Dear boss,
I’m a chairman that was lucky enough to have two full time night shift docs and the other docs got used to not having to do night shifts. Unfortunately, one of night shift people moved out of state and now my staff says that I either need to hire another night shift doc or create a pay differential for those working nights. I need some guidance.
Chairman under fire.

Dear Chairman,
I hope your staff appreciates that you still have one full timer who prefers nights. Despite the editor of this journal glamorizing the night shift, docs wanting those shifts don’t exactly grow on trees. As our hairlines recede and we become more gray, we don’t bounce back from night shift work as quickly as we used to, leading to increased burnout and potential health problems. Whether it’s for nights, weekends or holidays, I’m certainly hearing more about the need to provide differential pay than I have in years past. Physicians do nights for a variety of reasons and sometimes pay isn’t even enough. In a previous job I had, docs were paid on an RVU-based reimbursement system and generally earned about $50/hour more than the day shift. The nights were so chaotic and stressful, however, that not one of the younger, more energetic, more debt-ridden physicians volunteered to increase their monthly total. Although emergency medicine is a 24/7 business, and the reality of working nights, weekends and holidays should have sunk in during residency, there are times to consider differential pay. I approach a night differential like this: If someone volunteers to work nights and it comes with an additional perk, such as making their own schedule, that balances out a pay differential. If everyone does a fair or equal number of night shifts, it doesn’t make sense to spend the time tracking an additional differential since it should all work out in the long run. Finally, if the group wants to encourage someone to work more night shifts , then a differential makes sense. The differential needs to be enough to motivate a physician, but not so much as to break the bank. The final caveat is that the physician compensation pie is only so big, and paying a night shift differential will shrink that pie. In order to create that $10-25/hour night differential, additional money has to come from somewhere–usually a portion from the day shift hours and a smaller portion from the evening shift–or perhaps taking next years raise and using all of that money to pay for a shift differential. There are pros and cons to working each type of shift, as well as having a regular schedule. Although additional compensation is definitely a plus, it may not be enough to outweigh the cons to working more night shifts.

Mike Silverman, MD, is chairman of emergency medicine at Harbor Hospital in Baltimore and Faculty at the TeamHealth Leadership Academy


# Consensus/Fairn ess WorksTom Scaletta 2008-08-19 18:41
In both my current and prior medical director positions, we solved the night differential question by consensus. The group understands that the pie does not get any bigger (unless you improve charting and extinguish fee-splitting) but the sizes of the slices can change. At both places we decided, as a group, that about $50 was the right amount (per hour extra for a night shift) before the night schedule "miraculously" fills itself. In fact, at both places, we had an "over 50" rule (meaning that, if you were over 50 years old, you could opt out of nights) and at each place a "50-something" requested exclusive nights. Effective night owls are an asset to the patients and the medical staff. I would encourage the more of this breed (in a fair manner, of course).
Tom Scaletta, MD FAAEM
# Dear Bosssouth florida 2008-09-04 05:20
We work for a large contract managment group in south florida (Sterling), which has just been purchased by a venture capitalist group. To increase profitability for the venture capitalist the physician group is being asked to take a 40% salary reduction and sign a contract that is retroactive 2 months. They submit that they will recollect monies already distributed to us for services we rendered under the current contract. What is the purpose of a "contract" if you can simply write a new one and make it retroactive. If you don't sign you are terminated. Are retroactive contracts common, legal, and ethical?

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