What does the schedule of an Emergency Medicine Physician look like?

As an Emergency Medicine Physician, my schedule is anything but predictable. One of the hardest things I remember from my first year in residency, was teaching my body NOT to have a schedule. It took about a year for me to get used to switching back and forth. That’s part of Emergency Medicine. We work mornings, days, nights, weekends, holidays, you name it we work it. The hard part, is that our schedule is never the same. Often times we will work a couple of morning shifts, then transition into a couple of night shifts, and then back to mornings. The hardest transition being nights back to days within a short period of time. Of course, our schedules are dependent on the group we work for and what their requirements are, but every week is different for most EM docs.

How many shifts per month?

The hours in an EM doc’s shifts and number of shifts worked per month is largely dependent on the group requirements also. “Full time” for one group may be 12 shifts per month while for others it may be 15 or more. Some groups hire part time physicians, so the option to work less than 12 is also out there. My experience may not be the same as others, but I typically work 12-13 shifts per month. The number of shifts per month was a choice for me, thankfully.

That’s one of the things I love about Emergency Medicine. The shifts may be tough and at light speed, but the positive trade off is that we generally have more days off than any other physician in medicine. I used to work more shifts each month, but I noticed a little bit of burn out and blogging became my second job. Finding more of a balance is something I am grateful for, because I love medicine but I also love free time to be creative.

Emergency Medicine offers up a widely flexible schedule, on top of everything else I just mentioned. Have a dentist appointment you’ve been waiting to schedule? No problem. Just plan it for a morning when you don’t work until the afternoon. Easy peasy, with no time-off requests needed. You want to take a vacation with your family? We EM docs can typically stack a chunk of shifts together, allowing for multiple days off in a row. There are of course, the trade offs of night shifts and holidays, but at least there are many positives to sweeten the deal.

How long are the shifts?

The length of each shift will depend largely on the department’s flow and census. Physician coverage is also dependent on these numbers. Some locations may be very slow with a low census (think small rural town), so they will likely have single doctor coverage (only one doctor in the department seeing patients). These shifts could be up to 24 hours, but this is rare for any busier department. The majority of departments have shifts that are 8-12 hours (8-10 being most common), and staff multiple physicians during each shift, tailoring up or down for the busiest/slowest times of the day. I personally see patients for 8 hours on average, but my shift isn’t necessarily done at 8 hours. Many groups will sign out patients to the next oncoming doctor while others do not. In the latter case, the physician stays until their patients all have a disposition (admitted or discharged).

What does a typical shift look like?

A shift in the Emergency Department is typically busy. Unlike a doctor who is “on call” overnight, we don’t lay down or nap during shifts. There is rarely down time, for me, but again this is dependent on the population you serve and the areas surrounding the department. The best part about being busy for 8 straight hours, is that the time seems to pass quickly!

What about night shifts? Do you have to work nights forever?

Some Emergency Medicine group structures include a “buy in” period, where the newer physicians work more nights than those with more seniority. This has been my experience. When I started (almost 4 years ago!) I worked half of my shifts at night. Back then it was about 7 night shifts per month, single coverage, and it was brutal at times. Circadian rhythms do not like to be disrupted my friends. Chris had a night shift alter ego name for me, we won’t get into that part! You can check out this blog filled with tips for those night shift workers out there.

So there you have it! My full time job as an Emergency Medicine Physician allows me the time and flexibility to also be here, in this space, writing blogs and creating content. And now you know why!

Feel free to leave any additional questions about scheduling below in the comments!



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40 thoughts on “What does the schedule of an Emergency Medicine Physician look like?

  1. When it comes to Ems, how do you and C work your schedules so that you have enough time for her? Do you hire a sitter to come check on her when your shifts overlap or work it out so that you both have shifts at different times? My boyfriend and I have a similar situation and just got a dog (:

    1. Hi there! EMS is 3 now, so she’s able to be in her crate while we are at work. When we got her, Chris was actually off work on injury so it was perfect timing, he was home all the time. We don’t have a sitter or doggy daycare. She was crate trained very young and loves being in there. With the way our schedules overlap it’s actually perfect for her. She’s rarely in there more than 8 hours. When Chris was working 2 days on, 4 days off, it would sometimes be more than that if I was working those 2 days he was gone, but now he has a more normal schedule. Doggy daycares and walkers are a great option for people who work longer hours. Residency would’ve been a tough schedule to keep with a puppy, but I know many friends who do it!

