What's wrong with 20-24 shifts per month?

[Technorino]

I ask this because I see a lot of IM/FM docs working 10-12 hour "shifts" for 20-25 days out of the month and also because an EM mentor of mine used to work 220+ hour months for a long time before he turned 50+

I know the average for EM seems to be around 12 shifts or 120 hours per month but is it because the constant shift timing changes makes 20-24 shifts a month impossible?

I'd love to learn more about this because it seems like a good way to pay off loans aggressively in the beginning.

Thank you for your input!

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[RustedFox]

Been discussed on here before. Terrible idea when just fresh out to work yourself past the redline. The majority of new grads that do that end up being flagged somehow or other for quality issues, professionalism issues, or whatever.

 

[BoardingDoc]

I ask this because I see a lot of IM/FM docs working 10-12 hour "shifts" for 20-25 days out of the month and also because an EM mentor of mine used to work 220+ hour months for a long time before he turned 50+

I know the average for EM seems to be around 12 shifts or 120 hours per month but is it because the constant shift timing changes makes 20-24 shifts a month impossible?

I'd love to learn more about this because it seems like a good way to pay off loans aggressively in the beginning.

Thank you for your input!

Working 10-12 hours in IM != working 10-12 hours in EM. This is simply because in EM you frequently have shifts where you are so busy that there is literally no time to eat, urinate, etc.... As a result, most EPs work fewer shifts than hospitalists to compensate for the relative stress load.

 

[Frazier]

As merely a med student, I certainly could appreciate that a 10 hour shift in the ED was a far cry from a 10 hour shift in clinic (FM) or on the wards (IM).

I imagine the chasm between the two experiences only widens when actually practicing.

EDIT: yep, what the doc above me typed.

 

[Groove]

The circadian disruption is unique to the specialty. 7 shifts with day/swing/night shifts and requisite normalization of your body clock is akin to permanent jet lag. The shift variability is what makes 24/mo simply impossible. Also, the stress level is infinitely greater compared to an IM doc. Not that they don't work hard, it's just a different type of stress. We generally have very high acuity. My last 3 shifts included 3 intubations (one in a infant), one central line, one LP on a bad meningitis, a 2 hour code, few fracture/reductions, conscious sedation, and several very high acuity cases. I'm off today but I don't really feel "off", more like lying around the house and doing as little as possible. Hell, I feel like taking a nap and I slept 8 hours last night. Be my guest if you want to work 20+ shifts in EM but kiss goodbye quality of life. There's a reason this specialty has a high burn out rate. Personally, I find 18 shifts/mo deleterious to my personal life but not enough to stop working them since I'm trying to pay off my debt. Once it's off though I'd like to work 14-15 for awhile. That's a much more happy place for me.

 

[canigetawhatwhat]

I do 18. Its a lot. I couldnt imagine doing more than 20 in a month. Im happy with my 16-18 as a recent grad.

 

[GonnaBeADoc2222]

LOLZ at 20-24 shifts/month.

1) Circadian rhythm shifts suck. I am so much happier when I'm on stretches without nights. I'd rather manage the 12-20 sick patients at one time during the day than the nighttime trickle. More shifts = more transitions. Minimizing these transitions is key.

2) I believe alarm / interruption fatigue is deleterious to my overall mental / emotional health and I'd like to minimize my exposure to it.

I have an attending (one of my favorites actually) who probably does 22-24 nights a month. I'm not sure it's good for them.

I'll take my 1440 hrs/year and $300+k thanks. I don't need to make 600k.

 

[The White Coat Investor]

I did 22 nines as an intern. But the most I've done as an attending is 16 eights. I think if you're pushing past 18 you're at pretty high risk for burnout, but everyone is different.

 

[Janders]

I did it as a resident, so I'm sure I COULD do it now.

But I wouldn't. I think >18 is very high risk for burnout, emotional issues, quality issues, etc etc.

Perhaps if you worked ZERO overnights, so you stayed on the same sleep schedule, 20-22 would be doable at least for 1-2 years to aggressively pay off loans.

 

[fahimaz7]

I ask this because I see a lot of IM/FM docs working 10-12 hour "shifts" for 20-25 days out of the month and also because an EM mentor of mine used to work 220+ hour months for a long time before he turned 50+

I know the average for EM seems to be around 12 shifts or 120 hours per month but is it because the constant shift timing changes makes 20-24 shifts a month impossible?

I'd love to learn more about this because it seems like a good way to pay off loans aggressively in the beginning.

Thank you for your input!

The most I've done this year is 175. I could sustain that for a few years with the right group.

 

[bravotwozero]

The only way I could do 20 shifts was if I worked Monday to Friday, 9am to 5pm. Even then I'd probably burn out at some point.


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[TooMuchResearch]

I did it as a resident, so I'm sure I COULD do it now.

But I wouldn't. I think >18 is very high risk for burnout, emotional issues, quality issues, etc etc.

Perhaps if you worked ZERO overnights, so you stayed on the same sleep schedule, 20-22 would be doable at least for 1-2 years to aggressively pay off loans.

I think I'm going to try for the equivalent of 18 8s (about 145 hr/month) for the first 1-2 years, but most of the group is more in the 13-15 shift per month range, definitely more sustainable for me long term.

