I once assured myself with great confidence and the full bravado of an experienced attending that I would never again spend a night in a hospital. I had done my time. I had earned my days. However, life has a tendency to challenge your convictions. A few years later, everything had changed. I was divorced. My children had grown older and become more self-sufficient. My clinical career had become comfortable yet predictable. I found myself yearning for a challenge and something to reinvigorate me out of the mid-career slump.

Simultaneously, the work I was engaged in with the largest community-driven salary-sharing platform in healthcare was evolving into something more significant than I had anticipated. To develop it into a platform that could genuinely redistribute power back to clinicians, I needed time—real, uninterrupted time. I didn’t wish to leave medicine, so the only way to carve out that time was to completely turn my life around and adopt a night-float position, which meant working nights for a week and having every other week entirely off. I recognized that this schedule would be challenging, but I underestimated all the ways it would be tough.

When nighttime shifts truly pay off

Through our analysis of compensation patterns for night work among over 20,000 anonymous salaries on Marit, one key finding emerged: Night work is not the uncommon, career-stage-specific nuisance many people think it is. More than a third of all physicians on Marit work some nights, and in certain specialties, the expectation is nearly universal.

Unsurprisingly, emergency medicine leads the way, with 95 percent of physicians working nights. However, they are not the only field affected. In areas like critical care (83 percent) and surgery (72 percent), working nights is standard rather than an exception. Even in specialties that don’t typically imply “overnight” work, such as pediatrics, urology, or orthopedic surgery, about one in three physicians still report working nights.

What is particularly noteworthy is that night work does not consistently bring in higher compensation. When we compare salaries for clinicians who work nights to those who only work day shifts, the discrepancies vary greatly by specialty.

For certain specialties, the night shift premium is tangible and substantial. Nephrologists can make approximately $50,000 more annually for night shifts compared to their daytime-only peers. In cardiology, the difference is $46,000, followed by pediatrics at $43,000 and surgery at $36,000. Specialties such as anesthesiology, urology, and critical care also see consistent differences in the $22,000 to $26,000 range. This premium for night work underscores a broader reality: overnight shifts are both critical and challenging to fill.

However, this pattern is not uniform. In hospital medicine, the disparity decreases to just $13,000. In some specialties like OB/GYN and orthopedic surgery, the difference vanishes entirely. The reasons for these variations are numerous. In some instances, night coverage might be evenly distributed across the group without extra compensation. In other cases, the differences reflect the economic limitations of night work itself; the volume and pace of overnight care seldom match the productivity of daytime clinics or surgical schedules, and compensation tends to reflect that.

My own nocturnal equation

That’s the broader perspective. Yet the personal financial repercussions for me were even more pronounced. I stepped back from leadership roles that I had painstakingly built over the years, along with the accompanying stipend. I willingly left $50,000 behind and still ended up earning more working nights. Reduced responsibility. Lesser clinical load. Higher income. And there’s the schedule: 26 weeks off each year. That time became the essential resource Marit Health required to expand and the opportunity for me to prioritize my own well-being for a change. And if I ever wanted to increase my earnings further, I could pick up extra shifts whenever necessary. (I don’t take on additional shifts, but the option is appealing.)

On pure numerical terms, the financial benefits and the time off afforded by night work were indisputable.

The unforeseen psychological costs

Here is the aspect I did not fully foresee. The hospital at night is quieter, slower, and more deserted. The typical cadence of medicine fades away. There are fewer conversations, fewer colleagues around, and fewer collaborative moments.

The sense of isolation extends beyond the hospital. When I finally have time off, my friends and colleagues are occupied with work or family commitments. And as I head in for the night, they are enjoying dinner or winding down with their families. The metaphor of “ships passing in the night” feels very tangible. This separation becomes integrated into my everyday life.

The reduced clinical load also translates to fewer impactful moments in my practice, the kinds that remind you why you chose medicine in the first place. I have had to reevaluate how I define meaningful work. It’s much less about productivity and more about the intimate interactions with families during a late-night trauma or the fulfillment of administering an epidural for an