Nocturnist Experiences

[Groove]

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.

The secret is not to give them too many day off requests. I never let them have more than 7 and if they wanted more, they had to get it approved 3 months in advance. I also would deny any day off requests where you had more than 3 docs asking off for days on top of 3 previous requests so the 4th doc would get denied and if I ran into problems they were approved on a first come first serve basis. The slackers therefore knew that if they waited until the last minute to place requests they were less apt to get them. I generated multiple versions of the schedule (at least 10 each month) with detailed analysis of each doc. I easily spent a couple days when I first started and could knock one out in 2-3 hours near the end. They were good schedules. You just gotta run a tight ship with clear rule sets that make generation of the schedule feasible and minimize request denials.

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[robellis]

Recent News about Night Shift Work and Cancer: What Does it Mean for Workers? | Blogs | CDC

CDC - Blogs - NIOSH Science Blog – Recent News about Night Shift Work and Cancer: What Does it Mean for Workers? -

blogs.cdc.gov

 

[deleted77919]

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[emergentmd]

Template makes sense with residents but would never fly as attendings.

 

[deleted77919]

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[Mount Asclepius]

Recent News about Night Shift Work and Cancer: What Does it Mean for Workers? | Blogs | CDC

CDC - Blogs - NIOSH Science Blog – Recent News about Night Shift Work and Cancer: What Does it Mean for Workers? -

blogs.cdc.gov

‘Other factors that are more common among night shift workers might contribute to the risk of cancer:

• Lifestyle behaviors, such as smoking, higher than recommended alcohol consumption, poor diet, not enough physical activity, and being overweight or obese’

I believe circadian rhythms are important and I’m not going to argue that night shift work is an overall health benefit. I think the emphasis that working as a nocturnist is detrimental to your health is overblown though. I think more of it relates to other lifestyle factors that you are also have control over. Exposure to sunlight increased your risk of skin cancer. We should all avoid the sun and only be outside at night! Sunlight also increases vitamin D levels which is good for our health. Sensationalist broad generalizations aren’t necessarily universally true. I choose to accept the lesser evil that is consistent nocturnist work over working days, swings and still some nights with an inconsistent flipping schedule regardless. Sure, I’d rather do EM and only work days, but I’d also like to have no charting or threat of litigation. Unfortunately just working with the hand we’re dealt.

 

[turkeyjerky]

I would gladly agree to work the same number of hours and night shifts as everyone else and give up the ability to make requests if it meant having schedules that protect sleep and prevent bad turn arounds.

I think you’re in the minority there…

 

[robellis]

‘Other factors that are more common among night shift workers might contribute to the risk of cancer:

• Lifestyle behaviors, such as smoking, higher than recommended alcohol consumption, poor diet, not enough physical activity, and being overweight or obese’

I believe circadian rhythms are important and I’m not going to argue that night shift work is an overall health benefit. I think the emphasis that working as a nocturnist is detrimental to your health is overblown though. I think more of it relates to other lifestyle factors that you are also have control over. Exposure to sunlight increased your risk of skin cancer. We should all avoid the sun and only be outside at night! Sunlight also increases vitamin D levels which is good for our health. Sensationalist broad generalizations aren’t necessarily universally true. I choose to accept the lesser evil that is consistent nocturnist work over working days, swings and still some nights with an inconsistent flipping schedule regardless. Sure, I’d rather do EM and only work days, but I’d also like to have no charting or threat of litigation. Unfortunately just working with the hand we’re dealt.

Those other factors are contributory but there’s still a lot to be concerned about..just know that when you sign up to be a nocturnist you’re literally trading your health for money so it better be worth it

 

[Mount Asclepius]

..just know that when you sign up to be a nocturnist you’re literally trading your health for money so it better be worth it

Disagree. I’m not a nocturnist because of the money and anecdotally feel much better health wise currently now that I avoid the the random chaos of switching between days, mids and nights. As previously discussed, others may not tolerate nocturnist work as well.