  2. This was such a good read! I’m also considering EM because of the life-work balance. I was wondering if you could tell me more about your day in a life as an EM physician. What time do you wake up, get to work, go home, how many patients do you see in a daily, etc etc. Also, since you are working in shifts, does that mean you’re never on call? Looking forward to your response! πŸ™‚

    1. Hi there! It’s hard to say what time I wake up or get to work or go home because every shift is different! I either work very early, mid day, or late evening. Overnight shifts are less common for me now. Typically my shifts last 10 hours because we see our patients through to the end of their care. On average I see 2-3 patients per hour, which is definitely busy and fast paced in comparison to other ED’s I’ve worked in. Just depends on the site and coverage. Correct, I am never on call. Shift work only. We do have a backup schedule when needed but most docs prefer to be busy so it’s not typical that it is activated.

      1. Hi Dr. Majestic!

        Thank you so much for all the information! It was so helpful, as I’m considering EM as well! Can you talk more about what made you chose EM? I’m not sure if I’m interested in EM for the right reasons. Also, what kind of patients do you typically see in EM? I would really appreciate your reply πŸ™‚

        Thank you so much πŸ™‚

  3. Mam there is a period where you are at home… Say for 15 days and again you have to jump into medicine…… Doesn’t it affect your continuity or active way of practising medicine?

    1. Not at all. The length of school and training including experience clinically helps you never forget. Even if you have days off!

  4. Good evening,

    My question is: What time do ER doctors clock-in and clock-out on their morning, evening, and night shifts?

    Thank you


    1. It depends on the group. Typically the times are set based on flow in the ED. For me, it’s 6am, 12pm, 2pm, or 10pm. Shifts can be 8-10 hours or more. Depends on the patient load.

  5. Would you say that there were plenty of your colleagues with ADHD? I’ve heard that ADHD is common for doctors who thrive in this specialty. Do you feel like the lack of consistent sleep routine negatively impacts your health? Also: as a female physician, do you feel like you get the same degree of patient anger and hostility that my book about medical specialties warned me about? (is assault really common? Like do they train you to know what to do to protect yourself?)

    1. I honestly don’t know much about the medical history of my colleagues. I don’t necessarily think the field is good for, or predisposes anyone to ADHD, but it may seem that way because you’re switching from task to task. Circadian rhythm disruptions definitely negatively impacts health. Depending on the group you work for, there are some things you can do to help with this. As an Emergency Department provider we do encounter angry patients. I see this whether male or female providers are caring for the patient. Many of my attendings along the way taught me how to position and prevent events such as assault, but with the presentation of altered or confused patients, it is always a risk.

  6. Hi!
    I’m in the process of applying to medical school. How many hours a week did you work in residency, and do you think you would do it all over again or choose a different path?

    1. Hi there! Residency is tough in terms of hours, regardless of which specialty you choose.
      I worked at least 80 hours weekly + time outside of patient care on research, charting, studying, meetings, etc.
      I’m happy with Emergency Medicine, I wouldn’t choose another field of medicine. Knowing what I know now… if someone told me I had to do it all over again, I’d say no thanks! haha BUT if I had to start all over again with no memory… I wouldn’t change a thing πŸ™‚

      1. Hi Cassie! I’m considering multiple career paths including as an emergency physician, but also non-physician roles in the medical field. Can you expand on the comment that you would say no thanks? If you could go back knowing what you know now, would you still go the EM path, or would you choose a different specialty or even different (non-physician) field?

        1. The only field that I felt fit my personality was Emergency Medicine. I don’t think I would change anything, despite the fact that the field has many challenges that come along with it. I am passionate about science and medicine, but now that I am older, I can honestly say I could have been happy doing other things also. Obviously I don’t regret becoming a physician and I am fulfilled and grateful to have met my goals in life. Just looking back, I now know that there are many things that I enjoy in life that I could have pursued and found success in.

