Working exclusively nights out of residency?

[Dr. Texas]

I LOVE night shifts. In fact, I volunteer for more when I can. The pace, the staff, the pathology at night really do it for me (I know there are many kindred spirits out there.)

I'd like to work nights exclusively for my first attending job. But this is probably something I shouldn't advertise before my first interviews, right? I shouldn't walk in and be like "I'll work all nights, if you'd have me" right?

I feel like my preference for nights could be very productive later on in negotiations for pay/bonus/etc?

Any other advice or consequences related to only working nights?

Thanks in advance.

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[deleted480308]

I wouldn't push it during hiring because you don't want to be stuck with it as an expectation. Get hired and then start finding people that want to buy out of their night shifts

 

[DeadCactus]

I would think it's the opposite. I think it would make you much more attractive to many groups and give you increased leverage during negotiations. Agree that you have to be careful about making it the expectation unless you're completely committed to it. You don't want to walk in making that claim, have your outlook change a few months later, and suddenly decide you want into the day pool.

 

[Tenk]

This is an ace. Get hired first, make sure you like nights there then pull out the card for higher pay.

 

[The White Coat Investor]

We might be hiring. You like mountains?

Be aware your feelings may change over time.

 

[Psai]

Don't let them know cause they will lowball you. Get as much as you can from those lazy day only docs

 

[emergentmd]

Your board certified, not a psychopath, do all nights.... your hired.

If you are doing all nights, You should get a shift differential. I would gladly pay $500/night shift to get out of it.

 

[gman33]

Depending on the practice environment, working all nights initially may be an issue.

You will be waking up consultants that don't know you and may be less than helpful.

Working with less staff, backup etc from the start will likely make your job harder.

But if you really want to do it, many groups would love to have you.
Just make sure they make it worth your while.
If it's a smaller group, once you are pegged as a night doc, you may not be able to switch to days that easily.

 

[Janders]

We're not hiring.

Except if someone wants to work all nights. I'll hire that person.

When you disclose this is somewhat tactical and depends on the specific jobs; It might get you an interview you wouldn't have gotten, It might get you a nice differential in some environments, and some places might already have a night doc or two and not really care... each set up will be unique.

You like Lobstah?

 

[Dr. Texas]

I'll also work every Christmas for as long as I'm employed at your shop.

But seriously, thanks for all the great feedback.

But seriously, I would work every Christmas.

 

[Old_Mil]

? I shouldn't walk in and be like "I'll work all nights, if you'd have me" right?

Not that this is an excuse to be a d*ck, but the day you graduate from residency the calculus changes from "if they'll have you" to "if you'll have them."

Willing to work all night shifts should come with a higher rate.

 

[Dr. Texas]

Bumping this back to the top, if I may.
Have spoken with better half and she is OK with an all night shift schedule for a "a few years." She also has a crazy schedule and we do not have kids yet.
I'm for sure going to do all nights/nocturnal.

I'll likely be signing a contract in the next year and after reading through these messages, it seems as though this is something to advertise up front (ie the want for all nights).

What can you ask for if you want to do all nights... differential? scheduling priority? etc?

I also can work every Christmas and Easter, no questions asked. Should I advertise this?

 

[Perrin]

Bumping this back to the top, if I may.
Have spoken with better half and she is OK with an all night shift schedule for a "a few years." She also has a crazy schedule and we do not have kids yet.
I'm for sure going to do all nights/nocturnal.

I'll likely be signing a contract in the next year and after reading through these messages, it seems as though this is something to advertise up front (ie the want for all nights).

What can you ask for if you want to do all nights... differential? scheduling priority? etc?

I also can work every Christmas and Easter, no questions asked. Should I advertise this?

I'd be wary of a group that is willing to let you jump in as a nocturnist, doubly so if it's single coverage, and triply if it's right out of residency. We have triple coverage till 2am and double till 7am. We don't let anyone go all nights till they have worked here for a year or two, learned the system, and built a report with the admitting and consulting physicians.

This is so we know you are confident and capable of running your own ship as well as you being comfortable and familiar with the downstream doc's expectations and they comfortable with your workup and assessment. You'll be waking these folks in the middle of the night and sometimes writing bridge orders until they see the patients in the morning. They'll need to be familiar with you and trust you.

Sure, getting the extra money out of the gate is tempting. However, getting face to face time with these folks when they come down during the day is useful and builds trust. Being there during daylight also affords you the opportunity of 4-6 total ED docs being available for help and questions.

Come in there as a regular doc. Learn the system and the process. Then advance to being a nocturnist.

 

[deleted109597]

Learn the system and the process. Then advance to being a nocturnist.

