Monday, July 28, 2008

Reasons I'm Leaving Emergency Medicine (number 6)

Circadian rhythm refers to the body's biochemical sleep cycle. Here's a wikipedia entry that is not bad if you are interested.

All medical students and residents learn the hard way that staying up all night on call and being tied to a beeper is not good for one's general health or mental health. I still can't understand how you can sleep well with a beeper on... I never succeeded in doing anything more than catnap on call, but some people have the gift of quick and restful sleep. I am not one of these people.

The worst thing about Emergency Medicine has to be the nights. Whereas many physicians can kiss the overnight shift goodbye after residency we can not. To be sure, surgeons and some other medical subspecialists still have nights, but they can sleep, if the gods deign, between calls, and they never switch to a night schedule.

Coming up to a string of night shifts still provokes the fight or flight response in me. In the wee hours with ambulances rolling in and kids crying and drunks yelling and phones ringing one is hard-pressed to believe that it will ever end.

Add to this the quick switch back to a day schedule and our 'airline pilot' schedule (working about 15 shifts a month) looks less attractive. For me, it takes me two days to recover from two overnights, and more days to recover from three or four in a row.

It's like this. Start your workweek in Atlanta, for your third day of work catch a flight to London and work regular morning hours there for a couple of days, then fly back to Atlanta for some days off. Repeat.

Admittedly, some ER groups try hard to create some regularity in the docs schedule by staggering the shifts and moving them forward a few hours every few days, but there's just no good way to do this absent having a full time night doc or two.

To the goddess cirdadia... you are a douchebag.


  1. I say thank goodness for day docs. They save me from having to get up at 5:30 in the morning (yuck!) and let me keep to my nocturnal shift preferences all the time!

    And even better, there's another one just like me, so the rest of our group just has to take 1 night/week between all of them.

    If I had to rotate back and forth on a regular basis, life would be a -lot- harder.

  2. Nasty. I've heard that you need as many days off after nights as the number of night shifts you have just done. Wow. That was an awful sentence. Anyway, nothing will change until the admin evils have to do nights as well and realise how bloody hard it is.

  3. Night shift Sucks. I just quit night shift and it is amazing how much stuff gets done around the house now.

    So what are you going to do now?

  4. Ugh 911. Rotating shift work. Totally sucks. I hear ya. I may know nothing about being a doctor, but this I do know:

    I haven't slept through the night in 5 years. Ever since I was pregnant with my first kid. On most nights even if I can get into bed before 11pm, my body won't fall asleep. I've always had sleep issues anyway.

    Remember that 6 word memorial meme that was making the rounds? I was "Want sleep like crackwhore wants crack." Yeah.

  5. I enjoy Night Work myself, nothing like that 9am Martini before goin to Bed. Thats the problem with the Traditional Office Practice Model,the ER's the only place thats Open after 5pm. Somethings not right when I can order a Pizza at 1am but can't get my Lipitor refilled.

  6. our er doc group just instituted the "55" rule.
    after you have reached the golden age .. you are exempt from the deadly noc shift.
    this works well since the newer/young buck docs don't mind the late shift.
    i totally agree with the recovery hassle.
    25 years ago i could bang out those all nighters and still remain somewhat cognitive.. now my next day is shot to hell.

  7. Just to make your day, a study showed that rotating shift work increases your risk of prostate cancer.


  8. Shrodinger, did they make allowance for the lower incidence of Jacking Off in Shift Workers, which we all know decreases the risk of Prostate Cancer?

  9. As far as I know it's a wash, so I box the clown every time I go in to work.


  10. AAARRRRGGGHHH! I knew there was a reason for that hospital hand washing policy.

  11. Not that I'm a doctor, but rolling shifts work just fine for me. But then my natural circadian rhythym is apparently based on a day that is 31hours long or something.

    For 2 years I worked 2 graveyard, 2 swing, 1 day, 2 off. I liked it, since it made my weekend 16hrs longer than typical. Changing shifts every week is OK, but every day or 2 is better.

  12. I used to do computer operations in a fertilizer plant at night during my college years, so I know what you mean a little bit. It was creepy: I was afraid the ghosts of people poisoned by JR Simplot would return to git me.
    And there's the sex difference thing--it never once occurred to me to masturbate. Hmmm.

