12 Hour Shifts, Yes or No?

[corpsmanUP]

After some 12 interviews, and a handful more this next month, what I have found out is that I will probably be happy almost anywhere I go. But the one thing that is significantly different is the fact that programs pretty much have shifts in one of two camps. Either they work strictly on 12 hour shifts, or they work 9-10 hour shifts or a combo of 9's, 10's, and 12's. Besides the obvious benefits from each, like having more days off with 12 hour shifts and having more flexible off-hours on 9 hour shifts, what do you guys think someone should know about the various shift types?

For instance, one program I really like works only 12's, but they work like 7-7 and thus after check out you are likely to get home about 7:30 or 8:00. With kids, this means a work day has you seeing your kiddos for about an hour on most work days before they go to bed. On the other hand, you get to have many days off where you can pick them up and take them to school. One program I like only works 17 12 hour shifts even as an intern. But another of my favorite places works like 23 9 hour shifts per month. For someone like me who swims 4 times a week at least, this gives a great deal of perceived flexibility in times to hit the gym when you are working 6-3P, 9-6P, and 3 to midnight. I just honestly have no idea which I prefer and if this is such a big deal anyway.

I would love to hear from anyone with an opinion on this matter, especially if you have kids. Hope to hear from you.

---

Members don't see this ad.

 

[The White Coat Investor]

12s suck for several reasons:
1) When you work 12s there is no overlap with anyone else coming on. So you inevitably work 13-14s.
2) No morning off or evening off when working 12s.
3) Half (rather than 1/4-1/3) of your shifts are night shifts
4) 12 hours makes me tired. I can do 8-9 hours without peeing or eating, but I can't seem to make 12.
5) The handful of extra days off aren't worth the 15-20 lost "evenings or mornings" It is probably ok as an attending, but I would hate it as a resident.

 

[12R34Y]

My number 1 does 8's and my number 2 and 3 do 9's. would never do 12's if my life depended on it.

just my opinoin, but who wants to work 13 or 14 hour days on your EM month?

later

 

[DrQuinn]

We do 12s (and a few 10s) for PGY1s, 12s and 10s for PGY2s, and 10s for PGY3s at our program. Our 12's really are 12's... maybe 12:20 or so... we dont' keep our interns/second years after sign out, which usually occurs right at 7am/pm.

12s are rough but the more days off are worth it. Honestly I wouldn't mind doing 12s as a PGY3 if it let me have 2-3 more days off a month. Surprisingly, some of our PGY3s vetoed it and we are doing 10s.

8's are sweet. I mean, SWEET. Before you know it its time to wind it down and clean up your patients. But 23 shifts a month is a lot. 10s are standard, and 12s can be a little long. I myself would stick with the 12s.

Q

 

[GeneralVeers]

We do 12s (and a few 10s) for PGY1s, 12s and 10s for PGY2s, and 10s for PGY3s at our program. Our 12's really are 12's... maybe 12:20 or so... we dont' keep our interns/second years after sign out, which usually occurs right at 7am/pm.

12s are rough but the more days off are worth it. Honestly I wouldn't mind doing 12s as a PGY3 if it let me have 2-3 more days off a month. Surprisingly, some of our PGY3s vetoed it and we are doing 10s.

8's are sweet. I mean, SWEET. Before you know it its time to wind it down and clean up your patients. But 23 shifts a month is a lot. 10s are standard, and 12s can be a little long. I myself would stick with the 12s.

Q

I agree entirely with your assessment of 12's. We work 13 12-hour shifts per month, and although I'm really tired when I get home, those 2 days off are well worth it to go to the beach, go out of town, or do whatever needs to be done.

I was really interested in going to a program that made interns work 21 shifts at 9 hours each. The thought of actually working 21 days out of the month seems repugnant to me now.

 

[mikecwru]

12s suck for several reasons:
1) When you work 12s there is no overlap with anyone else coming on. So you inevitably work 13-14s.
2) No morning off or evening off when working 12s.
3) Half (rather than 1/4-1/3) of your shifts are night shifts
4) 12 hours makes me tired. I can do 8-9 hours without peeing or eating, but I can't seem to make 12.
5) The handful of extra days off aren't worth the 15-20 lost "evenings or mornings" It is probably ok as an attending, but I would hate it as a resident.

I agree with everything but #3. Going from 12 hr shifts to 10 hrs, increased our # of night shifts, albeit slightly. We had horrendous sign out problems with the 12s. We get out really close to off time now, unless you're a gunner (dies in the first half of internship) or you're very inefficient. I originally lobbied very hard for 12s, but now in retrospect, think our current 10 hr system is better. The # shifts/month increased 1-2.

We don't do 1 hr overlap like some places, but we do for example, 7a-5p, then a shift that comes in at 5p. We have two shifts that come in after you start, so you still have coverage to wind down and clean up. It works just as well.

mike

 

[margaritaboy]

I have done both 8, 10, and 12 hour shifts. The Copa typically does 8s, and 10s, but for one month in our internship and PGy-2 year we do 12s. The 12s are much more painful.

