Shift scheduling

[jd989898]

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I'm a medical student interested in EM, but I'm a bit intimidated by the circadian rhythm disruption that comes along with alternating day and night shifts. I was wondering if, in residency and beyond, an effort is made to stagger shifts for each individual so as to minimize complete circadian rhythm reversals?

For example, it would be a lot easier to work:

1pm-11pm, 4pm-2am, 7pm-5am, 10pm-8am, 1am-11am, 4am-2pm, 7am-5pm, and repeat

than:

1pm-11pm, 4am-2pm, 7pm-5am, 10pm-8am, 4pm-2am, 1am-11am, 7am-5pm, and repeat

I worry that if I do too many complete reversals of my sleep schedule I will not be able to fall asleep or that my sleep will be less restful and I'll end up being groggy the whole day.


Thanks

 

[Angry Birds]

Where did you get these timings from? I haven’t seen an EM schedule like either option.

In general, most programs have morning, evening and overnight shifts. You would never go from an evening to morning shift without at least a day off in between. Usually you only go forward in time. What this meant for me was that I was never short on sleep in residency.

 

[oldtown]

For example, it would be a lot easier to work:

1pm-11pm, 4pm-2am, 7pm-5am, 10pm-8am, 1am-11am, 4am-2pm, 7am-5pm, and repeat

than:

1pm-11pm, 4am-2pm, 7pm-5am, 10pm-8am, 4pm-2am, 1am-11am, 7am-5pm, and repeat




Thanks

It is exceedingly rare for any ED shift to start anytime before 5 am or to end anytime between 8am and about 2pm. Most of the time, ED shifts are somewhere between 8 and 12 hours long

i .e. Shifts don't typically start in the wee hours of the morning and end at lunchtime.

Also, you typically don't work as many shifts in a row as in your example. You may do 3 days on, 2 off, 1 on, 1 off, 1 on, 1 off, 2 on, etc. the shift times may bounce around in that framework and it is highly variable but you usually get some time to recover unless your scheduler is a sadist.

 

[TooMuchResearch]

Honestly, if being groggy and having trouble dealing circadian shifts is a big concern for you, EM is problem one of the worst residencies (particularly if you're going to one that does 12 hour shifts where you'll essentially be switching days to nights back to days frequently).

Source: I was at one of those programs.

I'm also someone that doesn't deal with the switching well and honestly it's one of the ****tier parts of the specialty. Im hoping that working fewer shifts as an attending is easier to do.

It's easier to work less. The schedule can still suck at times. The best solution is to work less.

 

[Groove]

I'm the scheduler in our group and to answer your question....it just depends. There's no rule to scheduling but most places will try to avoid the typicals ie. 24h turn arounds, strings > than 3 shifts in a row, multiple night blocks per month, etc..

For myself, I try to have the following:

-At least 10hrs between shifts
-No 24h turnarounds
-7 day off requests
-Min 1 day off after 3 consecutive shifts, 2 for 4+
-Circadian patterns (Sequential shifts can be at the same time or later with typical pattern of stagger forward i.e. (6a-3p, 9a-6p, 2p-11p, etc..))
-Max consecutive shifts = 3
-Min 2 days off after nights
-Night shifts grouped into single block / month

I use other criteria but in general... things move forward in a circadian friendly pattern which limits abrupt disruption and I think is just overall healthier for the docs. For instance, the last 3 days I worked... I had a 6a-3a, 9a-6p, and then a 2p-11p. That feels much different than 3 6a-3p's in a row, at least for me. You get a little extra sleep, aren't as rushed and can relax a bit more.

The problem with all of this if you are the scheduler? Everyone loves to bitch, piss, moan and complain and you rarely get any thanks whatsoever for the time you spent going over each doc and trying to put together a schedule you thought they were appreciate. Also, every doc is different.... I've got docs that hate day shifts and overnights but love late swings. Others like anything but hate working any morning shift after their days off. Others like at least 5 in a row so they can have longer blocks of days off. I try to be somewhat open to requests to a point in order to keep people reasonably happy, but only to a point. Many times, docs will request days off that overlap with pre-existing requests which limits availability during those days and jacks the schedule up for anyone that happens to be working. This thread has just reminded me what a colossal pain in the ass it is to do every month. At least I get paid to do it.

Anyway, to answer your question.... Yes, most places will try to keep your circadian rhythm minimally disrupted but it just depends on whether the scheduler gives a s***.

 

[Alvarez13]

Consider being a nocturnist. Then you get the schedule every time.

 

[hundreddaysoff]

I worry that if I do too many complete reversals of my sleep schedule I will not be able to fall asleep or that my sleep will be less restful and I'll end up being groggy the whole day.

You absolutely will not be able to fall asleep and you absolutely will be groggy, at least sometimes. Most likely around your block of overnight shifts, which in residency is about one week a month. Humans did not evolve to work the schedules that we work.

Everyone told me this was a drawback of the specialty going in. The most surprising part to me early on is that I could in fact do my job well on so little sleep. It wasn't even really that hard. But then later on in residency, I found myself a girlfriend, and then I realized what everyone was complaining about with this circadian stuff. Pretty easy when it's just you worrying about yourself... trickier when there's another person involved that you care about who depends on you to do things with her during normal people hours. I'm still working out this dynamic.

But don't get me wrong, I still love the specialty.

 

[deleted836128]

I am a scheduler for the PAs in my department. There are a few rules I stick to... there is a minimum of 11 hours between shifts, I try to do the morning shifts and evening shifts in a row and if not I leave a day off in between. No one works a morning shift after having worked a night shift. No one works more than five days per week. No one works more than eight shifts in twelve days. No one works more than 3 in a row.

 

[BAM!]

You absolutely will not be able to fall asleep and you absolutely will be groggy, at least sometimes. Most likely around your block of overnight shifts, which in residency is about one week a month. Humans did not evolve to work the schedules that we work.

Everyone told me this was a drawback of the specialty going in. The most surprising part to me early on is that I could in fact do my job well on so little sleep. It wasn't even really that hard. But then later on in residency, I found myself a girlfriend, and then I realized what everyone was complaining about with this circadian stuff. Pretty easy when it's just you worrying about yourself... trickier when there's another person involved that you care about who depends on you to do things with her during normal people hours. I'm still working out this dynamic.

But don't get me wrong, I still love the specialty.

just wait till you add kids!

 

[TooMuchResearch]

just wait till you add kids!

Why? I love going to bed at 2 am and getting up at 7!