In some ways you do describe the essence of any job as they all take away from our allotment of time in life that we can’t get back, with the trade off that we can obtain more money. Some may do it for love, but I think most end up continuing work as an EP (or any job) primarily for the paycheck. The one thing I’ve found over the years to be more valuable than anything else is time. The real question is whether I continue to work as an EP, not whether I’m a nocturnist or not. Either way they both take time away from my family and other pursuits that I can’t have back. I balance the negative aspects of continuing to work with the hopeful long term outlook that it will allow me FIRE earlier and then have more time with my family during quality years before my non-functional time runs out. There is always the chance something like cancer could creep up and get me sooner. I don’t worry in the least though about nocturnist life primarily driving a premature death. I also am not likely going to continue working as an EP once I hit FIRE, because giving up that time isn’t worth the extra money.

 

[robellis]

Disagree. I’m not a nocturnist because of the money and anecdotally feel much better health wise currently now that I avoid the the random chaos of switching between days, mids and nights. As previously discussed, others may not tolerate nocturnist work as well.

In some ways you do describe the essence of any job as they all take away from our allotment of time in life that we can’t get back, with the trade off that we can obtain more money. Some may do it for love, but I think most end up continuing work as an EP (or any job) primarily for the paycheck. The one thing I’ve found over the years to be more valuable than anything else is time. The real question is whether I continue to work as an EP, not whether I’m a nocturnist or not. Either way they both take time away from my family and other pursuits that I can’t have back. I balance the negative aspects of continuing to work with the hopeful long term outlook that it will allow me FIRE earlier and then have more time with my family during quality years before my non-functional time runs out. There is always the chance something like cancer could creep up and get me sooner. I don’t worry in the least though about nocturnist life primarily driving a premature death. I also am not likely going to continue working as an EP once I hit FIRE, because giving up that time isn’t worth the extra money.

Whether you choose to worry about it or not is immaterial, the science is clear that working when you should be sleeping is very detrimental to your health so yes you are literally giving up your health in that way if you do it long term..just something people/students should be aware of and certainly not like working an 8-5 job

 

[Mount Asclepius]

Whether you choose to worry about it or not is immaterial, the science is clear that working when you should be sleeping is very detrimental to your health so yes you are literally giving up your health in that way if you do it long term..just something people/students should be aware of and certainly not like working an 8-5 job

I think the science is questionable regarding the degree of impact and filled with many other confounding variables. I agree though with your overall sentiment and the importance of awareness. Unfortunately most of medicine as a field doesn’t allow for the 8-5 life.

 

[GeneralVeers]

I think the science is questionable regarding the degree of impact and filled with many other confounding variables. I agree though with your overall sentiment and the importance of awareness. Unfortunately most of medicine as a field doesn’t allow for the 8-5 life.

We should just do what ICU gets away with at my hospitals. The CC doc goes home at 7PM and the night is covered by an NP with the CC doc asleep at home. Why not have our midlevels manage all the BS and call us if needed? If there's a real emergency, then they can just have the ER doc come and ........oh wait, nevermind.

 

[emergentmd]

I would gladly agree to work the same number of hours and night shifts as everyone else and give up the ability to make requests if it meant having schedules that protect sleep and prevent bad turn arounds.

How would this ever fly as an attending?

So everyone gets a good circadian schedule, albeit not great when you are doing nights. So I have 3 kids who has activities, long breaks during holidays, summer vacations.

So when my daughter/son has sports tournaments every other weekend, I get to tell my family; "Oh, every schedule has me working half of your games, but look how much better I am sleeping?"

Since being an attending, I could atleast ask for 7-10 dys off a month and be at their activities/trips.

 

[deleted77919]

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[turkeyjerky]

Yeah, I think there's a reason that 120-130 hrs/mo is typically considered full-time in EM. Like a lot of people, I used to do >160 when extra shifts were plentiful and well-remunerated, and, as I remember, life really kinda sucked when I wasn't on vacation.

Honestly, it really shouldn't be hard to have both requests and reasonable turn-arounds (at least as long as the requests aren't all the same and people are reasonable).

