Trading Night Shifts for Other Shifts

[Got Em]

I understand that in general night shifts are unavoidable and if you work 12s, half of them will be nights, and if you work 8s, you'll generally get 1/3 nights. I'm just wondering if it's common practice to trade with other physicians on a regular basis, especially docs that have shift work sleep disorder, or just for one reason or another can't work nights.

For example, I've heard some trade 1 of their night shifts for 1 weekend shift, or 1.5/2 day/evening shifts. There is even one that said he pays a fresh EM doc out of pocket to do all of his nights.

Is this common? Is this frowned upon? I'm basically asking if it's common practice to "regularly" switch shifts instead of switching "every once in a while".

Edit - Sorry, should've put exactly what I meant by trading shifts. Here's an example:

Before trade:
Person A = 6 day and 6 night shifts per month
Person B = 6 day and 6 night shifts per month
Day shift pay = $2400 ($4800 for 2 days); Night shift pay = $3000

If Person A trades 1 night shift for 2 day shifts from Person B:

After trade:
Person A = 8 days and 5 nights per month (13 shifts total)
Person B = 4 days and 7 nights per month (11 shifts total)

Salary does not change. Person A will be working 2 days for 1 night's pay ($3000), while Person B will be working 1 night and getting paid for 2 days ($4800). Basically, whoever takes the night shift will be working 1 shift less per month, while getting the same salary. Of course, some people do this differently, but this setup is what I was asking.

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[Arcan57]

No, it's not common. None of your colleagues especially care if you find it "extra-hard" to deal with circadian disruption and offering that as a reason to swap a night for day would be met with anything from a polite declination to a snort of derision and GTFO.

 

[emergentmd]

Trading night shifts or getting off night shifts is pretty easy. Everyone is in the same boat and most are probably happy to have this discussion. You have two groups of people. 1st wants to stay on night and know its a commodity so would like to get paid more. 2nd hates nights with a passion and would pay anything to get off.

Our group has always paid extra for nights. Its much easier to set this up as a group than trade every month.

.

 

[emergentmd]

Trading night shifts or getting off night shifts is pretty easy. Everyone is in the same boat and most are probably happy to have this discussion. You have two groups of people. 1st wants to stay on night and know its a commodity so would like to get paid more. 2nd hates nights with a passion and would pay anything to get off.

Our group has always paid extra for nights. Its much easier to set this up as a group than trade every month.

If our group did not have a night stipend, I would pay someone to take all of my nights. Usually 500-750/night is the going rate.

.

 

[Got Em]

No, it's not common. None of your colleagues especially care if you find it "extra-hard" to deal with circadian disruption and offering that as a reason to swap a night for day would be met with anything from a polite declination to a snort of derision and GTFO.

Right. I'm not asking if it's common for EM docs to have difficulty dealing with circadian disruption. I also know that docs wouldn't trade a night for a day/evening shift.

This is why I asked specifically if it's common for someone to offer 1 of their night shifts for 1.5 or 2 of your day/evening shifts. Would they still say "GTFO" to this?

 

[gro2001]

I understand that in general night shifts are unavoidable and if you work 12s, half of them will be nights, and if you work 8s, you'll generally get 1/3 nights. I'm just wondering if it's common practice to trade with other physicians on a regular basis, especially docs that have shift work sleep disorder, or just for one reason or another can't work nights.

For example, I've heard some trade 1 of their night shifts for 1 weekend shift, or 1.5/2 day/evening shifts. There is even one that said he pays a fresh EM doc out of pocket to do all of his nights.

Is this common? Is this frowned upon? I'm basically asking if it's common practice to "regularly" switch shifts instead of switching "every once in a while".

I don't think its common. Think about what would happen to your average 32 hour/week working ER doc. On average, that would be 16 hours per week of nights, which if he switched at the 2:1 ratio to days you suggest would end up with him working 48 hour/week. Thats potentially 6 days a week, every week, if your shop does 8 hour shifts.

 

[Got Em]

I don't think its common. Think about what would happen to your average 32 hour/week working ER doc. On average, that would be 16 hours per week of nights, which if he switched at the 2:1 ratio to days you suggest would end up with him working 48 hour/week. Thats potentially 6 days a week, every week, if your shop does 8 hour shifts.

Good point. However, if they did it at the 2:1 ratio for only 1 of the nights, or if someone was willing do to 3:2 ratio, then I guess it would potentially work out. Thanks for the info!

 

[Arcan57]

For all practical purposes, the answer I gave above is the correct one. If you want to dwelve into the underpinnings, see below:

The circumstance you're describing (trading nights for days) is applicable to only a small minority of group set ups. Academic institutes tend to offer a flat salary for x number of shifts or hours per y time period. In this scenario, trading 1 night for 2 days may be possible. Most other groups will split between 1) flat-hourly wages and 2) RVU productivity. In these scenarios, offering 1.5/1 or 2/1 trades are generally non-starters since in most cases this results in a loss of income for the doc that accepted the night shift. Nights for weekends involves a little more nuance since routinely working either has significant negative effects on your personal life. In general it comes down to the fact that there are significantly more night shifts than there are weekend shifts. Most groups are going to be aiming for a level of staffing that requires 2 weekends/month worked. That generally leaves 2 weekends to bargain with, which may not be enough to eliminate overnights completely. Additionally, "weekendist" tends to be an extraordinarily unstable scenario for a variety of reasons. While I'm sure emergentMD has 3 partners that only work weekends, the average life expectancy of a weekendist in my group is less than 3 months.

