens at times, but SDN (including your prior posts here) often make it sound like a resident's call room is covered in dust from disuse, and in between doing chest compressions (and shacking up with nurses in the utility rooms), you may be able to go to the bathroom once in a 30-hour shift.

 

[Law2Doc]

No, we have in-house call, and since it's surgery, there are no "clinic" months. Unless you're working 98-116 hours/week (7*14 or 7*16) on night float, you've grossly exaggerated to this guy what kind of hours he would be doing on night float.


Sure, it happens at times, but SDN (including your prior posts here) often make it sound like a resident's call room is covered in dust from disuse, and in between doing chest compressions (and shacking up with nurses in the utility rooms), you may be able to go to the bathroom once in a 30-hour shift.

Most night floats aren't 7 days a week, they are six. Getting 4 days off a month is mandatory under the ACGME rules. 6 * (13 to 14) is going to put you at about 80, at least on paper. Whether you actually get out the door or not is going to depend on the program. I don't think I said anything about clinic months. I did say that some places/specialties have clinic hours (often on a weekly basis) you are obligated to go to if you aren't over your hours. Eg some places have clinic hours on say, Tuesday morning from 8-12 that residents on certain rotations are obligated to go to. Again, I don't think I've grossly exaggerated anything -- I've given an example of a schedule I actually lived.

As for the resident call room, bear in mind that some programs don't consider it appropriate for folks to sleep while on night float. Night float is different than call -- you have a shorter shift with supposedly ample time to sleep once you leave the hospital. You aren't in the hospital for 30 hours, you are in the hospital for about the same number of hours as the folks during the day, so there is an expectation that you will use the "at least 10 hours away from the hospital" to get your sleep, just like if you were working during the day. That's the one advantage of the call system you are working under -- since you are there for a longer shift it's not unheard of or unexpected for folks to go to sleep when it gets quiet. But yes, if you are on night float, the expectation in terms of using the call room is very different, and attendings are going to be annoyed with you if they call in and you are napping. You are given a list of tasks by the day team to handle, and are expected to round on all the patients periodically, as well as field various calls/consults. Sometimes this can be done quickly, and you can steal a nap. Most often it cannot because the expectation of the night float person is greater than the expectation of the overnight call person.

I'm sure a lot of this depends on the patient load carried, but I wouldn't expect to come home from a night of night float well rested and ready to enjoy the day. I have had that experience after an overnight call though. Very different systems.

 

[Llenroc]

I did one month of ER as a resident and it was utterly ****. They stuck me with a bunch of night shifts. Virtually all night shifts.

I thought that maybe they just screw the outside residents, but I looked everyone's schedule and predominantly ER work happens at nighttime. The busiest times are the best times of Friday and Saturday night, which also when the demand is greatest for labor. Hardly anybody comes into an ER at 1 p.m.

So if you like working at night, look at Emergency Medicine.