, 2025-04-21 05:13:00
Right after residency, Maryland-based hospitalist Anisha Bassi, MD, took on a 7 days on/7 days off shift. She worked 12-hour days, and if she wanted to boost her income, she would add in an overnight, or a 4 AM to noon.
It was tiring, she said, but she was young, and it still felt easier than the strain of residency she had just finished. Plus, the week-long stretch of downtime allowed her the ability to study for boards.
In working 7/7 shifts, Bassi was part of the most popular scheduling option among hospitalists, according to the 2023 State of Hospital Medicine Report, from the Society of Hospital Medicine (SHM). The shift’s popularity has grown steadily, and more than 60% of hospitalists now choose it, typically working 12- to 14-hour days on this schedule.
Many factors go into why hospitalists opt for the 7/7 schedule — and it’s highly individualized — but like anything, working this schedule comes with pros and cons.
Like Bassi, Colorado-based Josh Emdur, DO, also worked 7/7 schedules early in his career.
“For me, just out of training, the option was amazing,” he said. “It gave me a chance to work really hard, and then when I was off, I was off.”
This work hard/play hard routine was ideal for Emdur, a dedicated runner and skier, who also enjoys traveling and finding time to truly unplug. He also liked that 7-day stretches allowed him to know his patients well.
For me, just out of training, the option was amazing. It gave me a chance to work really hard, and then when I was off, I was off.
Josh Emdur, DO
“It’s hard to go in for a day of rounding where everyone is new to you,” he pointed out. “It takes you a while to get their medical history and figure out where they should be going next. When you’re working 7 days, you have the advantage of getting to know your patients, see them improve, and square everything away before you hand them off.”
According to the SHM report, the average patient stays around 4-5 days, so Emdur’s experience lines up in that regard. Another factor that made 7/7 shifts appealing to Emdur was his ability to fully embody the doctor persona while on the clock.
“You focus on your work, and then when you’re off, you’re completely off and forget about those pressures,” he said. “There aren’t many other specialists that have this ability, other than ER [emergency room] docs.”
Bassi appreciated that aspect as well and looked at her 7/7 work as an opportunity to make extra money while figuring out her next career steps.
“I could choose to travel with my time off, or moonlight and make more money,” she said. “It was a great lifestyle.”
That’s the sweet spot for 7/7 work, in Bassi’s opinion.
“If you don’t have a family and you’re looking to make good money right out of residency, it’s a great option,” she said. “The minute you’re finished your shift; you’re done and someone else is taking over.”
But once the responsibilities of marriage and parenting kick in, the 7/7 shift can lose appeal for some. That life stage is what led Emdur to switch directions. “I loved my 9 years on that shift, until it stopped working for my family,” he said. “My wife works full time, so working 7 days meant we’d only get every other weekend together, which would have left her to solo parent when I was working.”
Bassi, too, has long since left the 7/7 shift behind, and now works in private practice. Her year on 7/7s revealed for her that she would be happier in a private scenario as she progressed in her career.
“There are many rules when you work for someone else,” Bassi said. “I wanted independence when I saw patients. Now I function as a hospitalist, but only for my patients, which affords me much more freedom.”
With high rates of provider burnout in play, determining the right schedule for you personally to prevent that scenario is key. Employers are beginning to recognize this, too, and many are increasing the scheduling options for hospitalists. Quality of care is also a factor, and hospitals often include the 4-day average patient stay into that equation.
Other Options
Working 7 days in a row can be tiring, which is another reason younger hospitalists might find it more appealing than their more experienced peers. For hospitalist Kierstin Cates Kennedy, MD, the chief medical officer at University of Alabama at Birmingham (UAB) Hospital, the idea of 7/7 never appealed. Kennedy’s facility offers pattern scheduling, and she typically works 5 days on/2 days off. “After five days, I need a break,” she said. “I don’t need to push an additional 2 days.”
After five days, I need a break. I don’t need to push an additional 2 days.
Kierstin Cates Kennedy, MD
Emdur, however, said that the quality of care in 7/7 shifts is “very doable.” He points to the long stretch of time off as ample time to recharge, before doing it all again.
Kennedy said that at her facility, most hospitalists work no longer than 6 days at a stretch, unless they strongly wish for more days.
“We’ve designed that schedule based on the average length of stay,” she said. “If a patient is there on average 4 days, presumably they will only have one doctor, which leaves the patient more satisfied.”
Another upside to pattern scheduling, said Kennedy, is the ability to set schedules 3 months in advance, which makes taking specific days off more feasible than 7/7. “If you have a wedding coming up, or specific vacation plans tied to your children’s school schedule, you can block those days off,” she said. “But if you’ve got a 7/7 schedule, you need to find a replacement for your shifts.”
Kennedy said that UAB’s nurse practitioners were on a schedule akin to 7/7 and recently changed to pattern scheduling. While they were hesitant at first to make the change, she said they’ve overwhelmingly bought into the new schedule now that they’ve tried it. “They learned that it allows for more flexibility,” she said.
One of the other bonuses Kennedy sees in pattern scheduling is that in her facility, it has led to strong retention rates.
“I think that in hospital medicine, at the 5-year mark, many doctors start looking for something different,” she said. “We don’t see that, and I think that’s due to our scheduling options.”
Kennedy said that attrition remains low at UAB, and most hospitalists remain up until the 7- or 8-year mark. “That’s worth thinking about,” she said. “The hard pace of 7/7 has its risks over time. How much longevity can you get from it?”
While the 7/7 schedule may suit young hospitalists best, Emdur said it can also be a good fit for later career doctors. “Once the kids are away at school, having those stretches of time off can work well, especially if your partner can do it, too,” he said.
No matter what your scheduling preference, hospitalist work can be intense, said Emdur, which makes finding the optimal fit for your lifestyle essential.
