Does anyone else struggle with anxiety at work?

[HemorrhagicShock]

Again in medschool exciting becomes anxiety as an attending

A “boring” pcp clinic doesn’t lead sleepless nights or high stress on any random day

This is a profound truth that every medical student needs to hear. It has been my experience as an attending to the T

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[Groove]

Propranolol backfired on me.
Couldn't "wake up enough".

Wait. Hold the eff up.

We shouldn't be drugging ourselves to make it "through a shift". Hard stop.

I've never really had any fatigue from it but I only take 10-20mg. It also helps my blood pressure from spiking during a stressful shift. I mean, we shouldn't be "drugging" ourselves but don't we all chug half a pot of caffeine before going into every night shift?

 

[Mount Asclepius]

I mean, we shouldn't be "drugging" ourselves but don't we all chug half a pot of caffeine before going into every night shift?

No, no drugs. Coming from a nocturnist. You want to do this successfully, then no drugs. You need to learn good sleep habits and exercise to succeed at this career and working nights. Any drugs to help you sleep or to keep you awake will only worsen circadian disruption. You are far better off learning non-pharmaceutical approaches to shift work. This job is hard enough, but many burn out particularly by not learning healthy strategies to shift work.

 

[Groove]

No, no drugs. Coming from a nocturnist. You want to do this successfully, then no drugs. You need to learn good sleep habits and exercise to succeed at this career and working nights. Any drugs to help you sleep or to keep you awake will only worsen circadian disruption. You are far better off learning non-pharmaceutical approaches to shift work. This job is hard enough, but many burn out particularly by not learning healthy strategies to shift work.

No offense but you don’t have to flip every month like most of us. Having a set night or day schedule would be a supreme luxury. I work out 4-5 days a week and am in the best shape of my life but that doesn’t protect you from the fatigue that comes from circadian disruption. I’m talking about coffee for crying out loud, not cocaine or adderall.

 

[CoolDoc1729]

Propranolol backfired on me.
Couldn't "wake up enough".

Wait. Hold the eff up.

We shouldn't be drugging ourselves to make it "through a shift". Hard stop.

💯 my reaction as well .. and yes I drink coffee ... I think that’s a little different

Slightly off topic…
Couple weeks ago I had to do an eye FB was literally my first patient after I drank my full travel mug of coffee on the way to work, which is my routine .. and the patient complimented my steady hands 🤣🧐

 

[Mount Asclepius]

No offense but you don’t have to flip every month like most of us. Having a set night or day schedule would be a supreme luxury. I work out 4-5 days a week and am in the best shape of my life but that doesn’t protect you from the fatigue that comes from circadian disruption. I’m talking about coffee for crying out loud, not cocaine or adderall.

I don’t have a schedule that bounces around, but I do flip 2-3 times every month so I don’t know what you mean.

That’s fair. I drink coffee. I just see many others jump to meds and don’t agree that it’s the right approach.

 

[RustedFox]

Nocturnist here.
I "burn" the day after the last shift and then resume diurnal activity.

It's not easy.

 

[EthylMethylMan]

Nocturnist here.
I "burn" the day after the last shift and then resume diurnal activity.

It's not easy.

Props to you, man. And really props to all the docs doing any amount of nights. One of my most hated parts of the EM gig. I still shudder thinking about how awful the day after a string of nights would feel back in residency. Mental purgatory on paper, but true hell in practice. I remember going through the internal debate of "do I nap 4 hours, feel moderately like shiit the rest of the day, and have a really hard time sleeping later tonight; or do I stay up all day to get some decent sleep tonight, but endure a full-blown temporary mood disorder all day?" Maybe I was just really bad at circadian shifts, but f*ckin' hell, God did not make our bodies for this.