After I get off of a 12, my day is effectively over. No gym, no movie with my wife, no cooking dinner....I'm done. If you string 3-5 of those 12s together you start to wear down pretty fast.

The extra 2 hours I get from doing a 10 is extra hours I can use to go take a hike, go to the gym, grocery shop, cook dinner, or go out with friends. Of course, I am a big wimp, but it does make a much bigger difference than I thought it would. We have not had any sign-out issues with our 8 and 10 hour system.

 

[bartleby]

Having done both during the course of my education, I vastly prefer 8-10 hour shifts versus 12 hour shifts. Aside from the good thoughts in the posts above, keep in mind that aside from the more "open scheduling" in having varying shifts, you are much more likely to make use of the leisure time you have after a shift when you're doing shorter shifts. If a 12 hour shift winds up being 13 by the time you get out of there, keep in mind that you're starting to fade after the 10th hour of the shift and are roasted by the time you're finally out of there. If your 8 hour shift turns into a 9 or a 9 to 10, you've still got some juice left when you get home. Whether you're going out to dinner with some chums or headed home for some quality time with the family, you're going to be a lot happier with the shorter shifts.

While the total number of free days is important, I would not chose a program based on this alone. If you're going to be happy in a program, a couple of days a month won't matter.

 

[NinerNiner999]

I have found that when doing 12 hour shifts, back to back, I have close to no free time (after 8 hours of sleep, I have four hours to get/take sign out, drive home/to work, see my spouse, eat a meal, and study). It can be painful, especially while as a resident you will have to study for tests such as the inservice and step III. As has been mentioned, though, you will work less days doing 12 hour shifts, but your "free time" will be spent catching up on laundry, working out, chart reviews, procedure logs, follow ups, lectures, etc. When I do 8 hour shifts, I work more consistently throughout the month (more shifts), but I have more time during the day to live a balanced life.

 

[Seaglass]

We do a mix of 8's and 12's. People universally prefer the 8's. I also think that the time you gain from 8's more than makes up for a few extra shifts a month.

 

[mvalento]

we do almost all 12's at my program during intern year, 20-22 per month. you do get used to it. and man...when i had a few 8 hour shifts thrown into my community ED month...they seemed so easy! it will make for a nice transition next year when we have a mixture of 8's and 12's

 

[Eidee]

when ur at work, 12 hour shifts really suck. My mind starts to wander at around 7 hours and by 9-10 hours i wanna go home. One of my rotations was all 12 hrs shifts which translated to being a 15 hour day....with insane, traffic my commute was close to 1 hour there and 1 hour back, plus 12 hr shfit + 1 hour staying after to wrap things up. When I got home, I would collapse. I was too tired to watch TV and was afraid if I didnt get my sleep, the next 15 hour day would be hell.

Of course the big plus was when I basically worked like an animal for 2 weeks, I had the other 2 weeks off to study, travel etc. This was wonderful and now that I think about it, I wouldn't mind doing those type of work schedules once in a while.

I think programs that have 12's and are located in cities that tend to have insane traffic should set their shifts at a time of day when traffic is more forgiving... mabey 10a -10p. Mine were set at prime traffic time and it made me feel that my commute sucked a lot of my day

 

[deuist]

I would love to work 12s, even as an attending. Give me the extra days off.

 

[EctopicFetus]

Dueist, I think that this really depends on your background. I sort of think 12s would be better but I can totally see being exhausted by it. My #1 has overlapping 9's which is a great thing. I guess at some point if I have the experience I will be able to comment better.

When I rotated at ORMC they did 7-7 12's and they were uniformly happy with that. I think that unless you have done both it is hard to compare. Some of the people who have commented on here have worked both so that should be a good place to start!

 

[Hoya11]

Could someone provide a typical monthly schedule of Joe Schmoe attending ED Doc, Inc total hours worked, types of shifts and when, assuming that the person is a 40y/o attending (ie not buying in).

I know this is a tedious task, but is seems like there is a lot of conflicting info... like 13 12 hour shifts (156 hrs total) vs 23 8 hour shifts (184 hrs total). I am trying to get a grasp of how much Attendings work, I dont care so much about residency since its only temporary. It just seems like 184 hrs/mo is too many to work on a regular basis, any info greatly appreciated .... thanks

 

[beyond all hope]

I personally prefer more days off, and so 12s rather than 8s. However, it also depends on the intensity of your ED. If you're at a seriously intense ED, lots of sick patients and unruly patients and bad ancillary staff and poor support services, 12 hours are rough. (and believe me, everything thinks that their ED is the most intense/insane place around, but it just isn't true. I've seen fire and I've seen rain...)

