Switching sleep schedules after Night Shift

[RustedFox]

Problem doesn't seem to be English here.

You speak it. I speak it. We on here speak it.

I get the sense that the problem might lie somewhere else. Can't quite put my finger on it.

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[tkim]

English may be hard. But putting annoying posters on "ignore" is easy.

*PLONK* (for the old-timey interweb users)

 

[RustedFox]

English may be hard. But putting annoying posters on "ignore" is easy.

*PLONK* (for the old-timey interweb users)

Oh, no no no.

I'm so glad that we have students like this who are ready to tell us just how we've been doing it wrong for oh so many years.

 

[The White Coat Investor]

Your problem here lies not just in your attitude, but in your mathematics. I know, I know.... before you say it; "English is hard", but math might be harder for you.

For your model to work, you need 2 docs to do 15 nightshifts for one month. That's 30 nightshifts per month.
After two months of time, those two docs have satisfied their annual nightshift requirement of thirty nights. Check them off the list.
Every two months, you'll need two fresh docs to do all the nightshifts.
Therefore, you'll need 12 docs in that group to fill the year's worth of nightshifts.
No group has 12 docs in it under this model.
3 shifts/day x 30 days/month = 90 shifts a month.
90 shifts a month/15 shifts per doc = 6 docs.
Where is the work (in terms of number of shifts) for the other 6 docs each month?
They're gone.

You're assuming 3 shifts a day. Many shops are 5 or 6 shifts a day but still with a single overnight shift. So maybe 12 docs makes sense in that, giving everyone 2 months a year where they do nothing but nights. In a true 3 shift model with six 15 shift docs, you're looking at 4 months of all nights. Ugh.

But again, that model seems vastly inferior to me to a market-based model where people volunteer to work the nights because they pay more.

 

[The White Coat Investor]

The concept remains. Whatever nights you do, do them as close together as possible. English is hard.

Some people prefer that (I do.) But others do not. If you've got 4 nights a month, some of my partners want all 4 of them in a row, while others want one a week. That surprised me, but it's true.

 

[RustedFox]

You're assuming 3 shifts a day. Many shops are 5 or 6 shifts a day but still with a single overnight shift. So maybe 12 docs makes sense in that, giving everyone 2 months a year where they do nothing but nights. In a true 3 shift model with six 15 shift docs, you're looking at 4 months of all nights. Ugh.

But again, that model seems vastly inferior to me to a market-based model where people volunteer to work the nights because they pay more.

Valid critique; but if you've got 5 or 6 shifts a day, then you've either got more than one nightshift, or you've got one of the strangest arrival patterns of them all.

 

[The White Coat Investor]

Valid critique; but if you've got 5 or 6 shifts a day, then you've either got more than one nightshift, or you've got one of the strangest arrival patterns of them all.

When I think of a nightshift, I'm thinking of one that goes until 6 or 8 am, not one that ends at 12, 1, or 2. The busiest time is evenings, not early mornings. A typical 7 shift pattern might look like this:
6a-2p
9a-6p
11a-7p
2p-10p
6p-2p
7p-3p
10p-6a

I'd only call the last one a night shift, but I suppose someone could call the last four night shifts depending on how they define them.

 

[RustedFox]

When I think of a nightshift, I'm thinking of one that goes until 6 or 8 am, not one that ends at 12, 1, or 2. The busiest time is evenings, not early mornings. A typical 7 shift pattern might look like this:
6a-2p
9a-6p
11a-7p
2p-10p
6p-2p
7p-3p
10p-6a

I'd only call the last one a night shift, but I suppose someone could call the last four night shifts depending on how they define them.

Ah. We're splitting hairs over the definition of "nightshift". I'm going off of when the nighttime pay diff kicks in. Your three last shifts end after midnight - therefore are nightshifts.
More empirically, if you're awake during the wee hours - it's a "night".

 

[The White Coat Investor]

Ah. We're splitting hairs over the definition of "nightshift". I'm going off of when the nighttime pay diff kicks in. Your three last shifts end after midnight - therefore are nightshifts.
More empirically, if you're awake during the wee hours - it's a "night".

Our diff kicks off at 11 am. Seriously. Why would only only shift have a differential? Figure out which shifts are most desirable by that group of people and pay them the least. No reason to have a night shift differential and not an evening shift differential.

 

[RustedFox]

Your diff kicks on or off at 11 am ?

"Kick-off" might mean to begin.

 

[Apollyon]

I interviewed with a group that wanted me to do nights for 5 years. Great group and location other than that little teensy detail.

What, if you were still alive, they made you partner?

 

[TooMuchResearch]

What, if you were still alive, they made you partner?

