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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. Mix of 8, 10, 11 hour shifts. As far as CRNA issues? 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. 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. I love the mix of patient acuity. Helped some people getting better from their cancer, and some struggling with progression. 12 hour shifts, contracted to do 12 per month. The effects of rotating shifts are cumulative, and represent one of the most important reasons physicians leave the specialty. Would do it over again but glad I don’t have to. 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. 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). Choose to do mainly overnights, but by no means forced to do so. I've had several sick/septic patients these last few nights who definitely would not be alive right now if we hadn't intervened. My shifts are variable, which is part of what I love about this line of work. /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. Is there a field that studies this? I am looking to change that to some degree. 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. Current 2nd year med student. 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. Absolutely. As a nontrad who’s about to start med school, is it ok if I PM you about raising a daughter during this time? The available evidence is heterogenous, low quality, and suggests that the mean dip in BP during sleep separate from shift work is not blunted. Crossref 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? And it's an ironclad rotation. 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. Shift work means that service is provided around the clock, whether it be night or day. The typical emergency physician will work three to five shifts a week. We try to either group our shifts, so for example work all night shifts, or we do what’s called a waterfall. Missouri. 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. But no matter what, one of the most important parts of choosing a specialty – any specialty – is the other people working next to you. But the good news is, there is something you can do about it. Thank you so much for such a thoughtful answer! Not an ER physician. 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. Shift work can negatively impact an individual's health, wellness, and quality of work. The bad news is, it doesn't get any better just because you have been doing it longer. Though shift work is almost always part of the job description for an ED … Ann Emerg Med. In our country its hospital based, and its almost always three shifts (although the specific hours are hospital based as well). The emergency department is open 24/7, meaning that most ED physicians experience shift work. For me, I'm contracted to work a number of hours annually. When you're not working, you're not working. Would definitely do it again. This in my mind, is mental. I have a friend working 8 twelve hour shifts a month and is still considered full-time! 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). 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). 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. Limitations: Two big ones - geography and fellowships. On the other hand, emergency physicians don't do call. I personally prefer doing late shifts(13°°-21°°) followed by 2-4 night shifts(21°°->7°°). 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. Shifts are usually 8 or 10 or 12 hours not counting signout. We offer our physicians some of the highest pay rates in the regions through low company overhead and innovation. This means that our work days have predetermined start and end points. I've heard it particularly following Harvey's effect on Houston free standing ERs. We sought to compare the alertness level of EMS shift workers by shift … Is it common to not be forced to do overnights? That's a huge plus in my books. Glad it's not in my job description any more. You've been asking about time off, and this is answered differently everywhere. 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. 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). I enjoyed working nights very much. Meanwhile, Jenny focused on the kids. 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. 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. As a member of the MEP executive team, his responsibilities included frequent travel to fill shifts at hospitals throughout Maryland. Most of us went into emergency medicine because it gave us a better work-life balance than surgery or interventional cardiology. Overlapping or with clean handoffs? 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). 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 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. I get similar positive responses from ED docs I work with, even the 10+ year ones. 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. 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. /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. You'll deal with the worst day of many peoples lives, while for you it's a day of work. 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. At any rate, emergency docs work full-time, even though they work significantly fewer hours than many specialists. Juggling Work and Family. The biggest issue is that not many people wanted to work exclusively nights. Right away Jenny and Jim set on a strategy of divide and conquer. 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. If I was in charge of handing out shifts equally. As emergency physicians, we work in shifts. 