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I'm a nocturnist intensivist. Started off 4ish years ago working days at an academic center. Can honestly say that if I had not started on days and learned all of the aspects of rounding, speaking with consultants regularly and seeing the patient in a longitudinal fashion I would be at a rougher point in my career.

Pros: 

I like nights, it's easier for me to get 6hrs of sleep during the days and function as opposed to 6hrs of sleep at night and function in the morning

It's more peaceful. No administrators, fewer nursing "leadership" running around.

It's less busy. You're generally not pursuing overnight workups on patients unless they are new admits/consults, a lot of it is cross coverage.

Compensation is significantly better as is the shift load.

Cons:

The opposite of all those things.

While I love working nights, statistically I will die sooner than someone not working nights. (Studies are questionable)

There are no administrators so you don't get the opportunity to build a relationship with them and work to advance your career.

Doing mainly cross coverage and just initiating workups deprives you of a whole range of learning opportunities and you miss out on a whole spectrum of the admission. Like when you figure out what the hell is actually wrong with the patient.

Ok, there's nothing bad about the pay bump and working ten shifts a month.

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Day shift: at most places you will be focused on "rounding" on a list of patients. That means you must see them, follow labs, talk to consultants, speak with case manager/SW, and speak with families. There is a lot of work involved. You also will learn a lot as you will be involved in working up acute problems and addressing chronic issues. While all of this is going on throughout the day you will probably get a few admissions from the ED. Overall, you have more work on days but a lot more resources as well.

Night shift: at most places you will be focusing on admissions from the ED. Admissions are a huge part of hospital medicine! At our place we are expected to work all acute problems and address all chronic issues (complete full h&p, work up pneumonia, start home meds, address code status). You see as many admissions as you can until your shift ends. During this time you get a ton of cross cover calls from the nurses on the floor. Some of these are simple prn meds but some are rapid responses/codes. 

Overall, most people enjoying the work they do at nights as it usually is less social drama, administrative issues, and other BS. However, working nights may not work as well with your personal life.

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On 10/4/2019 at 11:03 AM, MediMike said:

I'm a nocturnist intensivist. Started off 4ish years ago working days at an academic center. Can honestly say that if I had not started on days and learned all of the aspects of rounding, speaking with consultants regularly and seeing the patient in a longitudinal fashion I would be at a rougher point in my career.

Pros: 

I like nights, it's easier for me to get 6hrs of sleep during the days and function as opposed to 6hrs of sleep at night and function in the morning

It's more peaceful. No administrators, fewer nursing "leadership" running around.

It's less busy. You're generally not pursuing overnight workups on patients unless they are new admits/consults, a lot of it is cross coverage.

Compensation is significantly better as is the shift load.

Cons:

The opposite of all those things.

While I love working nights, statistically I will die sooner than someone not working nights. (Studies are questionable)

There are no administrators so you don't get the opportunity to build a relationship with them and work to advance your career.

Doing mainly cross coverage and just initiating workups deprives you of a whole range of learning opportunities and you miss out on a whole spectrum of the admission. Like when you figure out what the hell is actually wrong with the patient.

Ok, there's nothing bad about the pay bump and working ten shifts a month.

I’m an EM and Hospitalist nocturn. Echo all of the above. Also for me, being more of an EM guy, I hate doing discharges and social work, which I don’t have to do on night shift. 

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4 hours ago, LT_Oneal_PAC said:

I’m an EM and Hospitalist nocturn. Echo all of the above. Also for me, being more of an EM guy, I hate doing discharges and social work, which I don’t have to do on night shift. 

Oooooh yeah, major plusses there. 

Another downside though can be a lack of relationships with your consultants. You rarely get to meet them and all they know of you is somebody calling them at 3am.

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1 hour ago, MediMike said:

Oooooh yeah, major plusses there. 

Another downside though can be a lack of relationships with your consultants. You rarely get to meet them and all they know of you is somebody calling them at 3am.

Working in a CAH, We don’t have any consultants in house, so I don’t get to know them either way. Agree this is a minus at a larger center.

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Agreed with everyone posting above. I would not do Nocturnist Hospitalist as first job out of grad school. You need to solidify what you learned in school and build on it. Which means seeing more patients, doing admissions/consults and following patients daily to really understand the treatment plan and outcome. Learning what a sick/critical patient looks like takes time. 

Alot of the nights (based on how your hospital is set up) your main job is cross cover. Which means tons of prn orders for pain, sleep meds, constipation. Putting hands on the patients and evaluating them from start to finish is where you will polish your skills. There is only so much you can read and absorb at 3AM.

Other down fall of night is, it is sometimes very painful to interact with consultants over the phone. You get very grumpy answers for doing your due diligence in patient care. 

If you are looking for leadership positions those are mainly on days. Your interaction with management is limited on nights. Again based on how your hospital is set up you definitely get to admit more/see consults/round and follow patients for longer period of time on days. You may also listen/attend lectures that are presented from different departments. Interacting with consultants face to face and learning from them is a big plus.

Ultimately you get what you put in at any job. Be proactive and be willing to learn. Look up things you dont know and understand pathophysiology not just which med to push. This will save you when it comes time to respond to rapids and treat critical patients that are crashing on days or on nights.

 

 

 

 

 

 

 

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