 

[RustedFox]

Props to you, man. And really props to all the docs doing any amount of nights. One of my most hated parts of the EM gig. I still shudder thinking about how awful the day after a string of nights would feel back in residency. Mental purgatory on paper, but true hell in practice. I remember going through the internal debate of "do I nap 4 hours, feel moderately like shiit the rest of the day, and have a really hard time sleeping later tonight; or do I stay up all day to get some decent sleep tonight, but endure a full-blown temporary mood disorder all day?" Maybe I was just really bad at circadian shifts, but f*ckin' hell, God did not make our bodies for this.

Yeah, but it beats dealing with all the nonsense during the day if your shop is the right volume

Sleep from 9a-3p, wake up and do nothing but play video games, read, eat.

Sleep from 9p-7a. #resumelife.

 

[PikminOC]

and the bums at acgme keeps approving to open sh.i.tty programs

They can't fill the ER slots

 

[RoyBasch]

Nocturnist here.
I "burn" the day after the last shift and then resume diurnal activity.

It's not easy.

Flip and burn baby

I've tried a lot of stuff over the years, and unfortunately I think this is what facilitates the fastest flip, the shortest hangover, and easiest return to normal day life.

But maaan, it sucks. It's like having a hangover scheduled in advance.

 

[GonnaBeADoc2222]

Yeah, but it beats dealing with all the nonsense during the day if your shop is the right volume

Sleep from 9a-3p, wake up and do nothing but play video games, read, eat.

Sleep from 9p-7a. #resumelife.

"Right volume" is key.

When I left my shift at midnight the other day, there were 50 in the WR. Mostly nonsense, willing to wait 5+ hours.

Thank god I don't do nights at this place.

 

[BoardingDoc]

When I left my shift at midnight the other day, there were 50 in the WR. Mostly nonsense, willing to wait 5+ hours.

I never understood this. I actually started feeling bad for some of these nonsense visits after a while. I used to moonlight at a tertiary center in a very low income area where I would show up for my fast track shift at 10a and immediately pull back 4 or 5 people who had wait times of OVER 24 HOURS. Literally, you've been here 25 hrs and 20 minutes for low back pain after an MVC. Here's your ibuprofen and some flexeril and off you go. To be fair, I also felt bad for these folks because once you cross that insane waiting threshold, it seems like you're the kind of person who is actually genuinely happy for medical advice and aren't demanding some BS. If the doc "blesses you" you legit feel better.

 

[Apollyon]

I never understood this. I actually started feeling bad for some of these nonsense visits after a while. I used to moonlight at a tertiary center in a very low income area where I would show up for my fast track shift at 10a and immediately pull back 4 or 5 people who had wait times of OVER 24 HOURS. Literally, you've been here 25 hrs and 20 minutes for low back pain after an MVC. Here's your ibuprofen and some flexeril and off you go. To be fair, I also felt bad for these folks because once you cross that insane waiting threshold, it seems like you're the kind of person who is actually genuinely happy for medical advice and aren't demanding some BS. If the doc "blesses you" you legit feel better.

Andy Jagoda (my EM hero) at Elmhurst in Queens (Mt Sinai covered it) said that - "if someone is waiting 16 hours to be seen, they have a reason why they stayed, and see them."

 

[MechEDoc]

Off topic but has anyone attended an airway course and found it useful?

Yes. Levitan w/ cadavers.

 

[CoolDoc1729]

No offense but you don’t have to flip every month like most of us. Having a set night or day schedule would be a supreme luxury.

Also a nocturnist. I flip to nights on Thursday or Friday and I flip to days on Monday or Tuesday 3-4 times a month 🤷🏻‍♀️

 

[EthylMethylMan]

Andy Jagoda (my EM hero) at Elmhurst in Queens (Mt Sinai covered it) said that - "if someone is waiting 16 hours to be seen, they have a reason why they stayed, and see them."

This also holds true for farmers and Amish people the second they arrive. I don't think I've seen a single BS presentation from either of those demographics.

