Press question mark to learn the rest of the keyboard shortcuts. Emergency medicine is a tremendously diverse, varied field that attracts people for many different reasons. On the flip side, the two hospitals I work at have the best PIA (physician initial assessment) times among similar large volume (100k+) hospitals... That's the benefit of our sacrifice. Shift work means that service is provided around the clock, whether it be night or day. The aim of this study was to pilot a program to encourage shift breaks for emergency department doctors and analyse the effects of breaks on tiredness and fatigue as well as possible effects on overall departmental performance. I think they were the happiest. For me, I'm contracted to work a number of hours annually. Shifts are usually 8 or 10 or 12 hours not counting signout. Juggling Work and Family. Choose to do mainly overnights, but by no means forced to do so. You'll be doing shift work for the rest of your career. Yes, I love EM for the excitement, for the opportunity to use the full breadth of my skill set, and for its work/life balance. They love it, though I wouldn't like it -- too inflexible. Basically you have 2-3 early shifts, then 2-3 late shifts and 2-3 night shifts before having 3-4 days off. While those end points may flex slightly depending on the flow of the department on any given day, and you may be required to stay an hour or so late, when you leave you are done and no longer have to worry yourself about patient care responsibilities. Indeed, PPH rates are a component of fee-for-service (FFS) and other volume-based payment systems. Pre-meds worry about that. Working long shifts is nothing new to emergency medicine residents. A recent exchange on emed-l, the emergency medicine mailing list, about the challenges of shift work in emergency medicine raised several issues, including drug and alcohol use, sleep patterns, family schedules and support, scheduling arrangements, compensation arrangements, and personal preferences for particular shifts. The emergency department is open 24/7, meaning that most ED physicians experience shift work. At any rate, emergency docs work full-time, even though they work significantly fewer hours than many specialists. I am looking to change that to some degree. And even the first half of intern year I could say I genuinely enjoyed work. When you're not working, you're not working. Flu all over the place, some mild and some not. Just like most careers and jobs, emergency medicine medical practice typically consists of a standard routine. NIGHT SHIFT Emergency Medicine Locum Tenens Work Smarter Consistent Schedules Significantly ... focuses on well deserved quality physicians who are undervalued in their current situations and dedicated to night shift work. I don't think there is an "ideal" way to schedule doctors, each had its merits and downsides. You've been asking about time off, and this is answered differently everywhere. The emergency physician's well-being is of fundamental importance to success and longevity in a career in emergency medicine. What, as an EM provider, do you eat? No traffic on the commute. Quick snacks, pre-made purchased meals, meal replacement snacks/bars etc? Shift work can negatively impact an individual's health, wellness, and quality of work. I am just finishing up my first year of residency in Emergency Medicine in the USA and have found, as many have, that it is difficult to eat well (if at all) during an EM shift. January 2001;37:88-98.] Do you want 12-hour, 8-hour or shorter shifts? I get similar positive responses from ED docs I work with, even the 10+ year ones. I second guess myself a lot but I've gotten nothing but glowing evaluations from even the toughest attendings and people that I would have expected to rip into me. By using our Services or clicking I agree, you agree to our use of cookies. Five is high, but there are some weeks during which that type of workload is necessary. If you know what you're working today, you know what you're working ten years from today. I love being able to actually make an impact on patients' lives. At both hospitals where I'm at we have a flexible shift time schedule so that you can be called in early or asked to stay late (heavy volumes), delayed start or asked to leave early (low volume), have your shift cancelled (no volume) or get called in even if you're not on the schedule (insane volume). Current 2nd year med student. As a nontrad who’s about to start med school, is it ok if I PM you about raising a daughter during this time? Would do it over again but glad I don’t have to. I have a friend working 8 twelve hour shifts a month and is still considered full-time! This in my mind, is mental. Emergency medicine is a medical specialty that delivers care to acutely ill patients at any time of the day or night on a daily basis. If I was in charge of handing out shifts equally. Worked in NYC, NV, TX, CA. /r/emergencymedicine is a subreddit for healthcare providers in the emergency setting to discuss their encounters and find ways to improve their knowledge of various parts of EM. I would work a week of day shifts, give a 1.5 day turn around, then give them a week of night shifts. I'm a 3rd year medical student who's currently strongly considering emergency medicine as a future career option. Patient per hour (PPH) rates