I notice that ER doctors sometimes work 24 hour shifts. Who exactly does this benefit? It seems to me that an exhausted and sleep-deprieved doctor (even if there are others around that aren’t sleep deprieved) is a liability to the hospital and I doubt that doctors themselves would choose this arrangement. If it’s to benefit the patients by allowing the doctor to work a patient from start to finish, I can’t think of that many serious issues that are completely resolved within a given 24 hours. There must be a good reason or they wouldn’t do it. I personally function best when I work a regular 8 or 10 hour shift and would never choose to work 24 hours straight. Any ideas?
I don’t think they’re on the their feet for the whole 24 hours. Rather, it’s the type of deal where they work eight hours, sleep eight hours in a bedroom at the hospital, but remaining on call so if some big emergency happens and they’re needed someone will come in and wake them up, and then work another eight hours after that. At least that’s how EMTs do it.
And then they’re also given a day or two or three to refresh.
I knew an ER doc who worked in a small-town hospital in 48 hour shifts, over the weekend. It was pretty much as joebuck20 described it, where he would work as needed. Most weekends were pretty mild, but he would occasionally get slammed and have to call in reinforcements.
I don’t know what the hospital’s motive was for working it this way, but my friend thought it was one sweet deal. He got in a whole week’s worth of work over the weekend, leaving him to play the rest of the week.
Money makes the World go around. If a doctor works regular 8 hour day shifts when the work load is heavy and then sits at home, being prepared to be called in for duty when need be, you just have to pay him some more on top of his wages for that inconvenience instead of having to hire two more persons to cover all 24 hours around the clock. I wouldn’t want to be operated upon by someone who has just finished a 72 hours on call shift, though.
Another reason I’ve heard is that many medical problems are not resolved within an 8-hour window, even assuming a patient arrived in the ER exactly at the start of a shift. A longer shift makes it possible for the same doctor to follow through with the patient as needed.
As one who’s unfortunately had many dealings with ERs, this doesn’t always happen, regardless of the scheduling. And some nurses and other medical professionals are better than others at doing an appropriate handoff to the next shift.
You’d be surprised how quickly you can get used to a set pattern. You may think you couldn’t do the 24 hour thing, but after a few months you’d most likely get used to it. Of course this doesn’t apply to everyone, some people just have to have a set sleep pattern to function. But I had a job where I worked 2 days of 13 hours and one 14 hour day and I was going nuts for the first month, but then I got used to the pattern and it was fine.
I am actually one of those physicians FORCED to work a 24 hour shift and then potentially stay another 8 hours following that. I can honestly tell you that, in my hospital, sleeping all night or 8 hours or anything for that matter is an unheard of situation. That’s why we are there, because there is work to do all night. In some small rural areas, a 24 hour shift may offer sleep. If one is sitting home and merely on call for a 24 hour period, that is NOT a 24 hour shift. It is beeper call from home a completely different situation.
We don’t allow our physicians in training to work over 24 hours without an 8 hour break, but we will allow, or shall I say force, our older attending physicians to do that PLUS work another 8 hours for a total of 32 straight hours without any break or sleep. That is the same as working 4 consecutive days back to back with no break and no sleep. Let’s all rais our hands if we think that is safe!!!
It’s usually the big boss sitting behind the desk acting like that is all OK and expected, and of course not personally doing it themselves.
If I were a pt, I would definitely ask the physician how many hours they had been on duty. If our public new this nonsense going on, they would surely shutter!!
Well, the reason I did it was money, and for some of those positions, it wasn’t unusual to actually have huge blocks of pretty free time. Many small EDs have low volume, and so it’s not unrealistic to try and cover long stretches with a single Doc. And in my experience, the nurses in some of those places are really good at taking the load off the Doc.
When I was just out of training for my ED certification, there were quite a number of ED staffing jobs available where you could work a whole 60 hours in a row. These were typically small rural hospitals with very spotty patient flow. We’d come in Friday PM at 6 and leave Monday AM at 6, typically. In the early days (70s and even 80s) of formal physician ED staffing, it was not unusual for (marginally-qualified) residents training in other specialties like Internal Medicine to moonlight as the staffing physician for a small ED.
But any shift over 12 hours needs to have breaks. In most situations where the scheduled shift is longer, the problem is that the breaks are unpredictable. You might get a few hours of uninterrupted sleep or you might even get a whole night’s sleep. You cannot safely work more than 24 hours without sleep, and even then more mistakes are made if the physician is sleep deprived.
As a consequence of more ED physician availability, recognition of the limitations of someone trying to work so many hours in row, and a general appreciation that a sleep-deprived Doctor is not a safe Doctor, there are far fewer such jobs, although I’m sure they still exist.
It’s not unusual in locum tenems positions for a couple of physicians to trade off 12 hour shifts so they don’t have to commute daily. And in that kind of instance, there probably are times when the off-duty Doc is requested to help. But most places have an ED Director who is ultimately responsible, and who pitches in for the unusual times that the scheduled staff just can’t cover.