Night Shifts

Melisa posed a question to me:

I have a question for you Leann. ER seems like such a tempting

specialty because it is shift work and there is no call. It seems like

you'd have fewer shifts a month than regular specialties. But I

wonder, if they spend the following day recovering from a night

shift, it is technically like they are gone for a whole day instead of

just a shift, essentially losing double the time from the family. Is

that how it is? Are you glad he is in ER because of the shift work

and no call? Or does it not seem worth it? I know it would be great

to not have call. You can't plan anything. I always assume that if

Brad is on call, he is gone. I'm kind of like Pavlov's dog. I hear a

pager buzz and my heart drops.

I will do my best to answer your quesitons. I'll try to explain some of his residency program, but I have to admit, it is hard to know how to compare crazy ER shifts to being on-call. Brian's program, unlike other residency programs, has them working no call hours at all. He hasn't been on-call since med school.

When he was deciding what specialty he best fit into, he came to the realization that his ADD-ness, and inability to get stressed-out were particularly useful in the ER and in OB. Those were the two he narrowed down to. He LOVED OB. The office visit portion was not his cup of tea, but managing labor/delivery excited him. Having a mix of office/action/surgery was a perfect fit for him. There were 2 major downfalls to OB, though. (We'll leave out the GYN part. We all know that sucks.) The malpractice insurance. He was concerned with the portion of his paycheck that would be deducted to cover malpractice. The second reason was because of the hours.

The ER offered a similar mix of office/action, without such a high insurance rate, and with shift work. However, he would have to let go of the OR, and the rush of delivering a baby.

In the end, it boiled down to office hours + call hours vs shift work.

Shift work won hands down, and we are both glad for the decision that we made.

One thing I love about shift work is knowing when Brian will be coming home. The rotations that he does in other specialties drive me nuts. I dread seeing 'surgery' written on the family calendar, b/c I know that means staying late. With the ER, there is a new set of doctors walking in the door at 6:45. Patients are handed off to the next physician. Brian walks out the door.

There have been a just few times that he has stayed late, maybe 3x a year. The reasons are usually a patient who has labs returning quickly then will be discharged, or a patient who is about to be transferred to another floor and explaining the case would not be worth just staying and managing the patient.

One of our big concerns about the ER was the required night shifts. The night shifts do put a wrinkle in the family routine, but we are learning to adjust. It is getting easier as the boys get older. Nights are hardest on me as I dont sleep well, and have to go into a 'survival mode' of sorts. However, the night shift is the one that allows for the most time spent with the boys.

Here is one of his schedules from a 31 day month. His work schedule is written in black. His home routine in red.

Day Schedule

1--7p-7a

2--off sleep from 8a-3p. awake from 3p-about 2am to stay on night schedule.

3--7p-7a awake @ about 10a. family time until he leaves at 6p.

4-- 7p-7a sleep from 8a-3p. family time from 3-6 when he leaves for work.

5--off sleep from 8a-3p.

6--off attempt to stay in 'night shift mode'

7--off sleep from 2a-about 10a

8--off

9--off

10--7p-7a leave for work at 6p

11--off sleep from 8a-3p, stay up until 2a

12--7p-7a sleep until 10a, leave at 6p

13--7p-7a sleep from 8a-3p, leave at 6

14--7p-7a ditto

15--7p-7a ditto

16--off sleep from 8a-3p, go to bed at normal time

17--off "normal" day schedule

18--7a-7p Leaves for work @ 6a, arrives home @7:30p

19--7a-7p reads 4yr old a story before he goes to sleep

20--7a-7p most often the baby is already asleep.

21--7a-7p Brian does not see the baby on most 'day shift' days. 4 straight days here.

22--off

23--7a-7p and sees the 4yr old only long enough to read him a couple books.

24--off

25--off

26--7a-7p he also does not get to eat a meal with us on day shift days.

27--off

28--off

29--7a-7p

30--7a-7p

31--7a-7p

He keeps reminding me that his residency program is really resident-friendly. His program does not allow their residents to work more than 12 hours in a 24 hour period *in the ER*. And they are not permitted to work more than 24 hours in a row when in other rotations, or when moonlighting.

He does have twice weekly meetings from 7a-9a on monday/wednesday. These meetings are required attendance unless they have a really really good reason for missing. If he has just come off a night shift, he must stay for the meeting. ((these meetings are a thorn in my side, and I think I am most excited about getting rid of them when he graduates. forget about any of the other perks. lol))

His first 2 years, he worked mostly in rotations. They covered every area of the hospital, and a few in a neighboring hospitals. The last 2 years are even/odd--even months in the ER, odd in a rotation.

um... I kinda got off on a rabbit trail there. sorry.

Back to your question. Is the hassle of a night shift/night shift recovery better than being on-call? I don't know. I think the answer would be different for every doctor, every family.

My husband actually preferrs the night shift. He has even dared to call it a 'perfect fit.' He gets to work during the busiest part of the day, and it allows him the most time with our kids. Now, if we could just figure out how the two of us could survive on night shifts without having to enter survival mode.... it would be smooth sailing.