Dear friends, thank you for the replies.
I like the division of the post in "scutwork" and "abuse" made by
@JustPlainBill and his answer is very informative...thank you!
I think that all comes down to the central management...it is the chairman/PD who decide how much is the ratio between md/nurse/pct/med stud and patients based on certain calculations, it is their job to do that, after-all.
In the unfortunate situation where this ratio is not well calculated, aka there are tons of patients and only very few providers/resources, there it is the most natural way to start the scutwork/abuse.
The already trained providers with a iron contract, like attending/nurses/pct would not work more than what their contract say....so who are you gonna call??the residents!!
D
The chief resident will dump all the work on the juniors then.
So, just to summarize:
Bad management-->incredible high workload-->trained provider protected by their contract-->scutwork/workload on residents-->chief abuse juniors
What do you think about this schematizing of events?
So, to begin with, you need to understand that most hospitals that have a residency training program, whether opposed or not, have a concept of "good teaching cases" for their inpatient work. So your comment about "The already trained providers have an iron contract..." is invalid. Attending physicians who are not associated with a residency training program but work at the hospital/clinic in question have their own patient panel and do not see residency patients unless it's a rare exception. Get that straight first. Patient cases that are good to teach residents everything from standard presentations of usual complaints to odd presentations of usual complaints to the occasional zebra that requires you to think about what you need to do to rule out a multitude of usual complaints to get to the real problem to cases where the disposition is going to be complex to arrange to just plain "it's your turn to take the next unassigned" will occur. It is called training for a reason.
Residency is usually it's own little separate world even in opposed programs at large teaching hospitals.
1) The PD generally sets the tone for the residency, is more of a figurehead, has very little to do with the actual day to day operation of the residency.
2) Most things are run by committee
3) ACGME plays a large part in expectations and requirements
4) Scutwork is a fact of life and intern year is about learning how to manage it.
5) Everyone gets scutwork
6) Dickheads who don't work and play well with others usually get dumped on as with anything in life
7) Whiners generally get dumped on also
8) You are tasked with a relatively low volume of patients to start with but it seems overwhelming because you don't know what you're doing. it's a world of difference being a med student and having an academic knowledge of what to do vs. having a human being that you're about to give a medication to your first time. Just wait until you get to replete potassium in an elderly patient with cardiac issues or start a patient on insulin as an intern.
9) You're really not that overwhelmed, just inexperienced.
10) The Chief and your seniors tend to get pissed at you for doing stupid stuff that interrupts their sleep.
11) No one knows anything straight out of medical school and trying to understand it is like trying to under riding a bicycle -- but the bicycle is on fire and you're on fire because you're in hell.
12) You are training to be a physician and that takes time -- if you're worried now about something as miniscule as scutwork, you should probably leave the profession and go sell cars or something.
13) You are generally seeing patients with government insurance -- which means they are either over age 65 or younger than that with major medical problems -- they're going to have rather long lists of issues, be non-adherent and you're their last hope. so you will need to see a higher volume -- that's why residency programs are run by medicare/Medicaid so that they can get their patients seen because their reimbursement is about $0.30 on the dollar.
14) Scutwork bites for everyone, get to work and get it done.
