A hospitalist is an in-patient physician, usually an internist, who coordinates care for hospitalized patients. The hospital medicine specialty rose in popularity in the late 1990s and now there are obstetrics, neurology and pediatric hospitalists.
Many premed students are curious about the different career paths available to them after medical school. Becoming a nocturnist is just one of the possible options.
A nocturnist is a hospitalist that works at night. At my hospital, there are nine day teams covered by nine attending physicians, four nurse practitioners and three residents. At night, one attending, two nurse practitioners and one resident provide care for 150 to 190 patients.
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Working at night is different. Some people perform better at night and their internal rhythm is set to the moon as opposed to the sun. Many nocturnists are day people who by choice work at night for a sundry list of reasons, including the need to raise children during the day or a desire to have fewer people to contend with at work.
Here is what a day – or night – as a nocturnist could look like:
8 p.m.: Expect to arrive around this time for your shift, which could range from eight to 12 hours. Expect to be rushing to get things done as soon as you arrive. Sometimes, there are patients remaining that have not been admitted by the evening team.
At night, the hospital feels quieter, but it has just as many patients as during the day – just fewer people to manage.
9:30 p.m.: You will spend much of the night greeting and examining patients. Expect to be interrupted often by other emergency department doctors needing help.
The most important job when taking emergency department admissions is to truly listen to the pertinent medical information and ask the correct questions. The nocturnist ensures the patient goes to the correct service.
At night there is a little more time to talk to patients. Everyone has an interesting story to tell that precedes the hospitalization and listening allows you to continually practice compassion.
One of the best things about working at night is the camaraderie among the small group of people who are dedicated to providing the highest quality overnight care. There are no calls from the clinic for admissions overnight and minimal commuting traffic.
2:10 a.m.: This is a common time to talk with the nurse practitioner about a sick patient. Nocturnists will examine the patient with the nurse and develop a plan. The nocturnist is an advocate for patients, ensuring the right care is provided.
If the nocturnist does not prepare the patient correctly for the day hospitalist, precious time is lost and the patient's stay is potentially extended. Fortunately, there are typically fewer layers of bureaucracy associated with overnight work.
4 a.m.: At any time of the night, you may find a patient is unresponsive. In some cases, the patient must be transferred to the intensive care unit.
One acute critically ill patient could render the entire night miserable, for that sick patient requires undivided attention. At the same time, other work is piling up somewhere else – usually in the emergency department.
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6:30 a.m.: At this point, early bird hospitalists begin arriving for day work, prompting the preparation of the daily list of doctor-patient assignments. Labs start to come back and nurses start to call about patients with low potassium and hematocrit levels.
The emergency department is also trying to prepare for the day shift and wants to set a disposition for remaining patients if at all possible, and an early morning admission is not uncommon.
Working with medical residents to admit a patient is a highlight of the evening. The residents are a tangible reminder of the reasons to embark on a career in medicine. Their wide-eyed optimism and enthusiasm does wonders for the soul.
8:10 a.m.: Now is the time to wrap up the evening's work and head home for some well-deserved sleep.
Being a nocturnist requires excellent communication, the ability to multitask and prioritize, and comfort working alone. You must also be a smart clinician.
Sylvia E. Morris received her M.D. from Georgetown University School of Medicine and her Master's in Public Health from Johns Hopkins Bloomberg School of Public Health. She is an assistant professor at Emory University School of Medicine and a community health advocate. Find her on Facebook and follow her on Twitter.