If 18 is too rough on personal (and work) life, will step it down sooner.

 

[alpinism]

Its not impossible.

There are still a few residency programs out there that work 20 - 12s per month.

However as others have mentioned you'd have a brutal lifestyle on par with general surgery residency. Combine that with the fact that most people in EM value their free time and having a life outside of medicine and you'll understand why working 200+ hours per month isn't a very attractive prospect for most attendings with 200K of med school loans.

 

[BoardingDoc]

I think I'm going to try for the equivalent of 18 8s (about 145 hr/month) for the first 1-2 years, but most of the group is more in the 13-15 shift per month range, definitely more sustainable for me long term.

If 18 is too rough on personal (and work) life, will step it down sooner.

Just make sure you aren't contractually obligated to work that many shifts each month if you're planning on cutting back unless you're positive you can scale back later. You can always pick up extra shifts. It can be hard to drop required ones.

 

[TooMuchResearch]

Just make sure you aren't contractually obligated to work that many shifts each month if you're planning on cutting back unless you're positive you can scale back later. You can always pick up extra shifts. It can be hard to drop required ones.

I've asked around, including some of my program's grads that work with the group. I won't be obligated to work that many and they let people modify their shift number request every time the next schedule is made. Basically each scheduling period we can request x number specific days off and request a total number of shifts over the scheduling period.

 

[winkleweizen]

I did 17 this month and I'm beat. My ideal is 14 or 15

 

[emergentmd]

I could work 20 shifts a month if I did not have kids. Once you have kids, that number plummets.

Sleep is very important. When you are single, you sleep when you want. Eat when you want. Have no other responsibility.

Have kids, and sleep is not guaranteed.

 

[Angulimala]

I work that much right now (as a resident), and let me tell you the benefits: I only have to see my spouse (awake; she's also a resident) 3-4 times weekly. We have 1 day off together in a 3 month period. You get to eat mostly burritos because you're too tired to cook, and drink a delicious pot of coffee daily. I run out of ambien in a week, and stopped taking benadryl (apparently it's associated with dementia, whoops!). I can tell you that all the seniors going off to work community jobs next year, signing up for 12/month...sounds like heaven.

 

[shookwell]

I worked 10x 12s and 13x 8s this month. Mostly to take advantage of the higher locums rates over the holidays. I usually work far less than that.

 

[Vandalia]

I ask this because I see a lot of IM/FM docs working 10-12 hour "shifts" for 20-25 days out of the month and also because an EM mentor of mine used to work 220+ hour months for a long time before he turned 50+

I know the average for EM seems to be around 12 shifts or 120 hours per month but is it because the constant shift timing changes makes 20-24 shifts a month impossible?

I'd love to learn more about this because it seems like a good way to pay off loans aggressively in the beginning.

Thank you for your input!

For roughly the same reason why MLB players have 160+ games a year and many go straight from that to play in South/Central American leagues, while NFL teams have trouble fielding a remotely healthy roster after 16 games.

They are both professional sports, but the work environments are dramatically different. Same thing with different medical specialties.

 

[RustedFox]

Brilliant analogy, there.

 

[Hercules]

Brilliant analogy, there.

+1 to that


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[witzelsucht]

I work that much right now (as a resident), and let me tell you the benefits: I only have to see my spouse (awake; she's also a resident) 3-4 times weekly. We have 1 day off together in a 3 month period. You get to eat mostly burritos because you're too tired to cook, and drink a delicious pot of coffee daily. I run out of ambien in a week, and stopped taking benadryl (apparently it's associated with dementia, whoops!). I can tell you that all the seniors going off to work community jobs next year, signing up for 12/month...sounds like heaven.

whoa? benadryl causes dmentia? i guess i should stop...only 12.5mg after an overnight or swing sometimes but still...

 

[witzelsucht]

hmm apparently only if you take it every day for three years is 50% more risk...still probably not good

 

[deuist]

I typically work 230+ hours a month between the military and moonlighting, all nights. I've been keeping that pace for about 18 months now. It's definitely a difficult schedule and something I won't keep it up once my active duty commitment is over. I think that I will go to 70 hours a month for the first few months to take a "break" before going back up to 140-160 hours.

 

[The White Coat Investor]

whoa? benadryl causes dmentia? i guess i should stop...only 12.5mg after an overnight or swing sometimes but still...

Between that and the additional cardiac risk factor for working at night, there are very good health reasons to figure out a way to have someone else work your share of the night shifts.

 

[witzelsucht]

I typically work 230+ hours a month between the military and moonlighting, all nights. I've been keeping that pace for about 18 months now. It's definitely a difficult schedule and something I won't keep it up once my active duty commitment is over. I think that I will go to 70 hours a month for the first few months to take a "break" before going back up to 140-160 hours.

so....more than i work as an intern. do you find staying nocturnal helps a lot? are you somewhere that things are pretty slow after 2am?

 

[deuist]

do you find staying nocturnal helps a lot?

It helps with scheduling. No place will let you work only days, but plenty of places will let you do only nights.

are you somewhere that things are pretty slow after 2am?

In the military, yes. We typically see 1-1.5 patients per hour from midnight to 6 am (and 3-4 per hour from 6pm to midnight). On the civilian side, I see the same number of patients regardless of the time of day.