Groups must also struggle with the issue of staffing the customarily less desirable shifts. Some groups may be able to obtain part timers or moonlighters to cover these shifts, while other groups may pay a premium to encourage physicians to work the otherwise undesirable shifts. The change from working a day shift to a night shift or visa versa, needs to be addressed by the group. This movement from one shift to another for the emergency physician can be disruptive to the physician's lifestyle. Some emergency physicians dread working midnight shifts while others have difficulty with alternating day and evening shifts.
Studies indicate that the best method is to work only days or only midnight shifts.
If the group does not have the luxury of a night mole, then shifting from days to nights is the best means to accomplish this rotation. The French system is recommended where there is a clockwise rotation of all three shifts over three days. If this is not possible, solitary nights are probably the least disruptive technique. In larger groups, this is easier to accomplish than in smaller groups with five or less physicians. Interventions to improve EP lifestyle have not been successful.