If you're at a place that runs a little smoother, or that actually has lag times (at my ED it's often slow between 4-10 am in the summer, but not now) 12 hours aren't that bad. You can actually take 20 minutes for a meal break, take bathroom breaks, etc. I guess this also depends on your efficiency and your work ethic. I know people who will take thirty minutes for a meal when there are seven charts on the rack, a full waiting room, and four unit players with shaky vitals.

If you're constantly running like a chicken with your head cut off, like I am, 12s are murder. I often don't have time to even sit on the can. Then 8s or 10s are the way to go.

 

[WilcoWorld]

Are there really people who don't take bathroom breaks for an entire shift? Sure, if I'm on my way to the head and someone codes, then in comes a respiratory distress, and I'm called away from writing those orders by an ambulance patient with right sided hemiparesis & aphasia I'm gonna hold it...but you had better believe I'm gonna take a leak while that patient's in the CT scanner (with stable vitals, of course), even if there are a couple of back pain's waiting. Come to think of it, that happened last month.

 

[deuist]

Dueist, I think that this really depends on your background. I sort of think 12s would be better but I can totally see being exhausted by it. My #1 has overlapping 9's which is a great thing. I guess at some point if I have the experience I will be able to comment better.

When I rotated at ORMC they did 7-7 12's and they were uniformly happy with that. I think that unless you have done both it is hard to compare. Some of the people who have commented on here have worked both so that should be a good place to start!

I've worked both 8's and 12's as a CNA. I prefer the 12's because, like I said earlier, I would much rather have the extra days off. I'm usually tired at the end of both shifts. But with the 12's, I can take a longer time to recover.

 

[beyond all hope]

I frequently don't take time to even go to the bathroom during a shift.

Like I said, there are lots of people that are more efficient and more willing to let other things slide. As a senior resident, when I'm in the ED it's my damn ED. I know that the attendings think it's their ED but they just take patients on their side (we divide the ED up into front and back). I'm the only one responsible for everything, and I take that responsibility very seriously.

I not only have to look out for my patients, but everyone else's as well. I'm constantly scanning the rack, looking for things I can do to keep the flow moving. Make sure the EKG and labs are drawn for the chest painers. Get a Upreg for that vag bleeder. Order a basic met for the dialysis patient. Get the off-service resident or med student suturing so I can free up my intern and junior to see more patients. Get the PCA off her ass to restock my ETTs.

I try to follow all of the sick patients, not just mine. I try to make sure that the ICU attending is called soon enough to get them out of the ED so I can free up my nurses (one sick patient can use up 4 nurses. I need them elsewhere.) Hang another liter of fluids. Call the lab and make sure the sample s aren't 'lost' (i.e. sitting in the bin while the lab techs watch soaps and chat)

I try to grab the charts for the wound checks and the needs prescription refilled so I can bang them out. I group patients together and see them in blocks of 2-4 at a time. Just the other night I grabbed all of the dental pains (4) at once, saw them one after the other, scribbled the charts + DC papers, grabbed the attending and forced her to see them all, DCed all within 30 minutes.

Nurses come to me to see sick patients, get an EJ or US guided line for difficult access, or negotiate with hostile/drunk/unreasonable patients. Traumas constantly roll in. In between, I may get the chance to do some teaching. I like teaching.

Meanwhile, my bladder starts to press up into my colon. I deliberately don't hydrate while I'm in the ED because then I'll be in the bathroom. I probably make myself prerenal by the end of my shift.

If I take a break for the bathroom, something won't get done.

Welcome to my life.

 

[GeneralVeers]

I frequently don't take time to even go to the bathroom during a shift.

Like I said, there are lots of people that are more efficient and more willing to let other things slide. As a senior resident, when I'm in the ED it's my damn ED. I know that the attendings think it's their ED but they just take patients on their side (we divide the ED up into front and back). I'm the only one responsible for everything, and I take that responsibility very seriously.

I not only have to look out for my patients, but everyone else's as well. I'm constantly scanning the rack, looking for things I can do to keep the flow moving. Make sure the EKG and labs are drawn for the chest painers. Get a Upreg for that vag bleeder. Order a basic met for the dialysis patient. Get the off-service resident or med student suturing so I can free up my intern and junior to see more patients. Get the PCA off her ass to restock my ETTs.

I try to follow all of the sick patients, not just mine. I try to make sure that the ICU attending is called soon enough to get them out of the ED so I can free up my nurses (one sick patient can use up 4 nurses. I need them elsewhere.) Hang another liter of fluids. Call the lab and make sure the sample s aren't 'lost' (i.e. sitting in the bin while the lab techs watch soaps and chat)

I try to grab the charts for the wound checks and the needs prescription refilled so I can bang them out. I group patients together and see them in blocks of 2-4 at a time. Just the other night I grabbed all of the dental pains (4) at once, saw them one after the other, scribbled the charts + DC papers, grabbed the attending and forced her to see them all, DCed all within 30 minutes.