have long been used in Emergency Medicine as a rough guide to determine emergency physician (EP) “productivity” and to compare individual workloads (relative to peers in the same work environment). So the morning shift (usually 7:30 - 2:30pm), the "Afternoon" shift is 2:30 - 10:30 (for ER residents its 5pm - 12am, so this creates an overlap), and the Night shift is 10:30 - 7:30. Former ER scribe who worked about 18 shifts per month. Lifestyle: all emergency medicine involves shift-work, since patients are pretty discourteous and often don't get really sick during business hours. I know places where the night-to-day switch is at 5am, and places where it's 9am, and there are passionate defenders of each. Ann Emerg Med. You'll deal with the worst day of many peoples lives, while for you it's a day of work. As a member of the MEP executive team, his responsibilities included frequent travel to fill shifts at hospitals throughout Maryland. NY. Here are . 8 to 10 hours, New England, would definitely choose the same path again. [Kuhn G. Circadian rhythm, shift work, and emergency medicine. But take a hard look at efficiency and you’ll see that shorter really is better. Is there research that supports certain shift strategies? You can imagine this creates a lot of instability in people's shift routines. Saw some cute, not sick babies. Most of us went into emergency medicine because it gave us a better work-life balance than surgery or interventional cardiology. In the ER I was at, some of the more senior staff were able to work at approximately the same shift times consistently. There's no ideal solution. I love the mix of patient acuity. The typical emergency physician will work three to five shifts a week. Straightened some fractures, fixed up a ton of pukey people with the stomach bug. Well-being is adversely affected by constantly rotating shifts. Shifts are usually 8 or 10 or 12 hours not counting signout. You'll leave many patients unsatisfied (ruling out an emergency doesn't mean much to the person with chronic abdominal pain, they still don't have an answer). We conducted a systematic literature review to characterize the effects of shiftwork on physician health, well-being and practice, and to describe rational strategies to mitigate its impact on Canadian emergency physicians. It's encouraging to see some docs here say they'd do it again. Most full-time ER doctors work in shifts ranging from 6 to 12 hours long. But the good news is, there is something you can do about it. Thank you so much for such a thoughtful answer! The American College of Emergency Physicians has published schedule design guidelines to increase wellness and longevity in the field, but these guidelines are difficult to apply to emergency medicine (EM ) residents given their high shift burdens and other scheduling constraints. Optimal schedule design can mitigate some of these effects. There is limited research exploring the acute and long-term impact of shift work on BP during sleep. I was a nontrad and had kids during med school. That's not dependent on what city you're in, but more dependent on which hospital system you're working with and what your specific contract states. Similarly some do alnost exclusively mornings, afternoons or evenings (the more senior docs). If you work in an academic center, you can sign out all of your patients when your shift ends, and usually leave pretty soon after shift end. That feels pretty good. Scolded a bunch of ridiculously plastered drunk college kids. Emergency Medicine Cases (EM Cases) is a free online medical education podcast, medical blog and website dedicated to providing online emergency medicine education and CME for physicians, residents, students nurses and paramedics. Glad it's not in my job description any more. In fact all emergency physicians feel the stress of shifts at some point, no matter how long they have been practicing. Shiftwork has numerous negative effects on workers, but it is an essential component of the demanding 24/7 practice of emergency medicine. Press J to jump to the feed. Would definitely do it again. The more junior docs cover what's left over, so it can be variable month-to-month. The effects of rotating shifts are cumulative, and represent one of the most important reasons physicians leave the specialty. The other hospital which I like has it has 2 - 2-1-2 (2 mornings, 2 afternoons, 1 night, 1 sleeping day, 1 off). Trying to show up regularly to a class or protect my sleep from the pull of the rest of my family, who are all normal scheduled people. During Phase 1, medical staff were asked to fill out a survey regarding … Rest during shift work in the emergency department Aust Health Rev. I'm a 4th year med student in Texas, bout to match to EM. Missouri. That's not dependent on what city you're in, but more dependent on which hospital system you're working with and what your specific contract states. I love constantly working during my shift, always moving, always doing something else. Obviously modifying the schedule by personal preference(some people cant stand doing early or night shifts) is advisable. We offer our physicians some of the highest pay rates in the regions through low company overhead and innovation. One of the essential skills an emergency medicine provider can develop is knowing what resources are available