Scheduling & seniority

[RetNavyPAC]

Wanted to get a feel for opinions on the issue of seniority when creating a schedule for PAs & NPs in the ED.

 

We have a decent-sized group (24 + 3 EM Fellows).  We work in all areas of the ED and geographically spread over 5 EDs (large level I trauma center, large community hospital and three small rural 1 doc:1 PA/NP coverage EDs.

 

We are lucky in that our department has two dedicated administrative staff to do ALL the scheduling for the docs and PAs/NPs.  It has always been thus and it has always been very equitable and fair.  It has also always been egalitarian (e.g. no one has a better schedule than anyone else).  It was that way when I started out as a full-time PA in the trenches, and it has remained that way since I became the Team Lead and then the Manager a couple years ago.

 

I think that this is the way it should be.  My contention is that no one really minds busting their ass, as long as when they look to their left and right, everybody else is also busting their ass.  When they don't - "All hands stand by for heavy rolls!"

 

We've hired PAs from other places who specifically stated that a major factor in their leaving their previous ED of employment was that the schedule wasn't fair.  The new guys and gals got the preponderance of shit shifts while the few senior PAs/NPs worked few (if any) weekends, holidays, overnights, etc.

 

Hardly a good recipe for recruitment or retention.

 

The only reason I'm venting is that I have a couple of senior PAs who are making noises about how it's 'unfair' that they can't have a 'set' schedule and/or not do nights or weekends because they've 'put in their time.'

 

This vexes me.  My argument to them is that due to their seniority they have indeed accrued benefits related to their seniority: influence, opportunity for leadership positions within our departmental structure (including protected time for those positions) - no to mention the fact that they each have many more years of merit increases than the rest of the group - and are the highest paid PAs/NPs in the group.

 

What I won't do is tell a young, eager, energetic ass-kicking PA or NP in the group is that, while I know how good they are they're just going to have to suck up a shittier schedule since they've not been here as long as those other guys. . . and watch all that energy and potential walk out the door.

 

Am I effing nuts?

 

Has anyone else dealt with this issue? (Hard to believe that answer will be 'No.')

 

Opinions?

 

 

[FfIghter23]

Honestly, I am surprised at those going into EM who don't understand the schedule of the ER prior to starting.

 

24/7/365. You better love it. You better be flexible. And when either of those things are absent, you better get out and go do something else for a while.

[cop to pa]

Not a PA.  But I've worked 24/7/365 jobs.  Some were fair, in that everyone got crapped on equally.  Others had schedules based on seniority.  I've been a junior guy and a senior guy in both.  While I enjoyed the better schedule as a senior guy in the seniority based model, I came pretty close to quitting as the new guy.  Also, when I became a senior guy, had a mentality that I deserved the better schedule after being dumped on.  So, my attitude didn't particularly improve as the old man. Neither did anyone else.  In some cases, attitudes became worse.  It was like forcing your way through a maelstrom just to get where you felt you were supposed to be.

 

I much prefer the equitable schedule.  I agree that working in the trenches and looking to see everyone, regardless of seniority, working the crap shift is a better overall morale situation.  Just my $0.02, take it for what its worth.

[gbrothers98]

I agree with your equitable schedule up to a point.

Couple areas where it can deviate.

Some places have a core of staff that stick around and others that come and go.

I think rewarding those whom stick around for the long term has a place in scheduling, especially when you start adding up cumulative holidays, weekends, nights at the same place.

There are those who are night people and those that arent. Let the nocturnists do their thing.

As the members of your group age, things change. I have seen 12 hour shifts turn to 8s, I have seen the older staff do less nights.

Something that helps alleviate issues such as this are differentials. There should be differentials that are real for working nights, weekends and holidays. 

My take on the differentials is that many workers are M-F, daytime. Just because you work in EM doesnt mean that you should also be required to take the abnormal hours without extra compensation. 

When weekends, nights, holidays are worked, the person that does it is missing out on the life everyone else has. 

As someone who is looking back on 17+ years of doing that, I have missed out on things I wished I hadnt and I wish I had much of that back. But that is life.

One last thing to add. When members of the group are making noise about scheduling, it should be heard. Particularly in the ED, everyone gets to eat the scheduling sh&t sandwich. When it starts to become overwhelming from an individual is their way of telegraphing the next step, which is usually leaving to whatever they consider the other side of the fence.

G Brothers PA-C

[HJK]

I agree with your equitable schedule up to a point.

Couple areas where it can deviate.

Some places have a core of staff that stick around and others that come and go.

I think rewarding those whom stick around for the long term has a place in scheduling, especially when you start adding up cumulative holidays, weekends, nights at the same place.

There are those who are night people and those that arent. Let the nocturnists do their thing.

