Specialty choice to avoid working at night?

[ACSurgeon]

And that's fine, but acting like anyone who did read it that way is just looking for toxicity and calling poster's opinions invalid is pretty ****ty and by itself, also emblematic of the toxic culture we're talking about. You at least get why some of us interpreted it that way.



We all prioritize what we feel is important. There's a reason ROAD exists/existed for so long. It's because some people find the "road" to happiness to be money and lifestyle. They're not being lectured on how they're giving up their "passion" for money and lifestyle. There are people wanting to do ortho as a pre-med. They're also not being lectured on giving up their passion or burnout. They're being cautioned for other reasons - competitive nature of those specialties - but not that they're giving up their passion. But if a poster wants to prioritize sleep, they get multiple posts questioning them about it as if sleep isn't every bit as important (and by some measures, more important).

Actually people in medicine will routinely dump on every other specialty. It’s the oldest thing ever. Specialties that get paid we’ll get beat on for being over paid. Ortho gets made fun of for being stupid. Surgeons for being workaholics. Neurologists for being useless thinkers. The “shaming” exists for every specialty. If you like what you do, you won’t care what others are saying.

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[Lawpy]

I don’t think counting people who care enough to chime in is a valid argument. You can count me and VAhopeful on the side of not thinking it’s toxic and now you’re tied 3:3.

Even though I disagreed with the statement of “are you really gonna prioritize sleep”, it’s not because I thought it was toxic. It’s because I thought it was a bad argument. Some people think a specialty could be so amazing that it’s worth sacrificing sleep for. Some won’t. I actually believe that people who prioritize sleep probably won’t fall in love with a specialty that requires night work. Simple as that

If someone “are you really not gonna have kids because you prioritize your sleep,” is that a toxic or condescending statement? I read it was one of surprise as the person asking can’t relate to the person being asked. That’s how I read that question.

Finally, while medicine has a lot of unnecessary bad behavior and “toxicity”, having nights/weekends/holidays covered is an essential service. It’s not toxic or optional to have a hospitalist/intensivist/ER doc working a night shift. Some students might hate the idea enough that it drives them away. Fine. Some can tolerate a few night shifts a year and can still work in those fields. Great. Some will do pure nights. Good for them.

finally part 2: we are living in a soft world. People don’t wanna be inconvenienced. People are faster to complain. People will complain even without a good cause. just because their is abuse in the system doesn’t mean we should make every inconvenience automatically classified as abuse.

I feel like the actual quality (and of course quantity) of sleep matters here, and while OP is hesitant on nights to avoid disrupting their regular sleep schedule, nights can be tolerable by many others who have no issues sleeping in the morning in a dark room. Sacrificing hours and quality of sleep may be a necessary evil in training but expecting anyone to sacrifice sleep is just cruel. I don’t like working 24s but i’ll do it anyways and try to repay my sleep debt soon after. Sleep is by far one of the most important things to focus on (along with personal/family life) and expecting anyone to sacrifice that for the “good of medicine” just feeds into the toxic work culture of medicine with devastating outcomes

 

[ACSurgeon]

I feel like the actual quality (and of course quantity) of sleep matters here, and while OP is hesitant on nights to avoid disrupting their regular sleep schedule, nights can be tolerable by many others who have no issues sleeping in the morning in a dark room. Sacrificing hours and quality of sleep may be a necessary evil in training but expecting anyone to sacrifice sleep is just cruel. I don’t like working 24s but i’ll do it anyways and try to repay my sleep debt soon after. Sleep is by far one of the most important things to focus on (along with personal/family life) and expecting anyone to sacrifice that for the “good of medicine” just feeds into the toxic work culture of medicine with devastating outcomes

You’ll find most people in medicine might prefer to avoid nights, a small minority love nights, and a small minority hate them enough to the point of thinking it’s a human rights violation. I think most of us might be critical of the last category. Again, some professions need 24/7/365 coverage. Medicine is one such profession.

 

[Mass Effect]

I don’t think counting people who care enough to chime in is a valid argument. You can count me and VAhopeful on the side of not thinking it’s toxic and now you’re tied 3:3.

