24 Hour Shifts

[deleted813736]

I am starting a new job that averages 7000/yr patients, 5 bed ER, 24 hour shifts. I have never worked more than 12's and those were a drag. For those of you who work these types of shifts, do you often clump them together? I was asked if I could do 2-3 in a row although I am not sure how reasonable/unreasonable this is. I am a new grad from 2020.

Thanks for anyones thoughts!

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[bravotwozero]

Don’t clump them, for your own sanity! The volume at your ER appears to be low enough that 24h shifts are doable. I have worked 24s at ultra low volume FSEDs that are brand new, where I saw 3-4 patients, all during the day. Those were not bad at all. Just make sure you have a decent blanket/sheets sleep mask/box heater to be comfortable enough at night to fall asleep.

 

[Apollyon]

24 on, 24 off will burn you to a crisp. Ask me how I know.

 

[deleted813736]

24 on, 24 off will burn you to a crisp. Ask me how I know.

So then maybe 48 on and 48 off is better??

 

[Apollyon]

So then maybe 48 on and 48 off is better??

Dude, are you insane? No, q3 (24 on, 48 off, at least).

 

[Sushirolls]

So then maybe 48 on and 48 off is better??

 

[bravotwozero]

24 on, 24 off will burn you to a crisp. Ask me how I know.

How do you know?
I’m hoping there’s a good story behind this...

 

[Birdstrike]

So then maybe 48 on and 48 off is better??

Bruh

 

[Apollyon]

How do you know?
I’m hoping there’s a good story behind this...

Nah, just being mondo f'd up.

 

[EMhawkeye]

Done 24's at a similar sized ER. Hated it.
Some nights would be great and I could get 3-4 hrs sleep.
Most sucked as I had to get up for a patient every 1-2 hrs.
Will never do them again.

 

[GeneralVeers]

Did 24 hour shifts exactly once. Just enough patients came in at night to be annoying and there was nowhere comfortable to sleep. Why do these people who build freestandings think a "Lay-z-boy" is adequate to get some rest in?

After hour 18 I was an impaired physician. Never again.

 

[calvnandhobbs68]

I am starting a new job that averages 7000/yr patients, 5 bed ER, 24 hour shifts. I have never worked more than 12's and those were a drag. For those of you who work these types of shifts, do you often clump them together? I was asked if I could do 2-3 in a row although I am not sure how reasonable/unreasonable this is. I am a new grad from 2020.

Thanks for anyones thoughts!

They asked you if you could do 2 in a row?? Uh ask whoever asked you that when the last time was they worked for 48hrs straight.

@EMhawkeye has it right, it’s not even just in ED…anyone who’s done 24s as a resident knows the thing that sucks ass the most isnt volume necessarily but when you get 1-2 admits/patients to see every 1-2 hours all night long. More volume clustered over a small period of time is way better than a slow trickle when you’re there for 24hrs straight. You have no guarantee you wouldn’t be essentially forced awake for 48hrs. It’s pretty well established that by the end of a 24 you essentially have the same cognitive performance as if you were intoxicated. Even if you do get a few hours of uninterrupted sleep, your circadian rhythm is gonna be royally screwed if you don’t get a post 24 recovery day to reset.

How many of these shifts are they wanting you to do a month?

 

[bravotwozero]

The key with 24s is to find a brand new freestanding or small hospital that’s just opening up. Initial volume is going to be super low, and you’ll even go a few shifts without seeing a single patient.

 

[Tenk]

I once did 24 on, 24 off, 24 on, 24 off, 24 on. After that I pretty much never signed up for another 24 hour shift outside of bonus pay. They are toxic.

 

[Apollyon]

I once did 24 on, 24 off, 24 on, 24 off, 24 on. After that I pretty much never signed up for another 24 hour shift outside of bonus pay. They are toxic.

I did 5 quick turnarounds once, to get time off for Hawai'i. Yes, 24 on, 24 off, 24 on, 24 off, 24 on, 24 off, 24 on, 24 off, 24 on. I don't know how I didn't kill anyone (including myself) during that.

That job ended up ending my clinical career. And, it wasn't from that string of shifts (that was about 5 years before the end).

 

[dchristismi]

As a resident, we had a community ICU rotation that was basically 24 on, 24 off, 24 on, 24 on or some ridiculousness like that.

But it was a 42 bed multiple ICU situation and basically you started rounding at 7 am, and usually finished around 3 the next morning, and then the annoying potassium-of-3 calls started coming in. It was brutal. But... it was residency and it was a "keep-'em-alive until 7:05 situation." I learned exactly how far I could push myself, that I could run 2 codes at once (one over the phone) and knew I never, ever wanted to do that again.

A 5 bed freestanding is a lot different, but I would defer to the above experts. I've done 12s at FSEDs and sometimes heaven, sometimes hell.

