Specialty choice to avoid working at night?

[deleted1095841]

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I don't mind working long hours during the day, but I really suffer when my sleep schedule gets disrupted. Are there any specialties (or options within specialties) where I can avoid working at night? (defined as 10pm-6am) This is different from the "lifestyle specialties" question, for which I know the ROAD is the answer, since I'm willing to work hard (e.g. 80 hrs/wk) during the day.

 

[ciestar]

This is immensely easier once you finish residency.

 

[DOVinciRobot]

In residency you will have to work nights regardless of specialty. As an attending it's much easier to not work at nights. Any clinic based specialty is a given.

 

[NotAProgDirector]

As already mentioned, if you're asking about once residency is finished, the answer is "almost everything". Daytime only EM is hard to find, but almost everything else can be almost all daytime. OB also hard to avoid night work, but not impossible. Especially if you're working somewhere that doesn't do off hours procedures (usually community based settings). Our university neurosurg group has lots of overnight call and OR time. But our private community based NS group does elective procedures only.

If you're asking about residency, that's more complicated. Derm and Rad Onc will be mostly daytime -- both will need a PGY-1 which will have variable nights. Path will have relatively low work at night. I'm sure there are other fields I'm not thinking of -- but most residencies will have a good share of nights in them.

 

[deleted1095841]

Thanks for the helpful responses! I'm much more interested in life post-residency, since that's much longer-term (and when I'm older and my health would be more severely affected by missing sleep).

Does this vary depending on academic vs private practice setting? And does it depend on me sticking to elective procedures only?

 

[Browns99]

I don't mind working long hours during the day, but I really suffer when my sleep schedule gets disrupted. Are there any specialties (or options within specialties) where I can avoid working at night? (defined as 10pm-6am) This is different from the "lifestyle specialties" question, for which I know the ROAD is the answer, since I'm willing to work hard (e.g. 80 hrs/wk) during the day.

You may be in for a rude awakening.....For one, you need to choose a field that you are passionate about or at a minimum, a field that you can see doing for the rest of your medical career. To try and fit a speciality that will avoid nights for that sheer reason alone, may lead you to picking a speciality that you may not end up happy with.

While it may be a priority to get into a field that works primarily days only, there are more important factors that should be considered first, like I noted above.

 

[Angus Avagadro]

PM&R might be a consideration for reduced night work.

 

[ACSurgeon]

You may be in for a rude awakening.....For one, you need to choose a field that you are passionate about or at a minimum, a field that you can see doing for the rest of your medical career. To try and fit a speciality that will avoid nights for that sheer reason alone, may lead you to picking a speciality that you may not end up happy with.

While it may be a priority to get into a field that works primarily days only, there are more important factors that should be considered first, like I noted above.

Meh if someone really hates working nights, it’s reasonable to exclude specialities with routine night work. Outside of critical care, inpatient medicine, emergency medicine, most specialties don’t have night shifts. This leaves a million specialties for the OP to choose from.

OP- if you can’t tolerate any sleep disruption, then you’ll have to rule out anything with procedures that could be emergent. If you’re ok with the occasional call/case ruining your sleep, you have a lot of options. Just remember any procedure based specialties will have some amount of emergency cases that will require you to go do, day or night.

 

[Browns99]

Meh if someone really hates working nights, it’s reasonable to exclude specialities with routine night work. Outside of critical care, inpatient medicine, emergency medicine, most specialties don’t have night shifts. This leaves a million specialties for the OP to choose from.

OP- if you can’t tolerate any sleep disruption, then you’ll have to rule out anything with procedures that could be emergent. If you’re ok with the occasional call/case ruining your sleep, you have a lot of options. Just remember any procedure based specialties will have some amount of emergency cases that will require you to go do, day or night.

So, it's unreasonable advice then? Sure, don't go into a field you fell in love with because it may require nights. We live in a soft world!

 

[ACSurgeon]

So, it's unreasonable advice then? Sure, don't go into a field you fell in love with because it may require nights. We live in a soft world!