As the members of your group age, things change. I have seen 12 hour shifts turn to 8s, I have seen the older staff do less nights.

Something that helps alleviate issues such as this are differentials. There should be differentials that are real for working nights, weekends and holidays.

My take on the differentials is that many workers are M-F, daytime. Just because you work in EM doesnt mean that you should also be required to take the abnormal hours without extra compensation.

When weekends, nights, holidays are worked, the person that does it is missing out on the life everyone else has.

As someone who is looking back on 17+ years of doing that, I have missed out on things I wished I hadnt and I wish I had much of that back. But that is life.

One last thing to add. When members of the group are making noise about scheduling, it should be heard. Particularly in the ED, everyone gets to eat the scheduling sh&t sandwich. When it starts to become overwhelming from an individual is their way of telegraphing the next step, which is usually leaving to whatever they consider the other side of the fence.

G Brothers PA-C

Wow. great points that I did not consider neither. it changed my view on the matter. Thank you.

[EMEDPA]

we schedule our night folks first. I am one of them. I work lots of shifts with no pattern other than no day/swing shifts. everyone else rotates all shifts, all days. we alternate holidays. I'm currently doing 12 of 14 nights and then am off for a bunch.

[Febrifuge]

Speaking as someone who specifically left the ER setting to go and get a flexible, weird-but-consistent schedule in the UC, and who is now craving the 9-to-5 and therefore branching out into a new area that ER folks consider to be eye-rollingly cushy, I agree with the initial post 100%.

 

Sure, GB raises some valid points, and a little consideration given to the people who have shouldered the load longer is fair. But as was said, those folks have many more years of merit increases, plus they have more influence and merit to begin with. It would be a shame to lose them, but they no doubt could go out and find something less taxing anytime they wanted. It seems to me they are choosing to remain in ER, which invovles some nights, weekends, and holidays, or else they are starting to leave but haven't yet realized that's what they are doing.

 

If I thought I could stroll in as a new guy and get an ER job that was 9 to 5 M-F, I would have done it years ago. Obviously that's not how it works; likewise, if the only people with good schedules were the old-timers, and each and every new person was handed the fuzzy side of the lollipop continually and exclusively, nobody would ever stay around long enough to become an old-timer.

 

Find a few little concessions, maybe, but don't mess with the fundamental reality of how scheduling works. Old guys can come work with me in the UC. Besides, I'm used to staff docs who LIKED working opposite the normal world, the weirdos. Overnights were only ever a thing when the core group of freaks was on vacation. Maybe get some people locked in to overnights, if you can find someone like that.

[RetNavyPAC]

Excellent points all & everyone.  Made me see some things from a different perspective that might have been overshadowed by my quest for egalitarian purity

 

We do have a 'nocturnist' who has a pretty set schedule - but that's the payoff for doing mostly nights.  Nobody resents his deal and for those he can't cover we have a pretty decent night shift differential (twice that of our for-profit 'competitors' across town).

 

And I do hear and listen to their 'concerns' and I give them consideration and examination, but I'd rather concentrate on greasing the well-running wheels.  You make the squeaky wheels see the benefit to the entire department - because what's good for the whole is good for the individuals. 

 

If they can't or won't - squeak away.  

[lightbearer06]

Where I work, the senior physicians can "buy out" of night shifts. Basically, they lose $15-20K of pay a year and this money goes right to the others that are working that crappy shifts.

 

To me, this is the best of both worlds. I remember a conversation that you and I had about having a nocturnist PA and there was no pay incentive. This simply is not feasible but I think if everyone pays into a pot and the nocturnist gets compensated appropriately, everyone is happy.

[EMEDPA]

for doing all nights I get an extra 5/hr and a greater % of rvu collections than the folks doing all shifts. (they get the increased $ and RVUs when they do a night too).

[ohiovolffemtp]

We have 2 folks who've agreed to work all overnights: 7p-6a for an additional $5-10/hour.  The rest of us rotate covering the nights they don't, but don't get that bump.  I've requested and almost always get the 3p-2a shift.  It eases my biorhythms with fewer shift hour changes.  I'm happy with that.

[Nonlegit]

We have 2 folks who've agreed to work all overnights: 7p-6a for an additional $5-10/hour.  The rest of us rotate covering the nights they don't, but don't get that bump.  I've requested and almost always get the 3p-2a shift.  It eases my biorhythms with fewer shift hour changes.  I'm happy with that.

 

As an aside, nursing staff in my ED have access to a VERY popular 3p-3a shift. I do it often when I need the days for classes. It definitely is a sweet shift for all the benefits of nights without a lot of the hassle of being up past dawn; low amounts of management, night shift camaraderie, night shift cases, differential, and on and on. All this and if you run home and get to sleep by 4a, you can wake up at 10a-11a and go about a fairly normal life.