 

[Dr Mantis Toboggan]

This also holds true for farmers and Amish people the second they arrive. I don't think I've seen a single BS presentation from either of those demographics.

Never discharge an Amish kid was what my old PEM attending used to say.

 

[Groove]

Also a nocturnist. I flip to nights on Thursday or Friday and I flip to days on Monday or Tuesday 3-4 times a month 🤷🏻‍♀️

Impressive. I simply can't do that. Most other EM docs can't either. Many of the nocturnists that I know don't flip completely to an early a.m. schedule either since that defeats the primary benefit that comes from having a set schedule. More often than not, they are night owls that still go to bed late and sleep late mornings on their day off. I have known a few docs like you that can flip on a dime with little to no repercussions (one was in his 60s) and you people are just built differently.

Still though..the ornery point of my post, and completely nothing personal....is that it's just slightly aggravating getting lectured by nocturnists about how regular docs should handle their circadian flips. Moreover, the whole "my body is a holy temple" philosophy to approaching EM shift work is just slightly hilarious considering that this specialty is probably killing us far faster than most poor lifestyle choices ever could.

 

[Mount Asclepius]

Still though..the ornery point of my post, and completely nothing personal....is that it's just slightly aggravating getting lectured by nocturnists about how regular docs should handle their circadian flips.

It’s because those of us that flip frequently and have mastered it well feel that we have something to share that could benefit others. Nocturnists learn some things over time. Through experience there are better ways to do things. Trust me, I was always one during medical school and residency that said I would always take a pay cut and pay others to work my nights. Then I felt the dysphoria of my schedule all over the place and craved consistency. Blocks of nights with my shifts all at the same time with larger blocks of time off, better pay, no PLPs, decreased staffing with more volume/revenue with less to share it amongst, and no admin or drama around became very appealing. I learned how to best navigate the disruption flipping from days to nights and back. You’re more than welcome to decline the free advice though.

 

[Mount Asclepius]

Moreover, the whole "my body is a holy temple" philosophy to approaching EM shift work is just slightly hilarious considering that this specialty is probably killing us far faster than most poor lifestyle choices ever could.

You can’t kill yourself with both? Salud 🥃

 

[TooMuchResearch]

These days I feel fatigued after working one evening shift. Perhaps this body is broken.

 

[RustedFox]

"Right volume" is key.

When I left my shift at midnight the other day, there were 50 in the WR. Mostly nonsense, willing to wait 5+ hours.

Thank god I don't do nights at this place.

Yeah, that's unacceptable in my head. Un. Ac. Cept. A. Ble.

 

[CoolDoc1729]

Yeah, that's unacceptable in my head. Un. Ac. Cept. A. Ble.

I mean 50 is a lot but there were 28 out there Saturday night for me … 18 had not gone through PIT yet .. I feel like some of the departing docs care and some are just like good luck with that $hit lol

 

[sloh]

Props to you, man. And really props to all the docs doing any amount of nights. One of my most hated parts of the EM gig. I still shudder thinking about how awful the day after a string of nights would feel back in residency. Mental purgatory on paper, but true hell in practice. I remember going through the internal debate of "do I nap 4 hours, feel moderately like shiit the rest of the day, and have a really hard time sleeping later tonight; or do I stay up all day to get some decent sleep tonight, but endure a full-blown temporary mood disorder all day?" Maybe I was just really bad at circadian shifts, but f*ckin' hell, God did not make our bodies for this.

This is so so underrated haha. I remember this feeling, couldn't pay me enough to endure it again.

 

[DrDrummer]

It’s because those of us that flip frequently and have mastered it well feel that we have something to share that could benefit others. Nocturnists learn some things over time. Through experience there are better ways to do things.

What’s your approach? I am also a fan of sleep hygiene, exercise, intentional light exposure or lack thereof. I use melatonin too sometimes and am an aggressive caffeinator which maybe gets into your “no drugs” area, but I’m curious about the specific approach that works for you.