Just because I don’t agree with your advice doesn’t mean it’s not valid for some people. However, my observation is that the younger generation is unwilling to compromise their comfort for the most part.

Also, plenty of people fall in love with a field and can’t match into it for a variety of reasons. Life goes on.

It’s one thing to tell someone To exclude every kind of surgical/procedural specialty or every kind of inpatient specialty etc. It’s a totally other thing to recommend that people steer clear of specialties where routinely doing night shifts is the norm. So, I think it’s reasonable for someone who has such strong aversion to nights to stay away from specialties that require nights.

Finally, most people “hate” surgery because of its grueling hours or the mean personalities. I would bet a lot more students would want to do a surgical field if residency was 50 hours a week with fluffy nice people. After all, who doesn’t want to cut into people and fix their problems? Similarly, someone with a strong aversion to nights will most likely not love a specialty that requires nights.

Finally part 2: most students apply to specialties based on theoretical knowledge of that specialty and certain expectations or imagination that may or may not be true. I chose general surgery after spending 1 month on surgical oncology and 1 month on urology/Ortho. I did no real general surgery before deciding on the field. I liked GI pathology and wanted to be a surgeon. Bam. Here we are.

 

[deleted1095841]

Meh if someone really hates working nights, it’s reasonable to exclude specialities with routine night work. Outside of critical care, inpatient medicine, emergency medicine, most specialties don’t have night shifts. This leaves a million specialties for the OP to choose from.

OP- if you can’t tolerate any sleep disruption, then you’ll have to rule out anything with procedures that could be emergent. If you’re ok with the occasional call/case ruining your sleep, you have a lot of options. Just remember any procedure based specialties will have some amount of emergency cases that will require you to go do, day or night.

I'm okay with a few nighttime emergencies; that's just life. 5-10 nights per year would be totally manageable. But 20 is pushing it, and 30 nights per year would be intolerable for me.

 

[ACSurgeon]

I'm okay with a few nighttime emergencies; that's just life. 5-10 nights per year would be totally manageable. But 20 is pushing it, and 30 nights per year would be intolerable for me.

Yea so probably have to rule out general surgery (although many of its fellowships could be viable to meet that goal). Most specialties rarely come in at night. Some specialties are notorious for having emergencies that are time sensitive. Figure out which 2-3 specialties you enjoy the most and then do a deeper dive on what an average job looks like and make as much of an informed decision as you can

 

[Chillbo Baggins]

I'm okay with a few nighttime emergencies; that's just life. 5-10 nights per year would be totally manageable. But 20 is pushing it, and 30 nights per year would be intolerable for me.

Ortho is night-time friendly compared to some of the surgical subs. As time has gone on and more research done, the number of true orthopedic emergencies has really gone down. With the exception of a few things like compartment syndrome and native hip dislocation, most problems can sit overnight without compromising outcomes. Even most open fractures can hang out with some IV abx and get the A team with a first start.

I would guess my attendings come in maybe 2-3 times per year for an overnight case.

 

[NotAProgDirector]

We have private practice surgeons who work at a community site, take no overnight call. OR at the community site isn't open after hours, at all. Office phone says to call in the AM or go to the ED. The cases they do are rather straightforward -- routine gall bladders, biopsies, elective hernia repairs, etc. Patients staying overnight are covered by noctunists, sometimes from home. Anesthesia also has no overnight call (no OR to cover).

My point is that if you're willing to work at smaller community sites, you can do no / minimal nights in almost any field. But you limit your options of the location you can get a position like this. Some fields you could do anywhere and the nights will be minimal.

Totally agree that enjoying your field is much more important. You could have a M-F 9-5 with a 2 hour lunch job and absolutely hate the field, and me miserable.

 

[deleted1081396]

Outpatient neuro.

 

[Ho0v-man]

Derm, optho, path, rad onc, Any clinic based specialty where you do nothing in the hospital if you don’t want to. I.e. FM, IM, allergy, etc

Medical genetics

 

[CyrilFiggis]

Any priority will require sacrifice in other areas. Are you really willing to avoid certain specialties that may be your passion because of sleep?