Nurses come to me to see sick patients, get an EJ or US guided line for difficult access, or negotiate with hostile/drunk/unreasonable patients. Traumas constantly roll in. In between, I may get the chance to do some teaching. I like teaching.

Meanwhile, my bladder starts to press up into my colon. I deliberately don't hydrate while I'm in the ED because then I'll be in the bathroom. I probably make myself prerenal by the end of my shift.

If I take a break for the bathroom, something won't get done.

Welcome to my life.

I have the same approach as you do, and I'm just an intern. I wish all of our seniors could be as gung-ho as you are. Unfortunately I'm seeing 3rd year apathy set in amongst my colleagues.

 

[corpsmanUP]

I've worked both 8's and 12's as a CNA. I prefer the 12's because, like I said earlier, I would much rather have the extra days off. I'm usually tired at the end of both shifts. But with the 12's, I can take a longer time to recover.

That is where the myth is in the 12 hour shifts I believe. Because ED work inevitably requires multiple days back to back, you will always have periods of 4-5 days in a row where you don't get a day off. But when you work 12's, you essentially have about 8 hours to sleep in between work days if you are lucky, and 2 hours to drive each way and do some essentials of life. But when you work 8-9 hour shifts, you have literally 15-6 hours between each day to recover, and often more if you are on circadian scheduling. So there is never likely to be a time where you have such minimal recovery time between consecutive days. Sure you can take an extra day to recover here and there when you have 3 days off instead of 2, but doesn't that sort of defeat the purpose of it? My thinking is that it would be more enjoyable to only have a day or 2 off in a row, but be rested and ready to start my days off when I get them. I just worked with a resident who pulled 5 straight 12 hour shifts so that he could get 5 straight days off. Add in that when you have conference, one of your sleep days vanishes and you end up with about a 4 hour recovery period between days. He looked like total crap at the end of it, and he admitted he would take 2 days to lay around before he even thought of doing anything fun.

If you really think about it, you are going to work the same number of hours in the week and month, roughly 47-49 hours per week at any program regardless of the shifts length. You can either spread out the pain, or spend your off time recovering from longer periods of pain. I can't imagine how anyone with a desire to maintain a family life, and a workout routine would want to be in favor of 12 hour shifts. I certainly would have no incentive to go to the gym before or after a 12 hour shift, especially if it was my 3rd in a row. Someone should honestly do a study to test the relative fitness of residents in programs that do 12's versus those in 8-10 hour shifts. I would bet my bottom dollar that if you took 100 from each and randomly put them on a treadmill that the 12 hour shift workers would have a lot longer cardiac recovery time at the end of the test. 12 hour shifts simply do not allow the average person to participate in a regular period of aerobic training, and by their nature, aerobics are only worthwhile if you do them REGULARLY. You can't argue that on your days off with 12 hour shifts, that you were able to go on a "longer run", or do "14 extra sets of weights". Life does not work on 12 hour shifts, and the body is not meant to do it. I would be willing to do it for residency and may have to, but as an attending I won't even consider it!!

 

[bartleby]

I'm sure you have good reasons for your preference, but remember when you're working in an ED as a physician it's a completely different shootin' match. You get no scheduled break time, and a minute or two to inhale a sandwich or take a leak is often borrowed and/or stolen. Plus, the buck stops with you.

I've worked both 8's and 12's as a CNA. I prefer the 12's ...

Another poster asked how many shifts attendings work. Obviously, it varies, but given a mixture of 8/9 and 10 hour shifts, most community places I've seen work between 15 and and 18 shifts a month. Some choose to work more for extra pay, others stick with their base salary. In my academic institution, it's 15 8/9 hour shifts per month.

 

[mikecwru]

You need some Xanax.

You have my permission to go take a leak.

mike

I frequently don't take time to even go to the bathroom during a shift.

Like I said, there are lots of people that are more efficient and more willing to let other things slide. As a senior resident, when I'm in the ED it's my damn ED. I know that the attendings think it's their ED but they just take patients on their side (we divide the ED up into front and back). I'm the only one responsible for everything, and I take that responsibility very seriously.

I not only have to look out for my patients, but everyone else's as well. I'm constantly scanning the rack, looking for things I can do to keep the flow moving. Make sure the EKG and labs are drawn for the chest painers. Get a Upreg for that vag bleeder. Order a basic met for the dialysis patient. Get the off-service resident or med student suturing so I can free up my intern and junior to see more patients. Get the PCA off her ass to restock my ETTs.

I try to follow all of the sick patients, not just mine. I try to make sure that the ICU attending is called soon enough to get them out of the ED so I can free up my nurses (one sick patient can use up 4 nurses. I need them elsewhere.) Hang another liter of fluids. Call the lab and make sure the sample s aren't 'lost' (i.e. sitting in the bin while the lab techs watch soaps and chat)

I try to grab the charts for the wound checks and the needs prescription refilled so I can bang them out. I group patients together and see them in blocks of 2-4 at a time. Just the other night I grabbed all of the dental pains (4) at once, saw them one after the other, scribbled the charts + DC papers, grabbed the attending and forced her to see them all, DCed all within 30 minutes.

