Why Nocturnist?

Trying to figure out what kind of doctor you should become? Wondering which specialty you should choose? Considering different practice styles? Then SheMD's Why Specialty Series is perfect for you! We're bringing you female physicians sharing WHY they chose their specialty. Today's post is on why Dr. Alison Hayward chose the nocturnist life and why it is a great option.



Ever since I started working as a nocturnist two years ago, fellow physicians have been asking me what it’s like with great curiosity. “I’ve thought about doing that….” they say, wistfully. Parents of young children in particular have seemed intrigued by the concept. My response: “it’s the best!” has been met with some seriously skeptical looks, but I’m being completely sincere.


Working night shifts exclusively has changed my life for the better in so many ways. I wouldn’t even consider going back to a typical shift schedule.


Some of the greatest aspects of a night job are ones I didn’t consider very deeply before making the change. During a recent holiday week, I had to come in for an atypical swing shift, and realized that I couldn’t park in what I had come to think of as “my spot” – the parking spot closest to the hospital door, always empty at the time I arrive for my night shift. Every night I do my car karaoke performances or listen to podcasts as I commute to work with zero traffic instead of cursing the stop and go gridlock that forms on the same highway every morning from 730 to 930am. When I have to schedule phone calls for my academic work or volunteer work, I try to schedule the calls at 1030pm during my commute, which has generally been considered a reasonable hour for the university students I am working with. Before making the change, I wished I could cut down on the administrative responsibilities of my job which prevent me from spending time doing other things that I value. Now I’m no longer required to attend the majority of departmental meetings or residency lectures to meet performance criteria, because I’ve always worked overnight prior to the day they are being held.


I mostly thought about the impact it would have on my ability to see my children, which has been as great as I expected. I often remember a medical student I rotated with in the ED saying “I’d never choose this specialty. I’m going to be there to put my kids to bed every night.”


Now I’m there each evening, reading books and tucking them in with kisses and hugs. Even more importantly, my schedule allows me to have almost every weekend off, where I used to work a typical emergency medicine schedule of two weekends on, two off per month.


The difference it has made in my mental health being able to spend every weekend having fun with my family has been immeasurable. I even get a date night with my husband every week now.


Because my department offers incentive pay for night shifts, I essentially got a significant raise in my salary by switching to working nights. I’ve been able to use some of that incentive pay to pay down my own time as if I had gotten a grant in perpetuity. Each quarter when the incentive pay gets disbursed I am able to distribute it to my investment account, to charitable contributions, and to paying down my medical school loans. I’ve been diligent about paying my loans off over time, but I did graduate with nearly $200,000 in loans, and now that I’ve started using my incentive pay to pay them down aggressively, I expect to have my loans paid off within the next year.


The last important thing that has been life-changing about my nocturnist career is creating the opportunity to form habits.


Being able to start and maintain healthy habits is something that’s very helpful to achieving many different kinds of life goals, and it’s something I’ve always made an effort to do regardless of what my other time commitments are. That being said, there is only so much you can do to maintain healthy habits when your work schedule is completely variable each week. There are so many barriers both mentally and logistically to successfully do it. Having a template schedule has allowed me to much more easily build healthy habits, everything from brushing my teeth twice a day to daily high intensity workouts to maintaining an intermittent fasting meal schedule. At the dentist or doctor’s office when they ask about getting my next appointment set up for a year in the future, I used to say “I’ll figure it out later.” Now I gladly agree and set the appointment knowing exactly when I will and won’t be working, whether it’s 6 months from now or a year away. My childcare schedule has consequently also gone from a less desirable highly variable schedule to a traditional split schedule, so it’s much easier for me to hire top candidates to work it.


When I agreed to become a nocturnist, the first thing that I promised myself I’d make a habit of was ensuring I got enough sleep.


On the variable schedule, I often found myself trying to burn the candle from both ends, a practice that was clearly unhealthy and also made me feel less sharp at work. In order to try to lessen the negative health impact that working night shift is known to have, I decided that sleep had to be a priority and should be treated like a part of work. I take a nap before my first night shift, sleep during the days in between the shifts, take a nap after the last night shift of the week, then go to bed early that night and flip flop back to diurnal life. End result: I’m getting more sleep now than ever before in my adult life (at least since having children), am happier, more productive, less burned out, and a better mom and wife. I’m looking forward to staying a nocturnist for the rest of my career as a physician.


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