 

[Mount Asclepius]

What’s your approach? I am also a fan of sleep hygiene, exercise, intentional light exposure or lack thereof. I use melatonin too sometimes and am an aggressive caffeinator which maybe gets into your “no drugs” area, but I’m curious about the specific approach that works for you.

There are aspects that I think are specific to a nocturnist, and then general things that are important to anyone doing shift work.

I’ve settled on flipping to nights preferably only 2, but occasionally 3 times per month working a block of shifts each time.

I try to stay up late the night before a block and sleep in the day of my first night shift. Waking up at a normal time and trying to get a nap in before a night shift doesn’t work for me.

I switch my schedule completely to nights when I’m on my block of shifts. I wake up right before my shift and head to work. Just like how most 9-5 people work. When I get off my shift I come home and exercise (for me that’s running). I spend a little time with my family during their morning (my evening). Then sleep for a full 8 hours.

I work hard during my block. See as many as I can and stay long if I need to. It’s a job because we make money doing it.

On my last shift though I don’t push it quite as hard so that I’m not staying as long. I skip exercise and try to get to bed as soon as I can post shift. I get a much shorter night’s sleep. I try to wake up naturally at the end of a REM cycle. I’ve kind of trained myself this way. Allows me to be less foggy on my transition day.

Then I end up staying up a little later than I normally would that transition day night given I’ve been used to being up at nights for the block and also went to bed a little earlier that day than the days during my block on.

Principles important to all:
1) Exercise. Lots of it. I run a lot. If you are tired, you’ll sleep well.

2) Eat right. You know what this means. Also don’t eat right before bed and don’t munch on night shifts.

3) Avoid pills. If you can find a way to fall asleep, stay asleep, and stay awake when you need to, you’ll get more rest and feel more rested. Most that I’ve talked to that utilize meds to help have fallen into a vicious cycle.

4) Enjoy life. I like coffee. I like it black. Ever since high school. I drink 1-2 mugs every day because I like the taste. I do also like how it wakes me up. I don’t overdo it, and especially not during shift when it can impact my sleep later. I also like a good drink. Homebrewed beer years ago creating my own recipes. Have since gravitated more towards wine, cocktails and whiskey. Maybe I’m hypocritical since caffeine and alcohol are also ‘drugs.’

5) Be flexible. Life throws you curve balls. I don’t set specific times since things occasional come up or the schedule gets thrown slightly off. If I’m too rigid it ruins the basics.

 

[emergentmd]

All the advice to be a nocturnists are great but no matter how you try to game it, it is just bad for you physical/mental health especially if you have young kids.

Our private group used to pay +$60-100/hr for overnights and I told my partners back in the day that I would pay as much as they want. The nocturnist made an extra $750/shift and a full timer was alotted 3/month so it costs each doc about $2200/month which was essentially one shift.

I would gladly work an extra day/mid shift a month than 3 overnights.

If you can avoid it, avoid it. The money is not worth is esp as you get older or have young kids. With kids, no matter how you game they system, they will break it. I just never had the heart to tell my young kids to leave me alone when they got home from school at 3pm b/c I had to sleep for my overnight. Plus, when they came into the room to give me a hug, no way could I tell them not to as those hugs are precious and don't last forever.

 

[Mount Asclepius]

All the advice to be a nocturnists are great but no matter how you try to game it, it is just bad for you physical/mental health especially if you have young kids.

Our private group used to pay +$60-100/hr for overnights and I told my partners back in the day that I would pay as much as they want. The nocturnist made an extra $750/shift and a full timer was alotted 3/month so it costs each doc about $2200/month which was essentially one shift.

I would gladly work an extra day/mid shift a month than 3 overnights.

If you can avoid it, avoid it. The money is not worth is esp as you get older or have young kids. With kids, no matter how you game they system, they will break it. I just never had the heart to tell my young kids to leave me alone when they got home from school at 3pm b/c I had to sleep for my overnight. Plus, when they came into the room to give me a hug, no way could I tell them not to as those hugs are precious and don't last forever.

