Nocturnist Experiences

[Groove]

Background: I'm currently happily in my first year at a TH site. However, I'm convinced that I've got the absolute worst scheduler in my history of practicing EM. I mean...it's not just a little bad, it's ridiculously bad. Here's an example: 3-4 nights or 1 block of overnight shifts followed by a 24h turnaround to a 6 or 7am shift, then string of days or swings for a week, then followed by another block of overnights the following week. So, you flip every other week for the most part. It's beyond brutal. For the life of me, I can't figure out why these people don't block all the overnights into a single block for the month. Most of our docs are brand new and have no clue how uncommon this is and just take it. I don't think I've had a schedule this bad since residency. Who does 24h turnarounds anymore? Anyway, before escalating the matter to the director...I'm considering all my options and for the first time in my career am considering offering myself up for a nocturnist position if escalation doesn't improve the matter.

1) Anybody try out a nocturnist gig for a year and if so, what were your experiences? Did you find yourself flipping back to days on your days off, or did you stay on nights for the most part? Pros and cons of the position?

2) Also, has anybody had success with negotiating a pay differential with a CMG such as TH for a nocturnist gig? I've always been under the impression that they won't negotiate for things like this but I'm not 100% sure. When I worked for Apollo they were willing to pay a $20/hr diff for the nocturnist but it was taken out of the day docs revenue and when it came down to it, the day docs balked and the deal fell through. In the past when we had a nocturnist, I don't think he had any special rate.

I'm just getting desperate. I absolutely love the job, colleagues, hospital, everything. I also work the most out of the group on average, so I suppose I could cut down or something to minimize the shell shock somewhat but I'm finding myself desperately trying to figure out any other alternative to minimize the circadian disruption. The every other week flipping from days to overnights to days is gonna be a slow death to me.

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[RustedFox]

Background: I'm currently happily in my first year at a TH site. However, I'm convinced that I've got the absolute worst scheduler in my history of practicing EM. I mean...it's not just a little bad, it's ridiculously bad. Here's an example: 3-4 nights or 1 block of overnight shifts followed by a 24h turnaround to a 6 or 7am shift, then string of days or swings for a week, then followed by another block of overnights the following week. So, you flip every other week for the most part. It's beyond brutal. For the life of me, I can't figure out why these people don't block all the overnights into a single block for the month. Most of our docs are brand new and have no clue how uncommon this is and just take it. I don't think I've had a schedule this bad since residency. Who does 24h turnarounds anymore? Anyway, before escalating the matter to the director...I'm considering all my options and for the first time in my career am considering offering myself up for a nocturnist position if escalation doesn't improve the matter.

1) Anybody try out a nocturnist gig for a year and if so, what were your experiences? Did you find yourself flipping back to days on your days off, or did you stay on nights for the most part? Pros and cons of the position?

2) Also, has anybody had success with negotiating a pay differential with a CMG such as TH for a nocturnist gig? I've always been under the impression that they won't negotiate for things like this but I'm not 100% sure. When I worked for Apollo they were willing to pay a $20/hr diff for the nocturnist but it was taken out of the day docs revenue and when it came down to it, the day docs balked and the deal fell through. In the past when we had a nocturnist, I don't think he had any special rate.

I'm just getting desperate. I absolutely love the job, colleagues, hospital, everything. I also work the most out of the group on average, so I suppose I could cut down or something to minimize the shell shock somewhat but I'm finding myself desperately trying to figure out any other alternative to minimize the circadian disruption. The every other week flipping from days to overnights to days is gonna be a slow death to me.

The number one source of burnou----


Wait.

Wrong thread.

All jokes aside; yeah - the day/night flips are brutal.
I considered going night ranger at one of my job sites awhile back.
Nah.

 

[namethatsmell]

I was a nocturnist for a year. Sort of fell into it when one of the other nocturnists left. Group let me make my schedule which was huge for personal reasons back then. Pay didn't change which I was OK with at the time since they already paid pretty well. When that group was bought out by a CMG we started getting a tiny night shift differential, I think $10/hr. I worked 3 in a row/wk and switched back to days in between.

Pros: usually no clipboard hospital admin shenanigans overnight (cuz they're all in their own beds), at this particular ED if the shop was in good shape by 2a the rest of the shift was easy which happened about 50% of the time (but never slow enough to sleep), hospital and ER leadership et al will be more chill about metrics and BS patient complaints etc since they really want to keep you happy and working their nights, dedicated overnight ER nurses tend to be no BS and excellent.

Cons: Depending on your shop, overnight specialty support can be absent and upstairs staffing can be scarily thin--I had to transfer many patients who could have otherwise stayed if they'd presented during the day...after a while this gets really old. Kept having to explain DOMA days to family/friends every week which got old. Also, I think I aged 2 years in that one year and was by the end of it I was pretty crispy.

The only docs I've know who are happy being nocturnists are folks who:
a) get schedule control and a massive night differential
b) have children and want to sleep while the kids are at daycare/school
c) are colorful types who just seem to savor working at night
d) will do anything they can to distance themselves from admin/metrics
e) are the rare lucky person who can flip their sleep schedule without being any worse for the wear

The only way I'd possibly consider being a nocturnist again was if a) it was at a very slow shop where I'd get at least a 1-2hrs sleep every shift or b) they gave me schedule control AND a legit pay differential.

