Shift Work #illumedati

Hey everyone, it’s Medicine Mondays again. Today I’m going to just kind of talk about “Shift Work“.

Shift Work, Night Shift, 2nd Shift, 3rd Shift
Photo by Johannes Rapprich from Pexels

Shift Work?


For most medical professions, there is some opportunity to do shift work. However, today I’m going to talk about my particular specialty — radiology.

In general, a “normal” schedule for a radiologist is 8-5pm, Monday-Friday affair. Usually, depending on how big your group is, you may need to work 8-12 hours on a Saturday and/or Sunday a month. For this example, let’s just say it’s every 4th weekend you have to work 8-12 hours. This is usually in the realm of 8am-8pm or so.

Another variation on this, is that you may need to do a “2nd shift” every so often, let’s say once a week in 4 weeks. This 2nd shift is usually something along the lines of 4pm-12am or 2pm-12am depending on what your group needs.

There is a gap in coverage from 12am-8am in this particular scenario. The options for covering this gap is to either use an external source, such as a teleradiology company, or an internal source, meaning your own night radiologists.

Interesting, but why does this matter?

Well, it all makes sense in that particular scenario right. However, not all time is weighted equally, and well, it shouldn’t be.

In some other jobs, working late shifts and graveyard shifts carry a premium. In that terminology, it’s either “time and a half” or “double time”, meaning you earn 1.5x or 2x the hours for time worked. Usually, “double time” is reserved for holidays, where coverage is scarce.

So then, what happened to radiology is that “2nd shift” and “night radiologists” came about to cover this need. However, the “premium” on these hours changed with time.

When reimbursements were relatively high, the group could afford the premium of sending out your overnight studies and have someone else read them for you. Your group would then make up the difference by being more productive during the regular day — and just eat the premium.

If you couple this is with a poor job market, many young radiologists jumped straight into doing nights in order to gain experience and be more marketable.

So what happened?

I believe, and still believe that the “7 on 7 off” for nights schedule is not sustainable. As expected, when the job market got better, people simply left these jobs for greener pastures — armed with more experience.

Now I think we’ve somewhat reached a status quo for the expectations of 2nd shift and night radiologists. You simply must pay them a premium for their services, or they will leave.

If you want a radiologist to only work 2nd shift (2pm-12am hours), then doing a 7 on 7 off schedule is reasonable. In my case, I work 8 on, 6 off because of hour my hours work. However, I think 7on7off and 8on6off are the only sustainable models for a 2pm-12am shift. These radiologists deserve at least 100% of whatever the normal pay is, if that includes call.

If “normal pay” doesn’t include any nights or weekends (call), then they should earn a premium over that, like 20-25% or so. That said, the more common thing to do is to just have your regular group take turns doing a week of 2nd shift.

For traditional “overnight” radiologists 8am-8pm (or similar), a 7on7off model is not sustainable. In general, a week of nights in three weeks time (7on14 off) is probably sustainable. Any more than that and you can expect your turnover to be very high. Of course, if they are only working 7on14 off, then the pay probably won’t be as high either, and probably won’t be 100% of normal pay.

However, you can account for this, by giving them a few day shifts once in awhile. If you do this, such that they work ~ 14 days a month, 7 of which are nights, then they deserve 100% of normal pay.

I see…

Offering less than 100% of normal pay for working more than what I’ve outlined above is not sustainable. Most likely you and your group will be looking for someone else every 6-12 months. Doing so puts a strain on the group to recruit and the possibility of making your own group work nights will strain the group even more. Or, you will just have to pay for night coverage from somewhere else — at a premium.

That said, for groups in highly desired locales, like the Bay Area, Southern California, New York City, etc. — they will just laugh at what I’ve said above and continue a revolving door of night radiologist hires. However, if you want to sustain your practice, the guidelines I’ve laid out above are very reasonable.

Anything else?


The pendulum swings both ways. When/if the job market shifts and becomes more saturated and it becomes more difficult to find a job, these “undesirable” jobs will probably pay less.

My wife is a psychiatrist and I always hear about all these people she knows doing tele-psychiatry and making so much money. This may be the case now since the job market is so wide open. However, I just worry that the same thing that happened to radiology before will also happen to psychiatry.

I can’t help but think that these tele-psychiatry companies will eventually start to lower salaries in order to help their bottom line. It’ll be a slow bleed and a slippery slope. Be careful out there.

Just remember, the money has to come from somewhere.


Late night hour coverage should cost a premium.

Understand what is sustainable.

Medicine Mondays Sensei


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

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