The point wasn't how many people think it vs how many don't. The point was that if one person felt that way, you may be able to dismiss their argument as someone "looking for toxicity". But when three separate posters tell you that's how they read it, that argument becomes much less compelling, regardless of how many others read it your way. I find telling posters they're "looking for toxicity" or that their argument is invalid to be offensive and ironically, suggestive of the very toxic culture we're talking about.

Even though I disagreed with the statement of “are you really gonna prioritize sleep”, it’s not because I thought it was toxic.

Again, no one said the argument itself is toxic. We said it's representative of the toxic nature of medicine. Like how could you consider prioritizizing your own sleep and health over medicine.

If someone said “are you really not gonna have kids because you prioritize your sleep,” is that a toxic or condescending statement?

That's a completely different statement in a completely different context addressing a completely different thing. For one thing, lack of sleep during the postpartum period is transient. For another, if someone felt that strongly about it, there are alternatives.

Finally, while medicine has a lot of unnecessary bad behavior and “toxicity”, having nights/weekends/holidays covered is an essential service. It’s not toxic or optional to have a hospitalist/intensivist/ER doc working a night shift.

Who suggested it was?

finally part 2: we are living in a soft world. People don’t want to be inconvenienced. People are faster to complain. People will complain even without a good cause. just because there is abuse in the system doesn’t mean we should make every inconvenience automatically classified as abuse.

Oh good lord. No one is making any "inconvenience" an abuse. I have no idea what thread you're reading, but doesn't seem like it's this one.

 

[Mass Effect]

Actually people in medicine will routinely dump on every other specialty. It’s the oldest thing ever. Specialties that get paid we’ll get beat on for being over paid. Ortho gets made fun of for being stupid. Surgeons for being workaholics. Neurologists for being useless thinkers. The “shaming” exists for every specialty. If you like what you do, you won’t care what others are saying.

And that relates to what I'm saying how?

 

[ACSurgeon]

The point wasn't how many people think it vs how many don't. The point was that if one person felt that way, you may be able to dismiss their argument as someone "looking for toxicity". But when three separate posters tell you that's how they read it, that argument becomes much less compelling, regardless of how many others read it your way. I find telling posters they're "looking for toxicity" or that their argument is invalid to be offensive and ironically, suggestive of the very toxic culture we're talking about.



Again, no one said the argument itself is toxic. We said it's representative of the toxic nature of medicine. Like how could you consider prioritizizing your own sleep and health over medicine.



That's a completely different statement in a completely different context addressing a completely different thing. For one thing, lack of sleep during the postpartum period is transient. For another, if someone felt that strongly about it, there are alternatives.



Who suggested it was?



Oh good lord. No one is making any "inconvenience" an abuse. I have no idea what thread you're reading, but doesn't seem like it's this one.

I find your tone toxic and condescending.

 

[Mass Effect]

I find your tone toxic and condescending.

The feeling is mutual, especially when you're arguing against points I never made.

 

[Dr G Oogle]

It’s just the toxic culture of medicine mixed with typical SDN behavior where it’s completely acceptable and expected to sacrifice sleep and life in favor of medicine 24/7. Those posts are disappointing but not surprising

I didn't read it as toxicity either. My interpretation was that the concern was the OP would end up in a specialty they didn't like because of not wanting to work nights. I can see why the particular wording could seem like the poster was minimizing the importance of sleep, but not everyone online chooses their words as carefully as we do for in-person interactions.

Its a valid concern. I love FM and the schedule is certainly great, but if you don't like the work then just doing it for the schedule is a recipe for burnout.

I think in general people who are truly passionate about a field are going to really concern themselves with sleep. Most people are going in with eyes wide open. To be fair if someone is choosing something like general surgery, neurosurgery or obgyn or most procedural specialties, and then complain about lack of “free time”, some, or most of the blame, really falls on the person for choosing that field. It is not possible to get good at those jobs and not sacrifice free time and sleep, especially the procedural ones. There is a clear correlation between time spent doing these procedures and outcomes. We do not do a good job of highlighting this fact to students.