Essentially all of the nocturnists in our group find working nights is easier with kids schedules. Many work nights specifically because it is easier for their schedule.

My mental and physical health is better with working nights. Not for everyone, but it’s not universally bad for everyone.

 

[emergentmd]

Essentially all of the nocturnists in our group find working nights is easier with kids schedules. Many work nights specifically because it is easier for their schedule.

My mental and physical health is better with working nights. Not for everyone, but it’s not universally bad for everyone.

This is just my personal experience. I was told it was better for the family to work nights. Work when kids asleep, up when kids home from school. I am an easy sleeper and can sleep almost anywhere so thought I would give it a try.

The did this for 3 months and it was mentally/physically draining. I came home and we had a black out media room. I would sleep but body just work up tired after 4-5 hrs. Too awake to go back, but still tired. Got up, did some stuff with kids, and +/- nap before work.

I just could not get any prolonged sleep and was hyper tired/grouchy for close to 3 months. I didn't feel I gained much quality family time b/c I was not mentally presents.

PLUS there is something to be said with sharing a bed with your wife.

 

[RustedFox]

I've never really had any fatigue from it but I only take 10-20mg. It also helps my blood pressure from spiking during a stressful shift. I mean, we shouldn't be "drugging" ourselves but don't we all chug half a pot of caffeine before going into every night shift?

Excellent point. I might be sensitive to B blockers. I was straight stupefied.

 

[The Knife & Gun Club]

Concur with the above. I went to a big center residency as well. I bet residents got like a couple ER peds tubes each by the time of graduation. We did get a dedicated NICU month which of course was overkill on the medical management side, but gave you another few key resuscitations and airways.

This has been the debate at my program lately. We’ve got a big peds hospital - level 4 NICU, Pedi trauma, pedi transplant that does everything including cardiac and multiviscerals. Kids are sick as hell, and the Peds ED is run by EM residents with no fellows.

Even with all that seniors graduate with a couple pedi tubes each max. Kids just don’t need intubation that much, especially with the advent of HFNC.

We could do a NICU month, but is it really educationally worth pulling a resident from the ER so they can trend sodiums for a month in the NICU just to get a couple extra tubes?

 

[emergentmd]

I trained 20+ yrs ago at a PH program (either 1st or 2nd busiest in the country at the time). We have an Adult ER, Psych ER, OB ER, and a Pedi ER. Residents in probably every specialty.

I got zero Pedi tubes. When sick kids came, the attendings/Pedi EM were protective and never let us close to a Pedi Kids. Pedi Tubes don't really scare me. Use the right size, and do your best.

Even in my 20+ attending career, I have done Zero Pedi tubes. Still do not scare me.

 

[WilcoWorld]

No, no drugs. Coming from a nocturnist. You want to do this successfully, then no drugs. You need to learn good sleep habits and exercise to succeed at this career and working nights. Any drugs to help you sleep or to keep you awake will only worsen circadian disruption. You are far better off learning non-pharmaceutical approaches to shift work. This job is hard enough, but many burn out particularly by not learning healthy strategies to shift work.

Yeah, but coffee tastes good
[insert Travolta Pulp Fiction gif]

But sleeping pills? No thanks. I'm plenty tired to sleep after a night shift, and I would be worried about still being zonked on shift if I took a sleeping pill for my pre-shift nap.

I'll use melatonin to facilitate a flip back to day shifts, but only occasionally.

 

[Mount Asclepius]

This is just my personal experience. I was told it was better for the family to work nights. Work when kids asleep, up when kids home from school. I am an easy sleeper and can sleep almost anywhere so thought I would give it a try.

The did this for 3 months and it was mentally/physically draining. I came home and we had a black out media room. I would sleep but body just work up tired after 4-5 hrs. Too awake to go back, but still tired. Got up, did some stuff with kids, and +/- nap before work.