Nurses come to me to see sick patients, get an EJ or US guided line for difficult access, or negotiate with hostile/drunk/unreasonable patients. Traumas constantly roll in. In between, I may get the chance to do some teaching. I like teaching.

Meanwhile, my bladder starts to press up into my colon. I deliberately don't hydrate while I'm in the ED because then I'll be in the bathroom. I probably make myself prerenal by the end of my shift.

If I take a break for the bathroom, something won't get done.

Welcome to my life.

 

[GeneralVeers]

You need some Xanax.

You have my permission to go take a leak.

mike

The day that I'm not allowed 5 minutes to go micturate is the day I quit Emergency Medicine. I'm pretty hardcore as a resident, but I also know when I NEED to take a break for patient safety. It's been hard to do, but now I accept that everyone won't get seen, and everything won't get done during my shift.

 

[12R34Y]

the academic center I attend as a student the EM faculty do 12 8 hour shifts a month.

Another suburban private/dem group works 12 12 hour shifts a month.

The day I work 18 shifts/month as an attending would be the same day I STOP working in that particular ED.

This is not uncommon in the midwest where I'm from.

15-18 shifts/month seems hyper extreme, but maybe I'm just working around a bunch of lazy folks.

12 shifts/month is the norm around these parts.

later

 

[corpsmanUP]

You need some Xanax.

You have my permission to go take a leak.

mike

LMFAO!!!

 

[mikecwru]

The day that I'm not allowed 5 minutes to go micturate is the day I quit Emergency Medicine. I'm pretty hardcore as a resident, but I also know when I NEED to take a break for patient safety. It's been hard to do, but now I accept that everyone won't get seen, and everything won't get done during my shift.

A modification of an EM truism:

"All (vaginal) bleeding stops, eventually."

This is a hard attitude to combat in most EM interns: balancing efficiency with sanity. You take people that are selected to be smart, anal-retentive over achievers, then select from them people that want to work in a hectic face paced environment with drunks, the dying, and the homeless. I've had to tell more than one intern "You need to sign out and go home, NOW." I don't think this is a function of our program, but more of the culture of EM "You do your own work, you don't sign out BS." As you progress along, you learn to balance not screwing your colleagues and not screwing yourself.

If I remember right, "beyond all hope" is a third year. So my rec for the xanax and taking a leak (might actually paradoxically relieve some tension) still stand. I have other suggestions, but they're a little too x-rated for this forum.

mike

 

[SoCuteMD]

I actually have a related question about 12 hour shifts. I am a "hit it hard and get it done" type of person. I love the idea that with some hard work, I can accomplish in 8 hours what takes others 10 or more to do. I love the idea that "if I get this done now, I can play later." It seems like a lot of EM docs are very similar in this regard. Part of the reason (a small part) that I think I will like EM is this attitude - and the fact that if I work lots of hours in a row, I can then go midweek skiing!!!! Can anybody speak to if or how that attitude affects your like/dislike of longer shifts? (More specifically: did you agree with me before you started and now you wouldn't trade your 9-10 hour shifts for 12s if your life depended upon it?)

Strange question, even more strangely worded, I know.

 

[Hoya11]

the academic center I attend as a student the EM faculty do 12 8 hour shifts a month.

Another suburban private/dem group works 12 12 hour shifts a month.

The day I work 18 shifts/month as an attending would be the same day I STOP working in that particular ED.

This is not uncommon in the midwest where I'm from.

15-18 shifts/month seems hyper extreme, but maybe I'm just working around a bunch of lazy folks.

12 shifts/month is the norm around these parts.

later

What kind of money are you making working 12 8 hour shifts a month?

Is it by the hour? Or are some of these guys making 200+ for working 3 days a week via a straight salary? That seems like too little to work overall, do they have side jobs? I just still dont get the typical working schedule/compensation of an ED doc....

Shift work then time off, fine, but how many total days a week are you working and how much money are you making? ugh! I am getting frustrated....
I dont want to work 3 days a week for 140, and I dont want to work 6 days a week for 200. Is 100/hr a good rule? Do you have control of how many hours? Does it just seem like there are an unlimited # of scenarios because you are so free to determine your # of hours?

I want to work 40-50 hrs per week, and make 200k/yr, is this going to happen in EM?


Thanks for any help still just trying to get a good picture of this...

 

[12R34Y]

What kind of money are you making working 12 8 hour shifts a month?

Is it by the hour? Or are some of these guys making 200+ for working 3 days a week via a straight salary? That seems like too little to work overall, do they have side jobs? I just still dont get the typical working schedule/compensation of an ED doc....