 

[deleted87051]

Anesthesia here. I work 18 5pm-7am in-house night shifts/year. Some anesthesiologists have outpatient jobs and never work nights. Others work in call heavy practices and do 50+ In-house nights/year.

Agree with others that clinic based specialties are a good bet. Psych hasn’t been mentioned but that can be exclusively daytime work too.

 

[deleted87051]

Outpatient neuro.

Yep. But not stroke neuro.

 

[Ho0v-man]

Yep. But not stroke neuro.

So to the point of a previous poster; our Neuro stroke where I’m at in a rural location does not do nights/weekends/or holidays.

You can get the schedule you want in any field if you compromise location.

 

[Styrene]

The majority of psychiatrists in the US don't work nights at all, as 75% are in outpatient practice.

At my psychiatry program, there are no nights after PGY-2. The majority of attendings do not work any nights. There are dedicated night attendings in the psych ER. But attendings can pick up night shifts if they so choose.

In PGY-1 and -2, each resident does approximately 4-6 weeks of continuous night float in PGY-1, 2-4 weeks in PGY-2, plus 8ish random weekend overnights each year (one night call at a time, day off pre- and post-call).

 

[munadani]

Derm, optho, path, rad onc, Any clinic based specialty where you do nothing in the hospital if you don’t want to. I.e. FM, IM, allergy, etc

Medical genetics

😂

 

[Candidate2017]

Agree with others that clinic based specialties are a good bet. Psych hasn’t been mentioned but that can be exclusively daytime work too.

The "problem" with psychiatry is I have so much flexibility and free time, I'm not forced to adhere to a regular sleep-wake pattern (I can often stay out late or sleep in late). So ironically, I slept better in residency 🤣

 

[deleted87051]

The "problem" with psychiatry is I have so much flexibility and free time, I'm not forced to adhere to a regular sleep-wake pattern (I can often stay out late or sleep in late). So ironically, I slept better in residency 🤣

I know a 2 psychiatrist couple who both went to 100% tele-psych practice. Their dogs get walked 3-4x/day.

 

[Mass Effect]

So, it's unreasonable advice then? Sure, don't go into a field you fell in love with because it may require nights. We live in a soft world!

Any priority will require sacrifice in other areas. Are you really willing to avoid certain specialties that may be your passion because of sleep?

This is the problem with medicine. You guys acting like the OP is being unreasonable for wanting to prioritize sleep. Like what kind of alien world do we live in where a sentence like the above is considered reasonable, as if regular sleep is a benign luxury that shouldn't play a role in career selection?

Sleep is just as important (if not more so) than any other health consideration. Disruption of a regular circadian rhythm can lead to a number of physical and mental health conditions, especially for those vulnerable to health problems.

 

[Lawpy]

This is the problem with medicine. You guys acting like the OP is being unreasonable for wanting to prioritize sleep. Like what kind of alien world do we live in where a sentence like the above is considered reasonable, as if regular sleep is a benign luxury that shouldn't play a role in career selection?

Sleep is just as important (if not more so) than any other health consideration. Disruption of a regular circadian rhythm can lead to a number of physical and mental health conditions, especially for those vulnerable to health problems.

It’s just the toxic culture of medicine mixed with typical SDN behavior where it’s completely acceptable and expected to sacrifice sleep and life in favor of medicine 24/7. Those posts are disappointing but not surprising

 

[Drrrrrr. Celty]

Depends entirely on how much you want to earn, what the type of group you join ( small pp, hospital based, large pp), and what setting you work in ( private only, community hospital, large tertiary center, trauma focused).

From the hospitalist or non-proceduralist perspective it's pretty easy to never work a night after residency or have a contract where you're working maybe only 1 to 2 weeks of nights a year. For most-private practice physicians with no affiliation to hospitals same. But this gets you less money while being on call at minimal will earn you a bit more pay.

 

[Matthew9Thirtyfive]

It’s just the toxic culture of medicine mixed with typical SDN behavior where it’s completely acceptable and expected to sacrifice sleep and life in favor of medicine 24/7. Those posts are disappointing but not surprising

Lol what? They are literally just asking op to keep in mind that ruling out any specialty that requires nights may eliminate a specialty they might otherwise love.