 

[gro2001]

For all practical purposes, the answer I gave above is the correct one. If you want to dwelve into the underpinnings, see below:

The circumstance you're describing (trading nights for days) is applicable to only a small minority of group set ups. Academic institutes tend to offer a flat salary for x number of shifts or hours per y time period. In this scenario, trading 1 night for 2 days may be possible. Most other groups will split between 1) flat-hourly wages and 2) RVU productivity. In these scenarios, offering 1.5/1 or 2/1 trades are generally non-starters since in most cases this results in a loss of income for the doc that accepted the night shift. Nights for weekends involves a little more nuance since routinely working either has significant negative effects on your personal life. In general it comes down to the fact that there are significantly more night shifts than there are weekend shifts. Most groups are going to be aiming for a level of staffing that requires 2 weekends/month worked. That generally leaves 2 weekends to bargain with, which may not be enough to eliminate overnights completely. Additionally, "weekendist" tends to be an extraordinarily unstable scenario for a variety of reasons. While I'm sure emergentMD has 3 partners that only work weekends, the average life expectancy of a weekendist in my group is less than 3 months.

Then there is the fabled night-weekendist-locums.

 

[The White Coat Investor]

I'll work one night for two days. Great trade IMHO. We pay about a 50% night differential.

 

[dchristismi]

I had a "weekendist" in my group who was semi-retired, and in exchange for no nights, he worked every weekend for about 3 years with only a handful of exceptions.

But he is definitely an exception, not the norm.

 

[Janders]

Anything can be arranged, if your open to the scheduling and monetary aspects of it.

Originally my group was basically straight RVU, and thus nights actually paid LESS (small enough hospital that its slowish from 0300-0600). So if you took someone's night in exchange for your 3p, not only are you doing them a FAVOR you are getting a PAY CUT to do it! It was fine, because we all split nights evenly and the occasional trade would just get reciprocated later.

But of course, you could take their night and $300 cash... 🙂

Now, we have an older partner who's opted out of nights, and a couple young people willing to do extras. So we've build a system into our pay structure to bonus nights above your "Fair share" and tax days above your "fair share". This makes it automatically fair, from a $$$ perspective, to work 100% or 50% or 0%.

So, you may need accounting creativity, but you can do it.

The real question is will you work in a group where people are hungry enough for the cash you are willing to pay to eat your nights?

 

[emergentmd]

The accounting is very minimal and doesn't really affect anyone.

30 nights in a month. Say you pay $500/night so that comes out to 15k/mo. This amount is taken off the bat from whatever Pot you pay the docs

Say there are 10 docs and all are assigned 3 nights/mo.

Docs that hates nights gives them up (say 4)

Docs don't want to give up nights but don't want to take on any more (say 5)

Docs loves night and wants all nights (1)

So every month, 4 gets out of nights (costs 6 ktotal). 5 not affected. 1 guy picks up $6k in night differential.

Some situations may have too many wanting nights thus they split what is avail. Some situations have not enough picking up nights then whats left gets given back to the non-nighters.

This makes everyone happy, math is easy, there is no scenario where anyone is screwed.

 

[gutonc]

I had a "weekendist" in my group who was semi-retired, and in exchange for no nights, he worked every weekend for about 3 years with only a handful of exceptions.

But he is definitely an exception, not the norm.

My (non-EM) group used to have a weekendist. He covered half the weekends which meant the rest of us had to do 2 weekends a year. It was glorious. He died 2 years ago. I have no idea if the 2 are connected but I miss him.

 

[Janders]

The accounting is very minimal and doesn't really affect anyone.

Our version is similar. We have 3 "day" shifts and one "night shift", thus you owe 25% nights to be a fair member.

Every time you work a day shift, you put $X into a pool.
Every time you work a night shift, you take $3X out of the pool.

The pool, by definition, is empty at the end of the quarter. If you do your fair share of 25% nights, you even out and it doesn't affect you. If you drift off of that target, you either get bonus money or pay taxes. We set $X as mutually agreed upon fair value that people are willing to pay to get out of to work nights, and also willing to take to pick up extra nights. In the future, we could move it up or down as the market dictates...

 

[Mjolner]

Our version is similar. We have 3 "day" shifts and one "night shift", thus you owe 25% nights to be a fair member.

Every time you work a day shift, you put $X into a pool.
Every time you work a night shift, you take $3X out of the pool.

The pool, by definition, is empty at the end of the quarter. If you do your fair share of 25% nights, you even out and it doesn't affect you. If you drift off of that target, you either get bonus money or pay taxes. We set $X as mutually agreed upon fair value that people are willing to pay to get out of to work nights, and also willing to take to pick up extra nights. In the future, we could move it up or down as the market dictates...