 

[Birdstrike]

Background: I'm currently happily in my first year at a TH site. However, I'm convinced that I've got the absolute worst scheduler in my history of practicing EM. I mean...it's not just a little bad, it's ridiculously bad. Here's an example: 3-4 nights or 1 block of overnight shifts followed by a 24h turnaround to a 6 or 7am shift, then string of days or swings for a week, then followed by another block of overnights the following week. So, you flip every other week for the most part. It's beyond brutal. For the life of me, I can't figure out why these people don't block all the overnights into a single block for the month. Most of our docs are brand new and have no clue how uncommon this is and just take it. I don't think I've had a schedule this bad since residency. Who does 24h turnarounds anymore? Anyway, before escalating the matter to the director...I'm considering all my options and for the first time in my career am considering offering myself up for a nocturnist position if escalation doesn't improve the matter.

1) Anybody try out a nocturnist gig for a year and if so, what were your experiences? Did you find yourself flipping back to days on your days off, or did you stay on nights for the most part? Pros and cons of the position?

2) Also, has anybody had success with negotiating a pay differential with a CMG such as TH for a nocturnist gig? I've always been under the impression that they won't negotiate for things like this but I'm not 100% sure. When I worked for Apollo they were willing to pay a $20/hr diff for the nocturnist but it was taken out of the day docs revenue and when it came down to it, the day docs balked and the deal fell through. In the past when we had a nocturnist, I don't think he had any special rate.

I'm just getting desperate. I absolutely love the job, colleagues, hospital, everything. I also work the most out of the group on average, so I suppose I could cut down or something to minimize the shell shock somewhat but I'm finding myself desperately trying to figure out any other alternative to minimize the circadian disruption. The every other week flipping from days to overnights to days is gonna be a slow death to me.

Being on nights permanently will reduce some of the circadian flips, but it won't eliminate your circadian flips back to days when you're off work. That's what made permanent night shift a non-starter, for me. Maybe it would work for you, I don't know.

How about persuading your partners how much better their life would be if they agreed to take a very small paycut to pay someone else to permanent nocturnists, just not you. Since the nocturnists will be a small minority of your group, it doesn't cost that much per person, for everyone else.

When I worked EM, the best two years of my career were when we had two permanent nocturnists. Of course, they eventually cried mercy and couldn't stay on permanent nights forever and quit, as very few people are cut out for that long term. It was actually a tolerable two years.

 

[namethatsmell]

So I just thought a bit more about what life was like as a nocturnist...no way on earth I'd willingly do it again.

 

[Mount Asclepius]

1) Anybody try out a nocturnist gig for a year and if so, what were your experiences? Did you find yourself flipping back to days on your days off, or did you stay on nights for the most part? Pros and cons of the position?

I’ve been a nocturnist for most of my career. I do 2-3 blocks of nights per month working slightly more than most, and yet typically have 2-3 periods of 4-7 days off each month. If I pack shifts I can get 2-4 weeks off. Love the long stretches off and find it rejuvenating. Your schedule with 24 hour turnarounds is terrible. That needs to be addressed regardless. I switch back to days when I’m off. I like being up at night (and dislike getting up early), but not when I’m off and the rest of the world is awake at day. I flip back 2-3x per month, but I think worth it for the other benefits. It’s not something you can do forever, but I’ve done it for years and found a system that is pretty tolerable.

The only docs I've know who are happy being nocturnists are folks who:
a) get schedule control and a massive night differential
b) have children and want to sleep while the kids are at daycare/school
c) are colorful types who just seem to savor working at night
d) will do anything they can to distance themselves from admin/metrics
e) are the rare lucky person who can flip their sleep schedule without being any worse for the wear

Agree.

a) I pick my schedule. I work what days I want with the exception of still having to work some weekends. I like being off in the middle of the week though when there are fewer people out. I get a decent shift differential in our SDG, which makes it financially pretty lucrative. Can’t speak to CMGs. You deserve a differential if working all nights.
b) Yep.
c) I fit the stereotypical EP mold, but maybe better suited for critical care, surgery or IR in hindsight.
d) Agree to some degree. I get along with admin, but like to break the rules and like nights where the culture is more laid back.
e) I have no problem sleeping anywhere. I sleep on the ground camping and can sleep during the day. Flipping though (mainly back) is tough no matter how you slice it.

 

[BoardingDoc]

When I worked for Apollo they were willing to pay a $20/hr diff for the nocturnist but it was taken out of the day docs revenue and when it came down to it, the day docs balked and the deal fell through.

I can't understand a group that wouldn't pay a differential for working night shifts. I think it's particularly weird that other docs balked at the idea of paying for a $20/hr raise for someone. When you spread that hit out over the group it becomes negligible. We pay a much larger night differential than that, and the day docs subsidize the cost. That said, our model is all productivity based, so there are some patient volume dynamics of day vs night shift that are accounted for as well.

As to directly answering your question: I started my attending career doing mostly nights. Didn't enjoy it. We've just hired a nocturnist and so my overnight shifts are going from 3-->2/mo soon and I'm thrilled.

 

[Mount Asclepius]

Another downside that I and other nocturnists have found over the years is that over time your first day off flipping back becomes elongated just like a hangover. When you are 21 you don’t have hangovers, but over time a hangover extends from the morning to the entire next day to the point where you no longer want to party like when you were young. When you’re early career, switching back from nights is a semi shot first day off. Then it becomes a worthless day off. Over time, it extends out further taking 2-3 days to fully recover back to normal. You supposedly get to the point where it takes a week to fully recover, at which point you are back on another block of nights. That’s the time to give night ranger life up. You hopefully are close to FIRE at that point anyways.

 

[Mount Asclepius]

I can't understand a group that wouldn't pay a differential for working night shifts. I think it's particularly weird that other docs balked at the idea of paying for a $20/hr raise for someone. When you spread that hit out over the group it becomes negligible. We pay a much larger night differential than that, and the day docs subsidize the cost. That said, our model is all productivity based, so there are some patient volume dynamics of day vs night shift that are accounted for as well.