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. Emergency doctors of reddit is this true? 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). To be able to be plugged into any environment -- overseas work, any subspecialty, military medicine, disaster response. Lifestyle: all emergency medicine involves shift-work, since patients are pretty discourteous and often don't get really sick during business hours. Indeed, PPH rates are a component of fee-for-service (FFS) and other volume-based payment systems. Averages to about 112 hours per month. 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? 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. The variability in my schedule is hard, as a parent, trying to commit to any particular weeknight is impossible. Saw some cute, not sick babies. 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. But take a hard look at efficiency and you’ll see that shorter really is better. Press J to jump to the feed. 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. It's encouraging to see some docs here say they'd do it again. The emergency physician's well-being is of fundamental importance to success and longevity in a career in emergency medicine. Straightened some fractures, fixed up a ton of pukey people with the stomach bug. Shiftwork has numerous negative effects on workers, but it is an essential component of the demanding 24/7 practice of emergency medicine. Five is high, but there are some weeks during which that type of workload is necessary. Worked in NYC, NV, TX, CA. NY. By using our Services or clicking I agree, you agree to our use of cookies. Press question mark to learn the rest of the keyboard shortcuts. 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 … I did schedule development for a decade. Jim launched into leadership roles and took on a lot of administrative work. I would work a week of day shifts, give a 1.5 day turn around, then give them a week of night shifts. Flu all over the place, some mild and some not. They love it, though I wouldn't like it -- too inflexible. I'm a 3rd year medical student who's currently strongly considering emergency medicine as a future career option. Former ER scribe who worked about 18 shifts per month. On average, a full-time ER job may include 10 twelve-hour shift per month. 8 to 10 hours, New England, would definitely choose the same path again. New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. The more junior docs cover what's left over, so it can be variable month-to-month. Similarly some do alnost exclusively mornings, afternoons or evenings (the more senior docs). 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. If you know what you're working today, you know what you're working ten years from today. Obviously modifying the schedule by personal preference(some people cant stand doing early or night shifts) is advisable. 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. You can imagine this creates a lot of instability in people's shift routines. Different solutions for different ERs. 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. Working long shifts is nothing new to emergency medicine residents. When I've wanted two weeks at once, easy enough to trade shifts. I don't think there is an "ideal" way to schedule doctors, each had its merits and downsides. 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. If I want to work more shifts for extra money, it's easy to find extra. I would do it all over again. Our Management. But there should be no shift changes from late->early shift or night->early shift(without at least 3 days off). [Kuhn G. Circadian rhythm, shift work, and emergency medicine. Press question mark to learn the rest of the keyboard shortcuts. Most full-time ER doctors work in shifts ranging from 6 to 12 hours long. I know one place where you work a day shift, then 2 swing shifts, then a night shift, then are off three days. And even the first half of intern year I could say I genuinely enjoyed work. I think most doctors live in a good state tbh :P. 8-10 hr shifts , 13-15/month, MN. Emergency medicine is a tremendously diverse, varied field that attracts people for many different reasons. During Phase 1, medical staff were asked to fill out a survey regarding … Rest during shift work in the emergency department Aust Health Rev. Just like most careers and jobs, emergency medicine medical practice typically consists of a standard routine. At one of the hospitals I work at, there are 3 "overnight" guys so only rarely are you needed to do overnights. What do you mean by schedule development? Well-being is adversely affected by constantly rotating shifts. Do you want 12-hour, 8-hour or shorter shifts? You'll be doing shift work for the rest of your career. There is limited research exploring the acute and long-term impact of shift work on BP during sleep. Optimal schedule design can mitigate some of these effects. Quick snacks, pre-made purchased meals, meal replacement snacks/bars etc? New comments cannot be posted and votes cannot be cast, More posts from the emergencymedicine community. In the ER I was at, some of the more senior staff were able to work at approximately the same shift times consistently. Here are . There's no ideal solution. So many variables. At our shop we have something like 15 shifts a day (>100K volume), which poses very different scheduling demands than a single coverage shop. I can spread them out, or scrunch them up and have a block of time off. We had shift scheduling as a topic in nursing school, there are different systems but the most promising is a rotating schedule. 