(Last Updated On: December 19, 2018)

Midnight Musings

Why I’m a Nocturnist

Hi.  I’m Tim Meehan.

I’m one of the nocturnists at UIHealth.  I’m hoping this semi-regular column will help shed some light (hehe) on the practice of EM in the wee hours of the day.

Things that we will (hopefully) talk about over the course of this experiment:

  • How to function when resource limited.
  • How to move a room (e.g. when to Fish/Cut Bait, utilizing the waiting room and pre-orders).
  • Hacks.
  • Consultant management & selling admissions.
  • Surviving the reverse circadian life (e.g. wellness as a night shifter).
It’s probably best to start with why I am an Emergency Physician as well as a dedicated Nocturnist.

EM chose me as a direct consequence of my experiences in clinic-based settings in medical school.  I found that I really liked all the core clerkships, but did not enjoy the practice of clinic-based medicine.  The only two specialties that, in my opinion, truly offer the breadth of clinical practice that I enjoyed were EM and Family Medicine… but, sorry Family Medicine, there was this pesky clinic thing.

Thus, EM.  Best choice I ever made within medicine, and one of the best I’ve made in my whole life.  Wouldn’t give this up for anything.  I constantly get to see new things, with new presentations, and get to save lives in the purest sense of the term.

However, EM can be demanding, and there’s a great fallacy out there in the interwebs, namely that of EM being a “lifestyle” specialty.  It isn’t, at least not in the traditional idea of a “lifestyle specialty.”  While you will have a lot of fun, and be financially well-compensated, the ED is a 24/7/365 operation and always needs to be staffed.  This will lead to missing weekends, holidays, and family events as a result of our shift coverage.

Sounds like a recipe for burnout, right?  

Well, EM has a lot of upsides that can help ameliorate this somewhat… for example:

  1. When you’re out, you’re out.  Minimal (or no) on-call responsibilities other than sick backup.  No clinic stuff following you home.
  2. You get to do all the fun stuff and then hand off to others to manage the (now) chronic problems.
  3. Rearranging the schedule to make time for an important date is relatively easily accomplished.
  4. EM is the best specialty.  And you get to practice it.  Bazinga!™
What about nights, aren’t they less desirable than days?

For me, the major benefit to working nights is that it helps me attain a greater work-life balance. I work when my kids are asleep and I sleep when they’re in school.  I can essentially make my own schedule and minimize the shift-work effect on my family (albeit at the tradeoff of my Vitamin D levels).

Nocturnists are prized, and frequently incentivized with nightshift differentials, scheduling preferences, and can often bank more RVUs by virtue of being solo. Plus, we are in demand virtually everywhere across the nation.  As an emergency physician, you will likely always be able to practice your trade, but nocturnists have a bit more leverage.

While there are some missed events from shift work, there’s also a lot of free time to support hobbies or other interests. If you are proactive enough to plan ahead, the schedule can be manipulated to allow for almost any extracurricular activity.

So, now we have the why covered.

You know a bit more about me and what has led me to this point in my career. In the next few posts we will tackle some of the issues that people see as the downside of working nights. Whether or not you end up as a nocturnist the tips and tricks should be applicable to any shift and they may make nights seem more enticing.

Tim Meehan, MD. MPH, FACEP

Assistant Clinical Professor Emergency Medicine and Medical Toxicology at UIH


Midnight Musings is an opinion based series and unless cited all opinions are the author’s own.