Time Off #illumedati

Hey everyone, it’s Medicine Mondays again. Today is just going to be some talk about “Time Off”.

Time Off
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Time Off?


I’ve talked about it before, but my work schedule is kind of weird in that I work 8 days and then I’m off 6 days. You would think that with having 6 days off every 2 weeks that I wouldn’t have any real need for a vacation.

However, I think people tend to misinterpret just how an 8/6 or 7/7 schedule works. In a “normal” M-F schedule you work 10 days out of the 14 days and have 4 days off. For now, I’m going to exclude call weeks.

So in this particular example, in an 8/6 schedule, you get 6 days off in a 2 week span versus 4 days off in a 2 week span in a normal schedule. Of course, that’s still a significant more amount of time off. However, I think you must also understand that the time off isn’t necessarily the same.

In my 8/6 rotation, I am working evening/night hours. It essentially equates to “3rd shift” hours since it runs from 1:30pm to 11:30pm or 2:30pm to 12:30am depending on daylight savings time.

So, then if you really boil it down, the difference is:

6 days off in 2 weeks, but 3rd shift hours, working one of the weekends


4 days off in 2 weeks, “normalish” hours, working neither weekend

Of course, things get a little more different if you include call into the equation, which for doctors usually is around 1:4 or 1:6 weeks normally.

I guess what I’m trying to say here is that the actual “time off” isn’t as different as what most people would think. It’s the “type of time” that is worked versus the “type of time” that is off.

To illustrate this point, let me give you another scenario.

In this scenario you only work 6 days in 2 weeks and you get full-time pay. Wow! That sounds great you might think. However, now consider this:

In those 2 weeks, you work Friday, Saturday, Sunday from 8pm to 8am.

This means you will always work every Friday, Saturday, and Sunday overnight.

That’s not so bad you might think, I still get 8 days off in 2 weeks. That’s a lot of time off.

You’re right, however, remember it’s the “type of time” off that matters. You’ve just worked Friday, Saturday, and Sunday, 8pm-8am. You have Monday-Thursday off… but does Monday really count? You just got off your shift at 8am that morning… and need to try to shift to a “day” schedule. Do you pound some coffee and try to stay awake all Monday, or get a quick nap and then head out…? So maybe Tuesday and Wednesday are actually days off. But then does Thursday really count either? You need to try to shift your schedule back to nights to work Friday night…

I see…

The 7 on 7 off overnight schedule is pretty common place in radiology. However, as I’ve said many times before, I don’t think it’s sustainable — and to be honest it was probably never designed to be sustainable.

Usually in these 7 on 7 off overnight gigs there is no room for any kind of vacation either. The idea is that you’re “off every other week” you’re “on vacation” every other week. But are you really? Switching your schedule between days and nights will becoming exhausting and will really mess with your circadian rhythm.

What I mean by never designed to be sustainable is that the people who do those shifts were usually trying to break into a certain tough job market. Like San Francisco, Los Angeles, Boston, etc. There was usual some “promise” verbal not written that after X years of doing nights you’d be given a day time position. Usually what ends up happening is these people doing 7 on 7 off either find another job or are let go.

Seems suboptimal…


Additionally, they likely were being significantly underpaid for what they were producing and value they added to the group. It’s usually a revolving door of new hires into this position. If you are considering such a position, you should inquire about where the previous hires are now — and especially how many are still with the current group. Additionally, you should try to talk to the previous hires directly over the phone if at all possible.

I know all of this because I have friends who have had to deal with this in the past few years. These are really good radiologists who simply got played by other people who are blinded by money. Whenever it comes to money, it’s always a slippery slope.

If you want to work nights, there needs to be some variation of 7 nights 14 something else — For example, 7 on 14 off or maybe 7 nights, 7 off, 5 day shifts in 7 or something to that effect. The first one probably won’t be full salary, but the second one should be. That’s the only way an overnight schedule is sustainable in my opinion.

Why did you decide to talk about this today?

Well, it’s kind of a little self reflection. I’ve been working 8/6 evenings for 5 years now. For the past 5 years I haven’t really used many of my vacation days. However, I’m not a young gun straight out of fellowship anymore. While I think I can do this job forever, I probably should take some extra days off once in awhile.

I have some days off coming in July — and I wasn’t planning to take them all off, but after some thought I think I will. I would like to work on this blog some more, help my daughter write her book, and teach the kids some baseball. We’re also doing a little staycation here in Waikiki as well. I also have some time off coming up in September as well that I wasn’t planning to take it all — but I may just take half of it off.

Probably starting this next year I’m going to begin using some of my vacation days a little more aggressively — meaning actually take my scheduled vacations off. The kids are getting older and my wife has been saving up some of her vacation days too. Most likely we’ll try to plan to take 1-2 weeks off every summer starting next summer to go somewhere and do something.

We all need time off. I think this kind of also is part of my Live for Today, Save for the Future post. I plan to work at this job for another 15-20 years, so it’s ok for me to use some of my vacation days, as long as I cap those days before I retire.

Anything else?

I guess this post is also kind of a warning to young physicians coming out who are chasing the job with the most “free time”. You may see a job where you only work 10 days a month or something like that. You really need to look at the “type of time” worked and the “type of time” off. Don’t just take it at face value.

Create a year long calendar of exactly how those days at work play out. Fridays, Saturdays, and Sundays are valued higher than Monday-Thursday — and they should be. Overnight shifts are valued higher than day shifts — and they should be. Holidays are valued higher than regular days — and they should be. Certain Holidays — Thanksgiving, Christmas, New Years, etc. are valued higher than other holidays. Make sure whatever you decide to do provides real value to you — and not just to you, your family as well.

Also, look at longevity. In that job I talked about above Friday, Saturday, Sunday 8am-8pm overnight — that’s just not sustainable.

However, what if it was Friday, Saturday, and Sunday 8am-8pm every other week… so you only work 6 days in 4 weeks? Obviously you probably wouldn’t get paid a full time salary, but maybe that difference in time off is worth it to you.

Don’t let other people undervalue your time.

Only you can decide what your time is worth, but I think doctors tend to undervalue just how much their time is worth — especially when just coming out of residency/fellowship.


The “type of time” off is what really matters.

Make sure you get adequate quality time off.

I should probably take more vacation instead of saving it all for a rainy day.

Don’t let other people undervalue your time.

Only you can decide what your time is worth, but I think doctors tend to undervalue just how much their time is worth — especially when just coming out of residency/fellowship.

Medicine Mondays Sensei


Agree? Disagree? Questions, Comments and Suggestions are welcome.

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