I just could not get any prolonged sleep and was hyper tired/grouchy for close to 3 months. I didn't feel I gained much quality family time b/c I was not mentally presents.

PLUS there is something to be said with sharing a bed with your wife.

This is why it may work for some and not others. I easily sleep 8 hours straight during the day between each night shift. I think running (exercise) and feeling tired helps. Always feel well rested other than my transition day back. I agree that if you’re only able to get 4-5 hours of sleep straight, it’s not going to be sustainable.

Agree with your last point. It’s a fair negative critique. The time apart makes us appreciate the time together though.

 

[Mount Asclepius]

I think unopposed pediatric anesthesia and neonatal resuscitation are the better rotations to do during training for pediatric airway exposure. Agree PEM and PICU volume just isn’t there. I’ve done several pediatric intubations in the ED as an attending over the years (respiratory arrests, drowning, bad burns, etc.) and am always thankful for my prior experience.

 

[miacomet]

I trained 20+ yrs ago at a PH program (either 1st or 2nd busiest in the country at the time). We have an Adult ER, Psych ER, OB ER, and a Pedi ER. Residents in probably every specialty.

I got zero Pedi tubes. When sick kids came, the attendings/Pedi EM were protective and never let us close to a Pedi Kids. Pedi Tubes don't really scare me. Use the right size, and do your best.

Even in my 20+ attending career, I have done Zero Pedi tubes. Still do not scare me.

Wow. I've done a bunch. Thank goodness for the Broselow tape and RTs who know vent settings. But I've worked places that are 50% kids, probably not usual.

 

[GatorCHOMPions]

This has been the debate at my program lately. We’ve got a big peds hospital - level 4 NICU, Pedi trauma, pedi transplant that does everything including cardiac and multiviscerals. Kids are sick as hell, and the Peds ED is run by EM residents with no fellows.

Even with all that seniors graduate with a couple pedi tubes each max. Kids just don’t need intubation that much, especially with the advent of HFNC.

We could do a NICU month, but is it really educationally worth pulling a resident from the ER so they can trend sodiums for a month in the NICU just to get a couple extra tubes?

Yea I thought NICU was worth it on the whole. We probably doubled or more the whole volume of peds resuscitations and tubes in the rest of residency during that one month. One bright side is we shared the unit with peds residents. They took more of the boring medical management cases and EM would get most of the airway and resuscitation type stuff. There’s also some other interesting things to learn there like neonatal abstinence syndrome. Plus other rare but important procedures such as umbilical lines, LPs, and a few residents got chest tubes. One important factor is our unit didn’t have any NICU fellows who would otherwise steal a lot of procedures.

 

[wareagle726]

I did the past 2.5 years doing M-W/M-Th nights alternating every week. Every weekend off. I had a 1:10 min drive both ways. . The job was tough. 25-30/night with lots of high acuity and trauma. Great people to work with, no pushback, all boarded ED docs that I love working with, ED pharmacists that I would trust to run a critical patient, trauma surgeons in house that trust us so it's tough but easy if you get what I'm saying. I'm fine flipping. Did the stay up until 2am on monday morning, get the kids to school at 7. Play golf or whatever until noon and sleep until 4. Last morning of the shift sleep from 9a-2p. Then get a good sleep that night and flip for the weekend. I figured I could work day shift and see my kids less because I would leave before they're up and get home after they're in bed. That was mostly the case. Idk if it had a real psychological toll on me because I've always been an Eyore in a sense. Started working a new job half of the month with a 9min drive and 10 hour shifts with many daytime shifts. To be determined which is better. The new job is boring and poorly run so a whole new set of headaches. Incredibly difficult to admit, nursing staff doesn't take anything seriously, etc... Overall I learned a lot on nights and became a much better doc because of it I think. It gave me the backbone I didn't have. I definitely wouldn't say it was a dream though.