No, they fire you after four because who wants to be partners with someone who's burnt out, tired all the time, and never shows up to the business meetings.

 

[deleted109597]

You know what works best for me? Not working night shifts. Seriously. Everything else is stop-gap. It costs me quite a bit to pay someone else to do them, but the improvement in my quality of life is huge.

Yeah, and **** that guy who has to work them.

Honestly, I agree with you partly. Yes, they suck. And if you can get a true nocturnist, that's great. Unfortunately, either we make an Australian model (only trainees at night, no consultants), or we deal with the fact that we work nights. Schedule makers could do it so you do a month of nights, then 2 months of not nights. It really wouldn't be that hard. But docs often aren't in control of the schedule, and when they are, they often don't do any real work, so what do they care?

 

[neoevolution]

What's the relative availability of day-only and night-only EM jobs? I'm guessing day-only would be rarer and come with a pay hit, but would someone who wanted a guarantee of night-only (maybe with a pay differential) have a hard time finding a job?

 

[gamerEMdoc]

What's the relative availability of day-only and night-only EM jobs? I'm guessing day-only would be rarer and come with a pay hit, but would someone who wanted a guarantee of night-only (maybe with a pay differential) have a hard time finding a job?

Day only.... unicorn
Night only... name your price

 

[sylvanthus]

A strange game.
The only winning move is not to play.

...

How about a nice game of chess?

Good movie.

 

[gamerEMdoc]

I work nights only. A mix of 6p-3a and 10p-7a and have been doing so for years. I don't make a differential, although I know at many places I could. I already get compensated very well, more than a standard academic job, so never wanted to push the issue re: a differential. To me though, more important that $10-20 more per hour is the ability to regulate my sleep schedule. When I was a resident, I could work 6 overnights, have a day off, then start days in 24 hours. Once I turned thirty, I couldn't do it. My sleep was horrible. I'd go to sleep and wake up 2 hours later wide awake, then crash a few hours later. Even when I'd sleep like 8 hours, I'd wake up exhausted. To me, working a mix of shifts was way worse than working all one type of shift, even if it was nights. Now, ideally I'd work all day shifts, I'm sure anyone would. But in the end, the only way to work all one shift is for the most part to work all nights. So to me, its worth it.

Once I committed and went to an all night schedule, a few things really helped me adapt to being a nocturnist:
1. On days off, I stay mostly on the same schedule, usually going to bed around 4 am. I usually wake up around 11am-2pm most days, and that almost never changes whether I work or not
2. On days I work, I take a provigil a few hours before my shift. Keeps me alert throughout the shift and I never feel tired
3. I do 30-60 minutes of working out daily
4. When I sleep, I use a white noise machine to block out the sound of my dogs, kids, wife, etc. I can't tell you how much one of these things help keep you asleep even though the amount of noise they generate is minimal.

That's it. I feel younger these days than I did 7 years ago. I've tried tons of strategies to adapt to shift work, night shifts, etc and this is what works for me. I'm sure there's things that works for others.

 

[migm]

Most of my nightshifts lead to me getting home at around 7-8am. I will sleep for about 7 hrs, then get up and try to be normal for a few hours. Then 6mg melatonin around 10-11pm, then wake up around 7-9am the next day. The next day I do feel a bit weird and out of it. I try to make sure to take melatonin the following evening around 10pm and get another night of sleep to fully catch up. I am fine by the following day.

 

[Venko]

I am a full time academic attending who only works night shifts but has administrative, teaching, and research responsibilities during the daytime most days. Also, I have a spouse who works a traditional schedule and two kiddos who demand my attention from 430 pm until 7pm.

I used to rely on caffeine but have quit using it altogether and feel significantly better.

My keys to switching from night to days are:

- to schedule regular exercise, nearly every day.
- after a night shift ends at 7-8 am, sleep asap until noon. Wake up and go for a walk, do something lightly engaging as others have mentioned.
- go back to sleep around 7-8 pm (which is three to four hours earlier than my traditional bedtime)
- wake up at my usual time in the morning 6-7 am.
- before my first night shift I usually wake up at 7 am go to meetings etc, and then nap between 830 and 10 pm.
- in between all the other nights, I sleep from 8-9 am to about 3 pm, and then also nap from 830 to 10 pm.
- I do not use medications, beer, caffeine etc because I think they may make the first day or night better but eventually contribute to worsened sleep, alertness, wellness, resilience etc. just my opinion on this though.

I have never been happier in all phases of my life and highly recommend committing yourself to an exercise heavy, chemical light, sleep focused schedule.

To help with the process, we have black out blinds, live in a very quiet neighborhood, invested in a fantastic bed, comfy pajamas, etc. every little thing helps.


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