Why isn't there schedule consistency?

[Insulinshock]

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Hey all-

So I'm having that mid 3rd year freakout trying to figure out what I want to do. ER has always been my #1 and I've always enjoyed the work, and some people say its a good lifestyle and some say its kinda poopy one once you have wife/kids, both of which I want. And yes, lifestyle balance is very important to me. A lot of the complaints I hear revolve around switching between days and night.

My question is then this: why don't EDs bunch the shifts all together... say, work all your nights in a row then be done for the month? It seems this would pool your less desirable shifts together, and cut down on the stress of constantly resetting your rhytm? Are there groups out there that work in this format? ER was the field that originally got me interested in medicine, but I worry what my life will be like 15 years out of residency.

Yes I searched the FAQ, yes I've googled, haven't found anything. Thanks yall.

 

[namethatsmell]

Are there groups out there that work in this format?

Yes

 

[DeadCactus]

From my limited observation:

The schedule is set by whatever the group comes to a consensus on. Some groups have a culture amendable to such a structured schedule. Other groups have a culture aimed at meeting a large and constantly varying need of schedule requests and the scheduling process becomes more like herding cats.

Like with anything else, you generally can't have it all. If you're willing to move anywhere in the country, you can probably find the schedule you want. If you're going to be geographically limited, you'll have to be ready to sacrifice in terms of schedule and/or pay...

 

[Birdstrike]

Groups know they can't recruit new people if the new guys are stuck on all the worst shifts. In EM, where you are always busiest when the banks are closed, there is an abundance of "worst shifts." So as not to stick the new guy on the worst shifts, which would be a recruitment death knell in a specialty chronically short staffed, the new, young and old share the worst of the worst and best of the best shifts.

You have a choice between, 1) A "painfully random" schedule with no consistency, or 2) A schedule painfully locked into a rigid, computerized template.

#1 Can and will wreak havoc on your circadian rhythms or any sense of having a normal schedule or normal life. The advantage of such a loose schedule structure, is that with enough notice, it's much easier to get requested days off (not holidays, but random days such as significant other's birthday, or random Sun-Thurs 5-day stretch off).

#2 Can allow one to plan farther in advance, knowing exactly what shifts you're locked into, and when. However, it always amazed me how hard it can sometimes could be to switch a random shift or group of shifts, at times, even in a large group. In EM, and in general, people always seem to have something going on on their days off, so without lots of notice, it can be very hard to switch shifts sometimes. This can become an epic headache, alway trying to get X, Y, or Z day off, by switching shifts and is never guaranteed. (Most of the) rest of the world schedules big, medium and small events of any importance at the same times, hours and on the same days every week, every month and every year: on Saturdays, Sundays, holidays and weekdays after 5pm. These are, and alway will be, the busiest times for an ED, and a huge amount of hours an EP spends at work will be during these times.

There is, and only is one way to make the randomness of the EM schedule more tolerable: work as few shifts as possible. In a specialty that's chronically short staffed with a seemingly endless onslaught of patients demanded to be seen within unrealistic time goals, this may not be a achievable for a large amount of EPs now, or in the future.

In other words, don't count on, "No big deal, I'll just work part time," as a likely or viable solution, especially as we move into an era where the government is trying to crush private medical practice and move towards a physician-employee model.

Doctor: "Mr CEO, can I just work 10 shift per month?"

Mr CEO: "Yes sir, no problem, when the ED overcrowding and healthcare crisis is over (smile)."

(Translation: Lol, this guy has no clue that he'll work as many shifts as we need him to, or I'll replace him, lol.)





...Just the opinion of one random unimportant-guy who writes stuff for free on the Internet.