Recently I was speaking to PA students, speaking to both first and second year graduate students. Some of them were about to graduate and some were about to step out of the classroom and into clinical rotations. Each student was thinking about what was next, whether heading out to roll up their sleeves for rotations or choosing their first job as a new graduate PA.
During the question and answer portion of the presentation, where I shared about burnout and boundaries, one of the students raised the question of shift work vs. a clinic position with “normal office hours” as a first job. She asked whether I thought that burnout was more likely with shift work or clinic work in an office setting.
Interestingly, during my presentation the program director was there. I shared my opinion that, biased by my experience with burnout, that I thought an inpatient position that was salaried without discrete shifts was most likely to lead to burnout. The program director’s background was primary care and she shared that she thought outpatient family practice was most likely to burnout.
We shared a chuckle and acknowledged that our perspective is skewed by our own personal experience with setting, work shifts, schedules and burnout.
Like many clinicians, this is a decision I’ve grappled with at various turning points throughout my career. So I’m eager for us to talk about shifts vs. office hours today.
It certainly sparked a healthy debate and conversation at that presentation so let’s bring that debate into today’s show.
We’re going to chat about the pros and cons of each type of practice setting and how to determine what’s best for you, your life and career based on the season you are currently in.
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The major advantage of shift work, even in high acuity settings, which often lend themselves to have shifts for scheduling, is that you can oftentimes leave work at work.
Take an Emergency Room or Trauma service for example. At the end of your shift, someone else is covering. There is no pager, no phonecalls, and once your charting is done and you log off, you’re off.
You can, with appropriate boundaries and coping mechanisms, turn off your brain and not worry about work at work. This often translates into the ability to decompress, rest and recharge when you are, quite literally, off the clock.
However, the biggest “con” of shift work can be the high acuity setting and the fact that there always seem to be shifts to pick up. Working in the ER there is often a text chain asking for coverage for certain dates. If those texts come in during your stretch of “off” days, it can interrupt your resting mojo and make you feel guilty and pressured into saying yes.
The other thing that could be seen as a con in this setting is the high acuity and strange shifts and nights. Oftentimes these positions have a night shift component or shifts that are longer and fewer.
If that works for your schedule, great.
If not, sometimes they are required anyway.
The big advantage of working in an office with “normal business hours” which I say with quotes around it because, they don’t always fall within normal business hours, is the predictability.
If you are set up to work at a clinic, in an office and you have patients from 8:30-4:30 Monday through Thursday, it lends itself to predictability and consistency.
The “con” is that this type of clinic work often follows you home. Due to your schedule and the restriction that comes with appointments at specifically scheduled time is that you can get behind on charting.
Over the years in healthcare the charting demands and Electronic Health Records have increased the burden of documentation, lending itself to death by a thousand clicks. This charting burden isn’t exclusive to outpatient or office-based settings, but it does cause those with predetermined appointments to be more likely to bring work home in the evenings.
A big “pro” of the office is that offices tend to observe more holiday closures and this can be a big benefit if your life outside of work runs on a Monday-Friday schedule or if you have others in your life with weekends and holidays off, like school aged kids.
One other “con” of office based clinical practice is that, if your clinic books out weeks-to-months in advance, is that short notice time off for illness or PTO, conferences or vacation can cause a scheduling snafu and make a headache for you seeing those patients and playing catch up.
There’s also the burden of following up on lab work and results for the patients that you’ve been seeing. The best outpatient positions have designated administrative time or the ability to get caught up on reviewing these results throughout the day or in a separate block.
How to Decide Which Is Right For you
No matter what your specialty is, there is one MAJOR thing to consider between shifts and regularly scheduled office hours: your LIFE.
I bet you thought I was going to say time or money, right?
The truth is, you can make shift work or an office schedule work for you in your life and your career. Either can lead to a great financial benefit and fulfilling clinical work. But in my experience, it’s what fits into your LIFE that is the most important.
Before I had kiddos and burned out, I LOVED working late. There was nothing more exciting clinically to me than an unstable patient with free air and a bowel perforation. Sign me up for all the middle-of-the-night laparotomies, running the small bowel and looking for the hole that is causing a person to be hypotensive as their body responded to the insult.
I thrived on the pager and loved the thrill of heading to the hospital in the wee hours in the morning.
Those days, before we had our little ones, challenged me clinically and I learned so much during that time.
I loved that aspect of my General Surgery position back in the day.
Now that I’ve settled into the office with regular office hours, I can see the benefits of a consistent schedule. When my kids have no school, our office is closed on certain federal holidays as well.
I can close my office well in advance to make sure I’m available during school break, parent teacher conferences and teacher workshops.
For me, I’ve really enjoyed this shift. I would note that I had about 6 months of decompression from the inpatient mey ley and hectic schedule to settle into consistency and office hours.
It depends for you on what you need during the season of life that you are in.
Here are a couple of questions to get those wheels turning.
- What does your schedule look like outside of work?
- How much time are you able to spend with those that you love in your life?
- Are you in a season where you have significant family and time demands outside of work?
- What are your career goals?
- What next move will help you to move towards those goals?
Still Not Sure?
If you’ve heard all of this and you’re thinking “Tracy, that sounds pretty cut and dry, but I’m not sure what is best for me” here it comes…
You can try both.
What have you done in the past and how has it felt?
If this would be your first position, think back to rotations. Which worked better – office or shifts?
I can personally remember the ER as a student – we had swing shifts. Days, nights, middle shifts, without a ton of days in between. There’s something that you really need to know about me. I LOVE sleep.
I am a much nicer person if I’ve had a great night of sleep. On this ER rotation I was upside down. Was it day? Was it night? I was exhausted (and to be honest, it was one of my first rotations so I was absolutely overwhelmed by the patients. I couldn’t tell who was sick as shit and who was there for a refill of their psych meds… it was the one rotation that I called my mom, sobbing from the driveway of the rental I lived in during PA school crying and telling her I didn’t think I was going to make it… and she told me to take a nap).
My friend and virtual assistant, Sarah – she works shifts, nights in the ICU – for her family this works great. That would be a TERRIBLE schedule for me. But each person has a different life and schedule outside of work. Someday I hope to have Sarah on the podcast to share all about how it works with her family!
I hope this episode helped to get the wheels turning and helped you to decide what would be the best choice for you – office or shift work – in your career and life.
Remember: The next move can help you to reach your career goals, personal achievements and the time and energy you can dedicate to both work and life.
You can get burned out working shift work or office hours. Anywhere that stress exists, burnout lurks. My experience with burnout is shared here.