Agree. Our differential is also higher. We are also productivity based. In our fairly high volume ED, our night nurses are much more motivated to clear the backlog from the day so they can chill a little bit at the end of their shifts. Given lower physician staffing at night, we can really move the department then resulting in better nocturnal productivity compensation. Not sure if your department is the same, or if your volume falls off dramatically at night.

 

[GassYous]

That's just unacceptable. They should be thanking you on bended knee for doing so many nights, not dumping on you like that.

 

[BoardingDoc]

Agree. Our differential is also higher. We are also productivity based. In our fairly high volume ED, our night nurses are much more motivated to clear the backlog from the day so they can chill a little bit at the end of their shifts. Given lower physician staffing at night, we can really move the department then resulting in better nocturnal productivity compensation. Not sure if your department is the same, or if your volume falls off dramatically at night.

Our volume drops at night to the point that working all nights without a differential would typically result in you getting paid less than daytime only docs. The differential we built in makes it so that even if it's slow, you make at least the same, generally more. If it's busy (which it frequently is) you make either a fair bit more, or a lot more.

 

[Mount Asclepius]

Our volume drops at night to the point that working all nights without a differential would typically result in you getting paid less than daytime only docs. The differential we built in makes it so that even if it's slow, you make at least the same, generally more. If it's busy (which it frequently is) you make either a fair bit more, or a lot more.

Seems reasonable. General concepts that I think are best:
1) If you work harder, you should be paid more. I think some component of productivity pay is best.
2) If you work nights, you should be paid more. It’s less ideal. There should be financial benefit to doing so.

 

[namethatsmell]

Seems reasonable. General concepts that I think are best:
1) If you work harder, you should be paid more. I think some component of productivity pay is best.
2) If you work nights, you should be paid more. It’s less ideal. There should be financial benefit to doing so.

Agree with both of these points.

And to expound on #2...the fairest thing a group can do in terms of scheduling is to have a differential for every shift type. Day shifts get paid the least, swings get paid more, and overnights the most. And those shifts on weekends and holidays pay better than on weekdays. Rewards people to take certain shifts and helps nip scheduling nepotism in the bud.

 

[turkeyjerky]

Groove, how many hours are you working a month? Once you get to a certain number of shifts, it becomes pretty hard to avoid some quick turnarounds, especially if you have any requests for the month. That said, corporate schedulers are the worst--they have no idea what these rapid swings do to your body and psyche, and most have no reason to care.

Can't believe anyone would balk at subsidizing a measly 20/hr for a nocturnist--divided amongst a group that's probably only 3-5 $/hr off your pay. Which is definitely worth it to cut out nights. (Esp w/ apollo where it's primarily productivity based so they probably wouldn't take much of a cut at all). IMHO a dedicated nocturnist should get a differential on the order of 20% (I'd guess that I'd need to decrease my hours by about that much if I were doing straight nights).

 

[bravotwozero]

Agree with both of these points.

And to expound on #2...the fairest thing a group can do in terms of scheduling is to have a differential for every shift type. Day shifts get paid the least, swings get paid more, and overnights the most. And those shifts on weekends and holidays pay better than on weekdays. Rewards people to take certain shifts and helps nip scheduling nepotism in the bud.

I have never seen a pay system like that anywhere, aside from a night differential. Have you?

 

[coachB]

I have never seen a pay system like that anywhere, aside from a night differential. Have you?

Pretty much exactly how we do it. Seems to work well.

 

[emergentmd]

When we were a private group, overnight bonus was $500/7 hr overnight shift. You may think that was high but we still didn’t have many that wanted to do it.

if we didn’t have enough volunteers, what was left was given randomly. I would have been happy to pay $1000/shift.

it takes a special person to do nights and in time you change for the worse. Do it with kids and you will make your family miserable.

I have never seen no stipend for a dedicated nocturnist.

if I worked in a place without a nocturnist, I would find a hungry doc and pay him to work my night shifts.

if u really want to do nights only and there is no stipend, then talk to some of the older docs. I am quite sure many would be willing to switch ur am shift for his night and pay you 500+. I know I would.

but to have a nocturnist and the group balk ar 20/hr bump, they is just downright shortsighted.

 

[namethatsmell]

I have never seen a pay system like that anywhere, aside from a night differential. Have you?

Several years ago a buddy told me about a group he interviewed with who did this. I think it was somewhere in PA or NJ.

 

[FemaleMD]

I’ve been a nocturnist for the past 9 years, & I keep it up because the night staff rocks and admin leaves me alone. ( I get the usual metric and bs “pt experience“ emails everyone in the group gets but the clipboard ppl don’t come out at night)

I started after the birth of our first child primarily for the shift/schedule control.

There has always been a small shift differential 20-40$ hr over day shift.

the group started out an sdg then sold out to a cmg but the reality of night life work has not changed.

we’re a two ER doc family, My night gig works for us as I put in my nights to work which are set then he gets to schedule his shift around known variables.

pre COVID I would keep to night or early mornings and sleep while the kids were in school.

 

[robellis]

I’ve been a nocturnist for the past 9 years, & I keep it up because the night staff rocks and admin leaves me alone. ( I get the usual metric and bs “pt experience“ emails everyone in the group gets but the clipboard ppl don’t come out at night)

I started after the birth of our first child primarily for the shift/schedule control.

