M-F schedule vs Shift Work

[hightower]

As a hospitalist my schedule is all over the place.  I rarely work M-F and have weekends off.  It's usually some weird combination of days.  Could be monday through sunday, friday through tuesday, tuesd-friday, etc.  But, I only generally work around 15-18 days per month.  So, it's not unusual to have 4-8 days off after working several in a row.  It's generally easy to request time off, even 2-3 weeks at a time.  It's great if you travel a lot or have to make plans with family/friends.  But, it also means that I work a lot of weekends and a lot of holidays.  It can be pretty depressing at times when your only days off are during the week and everyone else is at work and then you go back to work on a weekend when everyone else is off.

I got pretty burnt out as a full time hospitalist last year and for the last 6 months I've been working as an "optional."  Meaning I can pick and choose how much  I work and when I work.  It's definitely helped with the burn out because I don't work long blocks of days anymore.  My shifts are all admitting shifts now, so I don't have long 12 hour rounding days any more.  It can be nice in some ways, but other times I wonder if a more regular/routine schedule would be better?  I find it hard to get in to a rhythm and I don't have a very dependable routine for myself.  For instance, people with a normal schedule can go to bed and wake up at about the same time every day. That's hard to do with shift work where sometimes you work until midnight and don't get to bed until 2am.  I also can't have a routine such as going for a bike ride every saturday morning or going to the gym every evening at the same time, etc.  I have to carefully plan for things in advance like that and it's all based on what days/times I'm working that week.

I am considering an outpatient job that would place me in a M-F scenario, no weekends, no holidays, no call.  The days are only 8 hours long, but that includes a 1 hour lunch and 1 hour of downtime for catching up.  So, its 6 hours of work each day and fridays end early (by like 1pm usually I'm told).  But, I'm hesitant because I don't know if I'd like being in a job that requires 20+ days per month.  It also only includes 20 days of PTO per year (in addition to the holidays) which is a lot less free time then I'm used to now.  The pay is going to be significantly less than what I can make as a hospitalist, but I would be able to supplement my income with hospitalist shifts prn.

I've never had a M-F job so I guess it's a little bit of "fear of the unknown" that's making me hesitant to commit.  My wife works a M-F job and usually has weekends off.  She's not always totally thrilled about her job, but if I had the same schedule as her it would be a lot easier for us to coordinate our time off together.  As it stands now I work a lot of weekends so we don't get a ton of days off together.

I'm having a really hard time deciding what I want to do.  On one hand the dependable schedule, lower stress days, and every weekend/holiday off sounds amazing.  But, on the other hand, working 20+ days per month, less time off, and lower pay have me worried.  I have the option of working full time at a new hospital further away from my house that is smaller, lower volume and likely going to be less stressful than my last full time hospitalist position.  It also has the potential to make me a lot more money.  So, I'm trying to decide between that and the outpatient option.

Just curious what other's thoughts and experiences are on having a regular schedule vs a more random one??

[Zaphod]

I like the regular schedule, makes all of life more routine and easier to predict which lessens overall stress imo. Especially great for just more family time if it coincides with your wifes schedule. However, you do have a lot of other variables that are coming in to play so best of luck to your decision making.

[StarTrekDoc]

More importantly, is the work itself going to be satisfying beyond the scheduled work.    The scheduled 9-5 M-F work is nice, especially for social reasons as you mentioned

[RogueDadMD]

I have a random schedule. No two weeks are alike.

Some days some evenings some weekends some nights some holidays some office days.

My wife the last few years has worked T-Fri every week (shifts from 8-12 hours).

I have a lot of flexibility on when I work my shifts. While I do miss occasional evening or weekend activities because of my schedule, I don't miss a ton because I can request to avoid certain weekdays/weekends or even avoid specific shifts on specific days. I have more flexibility to take days off when I know the kids need me for something and the ability to request off for trips.

It makes exercise almost impossible to schedule a routine. When I WAS in good shape and exercising routinely I was planning trainer workouts weeks in advance and my personal workouts every week. It sucks getting home at 1-2am and waking up at 6am (usually one of the younger 2, needy, kids are awake by then).

I love having a different schedule every day because I'm not a Mon-Fri 9-5 personality. Also I hated clinic in residency so wouldn't do well with that as a full time job.

A traditional work schedule gives you predictability and routine. That can be great and sometimes necessary. If you have kids being home every night and weekend is great. Sounds like the Fridays aren't too bad either. When I work a weekend night shifts I don't mind the work but my has a lot to handle.

It also has drawbacks depending on you and what else goes on in your life.

[Hatton]

I guess the question that I have Hightower is how old are you?  Are you aiming for a long career or to fire?  I think most of us develop a rhythm to our practices.  If you can find a hospital setting that has congenial staff and good support that might make weird hours more palatable.  I personally like to work with people that I have known a long time especially in the OR.

