Urgent Help! Drowning Intern

[TreeOfLife]

I am wondering if anyone knows where I could find information on what is required of a hospital to run an internship program...specifically AOA accredited internship programs.

At the moment, a collegue of mine is being threatened to be kicked out of our internship program because she isn't performing "up to par". We happen to be in a program that is quite challenging and I believe would be for any intern just fresh out of medical school. I am curious as to what guidelines programs must follow with respect to having appropriate supervision for interns etc. At the moment, we are required to take call q3 and because of a shortage of interns, we are forced to do the call alone, with only 1 intern on. We do have a resident available to us to call should we have questions and a back-up intern that we can call in if we get more than 8 admits/call. For the most part however, it is an extremely busy call and quit overwhelming to tackle alone. Generally we have anywhere from 5-8 admits/call and have to tend to 15-25 patients on the floor. I am curious how other programs work and what is "normally" expected of an intern with regard to patient load, availability of support etc.

I feel terrible for this intern and want to see if there is anything I can do to help her out.

Any advice?

Thanks

---

Members don't see this ad.

 

[Strength&Speed]

that is on the high side of normal for admissions and call schedule. typically its 5 patients per call, maybe a bit more, but usually q4. the coverage on the patients on the floor is not that bad. 15-25 is standard. sometimes more. Sounds a bit stiff though. Good luck.

 

[southerndoc]

Most programs cannot fire you your intern year because your contract is for the entire academic year.

I have known of several interns/residents who did not have their contracts renewed by various departments within my hospital. There is no guarantee that you will be promoted or retained. Like medical school, there are standards which must be met.

At my hospital, ALL patients must be evaluated by a resident in addition to the intern. There are no new admissions where the intern sees the patient by him or herself. Is this how it is at your hospital?

 

[electra]

I wish just eight admissions....

 

[skypilot]

I am wondering if anyone knows where I could find information on what is required of a hospital to run an internship program...specifically AOA accredited internship programs.

At the moment, a collegue of mine is being threatened to be kicked out of our internship program because she isn't performing "up to par". We happen to be in a program that is quite challenging and I believe would be for any intern just fresh out of medical school. I am curious as to what guidelines programs must follow with respect to having appropriate supervision for interns etc. At the moment, we are required to take call q3 and because of a shortage of interns, we are forced to do the call alone, with only 1 intern on. We do have a resident available to us to call should we have questions and a back-up intern that we can call in if we get more than 8 admits/call. For the most part however, it is an extremely busy call and quit overwhelming to tackle alone. Generally we have anywhere from 5-8 admits/call and have to tend to 15-25 patients on the floor. I am curious how other programs work and what is "normally" expected of an intern with regard to patient load, availability of support etc.

I feel terrible for this intern and want to see if there is anything I can do to help her out.

Any advice?

Thanks

Wow, if they fire her doesn't the situation get even worse next year?!

 

[TreeOfLife]

that is on the high side of normal for admissions and call schedule. typically its 5 patients per call, maybe a bit more, but usually q4. the coverage on the patients on the floor is not that bad. 15-25 is standard. sometimes more. Sounds a bit stiff though. Good luck.

I think the issue is more in re: to the fact that we don't really have direct supervision when we are on-call. We have a resident that we can contact via telephone to ask questions to and who will come in in the event that something really intense happens that we can't handle. I am wondering how it works in other programs in this regard. Do programs have to have a supervising Resident "in-house" with the intern? Personally, I've been able to cope but my collegue needs the supervision.

 

[TreeOfLife]

Wow, if they fire her doesn't the situation get even worse next year?!

What do you mean by this? It will be hell for us interns that are left because the workload will be that much heavier.

 

[TreeOfLife]

I wish just eight admissions....

How many admits do you get when you're on-call? And do you have a resident there with you to assist? And how many patients on the floor are you responsible for in addition to the admits?

 

[TreeOfLife]

Most programs cannot fire you your intern year because your contract is for the entire academic year.

I have known of several interns/residents who did not have their contracts renewed by various departments within my hospital. There is no guarantee that you will be promoted or retained. Like medical school, there are standards which must be met.

At my hospital, ALL patients must be evaluated by a resident in addition to the intern. There are no new admissions where the intern sees the patient by him or herself. Is this how it is at your hospital?