However, prioritizing sleep and free time and open discussions about how each of the fields impacts those, should not only be ok, but widely performed. And should certainly not be mocked and equated to not caring about your job. I chose my sub specialty of urogyn with a big dollop of I want to be able to sleep 8.5 hours every night and on the weekends, and liking the job was a secondary consideration. On the other hand, I left a very lifestyle friendly specialty and switched into obgyn, knowing the limitations on free time and sleep, and instantly regretted it for that reason. Though passion drove my switch, I quickly learned that my passion goes as far as my restfulness.

TLDR: everyone here has a valid point

 

[Browns99]

They are saying in a dismissive manner (i.e. “we live in a soft world!”) as if it’s a bad thing to prioritize sleep




Dude your posts reek of condescension

Yup, for people like you especially when it is warranted. You'll find that, everything I say is factual.

 

[operaman]

For the OP - I really think most fields are wide open to you if you can tolerate poor sleep at times in residency. As an attending you can have pretty much any schedule you want so long as you’re willing to compromise other things to get it (ie. Location, salary, etc).

I’ll offer a few thoughts for residency selection too. You will definitely want to research the call schedule and understand what that will mean for your sleeping. You really have 3 options for overnight coverage in training and each has different rules.

1) in house overnight call- means you work your regular day but then you stay in house overnight. You are required to have a post-call day afterwards and they should be sending you home early in the morning the next day. This is where you find that 24 hour max shift rule with an extra 4 hour buffer for transition of care. You should then have a good 18 hours or so before your next regular day.

2) in house night float call- in this one, you would work only at night for a defined period of time. You come in for evening sign out and you leave after morning signout or rounds depending on the service. Sleep during this is worst at the transition points but can be pretty doable once you get accustomed to the new shift. A number of programs are moving toward this model if they have enough residents to do it. My former program does this now and the pgy2-3s each do 5 weeks of straight nights and then take no other call the rest of the year.

3) home call- you work your regular day and then go home but you carry the pager and may have to come in for emergencies or other issues that require an MD to be present. Regardless of how busy you are overnight, you still work your full next day. The 24+4 rule does not apply here so you could very well end up working 36+ hours straight and it would not even be a work hours violation. Many surgical subs do home call and while sometimes it truly is home call, other times it’s pretty busy and they are using home call to get around the duty hours issues that would come from having in house call. You can imagine how a smaller program would struggle having one or more residents always out on a post call day.

For all of these, especially the home and in house call, you’ll want to know how frequently it occurs. Most programs in my field were q4-6 so you were doing your overnight 1-2x per week. My program was q8-10 as a junior and q12-14 as a senior which made our otherwise brutal home call pretty doable.

You will also want to research how call changes toward your senior years (pgy4-5+). For some programs you just do backup call on a similar schedule to the juniors, for others the seniors do primary call as well, and for others the service chiefs take 24/7 backup call from home.

So that’s the nuts and bolts of residency call. If you find yourself looking toward surgical fields it would be worth the time to familiarize yourself with their call systems and apply and rank accordingly. 5-7 years is a long time even though it’s temporary, and as someone who came from a very lifestyle friendly program, it made a huge difference, especially for a non-trad like me who doesn’t bounce back from an overnight as quickly as he did in his 20s.

I don’t think the call system makes one iota of difference in your quality of training. I routinely do a number of procedures that many others in my field won’t touch without a fellowship because my training was so good even though my call was q8-14 depending on the year and my chief call was cushier than my attending call is now. The truth is that most cases occur during regular hours and most of overnight call is managing floor stuff and consults that can wait. Many of the overnight emergency cases are not even that interesting and you’ll get plenty during the day as well. I looked at it in my program and we went to the OR 1-2x a week overnight, so even if I’d taken 24/7 call that’s maybe 50-60 cases tops, and most not even that interesting. For me, the cases I don’t do now are either ones I don’t like doing or ones you legit need a different fellowship to do; nothing I would have remotely gotten from scrubbing the overnight cases I missed out on.

 

[Redpancreas]

I don't mind working long hours during the day, but I really suffer when my sleep schedule gets disrupted. Are there any specialties (or options within specialties) where I can avoid working at night? (defined as 10pm-6am) This is different from the "lifestyle specialties" question, for which I know the ROAD is the answer, since I'm willing to work hard (e.g. 80 hrs/wk) during the day.