  13. 911: I'm worried for you: Maybe you should stop using the humble douchebag as an invective, lest you be reincarnated as one.

  14. I ditched the nights, but still jack off like a caged monkey. I prefered the people who work nights. The nurses tend to be younger (aka hotter) less bitchy, and the patients generally sicker. My coworkers in EMS were also less bitchy and whiny. But I'm just not a night person no matter how I try.

  15. When I was working, I loved night work. I'd work 3 nights/week. A 12,a 12 then a 13 (of course, that was if we didn't have something come running in the door 15 minutes before closing, spewing nastiness all over the floor) and then I was off for 4 days. The trick for me was when I got off on Wednesday morning, I wouldn't go to bed. I'd spend the day doing whatever I needed to do and usually it was a very productive day because I was fine as long as I was moving so I didn't stop all day. Then, I'd go to bed between 7 and 8 wednesday night and be up at 6 on Thursday moring and be good to go the rest of the week.

    Maybe it helps that I'm naturally a night person. Hell, it's 1:50 now and if I didn't have to get up with 2 kids in the morning I'd be good to go for another 4 hours or so.

    ER work, even in the animal ER, is made for those of us with a fucked up internal clock. Ideally, my morning begins at 4 or 5 pm and my days are 30 hours long (18 awake, 12 sleeping).

    Why can't human ERs do non-rotating schedules? Is it just a matter of not having enough willing docs to work all night shifts? Not enough coverage over-all?

  16. goddess circadia5:38 AM, July 30, 2008


    I am not a douchebag.

    You are a pussy.

    And no, I don't care.

  17. This comment has been removed by the author.

  18. Hey wouldja look at that. I'm not just a disembodied voice of dissent and rancor. I actually have a face.

    Sorry Etotheipi, not naked and not faking hotness.

  19. I'll often switch back and forth from days to nights 3 or 4 times in one pay periods (2 weeks). Guess what I do on my days off? That's right! Weird sleep. My favorite move is a couple of day shifts with no days off then a couple of night shifts, one day off then a couple of day shifts...Kill me now

    One fellow day-night rotator just quit for that very reason...

    Hm, it's 2:16 am and I have to be to work in the morning. Gee. Isn't that special.

  20. I worked the graveyard shift in airline reservations when I was in college. It was not too bad, the most annoying part of that shift were the heavy breathing insomniacs and assorted weirdos.

    Overall, because it was always the same shift, your body eventually got used to napping during the day and being awake at night. Also, it was just me, I was single.

    In your case, the switching of day/night shifts must be quite exhausting and also, how do you maintain a family life?

  21. It has become too difficult to continue.

  22. i have never worked yet.. hopefully in the future since i'm still a student.. but not as a doctor... anyway, why do you have to travel back and forth to london and atlanta??? i'd just love to be in your shoes. :D

  23. Any sanity-preserving tips for someone still inside the gate? Tips other than "Get out while you can," I mean.

    I just started my 3rd year and feel something close to despair when I realize my current minimally tolerable schedule is nothin' compared to the poor interns' lot (not to mention how much yelling they have to endure).

    My hours aren't too bad, but alternating between 7am, 3pm, & 11pm start times is rough, as is early lecture after getting home around midnight the night before. Next month I do 12-14+ hour days but at least they all start at the same time.

    I'm a solid sleeper yet even I have trouble getting good sleep on a warm sunny day. I don't feel refreshed after sleep, have taken to sleeping in my free time to try to catch up, & feel my normally patient & good-natured self slipping away. I dream about sleep even in my sleep.

    Thanks if you have any helpful advice.

  24. dear medicine girl,
    yes. whatever you do, don't look at the money when you sign. look at 1. are the books open? 2. do they stagger their shifts? 3. how many docs have they lost in the prior 5 years. 4. if they have lost any docs contact those docs and find out why they left. 5. if you are offered a position where you are 'all nights' until the next hire and can then be all days then strongly consider it. it would be worth it. 6. yes, it is truly important to join a 'fully democratic group'... not a 'benign dictatorship' or anything other than a fully democratic group.


