As those of us working in healthcare know, people don’t just seek medical care between the hours of 9-5. This means that for those of us on the clinical side, hospitals and other healthcare centers need staffing at all hours of the day. It’s often tough to know which is a better fit for your professional and personal life, and often the choice is an binary as working in changing shifts (eg Emergency Department, Hospitalist, Urgent Care) or working with a fixed-schedule (Primary Care and many other outpatient practices). Given we sit on different sides on this, my co-author and business partner from The PA Blueprint, Jordan Fisher (PA-C), decided to discuss and debate shift work vs. fixed-scheduled work:
At this point in our careers, I (Shayne) am working in Family Medicine, doing the 8am-5pm, fixed-schedule thing. Jordan is working in Urgent Care, doing the 8am-8pm, shift work thing. There are certainly pros and cons to each type of work schedule, and we, of course, both feel that our current choice is FAR SUPERIOR to that of the other person. Given that we love to have a little banter about this topic, typically as one of us is stuck at work and the other is doing something really fun during their time off, we figured we could bring our friendly debate to the masses, especially as we get TONS of questions about this during our PA Blueprint presentations. Please find our agree-to-disagree, back-and-forth below, along with some recommendations about each type of work schedule, more of which can be found The PA Blueprint Ebook:
WHY IS SHIFT WORK BETTER THAN A FIXED-SCHEDULE?
JORDAN: Imagine this: WORK STAYS AT WORK. The minute you clock out, you are done. No late night phone calls or finishing charts at home. Anything that is left open-ended becomes the work of your colleagues (which you of course pay forward when you are the one working). Outside of work you are free to do whatever you want. String multiple shifts together to get a long weekend, or even get a full week off without using a day of PTO. The flexibility of shift work is prime for the young (like me) and adventurous (like me).
SHAYNE’S COUNTER: First of all, Jordan’s claim to be adventurous couldn’t be further from the truth: His idea of adventure is a spending spree at REI. Secondly, not everyone doing fixed-schedule work is doing hours and hours of work outside of our clinical time. If you are efficient, and are able to draw hard and appropriate boundaries, the extra-clinical work is minimal, and totally worth working shorter shifts as a trade-off. These days, fixed-schedule work allows me generous amounts of PTO, which should be used strategically, as saving up for a rainy day may actually be at the expense of your mental health! I find plenty of time to have adventures and act young with my current schedule, in addition to having shorter days and less overall stress.
WHY IS A FIXED-SCHEDULE BETTER THAN SHIFT WORK?
SHAYNE: First of all, let me point out that Jordan is like 15 years old, and I’m like 80, so obviously I am the wiser one within this pairing. Secondly, I’ve done both shift work for 4 years and fixed-schedule work for 4 years, so I have more experience to draw upon than Jordan (pulling the wisdom card yet again!). Now that I’ve discredited my debate partner, here are three reasons why fixed-schedule work is better than shift work:
- Fixed-schedule work better appeases the Type A, “prefers-to-feel-in-control” side of all of us. When you at least know the structure of your days and weeks, then you can be the master of your universe. With “lack of control or autonomy” being listed on Medscape’s National Physician + Suicide Report 2020, having more control may also actually help to prevent burnout.
- A fixed-schedule is typically much better for aligning yourself to standard “9-5 life demands”. If you have kids, then you may have to drop them off or pick them up, or take them to an appointment with their pediatric PA. Or, perhaps you just have a spouse with a 9-5 job, so aligning your schedules allows you to maximize your time spent together (assuming you see that as a good thing). Conforming to the societal norm of 9-5, Monday-Friday, might just be a good decision for some people.
- Shift work may not be good for your physical or mental health. Whoa, this just got serious, and fast. The bipolar nature of shift work, with really long work days and no structure on days off, may feel like too much of a roller coaster for your liking. If you thrive with structure, then shift work may present some challenges to find time for self-care and other important aspects of having life-work balance. Personally, I found that working 2-3 days in a row that started around 4am (self-care, breakfast, commuting, etc.) and ended around 9pm, was brutal, and really drove me to bad habits, burnout and depression. With a fixed-schedule, you may have better consistency with your routines, leading you to feel better mentally and physically.
JORDAN’s COUNTER: I will admit, the old man makes some good points. Shift work is not for the weak. The days you work are long, and if you are in certain settings, the hours may vary. You need to be on top of your game to maximize both days working and days off. This includes meal prep, fitting in exercise, and making sure you get an adequate amount of sleep. If you can do this, then you will get to enjoy monthly week long stints off to fill with fun.
OK, so up to this point, who is winning this friendly debate? Either way, here are some additional thoughts about what qualities may make you a better candidate for shift work versus a fixed-schedule:
WHO WOULD BE BETTER OFF CONSIDERING SHIFT WORK?
- You can fall asleep whenever.
- You like to have multiple days off in a row, including during the week.
- You don’t need structure.
- You are single or have a simple family situation.
- You don’t mind working weekends or holidays.
I think that, should you agree with some of the following statements, you may be a good candidate for shift work:
- You like variety.
- You don’t mind working different shifts, such as an overnight or second shift.
- You don’t mind running on a different schedule than much of the rest of the people around you.
- You prefer to work longer shifts and less days per week.
- You won’t feel totally burned out by working 3+ days in a row.
- You love the idea of moving your schedule around to accommodate time off without burning up your paid time off hours.
- Your personal life (family, self-care, chores, rest, etc.) is conducive to adjusting to a varied work schedule.
- You DO NOT have insomnia or other chronic sleep issues.
WHO WOULD BE BETTER OFF CONSIDERING FIXED-SCHEDULE WORK?
- You have a dog and don’t want to pay for doggy daycare.
- You don’t have discipline- it is very easy to skip workouts, eat out, and develop other bad habits after a long day.
- If everyone you hang out with lives for the weekends and you don’t want to miss out.
Pretty much the opposite of my answer above, if you agree with some of the following statements, you may be better off considering a fixed schedule:
- You prefer structured days.
- You like to plan your days and weeks.
- Your personal life has demands that only the typical 8am-5pm workday can accommodate (picking up/dropping off children, night classes, weekend plans, etc.).
- You are not an evening or night person.
DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read. 3) By clicking any links from Efficient Clinician to their helpful website and purchasing any of their products, I will receive a percentage of the purchase. But, as I said previously, I will never commit to any agreement that will sacrifice my integrity.
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