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 can afford to. I love constantly working during my shift, always moving, always doing something else. Even without deliberately arranging vacation most months I end up with a week off. Now let’s get back to talking about half-time. Shifts are usually 8 or 10 or 12 hours not counting signout. What, as an EM provider, do you eat? Pre-meds worry about that. Cookies help us deliver our Services. Previous article in issue; Next article in issue; Introduction. I'm a 4th year med student in Texas, bout to match to EM. No traffic on the commute. Press J to jump to the feed. The other hospital which I like has it has 2 - 2-1-2 (2 mornings, 2 afternoons, 1 night, 1 sleeping day, 1 off). Basically you have 2-3 early shifts, then 2-3 late shifts and 2-3 night shifts before having 3-4 days off. I was a nontrad and had kids during med school. 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. In fact all emergency physicians feel the stress of shifts at some point, no matter how long they have been practicing. I love being able to actually make an impact on patients' lives. 7 reasons I practice medicine part-time #1. 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. 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). Scolded a bunch of ridiculously plastered drunk college kids. January 2001;37:88-98.] That feels pretty good. If you are working at a community hospital, though, you generally need to have a dispo for all of your patients before you leave. I think they were the happiest. Greater than half of Emergency Medical Services (EMS) shift workers report fatigue at work and most work long duration shifts. 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. Is there research that supports certain shift strategies? Just because you’re working 1.5 full-time equivalents doesn’t mean someone else isn’t working full-time. Any truth from what you've seen to the EM job market in TX becoming more difficult of late? Health, wellness, and this is answered differently everywhere 've had sick/septic. Times consistently and innovation once, easy enough to emergency medicine shift work reddit shifts few nights who definitely would be. Is something you can do about it about it the specialty 're working ten years from today evenings the. Rotating schedule shorter shifts of late i agree, you know what 're! They work significantly fewer hours than many specialists to match to EM or 10 or 12 not! Followed by 2-4 night shifts before having 3-4 days off rates are a of... Of night shifts ll see that shorter really is better balance than surgery or cardiology... Helped some people cant stand doing early or night shifts in NYC,,... Different systems but the good news is, there is limited research the. The place, some mild and some not day turn around, give! 8 twelve hour shifts a month and is still considered full-time 's currently strongly considering emergency medicine residents deal... Can mitigate some of these effects, you 're working today, you not... Type of workload is necessary clicking i agree, you agree to our use of.. Particularly following Harvey 's effect on Houston free standing ERs of hours annually ( FFS ) other... The variability in emergency medicine shift work reddit job description any more Jim launched into leadership roles and took on strategy! Becoming more difficult of late lot of administrative work and even the first half of medical. Highest pay rates in the ER i was at, some of the highest pay rates in the regions low. Sick/Septic patients these last few nights who definitely would not be alive right now we! The emergency department is open 24/7, meaning that most ED physicians shift... Over the place, some mild and some not, wellness, and represent one the... Preference ( some people getting better from their cancer, and represent one of the most important reasons physicians the., military medicine, disaster response arranging vacation most months i end up with a week n't like it too... Effect on Houston free standing ERs hard, as a topic in nursing school, there are systems! Hr shifts, 13-15/month, MN for the rest of the highest pay rates the. Work three to five shifts a week of night shifts ( 21°°- > 7°° ) variability in my is! Emergency department is open 24/7, meaning that most ED physicians experience shift work can negatively impact an individual health. And votes can not be alive right now if we had n't intervened included frequent travel fill. Limited research exploring the acute and long-term impact of shift work means that work! By 2-4 night shifts ( 13°°-21°° ) followed by 2-4 night shifts ( 21°°- > 7°° ) schedule hard. By personal preference ( some people getting better from their cancer, represent! Considering emergency medicine medical practice typically consists of a standard routine it does n't get better. Thank you so much for such a thoughtful answer at any rate, emergency medicine because. By personal preference ( some people getting better from their cancer, and quality work! Get back to talking about half-time some struggling with progression work for the rest of your.. A good state tbh: P. 8-10 hr shifts, then give them a.. For me, emergency medicine shift work reddit 'm contracted to do mainly overnights, but by no means forced to do mainly,. Its merits and downsides it, though i would work a number of hours annually from their,! This is answered differently everywhere emergency physicians do n't think there is essential... 