    1. This is very dependent on the Emergency Department (location, how busy, coverage, etc). In our ED, the PAs tend to see the lower acuity patients, or help triage patients and place orders. They also help (or perform independently) many of the procedures such as laceration repairs, abscess drainage, splinting, etc. The PAs are supervised by the physicians meaning we oversee their care and answer questions if they have them, but PAs have their own licenses to prescribe and are responsible for their own patients legally. Some EDs are different but in our ED we never expect PAs to see the complex cases. Our physicians perform all of the more complex procedures such as intubations, chest tubes, resuscitations, etc. We also assume care for all of the critical cases and most abdominal pain, chest pain, elderly, septic. We work hand in hand with the PAs as a team but the physicians assume more responsibility (as they are technically the supervisor always) and heavier load of complex patients. This is highly variable in other fields outside of EM, and depending on the ED. Hope that helps!

    1. We see everyone that comes through the Emergency Department! That could be someone with a broken bone, or abdominal pain, or someone who is actively dying. Anybody who presents to our doors, we have to evaluate, diagnose, and treat. This happens during every shift. Every department is different in terms of how busy it is. Some ED physicians have down time when they are on shift, if no one presents to the ED. I personally don’t experience this because my location is a constantly busy, community department. It’s go-go-go for the entire shift!

  7. Hi Dr. Majestic,

    MS3 (IMG) here! Thank you for sharing your posts – I’ve began to find more and more interest in EM. I’m about halfway through my core rotations in NYC. Any recommendations on how to obtain strong LORs (SLOEs) for EM?

    1. Hi there! So excited for you! I recommend sticking with mentors that you know will help you stand out. If applying to EM, it’s desirable to have a LOR from EM providers or teachers in the field. Anyone can write a great letter, but try to choose someone that writes well, and will say more than just the standard stuff. Ideally, they should come from people who know you well on many levels. So… since you have time, work on that relationship with those people that you desire a LOR from. Hope that helps!

      1. Hi Dr. Majestic

        How are you going about paying off your student load debt? Are you the one to face family/friends when someone dies on your watch? Thank you ahead <3

  8. My name is Eliana, and I am a third year pre-med interested in EM. The thing currently holding me back is that I worry I will not make it through the grueling training because of my anxiety. Do I go through with it, or pursue PA?

    1. There are many ways to manage anxiety! PA school will have similar training with similar scenarios. I guess you have to figure out what is causing your anxiety to begin with… and see if that is something you can work with in order to pursue your dreams!

  9. Hi, I’m a mum
    About to embark on my Med school journey. Excited but also wondering how we’ll manage to juggle and balance. Thanks for sharing your journey!

  10. I used to work Emergency Medicine and we work in rural areas, so it’s a 24 hour shift clinic plus field work. During the corona virus, we were not allowed to work if we came in with a temperature and had to be isolated at home for at least 7 days to see if symptoms develop, and I swear that one guy put tea on his head or something before coming to work, because he always had a fever at least once a month.

    I had to cover his shift, since I’m an immigrant doctor in the EU, with no family, partner nor friends to have “responsibilities” at home. So I was doing 24 hour shifts every other day. This required me to drive that 80 km to work by 6:30 in the morning, because the doctors usually don’t finish their shifts at 7:00 and want to home early and dump their last calls or patients on me.

    I’ve been an EM doctor for 10 years and have Europeans treat their doctors like crap. I got burnt out and the director of the Department of Emergency Medicine probably doesn’t understand psychology, and I got fired for being burnt out at work. Plus my colleagues would leave the department in a mess in their rush to get home and don’t reset the clinic for the next shift, which means I have to prep the clinic. I went to a psychiatrist for burn out, and in Europe, a visit to a psychiatrist is stigmatized, so the director thought I was “unstable” instead of realizing that I was over-worked.

    I shifted to Family Medicine and it took me 8 months to get my circadian rhythm back to normal. EM is paid the least (EU paycheck is $1500 per month) for the amount of stress people put on their bodies. At 41, I realized that it’s not worth the stress of having broken sleep almost every other day and having to be on “alert” mode.

    Working in the ED, I would have to do 4 patients an hour because of the patient load and Croatians are spoiled people and start yelling when they have to wait longer than 30 minutes for an examination, and do not realize that I take patients based on triage priority. Then Croatia, people have “contacts” with my superiors and skip line for a simple bandage cut, and complain to the boss that they had to wait 30 minutes for a 5 minute job, while they can clearly see someone coming in with an ambulance with some sort of trauma.

    Then the dominos start falling and my superiors get angry at me for not treating his “friend”. I hope the USA health care system is better than the EU health care system. Why was I on this site? Oh yeah. Looking for why we have to start at 7 AM, when EM works 24h and baseline bloodwork can be taken either at the end of a night shift or the early morning shift.