 

[CoolDoc1729]

This is just my personal experience. I was told it was better for the family to work nights. Work when kids asleep, up when kids home from school. I am an easy sleeper and can sleep almost anywhere so thought I would give it a try.

The did this for 3 months and it was mentally/physically draining. I came home and we had a black out media room. I would sleep but body just work up tired after 4-5 hrs. Too awake to go back, but still tired. Got up, did some stuff with kids, and +/- nap before work.

I just could not get any prolonged sleep and was hyper tired/grouchy for close to 3 months. I didn't feel I gained much quality family time b/c I was not mentally presents.

PLUS there is something to be said with sharing a bed with your wife.

Yeah nights are definitely not for everyone. If I get out on time I do a quick workout (gym or brisk walk outside if weather permits) I get home, try to sleep from like 9-5 so everyone is working/at school/at church anyway. Get up by 5, shower, make dinner, clean up, hang out with kids and Mr C. I drink a travel mug of coffee and try to finish it on the 30 minute commute in; then no more caffeine. I don’t drink at all (it’s just not my thing). This has been the schedule we’ve followed for 8 years now. I work weekends mostly so during the midweek I switch back to days and basically am a stay at home mom (the other moms at preschool dropoff just realized I work at all this week)

Those of us who are night creatures are happy to take the nights and appreciate the $$$ 😉

 

[CoolDoc1729]

This has been the debate at my program lately. We’ve got a big peds hospital - level 4 NICU, Pedi trauma, pedi transplant that does everything including cardiac and multiviscerals. Kids are sick as hell, and the Peds ED is run by EM residents with no fellows.

Even with all that seniors graduate with a couple pedi tubes each max. Kids just don’t need intubation that much, especially with the advent of HFNC.

We could do a NICU month, but is it really educationally worth pulling a resident from the ER so they can trend sodiums for a month in the NICU just to get a couple extra tubes?

I had around 10 ped tubes during residency, mostly during the general anesthesia month. In 11 years’ practice I have intubated a 5 month old traumatic arrest, a 2 Year old status asthmatic, a 6 year old status epi and a 15 year old severe poly trauma at my community hospital two miles from the {peds hospital level 4 nicu facility level 1 trauma}center. All of them were much easier than I expected, and on par with the easiest adult airways. I think getting access and keeping the nurses from losing their minds is the bigger issue tbh

 

[Mount Asclepius]

I did the past 2.5 years doing M-W/M-Th nights alternating every week. Every weekend off. I had a 1:10 min drive both ways. . The job was tough. 25-30/night with lots of high acuity and trauma. Great people to work with, no pushback, all boarded ED docs that I love working with, ED pharmacists that I would trust to run a critical patient, trauma surgeons in house that trust us so it's tough but easy if you get what I'm saying. I'm fine flipping. Did the stay up until 2am on monday morning, get the kids to school at 7. Play golf or whatever until noon and sleep until 4. Last morning of the shift sleep from 9a-2p. Then get a good sleep that night and flip for the weekend. I figured I could work day shift and see my kids less because I would leave before they're up and get home after they're in bed. That was mostly the case. Idk if it had a real psychological toll on me because I've always been an Eyore in a sense. Started working a new job half of the month with a 9min drive and 10 hour shifts with many daytime shifts. To be determined which is better. The new job is boring and poorly run so a whole new set of headaches. Incredibly difficult to admit, nursing staff doesn't take anything seriously, etc... Overall I learned a lot on nights and became a much better doc because of it I think. It gave me the backbone I didn't have. I definitely wouldn't say it was a dream though.

Would be nice to have every weekend off, but it’s too much switching back and forth. The transition day is the hardest part for me and think it’s the only real downside to me of being a nocturnist. I think it’s best to work longer stretches and minimize the flipping. I also enjoy having some time off midweek when others are working, but also do want some weekends off.

