dchristismi

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We do 8s:

7a-3p
9a-5p
1p-9p
3p-11p
5p-1a
9p-5a
11p-7a

I love the 8s - have gotten very spoiled and wouldn't want to go back to longer.
 

Arcan57

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7-5, 9-8, 1-11, 7-6, 10-8. Elevens leave your head foggy, twelves are mostly incapacitating for activities afterwards.
 

bronx43

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We do 8s:

7a-3p
9a-5p
1p-9p
3p-11p
5p-1a
9p-5a
11p-7a

I love the 8s - have gotten very spoiled and wouldn't want to go back to longer.
So, do you work 5 days a week, instead of 3-4? I'm not a practicing EM physician, but I would think that I'd rather do 3 days of 12 hrs than 5 days of 8 hrs.
 

docB

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I do mainly 9s and 10s.

So, do you work 5 days a week, instead of 3-4? I'm not a practicing EM physician, but I would think that I'd rather do 3 days of 12 hrs than 5 days of 8 hrs.
As Arcan mentioned earlier. 12s pretty much kill you for anything else. When I did 12s, even when I was younger, it became work, sleep, work, sleep, work, sleep. That really starts to grind quickly.

Like DrC said, I wouldn't want to go back to 12s, I like my 9s and I keep pushing my group for 8s.
 

BlondeCookie

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So, do you work 5 days a week, instead of 3-4? I'm not a practicing EM physician, but I would think that I'd rather do 3 days of 12 hrs than 5 days of 8 hrs.

I would rather do 3 days of 12hrs instead of 5 days of 8hrs, but what hospital gives you that choice? Wouldn't you have to do 4 days of 10hrs to equal 5 days of 8hrs? 3 days of 12hrs only gives you a total of 36 total work hours.
 

Arcan57

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There are plenty of rural (and some lower volume urban/suburban) hospitals that do predominantly 12's. The choice may depend on what your hobbies/family issues are. If you like 3-4 day weekends to go on camping trips, travel, etc. then 12's make sense. If there's an activity you indulge that requires mental or physical effort on a daily basis (working out, running, interacting with your family), then participating in those activities while working 12's become very draining. The circadian shifts associated with 12's are also far more brutal, as they don't really allow for anchor sleep.

Right now 10's are kind of an ideal mix of days offs/shift length, but when my son is school age I would want the option of 8's or 9's.
 

dchristismi

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You non-attendings presume that the goal is a 40 hour work week. :p

Not the case. Even with the 8s, I average 4 shifts a week, but sometimes it's 6, and sometimes it's none. "Full time" means different things in different places. "Week" also takes on a new meaning, because it's a calendar constraint. It's easier to think "3 on, 2 off, 2 on, 1 off, 2 on, 4 off, etc). Every place is set up differently, and the group makes the rules. Want to work somewhere that does 8s? Then find a group that works 8s.

12s are physically and mentally brutal. I did that in residency, and deliberately looked for a group that didn't work 12. Because really, 12 becomes 13 if not longer, when it's all said and done. My 8s are usually 9s by the time I've wrapped things up.

Generally, the only time I'm working 5 shifts a week is when I've asked for a week off later in the month.
 

docB

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Generally, the only time I'm working 5 shifts a week is when I've asked for a week off later in the month.
True. And as Veers pointed out in another thread, asking for time off can make your remaining weeks "craptacular." :laugh:
 

southerndoc

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12s are physically and mentally brutal. I did that in residency, and deliberately looked for a group that didn't work 12. Because really, 12 becomes 13 if not longer, when it's all said and done. My 8s are usually 9s by the time I've wrapped things up.
If you're fee-for-service, 12's usually end up being 14's because if you sign anything out, the person who receives signout gets paid for seeing the patient.
 

docB

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If you're fee-for-service, 12's usually end up being 14's because if you sign anything out, the person who receives signout gets paid for seeing the patient.
That's how it is for us too. Has anyone found a way to split billing on sign out cases? That is a factor that greatly increases the never ending shift syndrome.
 

med2UCC

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That's how it is for us too. Has anyone found a way to split billing on sign out cases? That is a factor that greatly increases the never ending shift syndrome.
In the few places I've worked that were FFS, the docs agreed to hand over at the end of their shift and not worry about it. They reasoned that it all worked out in the end, so if I don't get paid for Patient X who I worked up today, I will get paid for Patient Y who you will work up tomorrow. They seemed to think it worked, but these were small groups with people who had known each other for years (and when a new person came on they got told the system and that was how it was, like it or lump it). Cheers,
M
 
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Greenbbs

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So, do you work 5 days a week, instead of 3-4? I'm not a practicing EM physician, but I would think that I'd rather do 3 days of 12 hrs than 5 days of 8 hrs.
we're pretty similar.

630-3
9-5
11-7
3-11
5-1
1030-7
and a fast track 11-7

our interns do 22 8's a month. PGY 2's do 20, 3's do 18, and 4's do 16. It's freakin beautiful.
 

J ROD

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we're pretty similar.