 

[Browns99]

It’s just the toxic culture of medicine mixed with typical SDN behavior where it’s completely acceptable and expected to sacrifice sleep and life in favor of medicine 24/7. Those posts are disappointing but not surprising

What are you actually talking about, please read the posts , and "typical SDN behavior", you must be speaking of yourself.

 

[Lawpy]

Lol what? They are literally just asking op to keep in mind that ruling out any specialty that requires nights may eliminate a specialty they might otherwise love.

They are saying in a dismissive manner (i.e. “we live in a soft world!”) as if it’s a bad thing to prioritize sleep

What are you actually talking about, please read the posts , and "typical SDN behavior", you must be speaking of yourself.

So, it's unreasonable advice then? Sure, don't go into a field you fell in love with because it may require nights. We live in a soft world!

Dude your posts reek of condescension

 

[Matthew9Thirtyfive]

Okay we can discuss it without it turning into an argument. I agree the “it’s a soft world” comment is condescending. But the overall message of that post and the entirety of the other post you quoted are not remotely toxic.

 

[NITRAS]

I love SDN. People getting called out for calling people out, for calling people out.

As a hospitalist, I haven’t worked a night in years. Don’t plan on it Unless i want the money.

 

[Matthew9Thirtyfive]

I love SDN. People getting called out for calling people out, for calling people out.

As a hospitalist, I haven’t worked a night in years. Don’t plan on it Unless i want the money.

That’s great. There’s nothing wrong with not wanting to work nights. There’s also nothing toxic about telling someone they might miss out on a field they love if they write off every specialty that works occasional nights, and acting like it’s toxic to say that is ridiculous.

 

[Lawpy]

Okay we can discuss it without it turning into an argument. I agree the “it’s a soft world” comment is condescending. But the overall message of that post and the entirety of the other post you quoted are not remotely toxic.

I’m talking about the delivery and how it’s presented.

 

[Mass Effect]

That’s great. There’s nothing wrong with not wanting to work nights. There’s also nothing toxic about telling someone they might miss out on a field they love if they write off every specialty that works occasional nights, and acting like it’s toxic to say that is ridiculous.

Have to disagree with you. Had those comments been worded like what you just wrote it would have been fine, but they weren't. I'm a psychiatrist and more than half my outpatient patient base is medical students and residents. The toxicity comes in in the way those posts were worded. When you criticize someone for prioritizing sleep (i.e. the "soft world" comment) or minimizing what someone wants to prioritize (i.e. the second comment), it perpetuates the mentality that what the OP is concerned about is silly. This type of thing is the reason doctors feel they have to come in to work sick and round with IVs in their arm, why they feel they can't prioritize raising a family, why women feel they can't get pregnant during residency. People SHOULD be prioritizing sleep. For some night owls, working nights may be a dream job. For some who don't care about regular sleep and can adjust, working nights may be fine. But someone who has said they want to prioritize a regular sleep schedule shouldn't be minimized or condescended to for it as if what they want is wrong when in fact what they want is healthiest option.

 

[Matthew9Thirtyfive]

Have to disagree with you. Had those comments been worded like what you just wrote it would have been fine, but they weren't. I'm a psychiatrist and more than half my outpatient patient base is medical students and residents. The toxicity comes in in the way those posts were worded. When you criticize someone for prioritizing sleep (i.e. the "soft world" comment) or minimizing what someone wants to prioritize (i.e. the second comment), it perpetuates the mentality that what the OP is concerned about is silly. This type of thing is the reason doctors feel they have to come in to work sick and round with IVs in their arm, why they feel they can't prioritize raising a family, why women feel they can't get pregnant during residency. People SHOULD be prioritizing sleep. For some night owls, working nights may be a dream job. For some who don't care about regular sleep and can adjust, working nights may be fine. But someone who has said they want to prioritize a regular sleep schedule shouldn't be minimized or condescended to for it as if what they want is wrong when in fact what they want is healthiest option.

