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Life in Emergistan: 24-hour shifts: an unexpected joy: Emergency Medicine News


24-hour EM positions, alternates


I worked for 20 years with eight and 12 hour shifts, day, evening and night. It was a normal life in our specialty. But I started as a locum about eight years ago and discovered the unique wonders of the 24-hour shift in the Critical Access Hospital along the way.

I can’t remember exactly where I worked my first 24 hour shift on this alternate trip. Maybe it was Indiana or Colorado. But it was the first time I had intentionally worked this long since the sometimes brutal residency schedule of calls when I was younger but, oddly enough, less resilient.

The 24-hour team is usually off the beaten track. It is found in hospitals on the mountainside and in the vast valleys where corn grows in summer. It is found in the cold north and the desert south. This is unusual in more populated areas. Its location and the very nature of the small outposts where you can effectively find a 24-hour crew make it a kind of work that is balanced between boredom and terror.

During busy shifts, disturbing or tragic shifts in small, remote hospitals, desperately ill people arrive with conditions far beyond the capacity of hospital staff and resources. Too often, these patients cannot be transferred by land or air due to the lack of paramedics or dangerous weather conditions or, lately, the lack of beds for hundreds of kilometers. This can make the 24 hour shift a chore of exhaustion and misery. In the end, however, weary and after doing your best for those who need it most, you may experience a remarkable sense of satisfaction, accompanying the painful urge to sleep, which makes the fresh morning air even sweeter. coming out of the door. .

Are the days gone?

Yet the 24-hour shift can be a joyful thing. Whether it’s the weather, the stoic nature of some rural people, or just stupid luck, sometimes nothing happens. Literally nothing. I think my personal best was two patients in 24 hours. I ate hospital food and watched movies in lavishly distributed call suites during those shifts. I stretched out by the fires in the lobby and watched Midwestern snow swirl outside or tumbleweed blast in the west. I lay down in a warm bed as the moon rose and the area fell into a wonderful rest. I would wake up in the morning refreshed and with money in my account, earned just to be ready in case something happened.

These deliciously difficult changes may one day be a thing of the past. Volumes fell during the pandemic, but they appear to be rebounding. Downtime is decreasing, even in critical access facilities, as patients have fewer care options and are even visiting these facilities in greater numbers. And many of these sites are closing as rural hospitals become less financially viable. Patients in remote areas will have more difficulty than ever as their only options are closed.

Those that remain open will increasingly be staffed with nurse practitioners, medical assistants and others untrained in emergency medicine. I have a feeling this is because emergency physicians see this job as an insufficient use of their training and skills. This attitude is a tragedy because it will make remote populations and subcultures even more vulnerable when tragedy strikes.

Of course, I understand why young doctors might avoid emergency departments with 24 hour shifts. The pay is usually lower, and it can be intimidating, especially right after training, to go from all possible resources to the only one available. Many of us have learned to be in these places through freelance moonlighting, something less available to modern resident physicians.

Good memories

All of this makes me a little sad for hospitals which are neither busy nor wealthy but which can provide volunteer physicians with an experience that is both educational and restful. It makes me equally sad for the doctors who will be working in increasingly busy departments and never know how medicine feels, when a shift doesn’t always mean a hard blow, when the night meant getting paid just for availability and willingness rather than speed and productivity.

The New Year brings a career change for me. My 24-hour shift days can fade in the rearview mirror. But I will always look back with fondness on the lives saved, as well as the naps taken, on those quarter marathons in rural America. And I will always recommend that doctors who want a fun change of pace to consider working around the clock, away from the hallowed halls of modern medicine, if only for snacks.

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Dr leappractices emergency medicine in rural South Carolina and is a columnist for the Greenville News. He is also the author of four books, Life in Emergistan, available at, and Knights who work, cats do not walk, and The practice test, all available on, and a blog, Read his past columns on