 

[sylvanthus]

We should just do what ICU gets away with at my hospitals. The CC doc goes home at 7PM and the night is covered by an NP with the CC doc asleep at home. Why not have our midlevels manage all the BS and call us if needed? If there's a real emergency, then they can just have the ER doc come and ........oh wait, nevermind.

Shhhhhh dont give them any ideas. Id be out a job.

 

[BoardingDoc]

I’m glad you’ve been able to go to all those things. I have two small kids, and there’s no way to go to all those things working 140-170s hours a month and feel human, at least with the schedules I’ve worked.

Maybe my job and schedule were just especially difficult.

I just think overall it is worth trading schedule flexibility for circadian protection, but clearly I’m in the minority. Maybe I’m just especially bad at tolerating terrible turn arounds.

I think the issue here is more related to the fact that you work 140-170 hr/mo.

 

[The Knife & Gun Club]

I think the issue here is more related to the fact that you work 140-170 hr/mo.

I have an attending who’s still working 240 hours per month, in his 60s. That just boggles my mind.

He was making fun of me for being “unmotivated” because I said I hadn’t seen my wife or dog in 10 days and wanted a day off.

 

[Dr Mantis Toboggan]

I have an attending who’s still working 240 hours per month, in his 60s. That just boggles my mind.

He was making fun of me for being “unmotivated” because I said I hadn’t seen my wife or dog in 10 days and wanted a day off.

The problem with q2 call is you miss half the good cases.

 

[Birdstrike]

I have an attending who’s still working 240 hours per month, in his 60s. That just boggles my mind.

He was making fun of me for being “unmotivated” because I said I hadn’t seen my wife or dog in 10 days and wanted a day off.

Bizarre

 

[The Knife & Gun Club]

The problem with q2 call is you miss half the good cases.

Bizarre

It’s one thing in surgery or a practice with some amount of regular Circadian rhythm. But that’s 20 twelve hour EM shifts, with half of them being nights. F that noise at 30 much less 60.

 

[Birdstrike]

It’s one thing in surgery or a practice with some amount of regular Circadian rhythm. But that’s 20 twelve hour EM shifts, with half of them being nights. F that noise at 30 much less 60.

I don't know how anyone can do that physically, let alone mentally, for more than a month or two. How people like that don't burn out, I'll never know.

 

[bravotwozero]

I don't know how anyone can do that physically, let alone mentally, for more than a month or two. How people like that don't burn out, I'll never know.

That guy sounds like a STEMI waiting to happen. Hope for his sake it doesn’t.

 

[Clean7795]

Some people genetically have an easier time adjusting their circadian rhythm or doing night work. Not me though.

 

[Angry Birds]

I have an attending who’s still working 240 hours per month, in his 60s. That just boggles my mind.

He was making fun of me for being “unmotivated” because I said I hadn’t seen my wife or dog in 10 days and wanted a day off.

How many ex-wives does he have

 

[GassYous]

How many ex-wives does he have

Only takes one

 

[Dr Mantis Toboggan]

That guy sounds like a STEMI waiting to happen. Hope for his sake it doesn’t.

There are some old school docs who legitimately love being in the hospital. I’m not one of them. There was a doc at our local VA who was chief resident there in like 1960. He worked well into his 80s and recently died, worked essentially right up to the end. Could’ve retired with a sweet pension really at any point in the last 25-30 years.

 

[southerndoc]

How many ex-wives does he have

Some people work a lot to escape their current wife not to support their ex-wives.

 

[skougess]

There are some old school docs who legitimately love being in the hospital. I’m not one of them. There was a doc at our local VA who was chief resident there in like 1960. He worked well into his 80s and recently died, worked essentially right up to the end. Could’ve retired with a sweet pension really at any point in the last 25-30 years.

I’ll never get it. I still have passion for this job and and most days would still even go so far as to say I “love” it. But there are so many things I’d rather do than go to work. I’ve been unemployed for long periods before and I was NOT bored.