I would like to know more about this. Why do you say "most programs can't fire you because the contract is for an entire academic year"??? My collegue was sat down with two 3rd year residents who gave her a letter that outlined exactly what she needs to do over the next year and if she doesn't accomplish that, she will either have days added to her internship at the end of the year or they will have to re-evaluate her position in the program.

 

[APACHE3]

I know you cant name it, but which state is your progrsm in? Or city???

 

[madcadaver]

ACGME requirements for residency programs can be found (surprise!!) on the ACGME website. Start at this link, click on the menu item on the left labeled "Res. Review Commitees" and choose the specialty you are interested in.

 

[Strength&Speed]

yeah, thats a bit odd. I dont know if there are absolute rules on whether an upper level needs to be present, but I'm not aware of any programs that allow for just an intern to admit without seniors present.

I think the issue is more in re: to the fact that we don't really have direct supervision when we are on-call. We have a resident that we can contact via telephone to ask questions to and who will come in in the event that something really intense happens that we can't handle. I am wondering how it works in other programs in this regard. Do programs have to have a supervising Resident "in-house" with the intern? Personally, I've been able to cope but my collegue needs the supervision.

 

[gwen]

hmmm, back in the day when i was an intern (2003-2004). we did about 6-7 admissions on average...but that's average. bad nights were 10-12 admissions for one intern.

now our hospital has new rules for interns...they cap at 5 admissions/night/intern. so guess who gets to do the rest? yup, the second year. the second year caps at 10. then the third year gets the rest. its never come down to the third year though. pretty funny. although, none of our interns (well, most) have not complained if they go a few over 5.

what i find interesting is that your interns are not supervised. i find that extremely scary (perhaps that's the same way in the rest of america). but our interns' admissions are always staffed by a second or third year. imagine your mother being admitted to the MICU or CCU by a dinky little med school graduate who doesn't even know how to wear a stethoscope or the upper limit of normal for troponins (ok, i exaggerate, but you know what i mean?!)

 

[TreeOfLife]

hmmm, back in the day when i was an intern (2003-2004). we did about 6-7 admissions on average...but that's average. bad nights were 10-12 admissions for one intern.

now our hospital has new rules for interns...they cap at 5 admissions/night/intern. so guess who gets to do the rest? yup, the second year. the second year caps at 10. then the third year gets the rest. its never come down to the third year though. pretty funny. although, none of our interns (well, most) have not complained if they go a few over 5.

what i find interesting is that your interns are not supervised. i find that extremely scary (perhaps that's the same way in the rest of america). but our interns' admissions are always staffed by a second or third year. imagine your mother being admitted to the MICU or CCU by a dinky little med school graduate who doesn't even know how to wear a stethoscope or the upper limit of normal for troponins (ok, i exaggerate, but you know what i mean?!)

Hmmm--your comments are interesting. I am curious where you were an intern. Was it an ACGME accredited program or an AOA? It sounds like that is a more reasonable program and less compromising of patient care.

 

[Taurean]

I would like to know more about this. Why do you say "most programs can't fire you because the contract is for an entire academic year"??? My collegue was sat down with two 3rd year residents who gave her a letter that outlined exactly what she needs to do over the next year and if she doesn't accomplish that, she will either have days added to her internship at the end of the year or they will have to re-evaluate her position in the program.

At least she's got to sit down and receive a letter with the outline of her problems and even a promise to have her internship extended. My position was terminated 2 days prior to the end of the PGY1 contract without any such letter or any formal written probation given previously, except for a first 6 months evaluation that did state a few problems, which were different ones from those used later to justify the termination of contract. During the appeal process it was argued that the feedback was given to me throughout the year and that I had an opportunity to discuss any grievances.

I would not recommend my former program to anyone. Apart from not following the guidelines, this Family Practice program might be very discriminatory against certain groups of people. You are welcome to PM me if you want to find out where to avoid going for the interview and save money and hassle.

 

[TreeOfLife]

ACGME requirements for residency programs can be found (surprise!!) on the ACGME website. Start at this link, click on the menu item on the left labeled "Res. Review Commitees" and choose the specialty you are interested in.

Do you know if the ACGME governs all GME MD and DO programs?