630-3
9-5
11-7
3-11
5-1
1030-7
and a fast track 11-7

our interns do 22 8's a month. PGY 2's do 20, 3's do 18, and 4's do 16. It's freakin beautiful.
what program? so, I can remember to rank them..:)
 

southerndoc

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That's how it is for us too. Has anyone found a way to split billing on sign out cases? That is a factor that greatly increases the never ending shift syndrome.
Generally we do it this way: if it's something simple that doesn't involve the physician doing much, then the original doc gets paid and the doc getting signout doesn't even have his/her name on the chart. The doc writes it up as if whatever is pending is negative and writes the prescriptions as necessary. Something like if a troponin is negative, patient goes home. If the CT abdomen is negative, goes home. The doc leaving usually tells the patient the plan ahead of time. If the patient requires a drastic change in outpatient management or if they require the doc receiving signout to consult another physician, admit the patient, etc., then the doc receiving signout will take over the patient.

Even with that, it's rare to sign out patients. Usually we sign them out if there is a delay. A signout might be a patient pending CT for a kidney stone who is now pain free, or a repeat troponin in a low-risk chest pain patient.
 

docB

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Generally we do it this way: if it's something simple that doesn't involve the physician doing much, then the original doc gets paid and the doc getting signout doesn't even have his/her name on the chart. The doc writes it up as if whatever is pending is negative and writes the prescriptions as necessary. Something like if a troponin is negative, patient goes home. If the CT abdomen is negative, goes home. The doc leaving usually tells the patient the plan ahead of time. If the patient requires a drastic change in outpatient management or if they require the doc receiving signout to consult another physician, admit the patient, etc., then the doc receiving signout will take over the patient.

Even with that, it's rare to sign out patients. Usually we sign them out if there is a delay. A signout might be a patient pending CT for a kidney stone who is now pain free, or a repeat troponin in a low-risk chest pain patient.
We do that too. We have had some problems with people leaving what we call "Christmas tree" orders. That's stuff like leaving an order "If CT negative get repeat CBC and if that's negative PO challenge and if that's ok dc patient."

We don't allow that any more but it happend because people were trying to capture that patient's RVUs.

BTW we called them "Christmas tree" orders because the paths branched out like the branches of a christmas tree. That and when you were following someone who did this you never knew what you were going to find under the tree.
 

Jeff698

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We do that too. We have had some problems with people leaving what we call "Christmas tree" orders. That's stuff like leaving an order "If CT negative get repeat CBC and if that's negative PO challenge and if that's ok dc patient."
OMG! That is a partner asking to be impaled on a blunt instrument.

For our residents about to become attendings, pay heed (not that any of y'all would do this). This is the fastest way to pissing off your new partners I can think of. You'll either loose the job or your partners will make you so miserable you leave. Talk about "do unto others...".

Take care,
Jeff
 

DrQuinn

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have a strong democratic FFS group here.
at our "main hospital" 40k, we do 6s, 7s, 8s.
6-noon
noon-7
7p-1a
9a-5p
5-mN
3p-11p
MN-6

with a PA in there.

we also cover rural sites that are either 10k (single coverage) or 20k (PA coverage) that are 12s.

12s kind of blow because you're there the whole day but seeing 1-2 an hour is nothing.

its the perfect mix for us. most of us work 100-140 hours a month. those on the higher end do more rural shifts. rural shifts = unadultered internet surfing time.
Q
 

bronx43

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have a strong democratic FFS group here.
at our "main hospital" 40k, we do 6s, 7s, 8s.
6-noon
noon-7
7p-1a
9a-5p
5-mN
3p-11p
MN-6

with a PA in there.

we also cover rural sites that are either 10k (single coverage) or 20k (PA coverage) that are 12s.

12s kind of blow because you're there the whole day but seeing 1-2 an hour is nothing.

its the perfect mix for us. most of us work 100-140 hours a month. those on the higher end do more rural shifts. rural shifts = unadultered internet surfing time.
Q
Do the rural sites pay more per hour?
 

TysonCook

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We have 10hr, 11hr, or 12hr.
7a-5p
8:30-6:30
11a-12a
12p-11p
4:30p-2:30a
6:30p-4:30a
9:30p-7a
and at hospital 2
7a-7p, or 7p-7a

Most of us average 16-18shifts a month, 180-190hrs/mo.
 

TysonCook

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Nope, but we get paid hourly. It was an educated decision when I took the job:) My ideal would be ~150/mo, which we're working towards...
 

Arcan57

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For those who are not yet attendings, 180-190 hrs/mo without residents as an attending is a monstrous workload. I know that's probably about what you are working as a resident, but it's a different game.
 

Hercules

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We have higher volume and lower volume days and do a mix of 9, 10, and 12 hr shifts:

Higher volume days:
7a-4p
11a-9p
4p-2a
9p-7a

Lower volume days:
7a-7p
12p-12a
7p-7a

My ideal would be all 8 or 9 hour shifts, but we're not there yet. We're also toying with adding MLPs so that will probably change our shift length.