Night Shift: White Glove Service

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For over 25 years I had, what some would consider, the worst emergency medicine job in the world. I was a full-time locum tenens physician and I only worked at night. At one time I had over 15 state medical licenses. My full-time practice was to help hospitals that were in staffing crisis. I would fly in monthly and take a week or more of night shifts. To some on the regular staff, I was a hero. Most just thought I was crazy. But for me, it was the perfect job. It allowed me the time and money to do all the other things that were going on in my life.

I say this, not to extol locum tenens work, but to say that everyone is different. What you want out of your professional and private life is different from anyone else. And the beauty of emergency medicine is that, to a large measure, everyone should be able to find the right job, in the right location, with the right hospital and staff that fits their unique needs. The best evidence suggests that over a third of all emergency departments are looking for one or more emergency physicians at any one time. That means that of the more than 4,000 EDs around the country, over 1,200 of them are looking for someone right now. All you have to do is look in the right place.

Finding the right job can be a little like looking for the right mate. Much like the bar scene, saddling up to a stranger with a lame pickup line just makes you look desperate. And it’s not very likely to introduce you to the right person. Similarly job ads can all start to look alike. How many times have you read “competitive salary” and wondered what that meant?  Recruiters are my friends and I love them all, but they have a job to fill as quickly as possible so they are going to tell you what you want to hear. Like the Navy Medicine recruiter who talked about duty assignments in warm sunny locations. That turned out to be the hot sands of Iraq and swimming in a filthy pond at Sadam Hussein’s palace.


And if you take a job and it doesn’t fit, you may start to worry about the stigma of multiple job changes. It may not be as bad as multiple broken marriages, but the hassle and damage to your self-esteem and confidence can be similar.

I think that modern daters have it right these days when they use on-line dating services that require an extensive personal inventory before matching them with a potential date. It may be old fashioned, but it is a good idea to talk to someone for a long time before you make life changing comments.

In the same way, EPs should think long and hard about what they really want out of the next job, before they go off to the next interview, or even start scanning the classifieds. Of course, these personal surveys are only as good as a person’s knowledge of themselves. Just as in dating, many EPs think they want something in their new job only to find that once they get it, even after years of hard work, they discover that it wasn’t so important after all or they just weren’t a good fit for that position.


For all the spouses reading Night Shift — and I know that as many spouses read this column as their other halves — there are many other aspects to the right job that have absolutely nothing to do with the hospital, the staff or the compensation. When I was in medical school in the Midwest, my wife and I had the opportunity to do a summer externship at a hospital located in a town in the Pacific Northwest. It’s where I got the bug for sailing. The town was absolutely gorgeous. The staff at the hospital was and remains some of the best clinicians on the planet. Some of whom have remained lifelong friends. They all made good money and had an enviable lifestyle. It looked like the perfect place for us to eventually settle and raise our family… except for two things. It was 2,915 miles from my wife’s family. And the ocean in the Pacific Northwest is too dang cold to swim in without a wet suit. Both of these were problems we could have dealt with, but in the end, we settled for the east coast and the warm waters of the Chesapeake Bay. But you only get to these questions if you take the time to ask them.

As anyone who has been following this column knows my son-in-law and daughter just went through the match to find an emergency medicine residency training slot. He looked at programs that emphasized the potential for an academic career trajectory. Others, located in inner cities, were programs that were infused with the adrenaline of unrelenting high acuity trauma. Still others were located in smaller university towns that emphasized learning in more relaxed collegial atmosphere. But in the end, his match list priorities reflected as much his desire to be where he could surf — a lifelong hobby — and my wife’s begging not to take our granddaughter too far away. Yes, there were even some tears shed by my wife as she told them that they could go “anywhere” they wanted. She was lying, of course, but I admired her acting.

The ad, the pictures and sometimes even the initial interview are just the beginning to finding the right job. It shouldn’t be made under the pressure of having to make a sudden move. I’ve done that before and the results varied from unsatisfactory to disastrous. Take the time to discuss, at length, with all the interested parties…including grandparents, what you might consider your perfect job. Take your time. Let the ideas stew a while. You might surprise yourself and change your priorities. And then when you are ready to have some fun looking around at the opportunities, take a look at a new service of EPM — the White Glove Service.

Wouldn’t you love to have your dream job delivered to you on a silver tray? We recently polled all our readers as to whether they would consider hearing about job opportunities that met their specific criteria of interest. About 30% opened the poll and a significant number responded. As we continue to poll we will look at the many other factors that you would find most interesting in a job opportunity even before hearing about any specific job or location. Only when there are opportunities that line up with your desires would you receive any information — one a silver platter so to speak.


Emergency Physicians Monthly is not a head hunter agency. And we don’t plan to become one. But we are all about emergency physicians, our lives, our professions, our families and our success. And I believe this is the way to thoughtfully go about finding a job that fits all of your desires and needs.

As a post script, there is another side of this equation. And that is the ED group, the hospital or even system. Every group will admit privately that they have some members of their group that may be good emergency physicians, but they are just square pegs trying to fit in a round hole. They aren’t a good fit for the patient load. That’s a nice way of saying that they are slow in moving patients and everyone else pays for it. Sometimes they have personalities that, even after trying to make adjustments, don’t fit into the vibe of the other staff members. It’s not terrible, but people are not happy. In the worst case scenario, it might prevent the group from growing or retaining other quality staff members.

If you are a director or maybe even a staffing coordinator, take an honest assessment of your staff and decide if some staffing changes would be good for everyone. And you can start the process by describing your opportunity. It doesn’t even have to be a current job opening. Moving the wrong person out and the right person in can end up being good for everyone. But it takes time and sensitivity. This process allows for that, instead of the usual chaos surrounding someone suddenly leaving and everyone scrambling to find a body to fill the hole.

Job changes don’t have to be like a series of bad marriages: impulsively decided on, soon regretted and then a painful and messy “divorce.” If you take your time to find out who you really are, what’s important to you and then go to the place or person who will introduce you to the right people, you are much more likely to have a successful union. I’d love to hear from you. And look for more from the EPM White Glove Service.


FOUNDER/EXECUTIVE EDITOR Dr. Plaster has been an emergency physician for more than 30 years, working exclusively night shifts for the past 20 years in emergency departments across the country. During that period, he joined the U.S. Navy and served two tours in Iraq. Dr. Plaster is the founder and executive editor of Emergency Physicians Monthly and the founder of Plaster Publishing.

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