 

[electra]

My hospital has one intern and one resident that staff the ICU and IICU, about 30 beds. The other 80-100 beds are the responsibility of the floor intern, as are all non-unit admissions. The fewest admissions I have had is 14 (8 after 5pm) and the most admissions is 22 (16 after 5pm).
The resident is available by phone and will come down for assistance, codes, etc., but otherwise it is all the floor intern. And it is hard. And you have to get up to speed and do it fast.

 

[Chief Resident]

I am wondering if anyone knows where I could find information on what is required of a hospital to run an internship program...specifically AOA accredited internship programs.

At the moment, a collegue of mine is being threatened to be kicked out of our internship program because she isn't performing "up to par". We happen to be in a program that is quite challenging and I believe would be for any intern just fresh out of medical school. I am curious as to what guidelines programs must follow with respect to having appropriate supervision for interns etc. At the moment, we are required to take call q3 and because of a shortage of interns, we are forced to do the call alone, with only 1 intern on. We do have a resident available to us to call should we have questions and a back-up intern that we can call in if we get more than 8 admits/call. For the most part however, it is an extremely busy call and quit overwhelming to tackle alone. Generally we have anywhere from 5-8 admits/call and have to tend to 15-25 patients on the floor. I am curious how other programs work and what is "normally" expected of an intern with regard to patient load, availability of support etc.

I feel terrible for this intern and want to see if there is anything I can do to help her out.

Any advice?

Thanks

With all due respect, this "colleague" of yours is likely going to get the boot. If not this year then most likely next year. It always starts with the old "not performing up to par" spiel and usually ends in termination due to "incompetence" or some other coded catchphrase that implies she's a bad doctor. My advice would be for her to finish intern year and transfer to another program for PGY2. It's not good to put it mildly to have a probation (which is likely to be the next step in her case) or termination from residency on your record, and it will make it much harder for her to transfer to a new program if she is terminated from the one she is currently in.

 

[Idiopathic]

Do you know if the ACGME governs all GME MD and DO programs?

I believe that they govern the accredited allopathic programs. I think the AOA governs the osteopatic ones, but they have adopted many of the same practices.

 

[island doc]

I am wondering if anyone knows where I could find information on what is required of a hospital to run an internship program...specifically AOA accredited internship programs.

At the moment, a collegue of mine is being threatened to be kicked out of our internship program because she isn't performing "up to par". We happen to be in a program that is quite challenging and I believe would be for any intern just fresh out of medical school. I am curious as to what guidelines programs must follow with respect to having appropriate supervision for interns etc. At the moment, we are required to take call q3 and because of a shortage of interns, we are forced to do the call alone, with only 1 intern on. We do have a resident available to us to call should we have questions and a back-up intern that we can call in if we get more than 8 admits/call. For the most part however, it is an extremely busy call and quit overwhelming to tackle alone. Generally we have anywhere from 5-8 admits/call and have to tend to 15-25 patients on the floor. I am curious how other programs work and what is "normally" expected of an intern with regard to patient load, availability of support etc.

I feel terrible for this intern and want to see if there is anything I can do to help her out.

Any advice?

Thanks

An intern does not, I repeat not, possess an unrestricted license to practice medicine in any state, therefore there must be adequate supervision by someone who does, lest the intern's employer be an accomplice aiding and abetting in practicing medicine without a license (a crime in all states). Sounds like your DME needs to be reminded of this.

 

[debvz]

I wish just eight admissions....

I wish just 15-25 patients to cover on the floors..... It's more like 60+ solo, and includes ICU patients...

 

[texdrake]

I am wondering if anyone knows where I could find information on what is required of a hospital to run an internship program...specifically AOA accredited internship programs.

At the moment, a collegue of mine is being threatened to be kicked out of our internship program because she isn't performing "up to par". We happen to be in a program that is quite challenging and I believe would be for any intern just fresh out of medical school. I am curious as to what guidelines programs must follow with respect to having appropriate supervision for interns etc. At the moment, we are required to take call q3 and because of a shortage of interns, we are forced to do the call alone, with only 1 intern on. We do have a resident available to us to call should we have questions and a back-up intern that we can call in if we get more than 8 admits/call. For the most part however, it is an extremely busy call and quit overwhelming to tackle alone. Generally we have anywhere from 5-8 admits/call and have to tend to 15-25 patients on the floor. I am curious how other programs work and what is "normally" expected of an intern with regard to patient load, availability of support etc.