Shift work then time off, fine, but how many total days a week are you working and how much money are you making? ugh! I am getting frustrated....
I dont want to work 3 days a week for 140, and I dont want to work 6 days a week for 200. Is 100/hr a good rule? Do you have control of how many hours? Does it just seem like there are an unlimited # of scenarios because you are so free to determine your # of hours?

I want to work 40-50 hrs per week, and make 200k/yr, is this going to happen in EM?


Thanks for any help still just trying to get a good picture of this...

The academic guys (happens to be a private hospital) working 12 8's make 200,000/year roughly.

The guys working 12 12's in suburbia private group are making 225-275,000/year.

Not uncommon.

later

 

[Hoya11]

The academic guys (happens to be a private hospital) working 12 8's make 200,000/year roughly.

The guys working 12 12's in suburbia private group are making 225-275,000/year.

Not uncommon.

later

Exactly what I wanted to hear, thanks man

 

[vtach]

Wow,

From what I am reading, I really am getting it in the shorts this year. Currently as a PGY-2 we are working 21-22 12hr shifts a month. Our schedule is 3 days (7-19), 3 nights (19-7) and 2.5 days off, then it all starts over again. It always seems like I am at work or sleeping. As for studying, there is no time to study or read.

 

[highdesert]

What kind of money are you making working 12 8 hour shifts a month?

Is it by the hour? Or are some of these guys making 200+ for working 3 days a week via a straight salary? That seems like too little to work overall, do they have side jobs? I just still dont get the typical working schedule/compensation of an ED doc....

Shift work then time off, fine, but how many total days a week are you working and how much money are you making? ugh! I am getting frustrated....
I dont want to work 3 days a week for 140, and I dont want to work 6 days a week for 200. Is 100/hr a good rule? Do you have control of how many hours? Does it just seem like there are an unlimited # of scenarios because you are so free to determine your # of hours?

I want to work 40-50 hrs per week, and make 200k/yr, is this going to happen in EM?


Thanks for any help still just trying to get a good picture of this...

If you are interested in making substantially more than that working 12 12's a month in a fairly suh-weet integrated health system, give me a shout by PM. We just got the go-ahead to hire another EM doc. My ED director is also the medical director for the hospital, so we tend to feel well taken care of. We are expected to work 12 12's, but we are given free reign to work as many or as few extra hours as we wish as double coverage. Based on 12 12s, our salary is very competitive. Our bonus usually adds an additional $50K-75K/year. I tend to work 175-190 hours/month by choice to knock down my gawd-awful med. school debt --> Make as much as you feel you can handle is the bottom line. I will probably dial the hours down a few notches after the first year or two (this is my first year out of residency). Most of the hours are single coverage in a 20K/year ED that is Level II. Guaranteed double coverage on Sat/Sun/Mon afternoon/evenings. We are looking to extend this to near complete double coverage -- thus the need for another doc.

Give me a shout if serious. Not the flashiest of towns, but hey...it's a safe place with excellent schools and a lower than avg. cost of living...

--Highdesert

 

[edinOH]

Next week on ER...

I frequently don't take time to even go to the bathroom during a shift.

Like I said, there are lots of people that are more efficient and more willing to let other things slide. As a senior resident, when I'm in the ED it's my damn ED. I know that the attendings think it's their ED but they just take patients on their side (we divide the ED up into front and back). I'm the only one responsible for everything, and I take that responsibility very seriously.

I not only have to look out for my patients, but everyone else's as well. I'm constantly scanning the rack, looking for things I can do to keep the flow moving. Make sure the EKG and labs are drawn for the chest painers. Get a Upreg for that vag bleeder. Order a basic met for the dialysis patient. Get the off-service resident or med student suturing so I can free up my intern and junior to see more patients. Get the PCA off her ass to restock my ETTs.

I try to follow all of the sick patients, not just mine. I try to make sure that the ICU attending is called soon enough to get them out of the ED so I can free up my nurses (one sick patient can use up 4 nurses. I need them elsewhere.) Hang another liter of fluids. Call the lab and make sure the sample s aren't 'lost' (i.e. sitting in the bin while the lab techs watch soaps and chat)

I try to grab the charts for the wound checks and the needs prescription refilled so I can bang them out. I group patients together and see them in blocks of 2-4 at a time. Just the other night I grabbed all of the dental pains (4) at once, saw them one after the other, scribbled the charts + DC papers, grabbed the attending and forced her to see them all, DCed all within 30 minutes.

Nurses come to me to see sick patients, get an EJ or US guided line for difficult access, or negotiate with hostile/drunk/unreasonable patients. Traumas constantly roll in. In between, I may get the chance to do some teaching. I like teaching.

Meanwhile, my bladder starts to press up into my colon. I deliberately don't hydrate while I'm in the ED because then I'll be in the bathroom. I probably make myself prerenal by the end of my shift.

If I take a break for the bathroom, something won't get done.

Welcome to my life.