[hightower]

StarTrekDoc wrote:

More importantly, is the work itself going to be satisfying beyond the scheduled work.    The scheduled 9-5 M-F work is nice, especially for social reasons as you mentioned

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I think the work will be satisfying, at least new and interesting for awhile.  Another option would be to do something part time with the clinic, maybe a tuesday, wednesday, thursday kind of thing and then do part time hospitalist shifts on mondays and fridays or even over the weekend.  That way I'd still get some of the regularity and predictability, but also the flexibility to take a 4 day weekend if I wanted to or power through and earn extra money by working extra on the weekends.

I haven't had that discussion with them yet.  I know they want me full time, but I would assume they'd probably be open to a part time gig too.

[hightower]

hatton1 wrote:

I guess the question that I have Hightower is how old are you?  Are you aiming for a long career or to fire?  I think most of us develop a rhythm to our practices.  If you can find a hospital setting that has congenial staff and good support that might make weird hours more palatable.  I personally like to work with people that I have known a long time especially in the OR.

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I'm 35.  My wife and I would like to aim for early retirement.  Our current desire would be to be able to semi-retire by 45 (my wife and I both working part time) and then full retire by 55.  We have the numbers worked out and it is possible to do if we stay the course and work hard.

I agree with you that having a rhythm to your practice and getting to know the people you work with is great.  That's honestly what I would prefer.  I haven't started any shifts at the new hospital yet, but will be doing my first shift there next week.  I guess I just need to try it out and see what feels right.  So far the outpatient option has been okay, but I've been leaning towards the hospital gig because it seems more familiar to me and the money is so much better.

[StarTrekDoc]

My concern is that you felt burnout at 35 yo and looking to different gigs yet want flexibility and higher income and FIRE 55.  That's a lot to squeeze in 20 yrs and burnout symptoms at this juncture.

Being from outpatient internal medicine I have a skewed opinion toward longevity over higher income intensity as a burnout risk.  Whatever position it is, you really should like your job -- either current, or 9-5 or the new hospital gig.

[YSH]

I find M-F schedules annoying because you are off when everyone else is off, which sometimes causes bottleneck issues elsewhere.  I used to work a more consistent M-F schedule, but then I was basically fighting with everyone else that also have a regular schedule for things that happen outside of work, ie appointments, grocery shopping, going to the gym, TRAFFIC.

I now have a shift like schedule where no two weeks are the same.  I also only work 0.5-0.85, depending on the month's needs.  Personally, I love it.  I don't have to fight with everyone else when I need to get errands done or when I am trying to live my life.  I can schedule things during "off hours" and not feel rushed.  I can get a table at a nice restaurant during the week for lunch or dinner with a friend and not have to wait in line, make reservation a month ahead of time or feel like the wait staff is rushing us out once we are done eating.

 

 

 

 

[wideopenspaces]

So this is coming to you from a woman's perspective :-) I LOVE having a regular schedule at this time in my life. It allows for the greatest amount of family time, in my experience (and based on what you have described). If I didn't have kids, if I was single, if my spouse had a flexible schedule, then sure-I'd consider shift work. But I like to spend my free time with my kids and my husband. I'm just part time right now and I have 3 days a week where I'm just at home with the baby. I am thankful to be able to do this but at the same time, it's definitely not as good as when we're all home together on the weekends. But maybe I just really like my husband more than is normal? I'm not sure. But I would not be happy if either of us was working weird hours and we didn't get to spend our free time together. But as you can see from the different responses, this very much seems to be driven by personality and current life situation and life goals. Ultimately you know yourself best and can hopefully use that as a guide to what might be best for you. Good luck figuring it out!

[pulmdoc]

Is there a reason your hospitalist schedule was so chaotic? The hospitalists I work with work 7 days on, 7 days off. Working every other weekend can be rough, but there is predictability and flexibility in that kind of schedule.

Outpatient IM is a completely different beast than hospitalist work and a poor setup can lead to burnout just as easily. How many patients/day? How many new vs established? How much ancillary support do you have? What office procedures are you expected to do, and do you feel comfortable doing them? How does the compensation model match up with how busy you want to be? These are all important questions to try and get answered before you make the switch.

[Anesthesia84]

I love having my work be during the day M-F (I work 4 days with a rotating day off each week). I took a large paycut to have this schedule (no required nights/ weekend/ call) but for me the benefits are worth it. We have 3 young kids, and  my husband is a cardiologist with a "regular" schedule (plus call) so weekends are our family time. The kids' activities are mostly evenings and weekends so I am often able to be free. The kids also like the reliability of me being home pretty much every night for bedtime. I exercise regularly and find it easier to do when I know I can get up early (my internal alarm clock gets me up by 4:30, ha) and run/ swim/ etc before work.

Now that I've worked this schedule for a few years, there is pretty much no way my group could convince me to do otherwise. We are planning to get to our one person- FI number by age 40 so that if there are changes coming in my group, me working will be optional. Luckily, my husband is planning to work for awhile so that makes it a lot easier for work to be optional for me

[hightower]

pulmdoc wrote:

Is there a reason your hospitalist schedule was so chaotic? The hospitalists I work with work 7 days on, 7 days off. Working every other weekend can be rough, but there is predictability and flexibility in that kind of schedule.