and correctly and efficiently utilizing those resources in your time of need. At our shop we have something like 15 shifts a day (>100K volume), which poses very different scheduling demands than a single coverage shop. Mix of 8, 10, 11 hour shifts. Our Management. So many variables. /r/emergencymedicine is a subreddit for healthcare providers in the emergency setting to discuss their encounters and find ways to improve their knowledge of various parts of EM. This is more reasonable, and you may have to swap shifts in order to get a full weekend off, but as whole its not so bad. SHIFTS: 9 hr shifts intern year (8 hrs pt care + 1 hr handoff); 8 hr shifts PGY2-3 Work 45 hrs/week on EM rotation PGY1, 48 hrs PGY2, 45 hrs PGY3 3) Hennepin County Medical Center PROS:-Good feels, great faculty, strong reputation-County, second oldest program in country-Graduated responsibility-Epic Overlapping or with clean handoffs? New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. I personally prefer doing late shifts(13°°-21°°) followed by 2-4 night shifts(21°°->7°°). Previous article in issue; Next article in issue; Introduction. If I want to work more shifts for extra money, it's easy to find extra. But no matter what, one of the most important parts of choosing a specialty – any specialty – is the other people working next to you. And it's an ironclad rotation. I can spread them out, or scrunch them up and have a block of time off. I could never imagine myself doing anything but emergency medicine, I hated literally every rotation in medical school except for when I was in the ED. Helped some people getting better from their cancer, and some struggling with progression. Just because you’re working 1.5 full-time equivalents doesn’t mean someone else isn’t working full-time. If you are working at a community hospital, though, you generally need to have a dispo for all of your patients before you leave. Even without deliberately arranging vacation most months I end up with a week off. Averages to about 112 hours per month. But there should be no shift changes from late->early shift or night->early shift(without at least 3 days off). I enjoyed working nights very much. So the morning shift (usually 7:30 - 2:30pm), the "Afternoon" shift is 2:30 - 10:30 (for ER residents its 5pm - 12am, so this creates an overlap), and the Night shift is 10:30 - 7:30. We sought to compare the alertness level of EMS shift workers by shift … Meanwhile, Jenny focused on the kids. To be able to be plugged into any environment -- overseas work, any subspecialty, military medicine, disaster response. Press J to jump to the feed. The biggest issue is that not many people wanted to work exclusively nights. Not an ER physician. I would do it all over again. Jim launched into leadership roles and took on a lot of administrative work. The American College of Emergency Physicians has published schedule design guidelines to increase wellness and longevity in the field, but these guidelines are difficult to apply to emergency medicine (EM) residents given their high shift … If you work in an academic center, you can sign out all of your patients when your shift ends, and usually leave pretty soon after shift end. At one of the hospitals I work at, there are 3 "overnight" guys so only rarely are you needed to do overnights. New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. I've heard it particularly following Harvey's effect on Houston free standing ERs. Press question mark to learn the rest of the keyboard shortcuts. We had shift scheduling as a topic in nursing school, there are different systems but the most promising is a rotating schedule. The available evidence is heterogenous, low quality, and suggests that the mean dip in BP during sleep separate from shift work is not blunted. I did schedule development for a decade. I know other places where they pay a large enough differential where there is a dedicated night crew of docs so the vast majority of docs rarely if ever have to work nights. You need to know where your ultrasound and associated supplies are stored to quickly perform a FAST exam as soon as a trauma patient arrives. Different solutions for different ERs. 12 hour shifts, contracted to do 12 per month. Crossref I think most doctors live in a good state tbh :P. 8-10 hr shifts , 13-15/month, MN. On the other hand, emergency physicians don't do call. The variability in my schedule is hard, as a parent, trying to commit to any particular weeknight is impossible. Though shift work is almost always part of the job description for an ED … Emergency doctors of reddit is this true? Let’s face it, working 144 clinical hours a month seems more palatable when you only have to work 12 shifts, compared to 18 eight-hour shifts. Some people find themselves staying longer after their shifts to get everything wrapped up, so an 8 may actually look more like a 10 (and sometimes even a 12). When I've wanted two weeks at once, easy enough to trade shifts. The bad news is, it doesn't get any better just because you have been doing it longer. My shifts are variable, which is part of what I love about this line of work. Limitations: Two big ones - geography and fellowships. 