The list of what not to do is shorter.

-Emergency Medicine
-Surgical Fields with Emergencies-Spine, Trauma, etc.

Some of these fields will have exceptions.

 

[RangerBob]

As other points out, almost any specialty can accommodate daytime only practice. EM, OB, trauma surgery are unlikely to work. But most others should. So rule those ones out, and then from the remaining list (ie., most specialties) see what you enjoy the most. If one is really that adverse to working overnight, then you can filter out specialties with more overnight call/hours during residency.

I really dislike nights, but when I was actually on it was a lot of fun. It was great learning and the pace is just so different. But it really messed with my sleep-wake cycle and connections with other people outside of work, so I certainly don't fault anyone for wanting to choose a specialty where they can work daytime only. I'm in the exact same boat--overnight call I can do (and I do often, but rarely get called), but I don't ever plan to work an overnight shift again. The last overnight shift I did was intern year, and I expect to keep it that way.

 

[BuildingMyOwnLuck]

So, it's unreasonable advice then? Sure, don't go into a field you fell in love with because it may require nights. We live in a soft world!

Imagine studying for a quarter century (high school + uni + med + residency), sacrificing your 20's and going into large debt to then want to have a job where you don't have to damage your health by messing with sleep ("why we sleep" is a good book about that) and someone calls you "soft".

 

[Browns99]

Imagine studying for a quarter century (high school + uni + med + residency), sacrificing your 20's and going into large debt to then want to have a job where you don't have to damage your health by messing with sleep ("why we sleep" is a good book about that) and someone calls you "soft".

I can imagine, because I've done it....no one forced you into it and no one told you to sacrifice your 20s, could have gone another direction.

 

[Mass Effect]

I can imagine, because I've done it....no one forced you into it and no one told you to sacrifice your 20s, could have gone another direction.

This is called missing the point, by like a mile.

 

[ortnakas]

Threads like this are what gives SDN its toxic reputation.

 

[Browns99]

This is called missing the point, by like a mile.

Yup, according to you, which means absolutely nothing...have a Wonderfull night!

 

[Espressso]

Haven't been on SDN in like, 5months. Looks like I haven't missed much lmao

 

[Captain_Falcon]

Haven't been on SDN in like, 5months. Looks like I haven't missed much lmao

Were you too busy sleeping or something?

 

[Espressso]

Were you too busy sleeping or something?

Been snoozing since match day my friend

 

[Mad Jack]

Psychiatry is pretty light on nights even in residency.

 

[Mad Jack]

The list of what not to do is shorter.

-Emergency Medicine
-Surgical Fields with Emergencies-Spine, Trauma, etc.

Some of these fields will have exceptions.

Interventional cardiology is another one

 

[longhaul3]

The list of what not to do is shorter.

-Emergency Medicine
-Surgical Fields with Emergencies-Spine, Trauma, etc.

Some of these fields will have exceptions.

Despite the outrageous number of middle of the night spine consults, most of which require no intervention or follow-up and many of which are questionably indicated, there are not that many true emergencies that can't wait until morning.

However, given the complexity of spinal pathology and the risk of morbidity from a mismanaged injury (and the fact that we are always available) there is no incentive for people to think twice about calling a spine consult and that will not change any time soon.

 

[Matthew9Thirtyfive]

I can imagine, because I've done it....no one forced you into it and no one told you to sacrifice your 20s, could have gone another direction.

Not wanting to sacrifice your health doesn’t make you soft. I’ve seen first hand what years of ****ty sleep and working poor hours does to you. The people who try to punch at the people making decisions that prioritize their health tend to be the people who went the other way and regret it.

 

[operaman]

Not wanting to sacrifice your health doesn’t make you soft. I’ve seen first hand what years of ****ty sleep and working poor hours does to you. The people who try to punch at the people making decisions that prioritize their health tend to be the people who went the other way and regret it.

Agree 100%. There are so many medical conditions that can get aggravated by poor sleep; it’s a sign of good personal responsibility that someone is proactively looking for their best options. I’d take that over someone trying to Leroy Jenkins their way into a q3-4 busy home call surgical program and then crashing and burning and screwing themselves and their fellow residents.