 

[DrQuinn]

Wow,

From what I am reading, I really am getting it in the shorts this year. Currently as a PGY-2 we are working 21-22 12hr shifts a month. Our schedule is 3 days (7-19), 3 nights (19-7) and 2.5 days off, then it all starts over again. It always seems like I am at work or sleeping. As for studying, there is no time to study or read.

Dayum. That is a little on the high side. 12s like that can be pretty rough, even with 2.5 days off every 8 days. But, alas, all is for naught, in a year and a half you will be done and will be working the exact same job wtih the exact same pay with the exact same residents all over SDN. It'll happen before you know it.

Q

 

[The White Coat Investor]

Are there really people who don't take bathroom breaks for an entire shift? Sure, if I'm on my way to the head and someone codes, then in comes a respiratory distress, and I'm called away from writing those orders by an ambulance patient with right sided hemiparesis & aphasia I'm gonna hold it...but you had better believe I'm gonna take a leak while that patient's in the CT scanner (with stable vitals, of course), even if there are a couple of back pain's waiting. Come to think of it, that happened last month.

I've found the best time to sneak off and pee is during "medic time." What is "medic time" you ask? Well, you know when you get that trauma call on the tele and they say ETA 6 minutes? Medic time is the difference between 6 minutes and the time they actually show up. As near as I can tell it is caused by a paramedic in the back of the box trying to guess where the box is by the sounds outside, rather than asking the driver.

 

[edinOH]

For what it's worth, I took a job next year working 12 hour shifts. I'm in a residency working 12s now.

The minimum for new guys next year is 14 shifts per month. That equals rougly $280,000 yearly not including yearly retirement (30k) and health benefits.

As it stands now I'm working 16 shifts monthly in our ED plus moonlighting usually another 4 shifts. (As chief I work two less shifts monthly than everybody else) All 12 hours. The moonlighting is worth an extra $1200-1440 per shift. The money is in the moonlighting obviously!

My thoughts are that I will start my new job working approximately 20 shifts monthly for a couple of years. From what I hear, the work is there for 20 shifts if you want it. That will translate into roughly $370,000 yearly plus the benefits as described above. After two years my rate increases and the above will easily be $425,000.

Hell, where else in medicine can you work 2/3 of the month and make that kind of money? The poor bastards in medicine and surgery are working most everyday of the month for less than that.

My point isn't about how much money I can make, rather how much money I can make working 20 out of 30 days of the month.

Aside from Neurosurgery or one of the surgical subspecialists with an excellent referral base, tell me where else in medicine you can do this with any regularity.

 

[bartleby]

What do you think your career endurance is going to be working resident hours indefinitely? Screw your career... what about your personal/family life?

My thoughts are that I will start my new job working approximately 20 shifts monthly for a couple of years. From what I hear, the work is there for 20 shifts if you want it.

 

[EctopicFetus]

You do realize that 20 12's per month is 2880 hours per yr. 2040 is 40 hours per week for 52 weeks. Crazy!

 

[bartleby]

The numbers mean nothing as absolutes. The average community job is often 1500-2000 hours per year. You are not talking about a menial low stress job with fixed hours and no nights or weekends. When you are at the beginning of your career, it is easy to lose sight of the fact that this job _will_ take its toll on you. A career in Emergency Medicine is a marathon, not a sprint.

You do realize that 20 12's per month is 2880 hours per yr. 2040 is 40 hours per week for 52 weeks. Crazy!

 

[edinOH]

Believe me, I understand your point.

My point is that those in other specialties are working that many or more hours weekly/monthly for often times much less return.

I don't mind working hard for a few years on the front end if it means being able to put a few exta dollars away. These dollars will earn me some nice compound interest over the later years.

Of course I don't plan on doing it forever.

This is just an extension of everything else we have chosen for our lives. Hard work now for the reward later on. Delayed gratification has gotten me this far, why not a little further?

In our ED I see alot of miserable bastards in their late 40's-early 50's working these kinds of hours for their entire careers in the other specialties. I consider it a privileldge and good luck on my part that I can put in these kinds of hours now and then pull back as I see fit on my timeline and still maintain my desired standard of living.

This (among other things) is what makes EM unique.

I hope to find that magical balance between wealth and age. In other words, it is useless to die rich. Might as well enjoy what you have when you have it.

I will be 32 this spring when I graduate. Work like a dog for ten years, invest and then cut back. As long as I'm not one of those poor son's of bitches who presents to the ED with a STEMI at age 42 I should be all right!

 

[EctopicFetus]

edinOH good luck!

 

[mikecwru]

Just with all those hours worked:

1. don't get a pool
2. don't get a pool boy

I heard an anesthesiologist that used to joke: "All my ex-wives were good housekeepers..... they all kept every house I ever had when we divorced."

mike

Believe me, I understand your point.

My point is that those in other specialties are working that many or more hours weekly/monthly for often times much less return.

I don't mind working hard for a few years on the front end if it means being able to put a few exta dollars away. These dollars will earn me some nice compound interest over the later years.