I feel terrible for this intern and want to see if there is anything I can do to help her out.

Any advice?

Thanks

How do you make an 80 hour work week on Q3 call?

Also any program that puts an intern on unattended this early in a residency really needs to have their medical care standards questioned.

 

[texdrake]

My hospital has one intern and one resident that staff the ICU and IICU, about 30 beds. The other 80-100 beds are the responsibility of the floor intern, as are all non-unit admissions. The fewest admissions I have had is 14 (8 after 5pm) and the most admissions is 22 (16 after 5pm).
The resident is available by phone and will come down for assistance, codes, etc., but otherwise it is all the floor intern. And it is hard. And you have to get up to speed and do it fast.

Sounds like your ER doesn't know how to do their job. If your hospital has only 150 beds total their is no way you should have 22 addmissions in a night, hell you probably shouldn't have that many in a full day. 150 beds is a small community hospital.

 

[Strength&Speed]

seriously, whats up with that? 16 patients after 5pm? thats ridiculous. i would say you are on the 99th percentile of number of admissions.

My hospital has one intern and one resident that staff the ICU and IICU, about 30 beds. The other 80-100 beds are the responsibility of the floor intern, as are all non-unit admissions. The fewest admissions I have had is 14 (8 after 5pm) and the most admissions is 22 (16 after 5pm).
The resident is available by phone and will come down for assistance, codes, etc., but otherwise it is all the floor intern. And it is hard. And you have to get up to speed and do it fast.

 

[A. Melanoleuca]

The only way you can screw up as an intern is if you are a cowboy and take drastic action with the patients you are covering without consulting your upper level.

Believe me, when I'm on call if I get anything even slightly different from routine I page my upper level and at least let her know what is going on. She will either agree or disagree but I have never had any upper level get angry for waking them up.

It's not that I don't know what I'm doing (which I don't some of the time), it's just that the upper level is responsible.

Oh, you can also screw up by being late, being absent, having a bad attitude and sexually harrassing a patient. I assume we're not talking about this kind of obvious infraction.

On the other hand since the contracts are for one year they do not have to be renewed so I suppose a program can just not pick up your contract if you are not technically screwing up but not exactly covering yourself in glory either. I think it would be kind of wierd to find out only two days before that you are not being picked up. Seems to me a warning or two would be in order.

I know some programs can be vindictive. My particular program had a bad reputation for that until they replaced the program director with a someone who is resident friendly.

 

[A. Melanoleuca]

I am wondering if anyone knows where I could find information on what is required of a hospital to run an internship program...specifically AOA accredited internship programs.

At the moment, a collegue of mine is being threatened to be kicked out of our internship program because she isn't performing "up to par". We happen to be in a program that is quite challenging and I believe would be for any intern just fresh out of medical school. I am curious as to what guidelines programs must follow with respect to having appropriate supervision for interns etc. At the moment, we are required to take call q3 and because of a shortage of interns, we are forced to do the call alone, with only 1 intern on. We do have a resident available to us to call should we have questions and a back-up intern that we can call in if we get more than 8 admits/call. For the most part however, it is an extremely busy call and quit overwhelming to tackle alone. Generally we have anywhere from 5-8 admits/call and have to tend to 15-25 patients on the floor. I am curious how other programs work and what is "normally" expected of an intern with regard to patient load, availability of support etc.

I feel terrible for this intern and want to see if there is anything I can do to help her out.

Any advice?

Thanks

How can you do q3 call without going over your 80 hours? I mean, that's 48 hours in one week of just call. Is it day one (12 hours), day two (12 hours) day three (28 hours), post call then day five (12 hours), day six (12 hours) day seven (28 then transition to day one on call?

Thats 56+48=104 hours which is way more than you are allowed. Seems like if this is the case you could storm in and threaten to blow them to the RRC for violating work hour rules.

The way I feel about intern year and how much of our time is wasted on most rotations I would be pretty angry to go so far over. A couple hours here and there is no big deal but that is outrageous. If they don't have the interns to cover their responsibilties that should be thier problem, not yours. You have to decide if you prefer getting hosed to making an issue of it.

Yeah, I know. Residents used to work 130 hours a week with no complaint blah blah blah. Paying dues blah blah blah. Old school blah blah blah.

Look, if your program can't train you in 80 hours per week then there is something wrong with the program. It is either inefficient, sloppy, or both. Just because that's the way it has always been done does not make it right.