Medicine as a whole has a vast array of options and many of them I can’t imagine doing. Some of those are simply that I find those fields uninteresting; others because the lifestyle is terrible. I’m not about to knock someone else’s reason for avoiding a field, especially if they’re doing it early in the game when their decision has zero impact on others.

 

[YCAGA]

Finally, while medicine has a lot of unnecessary bad behavior and “toxicity”, having nights/weekends/holidays covered is an essential service. It’s not toxic or optional to have a hospitalist/intensivist/ER doc working a night shift.

Everything is so reactionary these days that saying what you said here is considered "harsh" or "toxic", when in reality nights are a fundamental aspect of high quality medical care. The only way for everyone in medicine to avoid nights/weekends/holidays is to sacrifice life and limb during those times.

I think it is objectively "soft" to say nights are unbearable when in utopic health systems like Denmark with surgery residents working 36hrs/week, making close to 6-figures USD (pre-tax, yes I know their attendings make way less too), months and months of paid maternity/paternity leave, etc...even there they still have night call for residents and attendings. On the other side of the spectrum, US physicians had nights when residents worked 100-120 hrs/week routinely. Nights are not inherently toxic, nor is prioritizing sleep inherently soft. But being dogmatic to one side of the spectrum is toxic and soft imo.

There are toxic ways of handling nights and weekends (Q2 with no post-call day...had a few attendings who say they did this on trauma surgery months in the early 2000's). There are also non-toxic ways...night float being the most realistic solution if the specialty is big enough. Unfortunately, night float is not realistic in many cities in specialties like CT surgery or even a more "laid-back" surgical sub-specialty like urology. Too few surgeons to make night float make economic sense. This is true even in utopic systems like NW Europe. The difference in Europe is that they do not let attendings come in and bill the next day if they stayed up operating until 5am. In the US attendings have no protection like a "post-call day." A CT surgeon at my school came and talked to us after being up for like 40 hours because he had an emergency case on a Monday night and cases all day Tuesday.

Finally, one ironic consequence of all of this is SDN's favorite topic: mid-levels. Some fields mentioned (critical care, inpatient medicine) have zero in house nights for physicians and zero first call for physicians in my city. In-house and first-call is covered entirely by midlevels. Pulm/cc and IM works 7a-7p at most. So that wraps back around to my opening sentence of nights being a fundamental aspect of high quality medical care.

 

[Mass Effect]

Everything is so reactionary these days that saying what you said here is considered "harsh" or "toxic",

What? No one said that was toxic or harsh.

when in reality nights are a fundamental aspect of high quality medical care. The only way for everyone in medicine to avoid nights/weekends/holidays is to sacrifice life and limb during those times.

Again, no one said otherwise. I'm not trying to be a dick, but misrepresenting what people are saying only adds to the discord. No one said that nights aren't necessary for the medical profession as a whole. But ask individual attendings who works nights and the majority will tell you they haven't worked a night shift since residency.

 

[oldman]

another option is to work in industry - you can do enough medicine residency to get a medical license and then work for a corporation.

 

[KaratCake]

another option is to work in industry - you can do enough medicine residency to get a medical license and then work for a corporation.

Just curious, what are some examples of this? What could something like residency training really help with outside of being a physician?

 

[Goro]

I don't mind working long hours during the day, but I really suffer when my sleep schedule gets disrupted. Are there any specialties (or options within specialties) where I can avoid working at night? (defined as 10pm-6am) This is different from the "lifestyle specialties" question, for which I know the ROAD is the answer, since I'm willing to work hard (e.g. 80 hrs/wk) during the day.

FM
PM&R
Peds

 

[calivianya]

Just curious, what are some examples of this? What could something like residency training really help with outside of being a physician?

Street cred, essentially.

If you haven’t even finished residency, people may not want to hire you as a consultant. Sure, technically you have a degree, but anyone can check in two seconds and see that you don’t have a license or any actual training, so you’re not a full physician.

 

[CyrilFiggis]

Man, this is hilarious. I make one statement 10 days ago and everyone goes nuts. People are making implications about my tone, what I meant etc.