As I said, the line about being soft definitely was condescending. I already agreed that it was unnecessary. But what part of this is toxic?

Any priority will require sacrifice in other areas. Are you really willing to avoid certain specialties that may be your passion because of sleep?

This is the post I was referring to when I was writing that.

 

[rulerkk]

As I said, the line about being soft definitely was condescending. I already agreed that it was unnecessary. But what part of this is toxic?

This is the post I was referring to when I was writing that.

My interpretation is that It’s a leading question. That commenter could have elicited the same thought provoking question’s answer from OP without the condescending tone (are you “really” …) about sleep. Which is undervalued by many people within the workaholic culture of medicine

 

[Matthew9Thirtyfive]

My interpretation is that It’s a leading question. That commenter could have elicited the same thought provoking question to OP without the condescending tone (are you “really” …) about sleep. Which is undervalued by many people within the workaholic culture of medicine

I guess? If that post is considered toxic then wow. Y’all must just be offended all the time.

 

[Lawpy]

I guess? If that post is considered toxic then wow. Y’all must just be offended all the time.

The issue is more so on enabling the toxic work culture. It’s not as bad as that “we live in a soft world!” post which is directly toxic but still problematic

 

[Mass Effect]

As I said, the line about being soft definitely was condescending. I already agreed that it was unnecessary. But what part of this is toxic?

This is the post I was referring to when I was writing that.

As @rulerkk put it nicely, it's the way in which it was said. The sentence said "are you really willing to avoid certain specialties that may be your passion because of sleep?"

You don't get that statement is leading and minimizing at the same time? Picture the sentence written this way: "are you really not going to come in to round on 20 patients because you have a fever of 104?" The sentence is stated in a way in which there is only one right answer or else it's a bad idea.

The sentence on its own is not toxic and I don't think anyone said it was. It's the mentality behind it that's toxic and that mentality can be inferred in the way in which it's stated. It suggests sleep is not an important enough reason to prevent you from picking the specialty you want (in fact, you can pick the specialty you want in many cases and STILL protect your sleep) and that type of thinking is part of the toxic culture of medicine.

I guess? If that post is considered toxic then wow. Y’all must just be offended all the time.

Has nothing to do with us being offended. Frankly, I couldn't care less as I'm an attending blissfully happy in my choices. But calling out the problematic mentality is fair game.

 

[Matthew9Thirtyfive]

The issue is more so on enabling the toxic work culture. It’s not as bad as that “we live in a soft world!” post which is directly toxic but still problematic

Yeah but that’s not a valid argument. That poster is not saying it’s bad to prioritize sleep. The soft world comment is bad, but I already said that twice so that’s not a valid argument either.

 

[Mass Effect]

That poster is not saying it’s bad to prioritize sleep.

He sure is implying it.

 

[Matthew9Thirtyfive]

As @rulerkk put it nicely, it's the way in which it was said. The sentence said "are you really willing to avoid certain specialties that may be your passion because of sleep?"

You don't get that statement is leading and minimizing at the same time? Picture the sentence written this way: "are you really not going to come in to round on 20 patients because you have a fever of 104?" The sentence is stated in a way in which there is only one right answer or else it's a bad idea.

The sentence on its own is not toxic and I don't think anyone said it was. It's the mentality behind it that's toxic and that mentality can be inferred in the way in which it's stated. It suggests sleep is not an important enough reason to prevent you from picking the specialty you want (in fact, you can pick the specialty you want in many cases and STILL protect your sleep) and that type of thinking is part of the toxic culture of medicine.



Has nothing to do with us being offended. Frankly, I couldn't care less as I'm an attending blissfully happy in my choices. But calling out the problematic mentality is fair game.

Yeah so basically you are inferring toxicity. I read it as “are you really going to rule out a specialty over sleep? If so, then just be sure you’re okay with missing out on something you might love.”