 

[Birdstrike]

That job ended up ending my clinical career. And, it wasn't from that string of shifts (that was about 5 years before the end).

Wait. What? Your clinical career ended? You don't see patients anymore, in any form? If so, PM me the how, because I want to do it too.

 

[Tenk]

I did 5 quick turnarounds once, to get time off for Hawai'i. Yes, 24 on, 24 off, 24 on, 24 off, 24 on, 24 off, 24 on, 24 off, 24 on. I don't know how I didn't kill anyone (including myself) during that.

That job ended up ending my clinical career. And, it wasn't from that string of shifts (that was about 5 years before the end).

I was already talking to myself like Gollum by the third one. No idea what I would be doing on the fifth.

 

[BoardingDoc]

Wait. What? Your clinical career ended? You don't see patients anymore, in any form? If so, PM me the how, because I want to do it too.

Yeah, wait, what? You're not practicing anymore?

 

[Apollyon]

I'm going to say it once, and not anything else, so, don't ask. I burned out, got set up, and fired.

 

[robellis]

I'm going to say it once, and not anything else, so, don't ask. I burned out, got set up, and fired.

Bro wut

 

[Kryptocoin]

I do some 24s prn. They are great to earn some extra cash and save time if you're a traveling doc. I would never do 24s full time but I pick two/three 24s a month in addition to my main gig. Some shifts are great ( sleep after midnights), others can be hell (drip, drip, all day). I never pick up a 24hr paying less 180/hr. The trick is to find a site with predictable flow (no new pts after midnight) and pays reasonable. Lot of recruiters will lie or underestimate their volume.

 

[gamerEMdoc]

Once did a 24 and pitched a no-hitter. Not going to lie, those last 4 hours were weirdly nerve wracking. The stress of not breaking the streak was getting to me. I felt like a pitcher with a no-hitter going through 7 innings.

 

[Vandalia]

Lot of recruiters will lie or underestimate their volume.

If you are being paid at a rate proportional to patient volume, cut their numbers in half. If you are being paid a flat rate, double the volume

Most of these people have retired, but there was a time when 72 hour shifts in residency, or multiple 24 hour shifts back to back were not unusual. There was a physician who I vaguely knew who was a couple years ahead of me as an undergrad who claims he worked a 96 hour shift at a rural hospital ER to pay for the move to his first job. He later wrote a book.

It was possible to practice Emergency Medicine after 48-72 hours, but I worded that carefully. After or around 24 hours:

1. Around or after 24 hours you lose the filter. You start to tell people the truth and what you are really thinking, which now is not good. Forty years ago no one cared: not the patient, certainly not the hospital. As we all know, today that is definitely not the case.
2. In my experience, you can wake an EM physician from a dead sleep and he can run a code. After 72 hours you can still handle an acute abdomen or sew a laceration. What is lost is the ability to find the needle in the haystack: The one case of "stomach flu" out of a dozen that is not "stomach flu." Again, decades ago when patients segregated themselves out, that wasn't such a big deal. If someone came to the ED they needed at least urgent care. Today, finding that "needle in the haystack" is arguably the most important EM skill. That skill quickly erodes with fatigue.

What was possible decades ago doesn't work now because the environment is completely different.

 

[robellis]

If you are being paid at a rate proportional to patient volume, cut their numbers in half. If you are being paid a flat rate, double the volume

Most of these people have retired, but there was a time when 72 hour shifts in residency, or multiple 24 hour shifts back to back were not unusual. There was a physician who I vaguely knew who was a couple years ahead of me as an undergrad who claims he worked a 96 hour shift at a rural hospital ER to pay for the move to his first job. He later wrote a book.

It was possible to practice Emergency Medicine after 48-72 hours, but I worded that carefully. After or around 24 hours:

1. Around or after 24 hours you lose the filter. You start to tell people the truth and what you are really thinking, which now is not good. Forty years ago no one cared: not the patient, certainly not the hospital. As we all know, today that is definitely not the case.
2. In my experience, you can wake an EM physician from a dead sleep and he can run a code. After 72 hours you can still handle an acute abdomen or sew a laceration. What is lost is the ability to find the needle in the haystack: The one case of "stomach flu" out of a dozen that is not "stomach flu." Again, decades ago when patients segregated themselves out, that wasn't such a big deal. If someone came to the ED they needed at least urgent care. Today, finding that "needle in the haystack" is arguably the most important EM skill. That skill quickly erodes with fatigue.

What was possible decades ago doesn't work now because the environment is completely different.

Well said

 

[emergentmd]

I am doing all FSERs with 6 shifts a month. I will say that this lifestyle is heaven. I have so much time on my hands that I am looking at picking up hobbies that I always wanted to do. 4/6 I get 7+ hrs of sleep, 1/6 I get woke up once, 1/6 I may get 2-3 pts (still get 2-4 hrs of sleep).

