Editors’ Note: This piece is the first on a series on our schedules in the ED. We plan on exploring all kinds of scheduling options and delving into the advantages and disadvantages of each. If you have any ideas for this series please email us at [email protected]
In writing this post, we set out to explore the perspectives of our colleagues who have chosen an emergency medicine career dominated completely or mostly by night shift work. While all of us have opinions from our own experience working nights, we suspected there were insights to be gained from targeted conversations with a few of our colleagues who have found the grass to actually be greener on the other side. Though not necessarily representing the unique perspectives of all women nocturnists in EM, we think the key themes we discovered speak to some important priorities and values of today’s emergency physicians, both men and women. We also hope to give some food for thought for those who might be contemplating this particular schedule format.
Not surprisingly, the reasons women choose to work primarily nights are multifaceted. Many women cited childcare as a key component of this decision. Physicians with school-aged children might drop the kids off or take them to the bus in the morning, sleep all day, and wake in time for dinner and evening family time before getting a couple hours of anchor sleep and going to work later. When it comes to childcare, the work schedule of the partner plays an important role, and women whose partners work from home or have set daytime schedules may have the easiest wins for childcare benefits. In fact, one physician we spoke to is thriving in an academic career with 3 small children at home and a husband who works full time. With a little help from friends and family, they haven’t had to employ a nanny or daycare during the four years she’s been working nights. Another doc initially started working nights in order to be available for an ailing parent during the day, and then found it fit her lifestyle best as she was consistently available on weekends to spend time with family.
Importantly, a key theme we discovered is the value of a set schedule. In fact, this feature was a prominent perk for most of the women we spoke with, and the single key motivator for one. In addition, many have been able to negotiate out of weekend shifts altogether. Others get to claim a few hours of Sunday night to count for their required weekend allotment. Freeing up weekends was also a benefit cited by one single woman without kids who valued having a full social life.
All of the women we spoke with received some sort of perk for working night shifts. This wasn’t surprising, as all reported feeling valued and appreciated by their colleagues and departments. Perks ranged from a bump in pay (some reported a 10% “night differential”) to a reduction in number of shifts, up to 20%! Preferred scheduling, lack of weekend shifts and getting excused from “required” staff and educational meetings were other benefits highlighted. Beyond time and money, though, many cited the camaraderie among staff who work nights as a prominent benefit.
Regarding the shifts themselves, we got mixed reports. Some women found acuity to be lower (e.g. urgent care overflow) while others reported higher acuity. Several noted fewer resources available at night, but also fewer distractions. Women working in departments with at least some degree of single coverage at night reported missing having a colleague to bounce things off of, and several cited this factor as a caution to new grads considering nights. Indeed, the burden of single coverage was mentioned as a distinct disadvantage.
Women we spoke with self-identify as excellent sleepers. They utilized various sleep aids (e.g. ear plugs, room-darkening shades, white noise machines), but only one reported using pharmacological assistance on a regular basis (we imagine there are more). Of note, she was the only nocturnist we spoke with who will be abandoning the nocturnal life, citing sleepiness on shift, difficulty switching back to days, and excessive extra-clinical workload as key challenges. Four to seven hours of sleep were needed during the days in between nights, and the perfect number of nights in a row seemed to be somewhere between two and four shifts.
Admittedly, a nocturnal schedule has certain drawbacks. Some women cited the physical toll and concerns over the health effects of working nights. Nocturnal shift work has been linked with an increase in heart disease, GI disease and hypertension. However, FemInEM nocturnists often weigh this against the other drawbacks of constant schedule switching amongst their addition non-EM responsibilities. Some of our surveyed physicians suggested that the circadian rhythm disruptions get harder with age, but some of the women we spoke with have been doing this for years (up to a decade). In fact, most thought they would continue working nights for at least several more years, if not for their entire career.
Though a career of night shifts is not for everyone, there are certain benefits that tip the balance for many of today’s emergency physicians. Positive themes we uncovered included the value of a set schedule in maintaining a consistent presence for dependents, the camaraderie of the night shift team, as well as the perks and status afforded nocturnists by the departments that employ them. On the other hand, the physical and emotional challenges associated with the circadian rhythm disruptions should be carefully considered, and women contemplating this path should be sure they can adapt to the sleep schedule before proceeding… with eyes wide open.