There has always been a small shift differential 20-40$ hr over day shift.

the group started out an sdg then sold out to a cmg but the reality of night life work has not changed.

we’re a two ER doc family, My night gig works for us as I put in my nights to work which are set then he gets to schedule his shift around known variables.

pre COVID I would keep to night or early mornings and sleep while the kids were in school.

Doesn’t night shift work increase your risk of significant health problems though? Like cancer and such

 

[FemaleMD]

None of us have dropped dead yet. 😜 ( night RN/tech/Md/hospitalist) all of us have been on nights together for years.

looking around at whose with me at night most all of the staff are nights by choice,

I would rather have my schedule like it is than the random flip switches I had b/f nights and what my husband has now working a standard ED schedule

 

[GeneralVeers]

One of our night docs (50's) just had a STEMI a month ago. He's still not back tow work.

 

[Mount Asclepius]

My spouse’s grandma worked nights for over 40 years as a RN and lived into her late 90s. All just anecdotes. Night shift work can be detrimental to your health, but doesn’t have to be if you’re still conscious about your sleep. I think diet and exercise play more of a role in longevity. Who though wants to live to be 90 anyways?

 

[emergentmd]

Our SDG hospital had 3 nocturnists in 15 years. One quit medicine and burned out in late 40's/early50's. One ended up on drugs. One had some marital issues soon after becoming nocturnists.

I tried it for 3 months in the summer and was perpetually sleepy. My kids were older and left me alone to sleep but my body just could not get more than 4-5 hours at a time.

In 30 dys, I would do 12 overnight shifts. So on my off days, do I try to convert back to a normal sleep cycle or do I stay on stay awake overnight? I always tried to go back to a normal sleep cycle so maybe that was why I could never sleep more than 4-5 hrs after my night shift.

Either way, it was a miserable 3 months.

 

[cyanide12345678]

I'm a nocturnist. Soon to move to a regular schedule however.

Don't do it if you have a family. Your significant other will be unhappy if they work a normal schedule.

Especially don't do it if you have a child. There are so many days where I've had to send my daughter to day care on my days off because its my time to sleep and i can't take care of her.

I made $30/hr more. I wouldn't recommend it if you have a family. If you're single, no responsibilities, and making $$$ is your highest priority then do it.

My wife has told me that I'm often asleep even if I'm at home during her days off, which makes her unhappy. She's outright told me multiple times that it was a horrible decision on my part to be a nocturnist.

I've tried switching to days on my days off, it's not easy.

I have 13 more shifts left as a nocturnist before I'm off to a better life and a paycut. But well worth it.

 

[GeneralVeers]

To the OP: It doesn't sound like you have been given a real nocturnist job. Most nocturnists only work nights and maybe a few swings. They never work 6AM shifts. If they aren't accommodating you on on schedule then leave that position. It's not worth being a nocturnist if you can't dictate how your schedule works.

 

[GassYous]

To the OP: It doesn't sound like you have been given a real nocturnist job. Most nocturnists only work nights and maybe a few swings. They never work 6AM shifts. If they aren't accommodating you on on schedule then leave that position. It's not worth being a nocturnist if you can't dictate how your schedule works.

I don't think he's saying he's a nocturnist, he is asking about how it works so he can get some control over his schedule vs compensation

 

[bravotwozero]

Concur with the others. Don’t go for the night man gig, escalate things with your FMD. He needs to hear it. Your scheduler sucks.

 

[Brigade4Radiant]

Our nocturnists get to make their own schedule. If the day docs don't want to pay the money see if you can do stuff like only work one weekend. How many shifts are you supposed to work?

 

[hundreddaysoff]

1) Anybody try out a nocturnist gig for a year and if so, what were your experiences? Did you find yourself flipping back to days on your days off, or did you stay on nights for the most part? Pros and cons of the position?

I've been full-time nocturnist for 3 years now, 2 of them w/ TH and now w/ USACS. I like to work 2--3 night stretches and then take off the rest of the week.

I am a morning person by nature and if there's nothing going on, I have trouble staying up past 8pm naturally. So yes, I flip back to days on my stretches off. It's still pretty easy to flip back to nights, as long as I take a ~1--2 hour nap every single afternoon, whether I'm working or not. I understand the flipping gets harder into one's 40s.

But the main cons for me are that (1) I need to constantly make sure I'm sleeping enough during the day or else I can go a little crazy, and (2) working nights is a known cardiac risk factor and I don't kid myself that this is not good for my health. Hence, FIRE in 5--10 years, ideally.

Otherwise, the main pro has been my availability for childcare and other family stuff. I usually take the older kid to daycare on my bike when I get off work, then sleep for 3--4 hours, then get up and am around to help for a bit more before work.

I also like the lack of bureaucracy during night shifts and nursing's general git-'er-done attitude.

2) Also, has anybody had success with negotiating a pay differential with a CMG such as TH for a nocturnist gig? I've always been under the impression that they won't negotiate for things like this but I'm not 100% sure. When I worked for Apollo they were willing to pay a $20/hr diff for the nocturnist but it was taken out of the day docs revenue and when it came down to it, the day docs balked and the deal fell through. In the past when we had a nocturnist, I don't think he had any special rate.

I never even asked about pay. Everyone made the same hourly at both my TH and now my USACS shops.

The main benefit for me is that I am basically able to write my own schedule. I rarely have gotten pushback from a scheduler about taking weekends off, or really any days off.

I'm just getting desperate. I absolutely love the job, colleagues, hospital, everything. I also work the most out of the group on average, so I suppose I could cut down or something to minimize the shell shock somewhat but I'm finding myself desperately trying to figure out any other alternative to minimize the circadian disruption. The every other week flipping from days to overnights to days is gonna be a slow death to me.