 

[rulerkk]

Yes, we are assuming toxicity. Maybe that poster just worded their question without realizing the tone comes off as supporting a problematic culture in medicine. Maybe they believe it would be foolish to rule in/out potential fields due to sleep disruption. I would assume the latter, but called out the former’s delivery problems. I describe that question with “good intentions, poor execution”

 

[Matthew9Thirtyfive]

Yes, we are assuming toxicity. Maybe that poster just worded their question without realizing the tone comes off as supporting a problematic culture in medicine. Maybe they believe it would be foolish to rule in/out potential fields due to sleep disruption. I would assume the latter, but called out the former’s delivery problems. I describe that question with “good intentions, poor execution”

Or maybe you’re used to looking for toxicity and read into it where there is none.

 

[Mass Effect]

Yeah so basically you are inferring toxicity. I read it as “are you really going to rule out a specialty over sleep? If so, then just be sure you’re okay with missing out on something you might love.”

Yes that is how I read it and I find the first part (bolded) to feed into the toxic nature of medicine.

 

[Mass Effect]

Or maybe you’re used to looking for toxicity and read into it where there is none.

Dude, you now have 3 different posters telling you they read it that way. But ya, we must be the problem.

 

[VA Hopeful Dr]

Dude, you now have 3 different posters telling you they read it that way. But ya, we must be the problem.

I didn't read it as toxicity either. My interpretation was that the concern was the OP would end up in a specialty they didn't like because of not wanting to work nights. I can see why the particular wording could seem like the poster was minimizing the importance of sleep, but not everyone online chooses their words as carefully as we do for in-person interactions.

Its a valid concern. I love FM and the schedule is certainly great, but if you don't like the work then just doing it for the schedule is a recipe for burnout.

 

[Mass Effect]

I didn't read it as toxicity either. My interpretation was that the concern was the OP would end up in a specialty they didn't like because of not wanting to work nights. I can see why the particular wording could seem like the poster was minimizing the importance of sleep, but not everyone online chooses their words as carefully as we do for in-person interactions.

And that's fine, but acting like anyone who did read it that way is just looking for toxicity and calling poster's opinions invalid is pretty ****ty and by itself, also emblematic of the toxic culture we're talking about. You at least get why some of us interpreted it that way.

Its a valid concern. I love FM and the schedule is certainly great, but if you don't like the work then just doing it for the schedule is a recipe for burnout.

We all prioritize what we feel is important. There's a reason ROAD exists/existed for so long. It's because some people find the "road" to happiness to be money and lifestyle. They're not being lectured on how they're giving up their "passion" for money and lifestyle. There are people wanting to do ortho as a pre-med. They're also not being lectured on giving up their passion or burnout. They're being cautioned for other reasons - competitive nature of those specialties - but not that they're giving up their passion. But if a poster wants to prioritize sleep, they get multiple posts questioning them about it as if sleep isn't every bit as important (and by some measures, more important).

 

[ACSurgeon]

Dude, you now have 3 different posters telling you they read it that way. But ya, we must be the problem.

I don’t think counting people who care enough to chime in is a valid argument. You can count me and VAhopeful on the side of not thinking it’s toxic and now you’re tied 3:3.

Even though I disagreed with the statement of “are you really gonna prioritize sleep”, it’s not because I thought it was toxic. It’s because I thought it was a bad argument. Some people think a specialty could be so amazing that it’s worth sacrificing sleep for. Some won’t. I actually believe that people who prioritize sleep probably won’t fall in love with a specialty that requires night work. Simple as that

If someone said “are you really not gonna have kids because you prioritize your sleep,” is that a toxic or condescending statement? I read it was one of surprise as the person asking can’t relate to the person being asked. That’s how I read that question.

Finally, while medicine has a lot of unnecessary bad behavior and “toxicity”, having nights/weekends/holidays covered is an essential service. It’s not toxic or optional to have a hospitalist/intensivist/ER doc working a night shift. Some students might hate the idea enough that it drives them away. Fine. Some can tolerate a few night shifts a year and can still work in those fields. Great. Some will do pure nights. Good for them.

finally part 2: we are living in a soft world. People don’t want to be inconvenienced. People are faster to complain. People will complain even without a good cause. just because there is abuse in the system doesn’t mean we should make every inconvenience automatically classified as abuse.