I wanted to add what I like about being a nocturnist EP, which I have been for 30 years. (ER Goddess: “Why I Work Nights and Dress Like Rainbow Brite,” EMN 2016;38:8; http://emn.online/Apr16ERGoddess; Special Report: “Surviving the Struggle: Nights in the ED,” EMN 2016;38:14; http://emn.online/Apr16SR.)
I'm one of only 1,400 of the 33,000 EM boarded physicians with that longevity, according to a recent letter from ABEM congratulating me.
I am currently working at an urban hospital in upstate New York with a census of more than 80,000 at our main facility and close to 40,000 at a freestanding suburban center. Night work has a number of disadvantages, most listed in the articles, such as the lack of radiologists for routine x-rays, off-site radiologists for CTs and ultrasounds, lower RN-to-patient staffing, having to deal with a greater number of intoxicated and violent patients, as well as the generally poor mood of patients and their families (they're not used to not sleeping). And, yes, Dr. Simons, the day after working a streak of nights is definitely one of lethargy. It makes you realize how much you depend on your adrenal gland during those stretches.
Because I don't have to deal with starting my shift at six different times during the day, however, I only have to deal with two biorhythm modes, one on days that I'm working and the one on days that I'm not. Plus, I get a more repetitive schedule that excludes weekends (except for Sunday nights).
I enjoy my days off, but I have found the camaraderie among the physicians, nurses, techs, and clerks who work the night shift — at least at my hospital — is probably the one aspect that makes me most look forward to heading in for my next shift.
I believe being a nocturnist has probably been a major reason I am still doing emergency medicine after 30 years. I know that Judy Tintinalli and Ron Krome, my mentors from residency, would be surprised to find out how much I truly enjoy the work I do.
Robert Rattner, MD