  25. Thanks! I saved & labeled your advice in my fully searchable Gmail account. I'll revisit it when it's time to get a job. For all the b.s. I endure as a student, it's a thousand times less (at least) than what the docs have on their plate. At times it seems like docs are human shields for students.

  26. dear medicine girl,
    are you a 3rd year student or resident? if a student then what do you think you are going to do? my simple advice for residency is to find a program that is at least moderately well respected AND has residents who are smiling. that's it.


  27. 3rd year student. Sorry if my comment about the interns confused you. As a student, my total work hours are reasonable & I endure much less (& less venomous) yelling than the interns, who are responsible for doing/knowing more.

    My near-despair comes from knowing that schedule-wise, it gets worse from here for quite a while. And yes, I know that the whole concept of medicine as a sinking ship should be additional reason for despair, but right now my shift work/sleep deprivation wins any contest for my attention.

  28. dear medicine girl,
    take heart, when people actually realize the ship is sinking and people start dying then our jobs and our training will again be valuable. i give it five years. alternatively, if the government 'fixes it' then we will take bankers hours and not work as hard for about the same money but more people will die needlessly.

    still interested in what you plan to do.

  29. I'd like to subspecialize in NMM/OMM (neuromusculoskeletal medicine / osteopathic manipulative medicine). I love all things neuromusculoskeletal & have spent more time doing OMM on patients/classmates/nurses/residents & taking continuing ed courses than any student I know. My mentor has a very successful cash-only practice & I'm fairly certain I could do something similar provided my skills continue to improve at a steady rate.

    I'm less clear about my residency choice b/c I have zero desire to treat every cold that walks thru the door (scratch Family Med & Peds) and PM&R w/a musculoskeletal focus is pretty procedure intensive. If I didn't love manual medicine so much I'd do EM or EM/IM. I super-performed in all the IM sub-sections on USMLE Step 1 & at least like *thinking* about IM concepts (no desire to be a hospital internist). I enjoyed my time in the Peds ER almost as much as I enjoy manual medicine (and managed to do some OMM there working under both DOs & MDs). Haven't been in the adult ER yet, but I've been told my personality fits the specialty, whatever that means.

    Longer answer than I'd guess you expected or wanted.

  30. Oh yeah, almost forgot -- Didn't realize people don't know the ship is sinking. How the hell could they miss it? Or is it just that I read too much WSJ health blog & MDOD? ;-)

    Actually, several docs told me in 2000 that they would never pursue medicine if given the chance to do it over again and that I should do something else with my life if I wanted to be satisfied. They said many smart people in medicine were waking up to the fact that as smart people, they could do something with their lives that brought them happiness or money or at least a lot less bullshit. They told me the system was broken and that it would get worse before getting better. They were certainly right about the getting worse part. Still waiting for the upswing.

    A superstar anesthesiologist said the same thing to me about not doing it again -- yesterday. Then I see young guys like you getting out so early in the game. And read about how all the new nurses are getting in by lottery and aren't always the "cream of the crop." The only thing that makes me want to shove my [pathetic little] fist through a wall is incompetence. So I'm probably screwed and should just reserve my spot in the hospital anger management course now.

    It scares me that the system is so broken but may escape repair until people start dying of things that never should have killed them.

  31. dear medicine girl,
    i think those of us currently IN the system are merely trying to make as much money as fast as we can so we can get out. i think this is a violation of our hippocratic oath because we are doing it in a manifestly dangerous system and we should all march on washington. it won't happen so i'm not going to commit malpractice by continuing to push the sinking ship. perhaps i will have success on my own... i hope so. if i do i hope it will encourage others to sever ties with the thousands of paper monkeys who ride on our backs.

  32. What do you plan to do on your own? Whatever it is, I hope you'll find satisfaction and do some good.

  33. dear medicine girl,

    i have big plans. if they work out only partially then it's still good. i will be happy to work in medicine for less money and be in control of my little cage. more as it unfolds, and yes, i am going to continue to practice (but not for the man).

  34. I'm happy to hear you're not truly leaving medicine and am pulling for your success. Just canceled my reservation for the hospital anger management class. Congrats for getting out from under the man's thumb.