I wrote the following post a year and a half ago while brainstorming my next steps. Part 1 is what I thought would happen. Part 2, the companion post, will describe what actually occurred.
It’s been a mere 15 years since graduating residency, and by all accounts I should be in the prime of my career. An auspicious new gray hair recently sprouted from my sideburns, leading me to believe that my Doogie Howser, MD youthful exuberance will soon give way to a Marcus Welby, MD, patina of gravitas.
Here’s my mundane reality: I’m getting tired of the night shifts.
Here’s your mundane reality: So are you.
And one of us is going to have to do them.
Mel Herbert, a charismatic lecturer of EM:RAP fame, is a beloved (and hilarious) faculty mentor from back in the day. He once confided that in addition to the usual reasons he enjoyed his position as an academic (loved teaching, felt rejuvenated by the trainees, etc) he liked being in a position where there were grunts to do the heavy lifting. His exact quote was, “It’s hard work being a pit doc. I wouldn’t last in a community hospital.”
How to solve the problem of the depleting night shifts? I still enjoy what I do tremendously, and I value the people I do it with. I just want to be less of a grump when I’m not doing it.
Plan A: Reduce overall clinical load
My group equitably divides nights, weekends and holidays. All members of our group take equal bites of the “crap pie” of undesirable shifts. The up side: we are fairly treated and members don’t feel exploited. The down side: those nights don’t go away over time.
Recently, we agreed on an emeritus status where, after 20 years with the group, you can get out of nights - a “death with dignity” option for one’s medical career before your group sets you out on an ice floe. Since I don’t qualify, that doesn’t help much.
My best bet: as I approach financial independence and require less income, I might be able to reduce my shift load to the bare minimum to retain equity status. Perhaps a reduction in total shifts will help me feel less depleted, since having to quickly turnaround from nights to days may be as much of a factor in my fatigue as the nights themselves.
Plan B: Transition to a place with a night premium, work only day shifts
There are ED groups where day shifts pay less, overnights pay more, and physician response to the free market allocates the undesirable shifts accordingly. This is a possibility in the future, but I really like my group, and would not currently sacrifice the camaraderie among friends for my less desirable local options that fit this bill.
Plan C: Assemble per diem shifts at another place like Kaiser and only work days
Our local Kaisers treat per diems fairly. The ED shifts are less grinding than comparable shifts at neighboring community hospitals, and they generally are happy to accept the assistance that per diems offer.
Plan D: Urgent Care
For some folks, this is a low-stress, no EMTALA environment. It pays less, so you may work more to make the same income. A few friends (especially primary caregivers for children) made the move for the more traditional hours and an arguably family-friendlier, consistent schedule, and they have no regrets. They openly admit to atrophy of critical care and invasive procedural skills. Personally, taking the part of my scope of practice that is least exciting and making it into my entire patient load is a less palatable option. Financial independence means I won’t need to work for the paycheck alone.
Plan E: Exit Strategy from clinical emergency medicine
Almost like clockwork, the annual SEAK conference pamphlet touting various exit strategies from clinical medicine arrives when I am vulnerable to their pitch. Inevitably, I read the offerings and realize the cure sounds less appealing than the disease. I’m actively exploring other interests in medicine, some of which may lead to a path out of the ED as I figure out my second act.
Plan FI: Gainfully Unemployed
Financial independence means I have a golden parachute that allows me to check the box marked, “none of the above.” I’m not ready to leave medicine completely, so given the current options, I’ll pursue plan A for the short-term, plan E for the long-term, with Plan FI lurking in the background as a source of comfort if no better options come to fruition.
See an option I didn’t adequately consider? Let me know!
Stay tuned for Part 2, what actually happened.