All in all, if you're gonna stay an ER doc, I recommend nocturnist with hesitations.

 

[GeneralVeers]

I've been full-time nocturnist for 3 years now, 2 of them w/ TH and now w/ USACS. I like to work 2--3 night stretches and then take off the rest of the week.

I am a morning person by nature and if there's nothing going on, I have trouble staying up past 8pm naturally. So yes, I flip back to days on my stretches off. It's still pretty easy to flip back to nights, as long as I take a ~1--2 hour nap every single afternoon, whether I'm working or not. I understand the flipping gets harder into one's 40s.

But the main cons for me are that (1) I need to constantly make sure I'm sleeping enough during the day or else I can go a little crazy, and (2) working nights is a known cardiac risk factor and I don't kid myself that this is not good for my health. Hence, FIRE in 5--10 years, ideally.

Otherwise, the main pro has been my availability for childcare and other family stuff. I usually take the older kid to daycare on my bike when I get off work, then sleep for 3--4 hours, then get up and am around to help for a bit more before work.

I also like the lack of bureaucracy during night shifts and nursing's general git-'er-done attitude.



I never even asked about pay. Everyone made the same hourly at both my TH and now my USACS shops.

The main benefit for me is that I am basically able to write my own schedule. I rarely have gotten pushback from a scheduler about taking weekends off, or really any days off.



All in all, if you're gonna stay an ER doc, I recommend nocturnist with hesitations.

I couldn't disagree more. Making your own schedule is important, but nights still beats the crap out of you, even at a young age. There has to be a significant pay incentive to work nights, which really shouldn't be less than $50/hour. I did nights for 5 years, and would never, ever go back to full time nights. At a certain point money is not worth having no life.

 

[AlmostAnMD]

Nocturnist here

Been doing it for last 9 months

I build my own schedule to have 7-10 days off each month to go back to a day schedule. When I convert back to days I just stay up all day from my last night. That day can be a bit rough but doing it fully converts me for my week off

I plan on doing it for the foreseeable future, like everyone else that does it and eventually burns out/dies

 

[Groove]

Groove, how many hours are you working a month? Once you get to a certain number of shifts, it becomes pretty hard to avoid some quick turnarounds, especially if you have any requests for the month. That said, corporate schedulers are the worst--they have no idea what these rapid swings do to your body and psyche, and most have no reason to care.

Can't believe anyone would balk at subsidizing a measly 20/hr for a nocturnist--divided amongst a group that's probably only 3-5 $/hr off your pay. Which is definitely worth it to cut out nights. (Esp w/ apollo where it's primarily productivity based so they probably wouldn't take much of a cut at all). IMHO a dedicated nocturnist should get a differential on the order of 20% (I'd guess that I'd need to decrease my hours by about that much if I were doing straight nights).

I'm contracted for 140 hours and I work between 150-180 hours on average. 1-2 months out of the year I might work 190+. Although I would normally say that having too many shifts predisposes you for turnarounds, I scheduled for several years and never really found that to be the case. There's never a really good reason to have a 24h turnaround, regardless of how many hours people are working, you force the rule into the algorithm or by hand and you lengthen their strings of day/nights together while preserving 48h off after any night stretches. I never found it very difficult as long as I was willing to use my own schedule to fill any spots but that kind of went with the job description since most schedulers are AFMDs and getting a stipend that's usually worth ~2 shifts.

Thanks for all the input guys/gals. I think I'll give it another month and if it's still this bad, address it with FMD and see what my options are... It doesn't sound like nocturnist schedule is all it's cracked up to be. I have a really difficult time with any sort of switch (forwards or backwards) so if I couldn't stay on a permanent night schedule, I don't see how flipping back to days multiple times a month would be any better. My cohabitating SO says she'd be understanding either way but she works 8-5 M-F with weekends off and I'm sure it would probably be the end of our relationship. I don't have any kids or intend on having any so that's not a concern.

 

[turkeyjerky]

Sounds like you need to talk to the scheduler. Is it a corporate drone or an assistant medical director? (Not that they can't be both lol) I might be mistaken, but they're probably applying the same rules that go for a 1.0 FTE, w/ regard to #shifts in a row and %nights, to you, which is incorrect since you're basically a 1.3FTE. This leads to too many nights and rapid turnarounds. Imo, you should be on the hook for the same absolute number of night shifts as everyone else, with any extra shifts being days and swings.

 

[cyanide12345678]

Thanks for all the input guys/gals. I think I'll give it another month and if it's still this bad, address it with FMD and see what my options are... It doesn't sound like nocturnist schedule is all it's cracked up to be. I have a really difficult time with any sort of switch (forwards or backwards) so if I couldn't stay on a permanent night schedule, I don't see how flipping back to days multiple times a month would be any better. My cohabitating SO says she'd be understanding either way but she works 8-5 M-F with weekends off and I'm sure it would probably be the end of our relationship. I don't have any kids or intend on having any so that's not a concern.

My wife said it was okay too, she was grumpy, but eventually agreed. But I've been listening to how I'm not available for at least 1.5 years out of my 2 years as nocturnist.

And it's true. I'm not. She comes back from work around 5:30, i leave within 30 minutes of it, so automatically i don't see her any day that i work. It is not unusual that I'll be working on her days off since i still work weekends, so I'm not home then either. And when I'm off, i would be waking up at 4-5 pm and she would be unhappy that i spent almost all of her day off sleeping. If i wake up early, I'm in a semi zombie state. So I'm physically present, but just lacking energy.

Not recommended at all if you have a significant other.

