Attention emergency physicians: How about 8 hour shifts?
Posted by CEP America on Thu, Feb 18, 2010 @ 06:47 PM
By Imamu Tomlinson, MD, Dan Culhane, MD, John Ruffner
It's been suggested that the best emergency physician work schedule is 24 one-hour shifts per month. If pigs could fly! It seems the 12 hour shift is the most popular, but is it the best? (It came from emergency medicine's operating needs, and had little to do with patient considerations).
More relevant discussions center around ER shift lengths of 7 to 12 hours. After numerous discussions with colleagues about shift length, we asked: "What's wrong with 8 hour shifts?" The following are the findings of some of the key components of this discussion:
Scheduling Shorter shifts create more flexibility in drawing up the schedule (covering open days) and allows for better matching of provider hours to patient volume throughout the day. Shorter shifts also mean a provider will work more days in a month.
Productivity Many emergency physicians have described their experiences of substantial productivity drop-off in the last two hours of a 12-hour shift as they anticipated the arrival of the shift change. One comment seems to capture this dynamic: "With an 8-hour shift, it seems like a new provider is coming on just as productivity starts to drop." Another common response was: "It makes it easier to stay an extra hour when needed."
Clinical Decision Making Many colleagues expressed a concern about the quality of clinical decision making over 12-hour shifts. There really isn't conclusive data on this element, but there is a risk associated with the increased number of ‘hand offs' associated with more scheduled shifts.
Quality of Life Numerous colleagues provided their experience with shorter shifts, many of whom saw themselves as 12-hour providers - that's just who they were.
Here are some comments of those who converted to 8 hours shifts:
"Having 8-hour shifts is like having a real life."
"I don't feel that I'm working as hard."
"I don't know of any site that has converted to shorter shifts that has gone back to 12's."
"The nursing staff and our mid levels tell us it feels like they have more help."
"Working more days but on the days I work, I can get stuff done."
"I saw 35 patients on one of our 7-hour shifts and feel productivity is enhanced."
"Shorter shifts changed my life."
"As I get older, the short shift really works for me"
"I sure haven't seen any negative impact on patient care."
We'd love to hear your thoughts on emergency physician shifts. What about 8 hours?