Of course I don't plan on doing it forever.

This is just an extension of everything else we have chosen for our lives. Hard work now for the reward later on. Delayed gratification has gotten me this far, why not a little further?

In our ED I see alot of miserable bastards in their late 40's-early 50's working these kinds of hours for their entire careers in the other specialties. I consider it a privileldge and good luck on my part that I can put in these kinds of hours now and then pull back as I see fit on my timeline and still maintain my desired standard of living.

This (among other things) is what makes EM unique.

I hope to find that magical balance between wealth and age. In other words, it is useless to die rich. Might as well enjoy what you have when you have it.

I will be 32 this spring when I graduate. Work like a dog for ten years, invest and then cut back. As long as I'm not one of those poor son's of bitches who presents to the ED with a STEMI at age 42 I should be all right!

 

[Hoya11]

60 hours a week for 370

40 hous a week for 280

Im choosing 40 for 280

280 is a lot of money

EdinOh thanks for the info but are you some kind of superstar DOc that everyone is after to draw these high salaries, or are these offers pretty typical?

And can you comment more on how your rate increases with years experience? Thanks

 

[EctopicFetus]

60 hours a week for 370

40 hous a week for 280

Im choosing 40 for 280

280 is a lot of money

EdinOh thanks for the info but are you some kind of superstar DOc that everyone is after to draw these high salaries, or are these offers pretty typical?

And can you comment more on how your rate increases with years experience? Thanks

FWIW working the 240 hours per month (roughly 60 per week) is a salary of $130 per hour. Not totally crazy from what I hear. Then his bump is to around $150 per hour also not out of the realm of whats out there. I think it is his hours that make the salary so high. Ill let him comment on the details!

 

[edinOH]

Those numbers are correct. No not some superstar. Just average ED doc.

I really didn't mean to start throwing out numbers like I'm special or anything. Didn't mean to come across that way if I did. Just sharing some of my thought process as I begin this journey. Generally I don't wish to do this forever nor do I want to be a slave to a certain salary after twenty years. And no I don't plan on a pool boy!

Are there pool girls...?

 

[EctopicFetus]

edinOH what part of the country! Congrats! I dont think you came across poorly or anything. I think it was just that we are amazed by the numbers. You surely earned the salary. Am I right in saying that those numbers arent out of the ordinary?

 

[brats800]

i'm just a med student (at loyola in chicago) but i feel this is a good spot to post this question. we had an emergency medicine physician come and talk to the medstudents yesterday and he said that most EM physicians get paid the same hourly rate right out of residency as they would get paid 10 or 15 years out of residency. have you all found that to be true? if that was the case, what benefits would you get as you became more of a veteran/older in the department? he mentioned the after 50 = no night shifts that some places have... so yeah, my question is more of how does your salary/hours/etc improve as you get further out of residency? (i couldn't find the answer with a search) thanks!

 

[NinerNiner999]

There still seems to be some disbelief amongst the members about salary information that is being posted. For those of you still not convinced (EF, etc.), salaries in the $250-300k range are not hard to find and, DEPENDING ON THE HOURS YOU WANT TO WORK, may be the rule rather than the exception. Academics will always pay less than community pay (around $200k with limited clinical hours). Salaries will also most likely continue to rise in the next few years due to demand. Be wary about those you listen to about low salaries out there - most of your sources throughout residency will be academic clinicians who have not looked ouside of academics in several years (if ever) for community positions.

As you go through training, keep an eye open for the things you want in your job, the things you are willing to tolerate in your job, and most importantly, those things that you will absolutely NOT accept (no overnight OB coverage, etc). Pay attention to the hours you work as a resident and put a reaslitic goal together of how many hours you will work outside of residency. Only then will YOU have a realistic view of what salary you can expect - it will be different for everyone. A job paying $200k is just as easy to find as a job paying $400k per year - as long as you want to work the hours and play by the rules.

 

[NinerNiner999]

There still seems to be some disbelief amongst the members about salary information that is being posted. For those of you still not convinced (EF, etc.), salaries in the $250-300k range are not hard to find and, DEPENDING ON THE HOURS YOU WANT TO WORK, may be the rule rather than the exception. Academics will always pay less than community pay (around $200k with limited clinical hours). Salaries will also most likely continue to rise in the next few years due to demand. Be wary about those you listen to about low salaries out there - most of your sources throughout residency will be academic clinicians who have not looked ouside of academics in several years (if ever) for community positions.

As you go through training, keep an eye open for the things you want in your job, the things you are willing to tolerate in your job, and most importantly, those things that you will absolutely NOT accept (no overnight OB coverage, etc). Pay attention to the hours you work as a resident and put a reaslitic goal together of how many hours you will work outside of residency. Only then will YOU have a realistic view of what salary you can expect - it will be different for everyone. A job paying $200k is just as easy to find as a job paying $400k per year - as long as you want to work the hours and play by the rules.