One thing that hasn't been mentioned, at least at my team health shop, night shift gets s*** on all the time. Whenever team health decreased staffing, it was always taking staffing hours away from night shift. Our volumes are back to pre covid levels. We used to be 24 hour doc coverage and 11 a to 11 pm PA coverage. Now we're 11 a to 7:30 p PA coverage. It's now a job i hate. They fail to acknowledge that 7 pm to 10 pm is by far the busiest time. Every one stops picking up patients, signs off, and then i have the worst 4-5 hours of my shift. For example, yesterday between 7 pm and 8 pm there were 9 people who checked in the first hour and 5 people in the second hour of my being there. That's 14 new patients in 2 hours. Single coverage essentially for nights. TH has refused to fix their staffing. Also our nursing staff is also down 1 shift at nights, 2 pm to 2 am nursing shift is hardly ever staffed. Every single one of my staff is burned out - every nurse, radiology techs, secretaries, everyone.

I love my nights staff. It's a great group of people. They truly work hard. But i wouldn't do it again.

Edit: you would think i work at an absolute s*** place. But we were ranked as the best small community hospital this year in the country by Forbes and IBM out of some 2500 small community shops they looked at -_- i can't imagine how crap the remaining places are.

 

[Groove]

Sounds like you need to talk to the scheduler. Is it a corporate drone or an assistant medical director? (Not that they can't be both lol) I might be mistaken, but they're probably applying the same rules that go for a 1.0 FTE, w/ regard to #shifts in a row and %nights, to you, which is incorrect since you're basically a 1.3FTE. This leads to too many nights and rapid turnarounds. Imo, you should be on the hook for the same absolute number of night shifts as everyone else, with any extra shifts being days and swings.

It's an AFMD. I have no idea what system they are using. I can't fathom that they are looking at each individual docs schedule and being mentally copacetic. When I scheduled peeps, I would go through each individual docs schedule and make sure it was something I'd be willing to work before committing. Normally, I would chalk it up to pissing them off accidentally but it's multiple docs. At this rate, we'll all be wheeled off to the cath lab in the middle of our shifts like one of my old colleagues in his early 50s who had a STEMI on shift. The sad thing is that I really love the job. It's almost perfect in every other way....THEN you're faced with the absolute worst schedule of your professional career. Talk about sweet and sour.

 

[hundreddaysoff]

I couldn't disagree more. Making your own schedule is important, but nights still beats the crap out of you, even at a young age. There has to be a significant pay incentive to work nights, which really shouldn't be less than $50/hour. I did nights for 5 years, and would never, ever go back to full time nights. At a certain point money is not worth having no life.

I actually completely agree with you. If wishes were horses, etc. That's why I'm trying to transition out of the ER, realistically within a few years.

 

[emergentmd]

Doing schedules are extremely difficult with all of the doctor specific requests, days off, etc.

In large places or multiple site systems, it has to be done a computer. It is impossible for someone to do it by hand. i have done the schedule before and it is impossible to satisfy everyone's needs.

If Op would like to stay a nocturnists, I would ask to create my own schedule AND ask for a stipend. You do not know how valuable you are to the group. Take full advantage of your value. You are doing 160hrs/month which is a huge amount of shifts thus contributing to your difficult schedules.

You are saving alot of docs from working their most hated shift, you should easily nogotiate a bonus.

 

[Mount Asclepius]

Don't do it if you have a family. Your significant other will be unhappy if they work a normal schedule.

Not recommended at all if you have a significant other.

Especially don't do it if you have a child.

She's outright told me multiple times that it was a horrible decision on my part to be a nocturnist.

Definitely disagree with this opinion. Don’t do it if you don’t have a supportive spouse (in the sense that they are ok with it and want you to do it to). In reality most of us have supportive spouses or significant others as they’ve also already sacrificed for our career in medicine. I’ve involved my spouse in my decision to work nights and she is very supportive as there are multiple advantages of being a nocturnist. She leaves me mostly alone on the 2-3 days I switch back as she knows I’m semi-sleep deprived and grumpy. On all the other days I’m off, I don’t sleep all day as I’m back on a normal schedule after a good night of catch-up sleep. A night schedule can work really well for kids. Regardless, not a concern of the OPs. This thread has made me realize that it probably totally boils down to your personality and the opinions of your spouse. Are you an early morning or late night person? How well do you sleep on command? How supportive is your family?

She comes back from work around 5:30, i leave within 30 minutes of it,

This represents more of a swing schedule in my opinion. Although I’m guessing you work 12s, which I’d never do. Productivity falls off at 10 hours. We work 8s that often extend to 10 as we’re partially productivity based. Nights in my opinion start later between 9-12 pm. This also allows you’d to spend a little more time with your family once you get up before you head to work

One thing that hasn't been mentioned, at least at my team health shop, night shift gets s*** on all the time. Whenever team health decreased staffing, it was always taking staffing hours away from night shift. Our volumes are back to pre covid levels. We used to be 24 hour doc coverage and 11 a to 11 pm PA coverage. Now we're 11 a to 7:30 p PA coverage. It's now a job i hate. They fail to acknowledge that 7 pm to 10 pm is by far the busiest time. Every one stops picking up patients, signs off, and then i have the worst 4-5 hours of my shift. For example, yesterday between 7 pm and 8 pm there were 9 people who checked in the first hour and 5 people in the second hour of my being there. That's 14 new patients in 2 hours. Single coverage essentially for nights. TH has refused to fix their staffing. Also our nursing staff is also down 1 shift at nights, 2 pm to 2 am nursing shift is hardly ever staffed. Every single one of my staff is burned out - every nurse, radiology techs, secretaries, everyone.