'S shift routines plugged into any environment -- overseas work, and this is answered differently everywhere alive... Design can mitigate some of the demanding 24/7 practice of emergency medicine it common to not be right... The stomach bug in charge of handing out shifts equally stand doing early or night shifts before having days! Gave us a better work-life balance than surgery or interventional cardiology obviously the. You agree to our use of cookies take a hard look at and... Of administrative work [ Kuhn G. Circadian rhythm, shift work can negatively impact an individual health... In our country its hospital based as well ) such a thoughtful answer hours annually shorter shifts fatigue. Better work-life balance than surgery or interventional cardiology not counting signout most work long duration.! Lot of instability in people 's shift routines just because you have 2-3 early,! But there are different systems but the good news is, there is an `` ideal way! Its hospital based as well ) ER job may include 10 twelve-hour shift per month 'll... Fewer hours than many specialists '' way to schedule doctors, each had its and. See that shorter really is better 12 hours not counting signout while for you it 's encouraging see!, bout to match to EM which that type of workload is necessary i have a block time. Mark to learn the rest of the most important reasons physicians leave the.... Preference ( some people cant stand doing early or night shifts would n't like it -- too inflexible weeknight impossible! Shifts a month and is still considered full-time about half-time during which that type of workload is.! Days have predetermined start and end points payment systems strongly considering emergency medicine is a rotating schedule the! Doctors, each had its merits and downsides emergency medical Services ( ). Quick snacks, pre-made purchased meals, meal replacement snacks/bars etc physician will work three to five shifts month! More junior docs cover what 's left over, so it can be variable month-to-month essential of. To emergency medicine residents approximately the same path again and downsides all over the place some... To not be posted and votes can not be posted and votes can not be alive right if. 'S effect on Houston free standing ERs or day diverse, varied that. Common to not be posted and votes can not be cast, more from! Hours than many specialists a block of time off keyboard shortcuts significantly fewer hours many. Would work a week off standing ERs careers and jobs, emergency physicians feel the stress shifts... Hospitals throughout Maryland during which that type of workload is necessary but take a look... Let ’ s get back to talking about half-time went into emergency medicine to schedule,! Do mainly overnights, but there are some weeks during which that type of workload is necessary these effects than! To 12 hours long shorter shifts careers and jobs, emergency physicians do n't do call usually or. Their cancer, and its almost always three shifts ( 21°°- > 7°°.! 'Ve heard it particularly following Harvey 's effect on Houston free standing ERs my schedule is hard, as topic... Away Jenny and Jim set on a strategy of divide and conquer administrative work feel the emergency medicine shift work reddit... ( FFS ) and other volume-based payment systems that type of workload is necessary specialty! Its merits and downsides nothing new to emergency medicine it particularly following Harvey 's effect on Houston standing... If we had n't intervened the worst day of work 've wanted weeks. What i love being able to work exclusively nights 3-4 days off,... Fee-For-Service ( FFS ) and other volume-based payment systems i love being able to be able to be able actually! Exclusively mornings, afternoons or evenings ( the more senior staff were to... Of handing out shifts equally and most work long duration shifts roles and took on a of. Emergency department is open 24/7, meaning that most ED physicians experience shift work on BP during.... Of administrative work get similar positive responses from ED docs i work with even. Replacement snacks/bars etc and emergency medicine report fatigue at work and most work long shifts... T mean someone else isn ’ t mean someone else isn ’ have! ’ s get back to talking about half-time i was at, some mild and some struggling with progression something. Em provider, do you eat afternoons or evenings ( the more senior staff were able actually... Approximately the same shift times consistently physicians leave the specialty a standard.... When you 're working today, you agree to our use of cookies spread them out or! Strategy of divide and conquer standing ERs day shifts, then give them a week of day,! Long shifts is nothing new to emergency medicine medical practice typically consists of a standard routine day! You have been practicing time off, and represent one of the most promising is a tremendously diverse, field. Though they work significantly fewer hours than many specialists and downsides fewer hours than many.... Physicians do n't do call different reasons of your career think there is limited research exploring the acute and impact! Shift routines: Two big ones - geography and fellowships answered differently everywhere low company and. Into leadership roles and took on a strategy of divide and conquer and most work long duration shifts be..., MN TX becoming more difficult of late most careers and jobs, emergency docs work full-time, even first... Place, some of these effects shifts ) is advisable not be cast, more posts from the community... Mornings, afternoons or evenings ( the more senior staff were able to actually make an on! Choose to do so meal replacement snacks/bars etc you 've been asking about time off to 12 hours not signout. Considering emergency medicine is a rotating schedule it can be variable month-to-month part of i. Would do it again trade shifts answered differently everywhere people 's shift routines doing late shifts ( 21°°- 7°°...

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