I also agree working nights has made me a better clinician. Forced to read all my own X-rays, and essentially my CTs as well given our overnight send out radiology service is abysmal. We also staff less at night and see more pph which has improved my efficiency. I also think I’ve learned to manage the entire department better than the day physicians who become silo’d in their individual zones and don’t have to manage the whole department. All of our nocturnists are really strong physicians and it tends to be the pool our group’s leadership is drawn from. I certainly don’t think working nights is what it takes to make great EP or not, but it certainly made me individually better.

Again, not for everyone. I just think it’s misunderstood by those that struggle more with sleeping well during the day and they could acknowledge that some can pull it off without it being as detrimental to your health. Sure it will be bad for you if you don’t sleep during the day and live in a constant sleep debt. Sleep well though and it has a lot of advantages over bouncing all over the place with random shifts.

 

[bky3c]

I just think it’s misunderstood by those that struggle more with sleeping well during the day and they could acknowledge that some can pull it off without it being as detrimental to your health. Sure it will be bad for you if you don’t sleep during the day and live in a constant sleep debt. Sleep well though and it has a lot of advantages over bouncing all over the place with random shifts.

Just curious, as someone who always preferred nights for many of the reasons outlined in other posts, even though I'm very much an early bird and a terrible day sleeper. I'm aware of the studies that say shift work is terrible for your health, but do you (or anyone else here) happen to know whether they looked at how well the study participants slept during the day? It would be really interesting to know if general lack of sleep was the problem or if it's truly due to disruption of the circadian rhythm.

 

[Kryptocoin]

I don't mind nights unless it's at a busy site where I'm up ALL night. Then, F that. My nights shifts start out a bit busy but then thinned out at midnight. I routinely get 3hrs of sleep.

Underserved communities are usually the worst places to work nights since the uninsured, druggies and medicaid patients utilize the ER at all hours of the night.

 

[Mount Asclepius]

Just curious, as someone who always preferred nights for many of the reasons outlined in other posts, even though I'm very much an early bird and a terrible day sleeper. I'm aware of the studies that say shift work is terrible for your health, but do you (or anyone else here) happen to know whether they looked at how well the study participants slept during the day? It would be really interesting to know if general lack of sleep was the problem or if it's truly due to disruption of the circadian rhythm.

That’s the key question. I haven’t ever seen a study that’s teased out that distinction. I would be equally interested to know.

My gut says lack of sleep (and quality deep REM sleep) is a bigger factor than when you sleep, but don’t know.

I personally knew a handful of people who lived into their 90s working nights for decades. They did a lot of other things ‘right.’

Makes me suspect that it’s probably other concomitant, and not accounted for, unhealthy variables that influenced studies on shift workers health.

 

[PB2464]

Has anyone been able to sign a contract for day shifts only?

 

[Mount Asclepius]

Has anyone been able to sign a contract for day shifts only?

You can join my group. How much are you willing to pay me to work your nights? If you’re willing to give up enough money you can have the day hours.

 

[PB2464]

You can join my group. How much are you willing to pay me to work your nights? If you’re willing to give up enough money you can have the day hours.

This isn't necessarily a question for SDGs. I understand they would be more flexible, but they are pretty hard to find in my area, if at all.

 

[Rekt]

This isn't necessarily a question for SDGs. I understand they would be more flexible, but they are pretty hard to find in my area, if at all.

You’re mistaken if you think an SDG will give you days. If anything you’re more likely to do more nights as you’ll actually have people that have been at an SDG for 15-20 years and they aren’t about to take your night shifts.

 

[PB2464]

You’re mistaken if you think an SDG will give you days. If anything you’re more likely to do more nights as you’ll actually have people that have been at an SDG for 15-20 years and they aren’t about to take your night shifts.

Money talks for most people, as the other poster just implied. So I don't think I'm mistaken.
But let's just forget the whole SDG thing. CMG only. Anyone with experience?