Outpatient IM is a completely different beast than hospitalist work and a poor setup can lead to burnout just as easily. How many patients/day? How many new vs established? How much ancillary support do you have? What office procedures are you expected to do, and do you feel comfortable doing them? How does the compensation model match up with how busy you want to be? These are all important questions to try and get answered before you make the switch.

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Yeah, our group didn't use the 7 on/7 off scheduling.  They would do various lengths of blocks of days.  Sometimes 4-10 days on at a time which included a mix of admitting and rounding shifts.  It's a system that works well if you have a relatively low volume of patients on the census.  Our group used to be much smaller and much lower volume.  If the hospital hadn't gotten so much more busy over the last several years or if the leadership of our group had done a better job helping us adapt to the increase in volume, I wouldn't be having this conversation.  But, it has just become unsustainably crazy at this hospital in many ways.

I should mention that the outpatient opportunity I'm considering is actually an addiction medicine position at an outpatient opioid treatment center (suboxone).  It's much lower stress, much lower volume, much more focused practice.  The days are 8 hours long, but include 1 hour for lunch and a total of 1 hour of downtime built in for catch up.  The most patients that can been scheduled for any given day is 12.  It's a pretty sweet schedule really.  So far, the work has been pleasant on the few short shifts I've worked.  It's a very well run practice.  And no, this place is definitely not a pill mill.

I honestly don't think I could tolerate an outpatient IM position.  They see too many patients per day and are responsible for far too many problems.

[hightower]

StarTrekDoc wrote:

My concern is that you felt burnout at 35 yo and looking to different gigs yet want flexibility and higher income and FIRE 55.  That’s a lot to squeeze in 20 yrs and burnout symptoms at this juncture.

Being from outpatient internal medicine I have a skewed opinion toward longevity over higher income intensity as a burnout risk.  Whatever position it is, you really should like your job — either current, or 9-5 or the new hospital gig.

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You're absolutely right in that I have to make sure I'm enjoying whatever it is that I'm doing.  I feel ready to work fairly hard over the next 5 years to really boost my savings while I'm still relatively young.  I'd like to be able to gradually pull back after that though.

 

wideopenspaces wrote:

So this is coming to you from a woman’s perspective ? I LOVE having a regular schedule at this time in my life. It allows for the greatest amount of family time, in my experience (and based on what you have described). If I didn’t have kids, if I was single, if my spouse had a flexible schedule, then sure-I’d consider shift work. But I like to spend my free time with my kids and my husband. I’m just part time right now and I have 3 days a week where I’m just at home with the baby. I am thankful to be able to do this but at the same time, it’s definitely not as good as when we’re all home together on the weekends. But maybe I just really like my husband more than is normal? I’m not sure. But I would not be happy if either of us was working weird hours and we didn’t get to spend our free time together. But as you can see from the different responses, this very much seems to be driven by personality and current life situation and life goals. Ultimately you know yourself best and can hopefully use that as a guide to what might be best for you. Good luck figuring it out!

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I really appreciate your perspective.  I think you bring up a good point.  My current life situation is well suited to the shift work/random scheduling simply because I don't have kids and my wife and I can be fairly flexible at this point.  That could change in the next year or so.  We are trying for a family.  I definitely see the merits of a M-F schedule for family time.  The hospitalist position I'm looking at wouldn't be too bad in terms of weird hours.  The latest I'd be expected to work would be 7pm, but would definitely include weekends.

[hightower]

YSH wrote:

I find M-F schedules annoying because you are off when everyone else is off, which sometimes causes bottleneck issues elsewhere.  I used to work a more consistent M-F schedule, but then I was basically fighting with everyone else that also have a regular schedule for things that happen outside of work, ie appointments, grocery shopping, going to the gym, TRAFFIC.

I now have a shift like schedule where no two weeks are the same.  I also only work 0.5-0.85, depending on the month’s needs.  Personally, I love it.  I don’t have to fight with everyone else when I need to get errands done or when I am trying to live my life.  I can schedule things during “off hours” and not feel rushed.  I can get a table at a nice restaurant during the week for lunch or dinner with a friend and not have to wait in line, make reservation a month ahead of time or feel like the wait staff is rushing us out once we are done eating.

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That's certainly something I've thought about too. Especially as it relates to travel. If you want to do a weekend get away, it would often end up needing to happen on a holiday weekend in which travel can be nuts and very stressful.  In years past we've been able to schedule trips right after a major holiday to avoid all the craziness.  I'll never forget the first time we went to Yosemite the week after labor day and we saw the huge line of cars leaving the park and causing traffic jams for miles as they headed back towards SF.  We just happily drove right by them in the opposite direction.

But, if we end up with a kid or two the traveling will slow down for at least a couple years I'm sure so that won't be as big of a deal initially.