The Cons of Consistency in Scheduling in Medicine: Why You Might Miss Shift Work

As emergency physicians, we love to lament our schedule. We flip between nights and days, working random weekends and holidays. It’s erratic and impossible for our families to keep track of. We often think that if only we had a routine schedule, everything else would be manageable.    

Routine schedules sound attractive. You can finally sign up for the class that meets every Tuesday night. You will be free at the same time as most of your friends and family. You can attend weekend events where you previously would have been working. There are the health benefits of not disrupting your circadian rhythm or being able to establish diet and exercise routines. 

But having made the switch from an unpredictable emergency medicine schedule to a Monday through Friday, 9-5 job, I’ve found several drawbacks I never anticipated. They all seem obvious but carry a different weight once you’re actually living in the routine. 

Here are a few things I wish I understood before giving up the emergency medicine schedule.

You won’t actually be free on weekends

When you have an erratic schedule, you might get a haircut on Monday and squeeze a dentist's appointment in on Friday but go for groceries on a Wednesday afternoon. You get the job done, but you don’t have to waste a day doing it. You spread these tasks out over a week and get days back.

When you have a routine schedule, you have two days off to complete everything. You work all week, recuperate during the evening, see your family, and prepare for tomorrow.  You can try to complete some of these tasks during the week, but you’ll feel like you've just “worked a shift” and you'd prefer to go home and relax. 

This leaves you the weekend to get all these things accomplished. Repairs around the house, kid stuff, groceries – all necessary tasks will be squeezed into the only two free days you have. Before you know it, the weekend is over and it's time to return to the routine job.

You feel you’re leaving your week job to do your weekend job.

It's called ‘routine’ for a reason

Having the same pattern week after week is dull. 

You need vigilance to work an emergency department schedule. It gets switched around frequently enough to always keep you on your toes. You must mentally prepare for each shift. Nights mean something different than weekends or afternoons, and the shifts themselves can always be unpredictable. 

When you work a routine schedule, your brain starts to function differently. You look at Mondays as, well, Mondays. You look forward to Fridays and suddenly the phrase “hump day” makes sense. You begin the week eager and slowly phase out as time passes. 

You get through the weekend, attempt to reset, and then it's Monday all over again. It will be exactly the same next week. There is no variation and it doesn't take long to develop a sense of monotony, a drone where you live for two days off.  

You will be surprised to miss the diversity of your inconsistent schedule.

You’re suddenly on the same schedule as the rest of the world

Isn’t this the goal? To have the same schedule as your family and friends so you can enjoy time with them? 

It is, but this represents a small fraction of your time. The other 90% is spent carrying out tasks that keep your life moving forward.  Groceries, haircuts, oil changes, kid things – all are now not only squeezed into two days, they’re squeezed into the same two days that everyone else is also doing them. 

Sounds silly and obvious, right? 

But suddenly, you’re buying groceries at the same time as everyone else, competing for dinner reservations and waiting in line to do things you used to breeze through on Wednesday mornings. These are things you used to get done before an afternoon or morning shift - whenever it was convenient. You used to do these things at times that worked for you, not when you were free to do them.

This sounds trite, but these tasks can be enjoyable when you take the time to do them. It’s pleasant to stroll through a grocery store or be alone in a gym, for example.

When you switch to a routine schedule, you leave those experiences for more hectic and crowded ones.  

You will feel caged

This is the big one for me, coming from the world of independent contracting. 

The expectation that you’re at work every day will feel like confinement. It’s understood that this is what most people think is normal, but it’s the opposite of normal for us. We typically work a set number of hours, have a lot of flexibility with when those hours occur, can swap into and out of shifts, cover partial shifts, work doubles, and a host of other little tricks to get a schedule that works for us. 

With a routine schedule, this isn’t a choice. I can’t just decide to leave at noon when there is nothing to be done or pack 40 hours into three and half days and enjoy a long weekend.   

Even though you’re expected to be present for an entire shift, the feeling of a set schedule feels like a loss of liberty. Slow shifts feel like a break, like you got lucky, but slow days where you have nothing particular to do feel like a waste of time. 

Taking time off for vacation will really drive this feeling home. If you would previously just not give availability for a few days and head to the beach, you now find yourself asking permission to do the same.  Needing to be accountable for all your time isn’t that unusual or bad, it’s just a loss of freedom in scheduling that we may not be accustomed to, and it takes a significant change of perspective to accept.

If you are thinking about switching careers into something where you have a more “normal schedule,” remember that the grass isn't always greener on the other side. Consider whether the loss of freedom is really worth it (or, whether it’s negotiable) and whether you can come up with a way to keep your time off free before making the change.