As someone who had a career before medicine, my statement not only reflects a medical career, but any other occupation. Whether it’s sleep or another aspect of your life, sometimes you can’t have both. Maybe these are intrinsic to the job, or with medicine, they are temporal sacrifices during residency training.

I’m not minimizing sleep or wellness. If my statement was “toxic”, sure. I worked a job for a decade that was normal hours, great money, but even at 40 hours a week I hated what I was doing. I couldn’t see myself doing that for 45 years.

All I’m trying to say is that it is the exception to the rule that anyone’s work life balance is perfect. You’re always robbing Peter to pay Paul. If OP is willing to pursue their 2nd, 3rd or 4th specialty choice because they don’t provide enough sleep, that’s his choice.

Sorry I didn’t reply sooner, I’ve been sleeping.

 

[oldman]

Just curious, what are some examples of this? What could something like residency training really help with outside of being a physician?

I have a friend who works at Medtronic. He did an internship just to then be able to take step 3 and apply for a medical license. I don’t think he necessarily needed to maintain it to keep his job. He directs some of their medical trials.

 

[deleted1095841]

Thank you all for the helpful replies!

And I'm sorry this thread has caused some heated disagreements. I don't believe anyone was intentionally being toxic.

However, there seems to be an implicit assumption in medicine (not directed at any poster in particular) that specialties that are "interesting" or "one's passion" are different from those specialties which "promote work-life balance" or "allow for regular sleep." The result of this assumption is that we view prioritizing career satisfaction and wellness as an either-or choice. Taking this reasoning further, I would need to "settle" for a 2nd or lower choice specialty to prioritize sleep. Perhaps it is because I am early in my training, but I do not understand why it has to be that way. I don't even know what my 1st choice specialty is. (I used to think it was neurosurgery, one with admittedly poor sleep schedules, but after several months of medical school, I realize how many amazing alternatives there are.) I'm considering several different specialties which all seem interesting to me. (neurosurgery, neurology, psychiatry, allergy/immunology, infectious diseases, cardiology, pulmonology, gastroenterology/hepatology, ophthalmology, pathology, pediatrics) Some of them may allow me to get a good night's sleep, and others may not. And if I ending up liking a specialty much more than the others, and that specialty does not have a good sleep schedule, I might choose it anyway. But why is it so likely that the one I will end up liking is going to be one which does not allow a regular sleep schedule? The two seem pretty independent to me. If there's something I'm missing here, please don't hesitate to let me know.

 

[ACSurgeon]

Thank you all for the helpful replies!

And I'm sorry this thread has caused some heated disagreements. I don't believe anyone was intentionally being toxic.

However, there seems to be an implicit assumption in medicine (not directed at any poster in particular) that specialties that are "interesting" or "one's passion" are different from those specialties which "promote work-life balance" or "allow for regular sleep." The result of this assumption is that we view prioritizing career satisfaction and wellness as an either-or choice. Taking this reasoning further, I would need to "settle" for a 2nd or lower choice specialty to prioritize sleep. Perhaps it is because I am early in my training, but I do not understand why it has to be that way. I don't even know what my 1st choice specialty is. (I used to think it was neurosurgery, one with admittedly poor sleep schedules, but after several months of medical school, I realize how many amazing alternatives there are.) I'm considering several different specialties which all seem interesting to me. (neurosurgery, neurology, psychiatry, allergy/immunology, infectious diseases, cardiology, pulmonology, gastroenterology/hepatology, ophthalmology, pathology, pediatrics) Some of them may allow me to get a good night's sleep, and others may not. And if I ending up liking a specialty much more than the others, and that specialty does not have a good sleep schedule, I might choose it anyway. But why is it so likely that the one I will end up liking is going to be one which does not allow a regular sleep schedule? The two seem pretty independent to me. If there's something I'm missing here, please don't hesitate to let me know.

Life and limb saving specialities tend to have emergencies and if you define interesting as dealing with those things, you’ll have to sacrifice your call. No one said this has to define interesting and most people in call-heavy fields would much rather do elective work and no be a “hero.”

The discussion above was mostly about some people judging one for factoring in amount of night call in a specialty. That’s silly as I think most students will experience what you’ve described and be interested in a lot of different things and will naturally not chose to do anything requiring a lot of call.