Edit: you would think i work at an absolute s*** place. But we were ranked as the best small community hospital this year in the country by Forbes and IBM out of some 2500 small community shops they looked at -_- i can't imagine how crap the remaining places are.

I think this illustrates the difference between a CMG and a SDG. My partners stay late if it blows up and yet also leave me a good number to see as they know I want volume. I don’t see 14 in 2 hours though. We staff to fit our preferences. Some of us work hard, and some of us want a more reasonable pace. The reported best functioning CMG site burned him out in 2 years. I put in my sweat equity at a SDG and it was well worth it.

Sorry @cyanide12345678 to attack all of your points, but I just don’t think you had a good nocturnist setup leading to your negative opinions of working nights.

 

[cyanide12345678]

Definitely disagree with this opinion. Don’t do it if you don’t have a supportive spouse (in the sense that they are ok with it and want you to do it to). In reality most of us have supportive spouses or significant others as they’ve also already sacrificed for our career in medicine. I’ve involved my spouse in my decision to work nights and she is very supportive as there are multiple advantages of being a nocturnist. She leaves me mostly alone on the 2-3 days I switch back as she knows I’m semi-sleep deprived and grumpy. On all the other days I’m off, I don’t sleep all day as I’m back on a normal schedule after a good night of catch-up sleep. A night schedule can work really well for kids. Regardless, not a concern of the OPs. This thread has made me realize that it probably totally boils down to your personality and the opinions of your spouse. Are you an early morning or late night person? How well do you sleep on command? How supportive is your family?

This represents more of a swing schedule in my opinion. Although I’m guessing you work 12s, which I’d never do. Productivity falls off at 10 hours. We work 8s that often extend to 10 as we’re partially productivity based. Nights in my opinion start later between 9-12 pm. This also allows you’d to spend a little more time with your family once you get up before you head to work


I think this illustrates the difference between a CMG and a SDG. My partners stay late if it blows up and yet also leave me a good number to see as they know I want volume. I don’t see 14 in 2 hours though. We staff to fit our preferences. Some of us work hard, and some of us want a more reasonable pace. The reported best functioning CMG site burned him out in 2 years. I put in my sweat equity at a SDG and it was well worth it.

Sorry @cyanide12345678 to attack all of your points, but I just don’t think you had a good nocturnist setup leading to your negative opinions of working nights.

Well I'm burned out in my 2 years as nocturnist, so obviously my gig wasn't that great.

It is 12s though, 7 p to 7 am. And i drive 1 hour to work, so it's a 14 hour work day, so my spouse truly does not see me during that time. And chances are she will be going to work before i get home around 8-8:30 am.

Plus just having a resident spouse with a tough schedule and multiple 26 hour call days didn't make things easy for us, throw in a new born 6 months in to my being an attending and nocturnist and i think my situation was just particularly tough. And it didn't help that we had no family nearby to help with the kiddo.

I'm sure people can have a better nights experience, but honestly days is probably still better, or maybe it's just that the grass is greener on the other side for me and i haven't experienced the other side? But as of today, having been a nocturnist for 2 years, i think i would have been a better father and husband if i wasnt one.

 

[Clean7795]

You need to be able to fall asleep quickly, stay asleep, easily adjust to new sleep schedules, and naturally have a circadian type that jives with night work. On top of that your significant other has to be okay with it. That might be 1-2% of the population.

For everyone else it quickly becomes miserable and unsustainable. If you need the money that badly you probably ****ed up your finances somewhere pretty badly.

 

[deleted77919]

…

 

[Mount Asclepius]

Is it hard to do all nights? Yes! Is it also hard to have your schedule jerked around all over the place? Also, yes! Sadly for most there is no option 3 that involves just doing days.

I have felt very similar to the OP at times - just exhausted from having my schedule shift around constantly and wondering if dedicated nights would provide consistency to make the job more sustainable.

Agree. The ability to pick your schedule and have a consistent schedule minimizing the constant bouncing around is one of the big reasons I was drawn to nights amongst several other benefits.

 

[Mount Asclepius]

You need to be able to fall asleep quickly, stay asleep, easily adjust to new sleep schedules, and naturally have a circadian type that jives with night work. On top of that your significant other has to be okay with it.

Agree.

For everyone else it quickly becomes miserable and unsustainable. If you need the money that badly you probably ****ed up your finances somewhere pretty badly.

Also agree. You shouldn’t do nights solely for the money. If that is the only reason, there is a good chance it will lead to burnout.

 

[Mount Asclepius]

Well I'm burned out in my 2 years as nocturnist, so obviously my gig wasn't that great.

It is 12s though, 7 p to 7 am. And i drive 1 hour to work, so it's a 14 hour work day, so my spouse truly does not see me during that time. And chances are she will be going to work before i get home around 8-8:30 am.

Plus just having a resident spouse with a tough schedule and multiple 26 hour call days didn't make things easy for us, throw in a new born 6 months in to my being an attending and nocturnist and i think my situation was just particularly tough. And it didn't help that we had no family nearby to help with the kiddo.

I'm sure people can have a better nights experience, but honestly days is probably still better, or maybe it's just that the grass is greener on the other side for me and i haven't experienced the other side? But as of today, having been a nocturnist for 2 years, i think i would have been a better father and husband if i wasnt one.

Your spouse graduating and finding a new position is greener grass. Best of luck on the change. I think you’ll find your new situation much better. Maybe you’ll even want to come back to the dark side at some point.