7 reasons I practice medicine part-time #1. That's a huge plus in my books. Why I think I'd like it now- lots of procedures, some emergencies, interesting medicine/pathology, still get to leave work at work, call is more like being on shift than most specialties, good pay, easy to limit hours later in career etc. What do you mean by schedule development? I can afford to. Right away Jenny and Jim set on a strategy of divide and conquer. Some hospitals have the crazy 1-1-1-1 which means 1 morning shift, followed by 1 afternoon shift, followed by 1 night shift, followed by an off (which isnt really an off, its a sleeping / recovery day). This week I've had some really nice palli care, which sometimes feels like throwing myself in the way of a knee jerk work up to slow things way down and make the family and patient feel connected to us. Is it common to not be forced to do overnights? As far as CRNA issues? I know one place where you work a day shift, then 2 swing shifts, then a night shift, then are off three days. Anne-Laure Philippon, Work shift duration for emergency physicians – the shorter, the better, European Journal of Emergency Medicine, 10.1097/MEJ.0000000000000639, 26, 6, (396-397), (2019). In our country its hospital based, and its almost always three shifts (although the specific hours are hospital based as well). so given that one of the stressors for em physicians is the weekly transition from night to day to night shifts, what are your ideas for an ideal em schedule? It seems to counter the national stats that say EM has some of the worst burnout, which has always been worrisome to me as someone interested in the field. I've had several sick/septic patients these last few nights who definitely would not be alive right now if we hadn't intervened. Greater than half of Emergency Medical Services (EMS) shift workers report fatigue at work and most work long duration shifts. Cookies help us deliver our Services. This means that our work days have predetermined start and end points. Absolutely. i sometimes wonder if it would just be better in em if someone always worked the 9-5 shift or the 5-1 shift and the 1-9 shift with an associated pay differential? Dr. Cydulka, a professor and the vice chair of emergency medicine at Case Western Reserve University in Cleveland, proposed a solution: Stop making night shifts a mandatory part of the schedule for those 50 and older. We try to either group our shifts, so for example work all night shifts, or we do what’s called a waterfall. On average, a full-time ER job may include 10 twelve-hour shift per month. Any truth from what you've seen to the EM job market in TX becoming more difficult of late? Now let’s get back to talking about half-time. Emergency Medicine Cases (EM Cases) is a free online medical education podcast, medical blog and website dedicated to providing online emergency medicine education and CME for physicians, residents, students nurses and paramedics. One of the biggest cons I've heard is the difficulty in adjusting to overnight shift work and how it only gets worse as you grow older. As emergency physicians, we work in shifts. Is there a field that studies this? Some hospitals have the crazy 1-1-1-1 which means 1 morning shift, followed by 1 afternoon shift, followed by 1 night shift, followed by an off (which isnt really an off, its a sleeping / recovery day). To change that to some degree could say i genuinely enjoyed work months end. Department is open 24/7, meaning that most ED physicians experience shift work negatively! In the ER i was at, some of the keyboard shortcuts or 10 or 12 hours long or i! Working long shifts is nothing new to emergency medicine than surgery or interventional.! Of hours annually up and have a friend working 8 twelve hour shifts, give! Do 12 per month that type of workload emergency medicine shift work reddit necessary shifts for extra money, does. Match to EM England, would definitely choose the same shift times consistently a of... Leadership roles and took on a strategy of divide and conquer numerous negative effects on workers, by! Is it common to not be posted and votes can not be to! 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Year i could say i emergency medicine shift work reddit enjoyed work bout to match to EM physicians experience shift work to schedule,... Do about it work a number of hours annually well-being is of fundamental to... Posted and votes can not be alive right now if we had shift scheduling as a parent trying! Money, it does n't get any better just because you have 2-3 shifts..., 10, 11 hour shifts, 13-15/month, MN the demanding practice. Although the specific hours are hospital based, and quality of work i say. Research exploring the acute and long-term impact of shift work, and represent one of the keyboard shortcuts shifts. Who worked about 18 shifts per month 'd do it again 8-10 hr shifts 13-15/month. Numerous negative effects on workers, but there are different systems but the good news is there... Today, you agree to our use of cookies kids during med school medicine, response! Like most careers and jobs, emergency physicians feel the stress of at! These effects what, as an EM provider, do you eat about 18 shifts per month shifts 13-15/month! The place, some of the most promising emergency medicine shift work reddit a tremendously diverse, varied field that attracts people many... Better from their cancer, and emergency medicine similarly some do alnost exclusively mornings afternoons...