Twenty-Seven Overnight Shifts: Lessons Learned from Indian Health Service Providers

Posted by • August 2nd, 2016

guest blog 1

At GIMC with my colleague Dr. Adaira Chou

The morning after I arrived in New Mexico was beautiful and warm, a pleasant change from the Northeast winter. I was entering my second year of emergency ultrasound fellowship and about to teach a point-of-care ultrasound course to health care providers working for the Indian Health Service (IHS).

On that first day, as my colleagues and I were powering up the ultrasound machines and connecting the video projector before class, an IHS physician entered the room and asked if we could teach him how to perform an ultrasound-guided peripheral IV insertion. He said that many of his patients had difficult IV access and he was hoping that learning this skill would reduce the number of central lines he had to place. When we informed him that a skills station dedicated to ultrasound-guided peripheral IV insertion was scheduled for later that morning, he apologetically replied that he could not attend because he had just completed an overnight shift in the ED and had another shift that evening.

As fellow emergency medicine physicians, we sympathized with his situation and were impressed with his desire to learn a new skill after what he described as a busy overnight shift. As we prepared a gel-block, IV catheter, and ultrasound machine, we talked with the doctor and were immediately struck by his kind and passionate demeanor. We learned that he had been practicing for about 30 years and now mainly worked overnight shifts because he preferred the regular schedule. I assumed that as a nocturnist, he worked fewer hours than his colleagues, as is typically the practice in the urban academic hospitals where I have trained. But when we asked how many shifts he worked per month, he replied that he typically works 22 overnight shifts a month, but last month he worked 27 shifts. My colleagues and I stopped what we were doing and the room fell silent. Had we misheard him? He then explained, without a hint of resentment, that he worked the extra shifts because the ED had been short staffed.

This schedule made me think back to my intern year in the ED. In a typical month, I worked 21 shifts with a variety of day, evening, and night shifts. I remember being exhausted and having little free time but knew it was worth it given the prospect of a better schedule as an attending physician. When I asked our new colleague how he managed his schedule, he responded with such sincerity expressed in both his eyes and voice: “I love my job so it’s really not that bad. The patients are really appreciative and they need us here.”

We had similar encounters with many IHS providers throughout our time teaching at Gallup Indian Medical Center. Some IHS physicians from other sites travelled many hours to attend the course, yet they arrived with tremendous energy and enthusiasm for learning. Their dedication to improving their skills was motivated by a desire to provide the best possible care for their patients. This group of providers also had a special affinity with one another and felt supported by their communities, including friends and family who volunteered to be ultrasound models during the course.

During my final year of emergency medicine residency, I completed a clinical away elective at another site in New Mexico — the Zuni Comprehensive Care IHS site. I learned first-hand about the disparities that exist among practice environments and in the delivery of emergency care in this country. I learned to become a better physician by working at the bedside with the many remarkable physicians at Zuni who embodied the same dedication as the providers at Gallup. Furthermore, regardless of how long patients who sought care at Zuni had to wait, they were gracious, appreciative, and thankful. My time at Zuni reminded me of why I was pursuing a career in emergency medicine.

Although my experience with the IHS system during residency and fellowship was limited, I met many compassionate, dedicated, and talented emergency providers from IHS sites located in New Mexico (Zuni, Gallup, and Shiprock) and Arizona (Fort Defiance and Tuba City), including one of my residency classmates — Dr. Ken Bernard. A physician of Native American heritage, he currently works as an emergency medicine physician for the IHS and regularly publishes blog posts to raise awareness of the past and current state of the IHS. I encourage everyone to take a moment to learn from his unique perspective and life experiences by reading his posts on this site. He reminds us that as health care providers, we can make a difference by serving underserved populations in resource-limited settings both internationally and in our own country.

We all may not have the opportunity to donate time or contribute to the IHS, but we can and should acknowledge and learn from the dedication and tireless efforts of our colleagues who serve in the IHS. I went to New Mexico to teach a skill to these physicians but ultimately learned so much from them. We can all strive to embody their passion, commitment, and love for their jobs. I hope these worthwhile lessons will serve as touchstones to help me gain perspective on my own job, schedule, and work conditions. When I feel the urge to complain about working an extra overnight shift, I hope I will think back to the IHS colleague who, despite 27 overnight shifts, continued to participate in the early teaching sessions and was the first to arrive every morning, excited to learn a new skill to provide better care for his patients.

John Eiken, MD



John Eicken (@johneicken) is an emergency medicine ultrasound fellow at Brigham and Women’s Hospital in Boston, MA.  He completed his residency training in the Harvard Affiliated Emergency Medicine Residency program (BWH/MGH) and is currently pursuing a Master of Education degree in the Technology, Innovation, and Education (TIE) program at the Harvard Graduate School of Education.  John’s academic interests focus on contributing to and improving medical and ultrasound education for medical students, trainees, and providers.  

2 Responses to “Twenty-Seven Overnight Shifts: Lessons Learned from Indian Health Service Providers”

  1. Arlen Meyers says:

    I worked as a consultant for the IHS. Should it be privatized?

  2. Desiree Tsinnie says:

    I am of Native American decent as a member of the Navajo tribe. I live in Fort Defiance, Arizona. I am currently taking part in a trial study in Boston. Let me just say, I am enjoying the conveniences of the latest medical technology out here. Communications between patient and Healthcare providers are nothing short of miraculous. Unlike Indian Health Services, I can honestly say the wait time for a hospital visit is virtually NIL! Back home, you sit in the waiting room for hours and you’re lucky if you get your prescriptions on the same day. I can certainly understand the limitations of federal budget hampering the expenses of personnel, operation, equipment and overhead costs. I see a lot of frustration in the doctors and nurses back home and understand the high turnaround rate in personnel. Enjoyed your article. Just thought I’d contribute. Ha!