    So why not make it easier for the doctors and instead of waking up at 5 AM, let us wake up naturally at 7 AM or even 8 AM. It doesn’t matter if you’re working 24h shifts.

  11. Wow this was so helpful! im currently in school and i was bored so i read this, i want to become an er doctor too and now ive read this, i want it even more! im also considering to move from the netherlands to the usa for this job. the hard part is that i have to leave my family so im not so sure yet. Are you friends with your co-workers?

    1. Hi! Yes my colleagues are like a second family to me. We spend so much time together, it’s inevitable! It is nice to have my friends and family outside of medicine however. Good luck to you!

    1. As an Emergency Physician, my schedule is variable and flexible. So in short, yes. My work in social media is technically a business and I have been able to integrate it into my life, however it does take a lot of effort. Certain activities that may require a consistent schedule (sports games on the same night every week, classes, etc)- that stuff can be tough because my ER schedule is never the same and typically includes night shifts.

  12. Hi, Cassie!
    I am an emergency doctor in Spain. I love knowing how my colleagues work in other parts of the world. Here in Spain the most common work system in the ED throughout the country is through on-call. That means being 24 hours of uninterrupted work. I can say that I am lucky because in my ER we work 12-hour shifts: from 8 in the morning to 8 in the afternoon one day; from 8 p.m. to 8 a.m. the next day; and three days off.
    You said your shifts are 8 hours, but many colleagues stay until they solve the patient (reaching up to 10 hours per shift). This means that they can do more than 100 overtime hours per year. Is this excess compensated in any way? Worth? Could you show us your shift quadrant, even an old one, to see how you distribute the work? Thank you.

    1. Well… there is no real “paper” work anymore because it’s electronic but to put it bluntly… A LOT.
      It’s a double edged sword in my opinion. Makes it easier to find information on patients, but charting can feel like your life, instead of actually taking care of the patient.

  13. Hi,

    I read your blog post and thank you for the insight. I was wondering if a career in EM is conducive to entrepreneurship? I’m pursuing an MD/MBA at penn and want a career where I can practice medicine but have time to create a startup. Thanks for the help.

    1. Definitely! Your days required to work will depend on the type of group that you work for. There is always part time or per diem work as well, if you prefer to have more days off. My group only requires 12 shifts a month to be “full time” so even with the late nights and overnights, it leaves for a good amount of time to tackle other hopes and dreams.

  14. Hello! I am currently in medical school in the EU and EM seems like the best fit for me! However, I am very family oriented and hoping to come back to the states after my training. But I am a little concerned with the time commitment and burn out. Is there another route that you would have taken or an alternative that doesn’t require so much time and lets you have a life? Thank you so much!

    1. I wouldn’t have chosen any other path because I wasn’t super interested in the other fields. The burnout is real, medicine is changing and presents many frustrations. It is what it is at this point, but knowing what I know, I could be happy doing other things. At the time however, I wouldn’t have changed a thing! The difference is that I know have perspective and experience in the field. EM definitely lets you have a life outside of medicine. That’s the best part about the field. Good luck!

  15. Great post! My husband is an ER physician and he pulls 24-36 hour shifts because the hospitals where he works have to source doctors from outside of the area (in order to have enough doctors to cover all shifts), and the drive to these rural hospitals is so heavy that 12-hour shifts aren’t worth the 4-6 hour roundtrip on top of being awake for the majority of that shift. They usually have to source in larger cities because rural ERs require very experienced physicians who are able to handle a plethora of areas of medicine since rural towns don’t typically have specialists on call – may not even have specialists practicing in their town. For example, if a woman presents in active and imminent labor, that physician has to deliver the baby. If someone comes in with a blocked urethra, that physician has to do the immediate urology care that cannot wait for a transfer. They have to be extremely knowledgeable, experienced, and ready to handle any and everything because there is no other expert available. Larger city ERs can leverage specialists who are actually on shift around the clock, but out in the ‘boonies’, it’s usually just that one doctor at the hospital. My husband is a rock star and sometimes sees 50+ patients in a single 24-hour shift. There are plenty of slower shifts too, and these doctors are able to sleep in a ‘doctors’ quarters’ when they are not with patients.

    Either way, I just wanted to present another perspective. My husband has been practicing for more than 20 years and I know how challenging and brutal his work can be, so I applaud you for what you do!

Dr. Majestic

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