So how much does something like this actually work out to being? I mean what pay Range are day only making vs night only vs those who do 3 days and one night?

 

[SoCuteMD]

Don't think I would trade 2 day shifts to someone and cover their night shift in return. I probably wouldn't trade a weekend shift for a night unless I needed the weekend off.

 

[deleted77919]

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[Angry Birds]

I ended up getting a job with no nights even though I never intended for that.

They have a night differential and a few dedicated nocturnists so they didn't even have enough nights to go around.

Pretty happy about not having to do nights... Although this job is not several months away for me.

 

[Angry Birds]

However I agree that anyone who is concerned with this issue probably should not go into EM. Nights, weekends, and holidays is the trade off for EM.

I gotta be honest: during the last few months of residency I traded a bunch of evening shifts for overnights, since evening shifts are the ffing worst. This was under the table though and a bad case of senioritis.

 

[e30ftw]

You shouldn't go into EM with the intent of immediately rearranging the majority of your night shifts.

If you take a job then immediately start requesting to trade all your nights you will be known as "that guy".

I'm also curious what you mean by "giving away 1.5-2 day shifts" in exchange for a night shift. I would definitely rather work the hours on those 2 day shifts (and make twice as much) than give away the double-covered day shifts for a mostly-single-coverage night shift and throw away $2k that month in the process. Doesn't really add up unless you have a significant differential like in WCI's group. My job is hourly without a differential fyi.

I would absolutely trade any shift with any of my partners if they had a family emergency or significant scheduling conflict. Stuff like this happens once in a while. Now if the same person asked every month not to work nights it would become an issue..

 

[Got Em]

You shouldn't go into EM with the intent of immediately rearranging the majority of your night shifts.

If you take a job then immediately start requesting to trade all your nights you will be known as "that guy".

I'm also curious what you mean by "giving away 1.5-2 day shifts" in exchange for a night shift. I would definitely rather work the hours on those 2 day shifts (and make twice as much) than give away the double-covered day shifts for a mostly-single-coverage night shift and throw away $2k that month in the process. Doesn't really add up unless you have a significant differential like in WCI's group. My job is hourly without a differential fyi.

I would absolutely trade any shift with any of my partners if they had a family emergency or significant scheduling conflict. Stuff like this happens once in a while. Now if the same person asked every month not to work nights it would become an issue..

I'm sorry, I realized that my original post wasn't clear at all. This is what I meant.

Before trade:
Person A = 6 day and 6 night shifts per month
Person B = 6 day and 6 night shifts per month
Day shift pay = $2400 ($4800 for 2 days); Night shift pay = $3000

If Person A trades 1 night shift for 2 day shifts from Person B:

After trade:
Person A = 8 days and 5 nights per month (13 shifts total)
Person B = 4 days and 7 nights per month (11 shifts total)

Salary does not change. Person A will be working 2 days for 1 night's pay ($3000), while Person B will be working 1 night and getting paid for 2 days ($4800). Basically, whoever takes the night shift will be working 1 shift less per month, while getting the same salary. Of course, some people do this differently, but this setup is what I was asking.

 

[goodoldalky]

If you do not want to work overnights, I would suggest picking a different specialty.

 

[Got Em]

If shifting schedules is enough of a concern you are already trying to figure out how to get out of it, I wouldn't jump into EM as a field.

You shouldn't go into EM with the intent of immediately rearranging the majority of your night shifts.

If you take a job then immediately start requesting to trade all your nights you will be known as "that guy".

If you do not want to work overnights, I would suggest picking a different specialty.

My original post was probably very unclear. I posted mainly to ask if it was common practice to trade shifts due to what I've heard from different attendings. In a study 43% of EM docs were considering leaving practice due to night shifts (Smith-Coggins R, et al). Of course it's a major concern for a medical student. However, I did not state that I'd be unwilling to work night shifts.

 

[goodoldalky]

Then your answer is no. Unless you are some sort of MD/MBA administrator or the medical director you will probably work a lot of nights.

 

[Birdstrike]

Don't even try to convince yourself there will be a way out of nights. You'll have to do them. A lot. They will suck. Bad. I'm sorry if that sounds negative, but it's true. Nights are a part of EM, in some measure.

 

[Janders]

wait, medical directors get out of nights? I need to check that rule... 🙂

Agree with everyone's tone-- If nights are a non-starter, find a different career.

That said, you can make ANYTHING happen for the right amount of money/sacrifice. For example, if you wanted NO nights but would work EVERY weekend, then you very well might find a group to take you up on that. Also, for the right amount of $$$ you can certainly find someone to sell/trade your nights to; this amount of $$$ may be a very significant portion of your income, so know that.

 

[BlackDynamite]

Is anyone else excited about having to work holidays? I'm at the in laws for thanksgiving, and I would love to have an excuse to be elsewhere.

 

[e30ftw]

don't mind cause family usually rearranges around the schedule.

worked T-day at a rural satellite. saw 10 pts, made $3k. watched 3hrs of football.

 

[Cerberus]

Even my Chairman does the occasional night shift. It's part of the job. No one likes it but then again no one likes the alternatives in most other medical specialties either.