Nocturnists: The Night Owls of the Medical World

December 10, 2009
MD Magazine® Staff

A variety of factors are prompting hospitals to expand coverage to provide 24/7 hospitalist care, leading to the creation of a new sub-specialty: the nocturnist. Although many programs, in an effort to recruit nocturnists, promise shorter hours, more flexible scheduling, and better pay, the lifestyle adjustment nighttime coverage requires is not for everyone.

What are the advantages of having dedicated nocturnists instead of rotating doctors?

Well, for one thing, it keeps the daytime doctors refreshed, so they can have a better night’s sleep. It’s more of a regular work schedule, so they can focus better on their daytime duties, and at night, they can take care of the admissions and the emergencies at night, which is what they are meant to do.

Have you seen any statistics or studies that show improvements to patient care when nocturnists are hired in a hospital setting?

I don’t think we can connect any studies that have been done, right off the top of my head, because it’s a new thing, a new concept.

What would you say are the benefits to being a nocturnist? Is there a downside to working as a nocturnist?

Well, the biggest benefit is obviously more free time, because most nocturnists get a week on, and then a week off, which gives you enough time to catch up with your family and personal life, and most nocturnist jobs are two weeks a month. Another benefit to being a nocturnist is that they usually receive a higher base pay than regular hospitalists, and they get the whole benefits [package]. Sometimes they have a bonus package, but it depends on how many patients they see. Obviously, the detriment is that you’re working against the body clock, because you have to get used to the shift work. Another drawback is that you don’t get to follow the patients during the day. Sometimes, you’d like to know a little more about what’s happening with them. You work with them, and you take care of them, and then another person comes in and takes over in the morning.

Is it difficult to find and recruit doctors who are willing to take on this role?

It has been a bit hard, because most people are not familiar with the concept of a nocturnist, but I think once they’ve done it for a cycle, some doctors find it easier than the daytime shift.

What do you like best about the nocturnist position, and are there any things that you particularly don’t like about the idea?

Generally, if you’re a nocturnist, you can become less involved in the hospital’s activities, such as meetings and committees, and you don’t want to let that happen. At night, it’s just you and the patient and maybe one or two relatives over the course of the night. It’s pure medicine. You do a lot of procedures, you can handle emergencies, but mostly you’re really on your own.

Is that the most challenging part of the job?

Yes. if you’re the only doctor in the hospital that night, if something happens, you’re the first point of call. You will be responsible for making sure all of the patients in the hospital are taken care of. I think it’s a lot more hands-on medicine, and obviously there are a lot of other concerns, because at night, it’s pretty much you. For the right hospitalist who is familiar with doing procedures and doesn’t mind being on his or her own, it’s a good job to start with, if you want to be right in the center of the action.