Counterpoint to above is that the overwhelming majority of jobs out there have single coverage day and night. I've worked at multiple hospitals, and have spent a grand total of 2 hours shadowing somebody to "learn the system". I mean, I get the point, but it's not like those shops where there is double coverage during the day have guys that like being asked "who do I call first?" That's everywhere. You learn as you go. Would it be nice if there was more graduated responsibility? Sure. So would getting paid more, or having patients board upstairs, or any number of things that would make our jobs easier.

 

[DarkHorse22]

We might be hiring. You like mountains?

Be aware your feelings may change over time.

Would this be exclusively for nights?

 

[Apollyon]

Would this be exclusively for nights?

7 months later, I wonder if that job has already been filled months ago...

 

[Janders]

Common things offered for all nights are $ differential and scheduling preference.

Everything is negotiable.

In our group we don't have anyone doing all nights, but if you work extra nights you get bonus money-- proportional to the number of extra nights. We have hired people who do extra nights for their first 1-2 years (i.e. 60% nights instead of 25-30%) and they get the $$ as well as some type of scheduling preference.

I know groups where 14 shifts a month gets you full time partner salary and bonus, but 12 a month get you that if you are all nights.

 

[DarkHorse22]

7 months later, I wonder if that job has already been filled months ago...

whoops. need to pay attention to those dates.

 

[Angry Birds]

I personally don't think it's a big deal to work nights right out of residency, as long as you weren't a particularly weak resident. At many/most single-coverage hospitals, the volume is way lower over nights. This lower volume might actually be a nice thing for a brand-new attending. Compare that to the crazy evening shifts...

 

[emergentmd]

Our Group made you do normal shifts for a month and you can go all nights after that. I think a month daytime is good as there are double/triple coverage to answer any logistical questions. After that, the learning curve really flattens out.

Do I get things done faster b/c I have been there for 15 yrs? Sure, but after a month, the backdoor techniques rarely is needed.

If I were you, this is what I would do.

#1 - Gauge how desperate the group is. If you know they will hire anyone off the streets, I would hold off on the "all night card" or just ask them in passing if there is a night/holiday differential. I would be many would agree to a higher differential or at worse negotiate with some older docs who would gladly pay you money on the side to take their nights. Our group had a night differential so we had nocturnist who did most nights. But if we didn't have a differential, I would gladly pay someone $$$ to cover my share.

# 2 - If the group has limited openings or a tight market, I would bring up the night differential up front. As they are a sought after group, you have very little negotiating leeway. So better to know up front. If you really want the job, tell them you are willing to do nights for 2 yrs. Even if you were not on top of their list, You have immediately jumped to the top of the list. If you are lukewarm about the job, don't tell them you are a nocturnist. Once you start the job, going to nocturnist should be a piece of cake. Otherwise, I would just work the regular shifts and feel out who would be willing to pay you to cover their nights. I can bet you can find 80% of the docs willing to throw some $$$ at you for nights.

 

[GeneralVeers]

I work (almost) all nights. It has many advantages:

1. I get to make my own schedule
2. No C-suites or management around to slow down my work flow
3. Night shift nurses are usually much more adept (and fun) than their daytime peers
4. Some nights can get 2-3 hours of no patients. It's great to catch a nap or watch Netflix.

I usually get around $40/hour night shift differential. If no differential, and no pick of schedule then I wouldn't do it.

 

[bravotwozero]

I don't understand how people work that many nights. It's brutal on your system. I don't think you should be doing it. It'll wear on you. Just working 2-3 nights per month is enough for me. I really don't think the perks/money are worth it.


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[Dred Pirate]

I know of an ED group that requires the new guys to work nights exclusively for 2 years

 

[GeneralVeers]

I don't understand how people work that many nights. It's brutal on your system. I don't think you should be doing it. It'll wear on you. Just working 2-3 nights per month is enough for me. I really don't think the perks/money are worth it.


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The key for me is to stay on a night schedule all the time, even my days off. That way I'm not flipping back and forth and messing up the circadian rhythm. I actually find it less disruptive than having to get up at 5AM to work a day shift, then forcing myself to go to sleep at 9PM.

The other advantage to staying on night schedule, is the gym is deserted at midnight.

 

[Old_Mil]

We don't let anyone go all nights till they have worked here for a year or two, learned the system, and built a report with the admitting and consulting physicians.

If anyone's looking for a job, this might not be a bad place to check out. Finding a group that schedules with a thought that's deeper than "throw any available warm body into any available hole in the schedule" is pretty rare. The fact that they do this indicates that there are some higher level thought processes going on administratively...