Post shift I typically feel well, and maybe take a 1 hr nap if tired.

I would never do a 24 hr shift if most of the time I don't typically get straight sleep. That would be a horrendous and everyone would have to be around me post shift.

 

[robellis]

I am doing all FSERs with 6 shifts a month. I will say that this lifestyle is heaven. I have so much time on my hands that I am looking at picking up hobbies that I always wanted to do. 4/6 I get 7+ hrs of sleep, 1/6 I get woke up once, 1/6 I may get 2-3 pts (still get 2-4 hrs of sleep).

Post shift I typically feel well, and maybe take a 1 hr nap if tired.

I would never do a 24 hr shift if most of the time I don't typically get straight sleep. That would be a horrendous and everyone would have to be around me post shift.

How much you make per hour doing those?

 

[sylvanthus]

I'm going to say it once, and not anything else, so, don't ask. I burned out, got set up, and fired.

Daaaaaaaammmnnn man.

 

[turkeyjerky]

How much you make per hour doing those?

Pretty sure he owns his free-standing, so probably quite a bit (facility fees are ca$hmoney baby!)

 

[robellis]

Pretty sure he owns his free-standing, so probably quite a bit (facility fees are ca$hmoney baby!)

He owns his own ER? Wtf lol that’s crazy baller level

 

[sloh]

Wait. What? Your clinical career ended? You don't see patients anymore, in any form? If so, PM me the how, because I want to do it too.

If you were financially independent, you would stop practicing pain as well?

 

[d2305]

Psychosis sets in after about 48 hours.

 

[Apollyon]

Psychosis sets in after about 48 hours.

I thought it was 50% of people in 5 days (120 hours).

 

[Birdstrike]

If you were financially independent, you would stop practicing pain as well?

The Derm-equivalent schedule and much lower stress level reduce the sense of urgency to get to retirement. But when I have enough money to retire, I plan on retiring. I'll do plenty. I might even work, perhaps as a volunteer, so I can still contribute, yet come and go as I please. But my plan is that I won't be doing any more doctoring after I'm financially able to retire.

 

[emergentmd]

I remember with disdain in residency when I moonlighted doing a 72 hr shift for $55/hr. Sure saw only 3-5ppd but holy crap that was a miserable shift. But when I was making resident money at $5/hr, I thought I had diamond hands.

 

[robellis]

I remember with disdain in residency when I moonlighted doing a 72 hr shift for $55/hr. Sure saw only 3-5ppd but holy crap that was a miserable shift. But when I was making resident money at $5/hr, I thought I had diamond hands.

Ok so how much do you make per hour you never answered

 

[emergentmd]

Ok so how much do you make per hour you never answered

Let’s just say I make much more not working than working.

 

[d2305]

I thought it was 50% of people in 5 days (120 hours.

Individual results vary.

 

[GeneralVeers]

Let’s just say I make much more not working than working.

So do most Americans right now.......

 

[turkeyjerky]

So do most Americans right now.......

Crazy thought, but maybe we should pay them more to work then?

 

[Birdstrike]

Crazy thought, but maybe we should pay them more to work then?

Of course! Pay them more. Pay me more. Pay everyone more. Why not?

 

[emergentmd]

So do most Americans right now.......

Truth, its the American Way. I have an inlaw that took home about 60K but worked 60 hrs/wk. He prob makes a fraction of that but won't go back until all the freebies run out. Makes little sense to go back to work when he has to spend alof the money on meals, transportations, chilid care, etc. He is happy collecting freebies and likely will make out better just not working.

 

[MechEDoc]

I am starting a new job that averages 7000/yr patients, 5 bed ER, 24 hour shifts. I have never worked more than 12's and those were a drag. For those of you who work these types of shifts, do you often clump them together? I was asked if I could do 2-3 in a row although I am not sure how reasonable/unreasonable this is. I am a new grad from 2020.

Thanks for anyones thoughts!

I work 24s, 5 in a row (day on, day off). It's brutal, but my free time is awesome.

 

[oldtown]

I work 24s, 5 in a row (day on, day off). It's brutal, but my free time is awesome.

Oh man. I would spend 18 of those 20 days off each month dreading the next stretch of shifts.

 

[deleted6669]

It's all about the volume. I have friend who does two 72s/mo as a full time job with a census of 7/24 hrs.
I do 24s as my primary job and have for the last 8 years. A busy shift is 18-21 patients and a slow shift is 0-8. Most shifts I get to sleep through the night in a very nice call room. I was a medic before going back to school so the long shifts are less of an issue for me. I would never go back to busy 8s again. I feel like I deliver much better patient care seeing fewer patients than when I worked at a busy, urban trauma center moving the meat.