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How I Get My Mind Ready for the Night Shift

Posted on Wed, Nov 30, 2016
How I Get My Mind Ready for the Night Shift

By Shilpa Amin, MD
 
I have been out of residency for seven years. For the duration of my career I have worked the late shift, either 4 p.m. to 2 a.m. or 5 p.m. to 3 a.m. In the past four years, I transitioned solely to nights. Why, you ask. How? I usually get looks of bafflement when I tell people that I work overnight in a very busy urban emergency department with single coverage, while juggling a family with three young children.
 
I transitioned to nights because it was easier for my family life. My children are in school. I typically leave when they are sleeping and can get home just before they wake. I sleep when they are at school and wake up to pick them up after school. They hardly notice that I’ve gone to work. This works well until they have a day off from school and don’t understand why I’m sleeping all day! Luckily because I work nights, I have a fairly set schedule and can work around their school calendar.
 
People ask me how I stay up all night. After all, it’s not natural. The key is having a routine that I go through each time I leave for work. My shift starts at 9 p.m. I start my routine at 7 p.m. My ritual is to read books to my children, put my scrubs on, brew and drink Mauritius tea at the kitchen table and decompress. l leave at 8:30 p.m. and pick up treats for the night staff from the same café. I call my husband or my sister on the drive, and park my car in the same spot.
 
I take a look at the waiting room on my way in. It’s been busier than normal the past few weeks. When I walk inside, I greet everyone and mentally get my plan together with my advanced practice provider about which patients to see. Throughout the night I drink a few cups of green tea for a boost of energy. The 4 a.m. hour is especially tough for me.
 
On my 20-minute drive home, I listen to my favorite station on Pandora and that’s usually enough time for me to decompress from the events of the night. When I get home, I send the kids off to school and fall back to sleep!
 
I look forward to my evening and morning routines because it gives me a sense of control, and that is rare during an ED shift.

Shilpa Amin, MD, FACEP, is a full-time attending emergency physician. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, N.Y. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine and served as chief resident. She enjoys spending her free time cooking, traveling and trying new cuisines with her husband and three young children.
 

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Studer Spotlight: The Real Cost of Emergency Department Physician Turnover

Posted on Wed, Feb 24, 2016
Studer Spotlight: The Real Cost of Emergency Department Physician Turnover

Since 2010, EmCare has maintained a strong partnership with Studer Group to improve clinical and operational results for our client hospitals. As a result of this partnership, Studer Group has provided access to exclusive content only available on StuderGroup.com. Each month, one of Studer Group's insightful articles will be made available to Emcare.com blog readers. For more information about EmCare's partnership with Studer Group, click here. For more exclusive content, including webinars, learning labs, networking opportunities and more, visit StuderGroup.com.

By Sachin Shah, MD, MBA, FAAEM

According to a May 2015 poll released by the American College of Emergency Physicians, three-quarters of the more than 2,000 physicians surveyed reported higher emergency visits from the previous year1. In an already fast-paced and at times, stressful environment, this increase in patient volume can contribute to physician stressors. Time constraints, longer practicing hours, reduced work/life blend, can all lead to decreased physician engagement, satisfaction, burnout and turnover.

The median annual salary for an emergency department physician is $261,054, as reported by salary.com2. While estimates on the actual cost of emergency physician turnover ranges from $50,000 to $500,000, depending on the types of cost included (lost revenue from previous physician; recruiting costs – such as advertising, interviewing, moving & signing bonuses; hiring; training; reduced productivity during learning curve; etc.), a conservative estimate is about $160,000.

Let’s say an emergency department physician generates $1.2 million in revenue annually. According to Cejka Search, a physician recruiting company, the average recruitment costs are $64,0003 including potential signing and recruiter fees. If we add in emergency physician training costs, including ED specific orientation, shadowing/joining peers during shifts, billing/coding courses, hospital required orientation and so on, that adds another $10,000 to $20,000 in training costs. During the onboarding process, productivity of the newly hired physician is typically around 80 percent for the first four months, which results in a loss of around $20,000 a month. As a result of these factors, it ends up costing the organization around $164,000 to replace one physician.

So how can we improve physician satisfaction and reduce turnover? Establishing a solid recruiting and selection process is a good place to start. Medical experience and skill are important, but so is personality, how well they work with potential colleagues and if they are committed to the mission, vision and values of the organization.

Senior Leaders can gather reward and recognition opportunities through Rounding on Patients and Staff and share specific feedback in thank you notes or by managing up physicians in front of peers. This lets the physician know that his or her efforts do not go unnoticed and reiterates they are a valued member of the care team.

At Studer Group, we’ve found that physicians are eager for data and feedback about their performance. Through regularly scheduled conversations, leaders and physicians can review patient experience scores, comments from Senior Leader Rounding, and discuss opportunities for improvement. This is also a good time to ask physicians if they have the tools and equipment they need and any development or training they would like to consider.

Sachin is a Board Certified Emergency Medicine physician with over 15 years of experience in the field. Following his training at Jacobi and Montefiore Hospitals in the Bronx, he became a faculty member of Temple University. Sachin is the Medical Director of the ED at Nyack Hospital in Nyack, NY. Previously, he was the Associate Medical Director of the Emergency Department at Westchester Medical Center in Valhalla, NY.

Sachin has been successful in operational improvements in the Emergency Department as well as the Hospital. In addition to helping steward a financially successful medical practice, Sachin has facilitated excellent performance on Turn Around Time metrics and Core Measures. He is proud to be involved with the American College of Emergency Physicians at both the state and national level.

 

References:
 
  1. American College of Emergency Physicians (ACEP). ER Visits Continue to Rise Since Implementation of Affordable Care Act. May 4, 2015. http://newsroom.acep.org/download/2015+ACEP+ACA+Poll+Report+FINAL.pdf
  2. Physician – Emergency Room Salaries. Salary.com. http://www1.salary.com/ER-Doctor-salary.html
  3. Cejka Search and AMGA 2012. Physician Turnover – What You Don't Know Can Cost You white paper

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