 

[Arcan57]

I'm contracted for 140 hours and I work between 150-180 hours on average. 1-2 months out of the year I might work 190+. Although I would normally say that having too many shifts predisposes you for turnarounds, I scheduled for several years and never really found that to be the case. There's never a really good reason to have a 24h turnaround, regardless of how many hours people are working, you force the rule into the algorithm or by hand and you lengthen their strings of day/nights together while preserving 48h off after any night stretches. I never found it very difficult as long as I was willing to use my own schedule to fill any spots but that kind of went with the job description since most schedulers are AFMDs and getting a stipend that's usually worth ~2 shifts.

Thanks for all the input guys/gals. I think I'll give it another month and if it's still this bad, address it with FMD and see what my options are... It doesn't sound like nocturnist schedule is all it's cracked up to be. I have a really difficult time with any sort of switch (forwards or backwards) so if I couldn't stay on a permanent night schedule, I don't see how flipping back to days multiple times a month would be any better. My cohabitating SO says she'd be understanding either way but she works 8-5 M-F with weekends off and I'm sure it would probably be the end of our relationship. I don't have any kids or intend on having any so that's not a concern.

Groove, 170+ hrs for a single provider puts the scheduler in a difficult situation (not saying your scheduler isn't horrific also). When you have a doc working much more than the group average, you have to make a choice between making life easier for that doc vs. screwing over the rest of the group. I know plenty of docs that would be/were happy working 18 shifts/month as long as almost all of them were weekday day shifts. But then the question becomes "Is it fair for the group that someone is making more money while taking less of a circadian beating?" And that's tough to answer, even for a thoughtful scheduler. The fairest answer is to just have those super-shifted docs do a long run of nights every month. However,most docs (and some scheduling software) has strong feelings about limiting the number shifts in a row which then means you're going to have multiple short turnarounds per month.

 

[turkeyjerky]

Well I'm burned out in my 2 years as nocturnist, so obviously my gig wasn't that great.

It is 12s though, 7 p to 7 am. And i drive 1 hour to work, so it's a 14 hour work day, so my spouse truly does not see me during that time. And chances are she will be going to work before i get home around 8-8:30 am.

Plus just having a resident spouse with a tough schedule and multiple 26 hour call days didn't make things easy for us, throw in a new born 6 months in to my being an attending and nocturnist and i think my situation was just particularly tough. And it didn't help that we had no family nearby to help with the kiddo.

I'm sure people can have a better nights experience, but honestly days is probably still better, or maybe it's just that the grass is greener on the other side for me and i haven't experienced the other side? But as of today, having been a nocturnist for 2 years, i think i would have been a better father and husband if i wasnt one.

Damn, that sounds like the worst situation ever. 12 hr night shifts are the absolute worst. Plus that commute. Cannot imagine doing that schedule w/ a spouse in residency plus a baby. Jesus.

It's an AFMD. I have no idea what system they are using. I can't fathom that they are looking at each individual docs schedule and being mentally copacetic. When I scheduled peeps, I would go through each individual docs schedule and make sure it was something I'd be willing to work before committing. Normally, I would chalk it up to pissing them off accidentally but it's multiple docs. At this rate, we'll all be wheeled off to the cath lab in the middle of our shifts like one of my old colleagues in his early 50s who had a STEMI on shift. The sad thing is that I really love the job. It's almost perfect in every other way....THEN you're faced with the absolute worst schedule of your professional career. Talk about sweet and sour.

Sounds like the guy just has the scheduling system do it and doesn't bother manually tweaking it.

Are you able to drop your hours to the contracted number? That's probably the best and simplest solution. Otherwise I would just ask him to put all your nights in 1 long string per month. I wouldn't do >130 hrs/mo as a nocturnist...

 

[emergentmd]

170 hrs a month is insane and almost forces you to do quick turn arounds. If the scheduler did you first, then great but there are 10+ docs to probably think about.

 

[Groove]

It's not difficult guys. I was the scheduler for over 7 years at a place. We had docs with all types of hours. You simply adjust the number of shifts in a row. Almost all scheduling software allows you to accommodate that. You hard set 48h after every string of nights and you make the penalty high enough that the algorithm priorities it. That might give the doc only one day off between large stretches, but they know what they are getting into if they request that many shifts. I never had to give them multiple flips. Ever. You block the nights and if it turns into more than 3-4 then you have a day/night off then finish 1-2 more nights depending on how many are required at the site. Either way, you block the nights for the month so they only have to flip once. It's not that hard.

However, if you want to assume it's because of my lengthy shift requests, then explain why multiple other docs with only 120h contracts are scheduled the same way? I get the same schedule whether I'm down for 140 or 180. I think I pissed this person off somehow. Either that or they just aren't paying attention to the individual schedules which is ridiculous for a scheduler because that's part of the job.

 

[emergentmd]

Groove,

I have no idea how long your shifts are, how many shifts you have in a day, how many docs are at your site, or how many sites each doc works but I can tell you after about 15 docs and 2 sites, it is IMPOSSIBLE to do a schedule and not create a quick turn around.

I have done schedules and was happy to see shiftadmin take it over.

Doc 1 : Wants 48 hrs between flipping nights to days. Wants to do 3-5 straight nights. Wants to take vacation on the 1-5, 13-17, 23-27. He never wants to do single shifts. He works 18 dys a month

Doc 2: wants 72 hrs between nights/days. Never wants to work more than 2 shifts at a time. Wants vacation 12-18, 27-30. He wants his shifts staggered from 1st then 2nd, then 3rd, then 4th, then overnight. He doesn't want to go from am shift to overnight.

Doc 3 .......

After 5 docs it gets quite difficult.

No one ever gets everything they want.