 

[femdoc]

How can you do q3 call without going over your 80 hours? I mean, that's 48 hours in one week of just call. Is it day one (12 hours), day two (12 hours) day three (28 hours), post call then day five (12 hours), day six (12 hours) day seven (28 then transition to day one on call?

Thats 56+48=104 hours which is way more than you are allowed. Seems like if this is the case you could storm in and threaten to blow them to the RRC for violating work hour rules.

The way I feel about intern year and how much of our time is wasted on most rotations I would be pretty angry to go so far over. A couple hours here and there is no big deal but that is outrageous. If they don't have the interns to cover their responsibilties that should be thier problem, not yours. You have to decide if you prefer getting hosed to making an issue of it.

Yeah, I know. Residents used to work 130 hours a week with no complaint blah blah blah. Paying dues blah blah blah. Old school blah blah blah.

Look, if your program can't train you in 80 hours per week then there is something wrong with the program. It is either inefficient, sloppy, or both. Just because that's the way it has always been done does not make it right.

Excellent response. TOL, please look into this situation and advise your colleague accordingly. This definitely gives her some leverage.

 

[medlaw06]

ok...so, i have been reading this and I am NOT an intern (MS 4) but my fiance is an sintern @ at a LARGE university based hospital...she is on call q4 etc etc...having read some of the posts that people have left AND looking at some of the things that TOL has written, there is SOMETHING fishy about this....either HIGHLY MALIGNANT programs like the one TOL described ARE actually out there (if so, PLEASE PM me and let me know so I do NOT apply there) OR there are things that TOL is either exaggerating or not telling the truth on....

I realize I sound harsh, and I realzie I am JUST an MS4 who has "no clue" what an intern's life is like, but from what TOL is saying, it is either a) not true b) not realistic c) over exaggerated d) a PROGRAM that I WOULD want my contract terminated from or e) all of the above

JUST my $0.0000000000000000000000000000000000000000000000000002

 

[sepsis]

I'd love to know as well. Is there any way we can find out about programs doing such things to interns? You know that they won't tell you those things in the interview.

As for me, I think it's malpractice to have an intern admitting without a senior.They won't let me so much as blow my own nose in my subi so what makes me so different now than in 8 months from now, when I'll be doing only 4 weeks of inpt gen. medicine until intern year?

It makes me sad for the pt's and the intern.

 

[APACHE3]

Generally the reviews seem candid and truthful. I put much more stock into the med student rotation or PGY-1 comments, than any upper level. PGY-4 commenting on scutwork has me worried for some reason. IMHO

 

[InternalWhizzzz]

I thnk you should report your program, and have them go on probation. An unsupervised intern is extremely unacceptable. You are dealing with a patient's life....your not growing cell cultures...

that's a horrific program, please let all of us know and we won't apply to the program.

 

[TreeOfLife]

Thanks for your responses. I have told my fellow intern to sign onto scutwork and read what you all have to say. It got me to thinking myself actually. Let's talk about the issue of "supervision" from an upper resident. I wonder what would be classified legally as "supervision"??? We are on-call solo. Once in a while throughout the call an attending may stroll through to check on his/her patient but otherwise we are there alone with only the nurses to sweat with. If I have issues that I feel I can't handle, I can page the R2 that is on-call. Their "on-call" is from home sleeping in their bed. I have paged them on several occasions and they will advise me how to handle certain difficult issues or how to write a particular order should I need the guidance. In the morning, our PD goes over all of the admissions from the evening before, looks at our notes and orders and will either adjust or sign off. This may be considered "supervision" being that he "looks over" the files but by this point, the orders were already put in the patient file and possibly dispensed to the patient. By morning I could have g-d forbid killed someone with my order possibly. With this being said I wonder what you all think about this level of "supervision"??? I never have felt real comfortable going these calls alone but I've sucked it up and handled it. On the otherhand, I see my co-intern really struggling being alone and I really don't blame her.

 

[benjee]

TreeOflife, it sounds the program is pretty horrible/malignant!!!!How can an intern do all the admissions on their own without any senior guidiance??since u guys just started and still learning.Not to mentioned if more than 2 pts crash at the same time!!!!! Believe me, It can happen!!!!Not too long ago, I heard about this kind of programs do exist but not common and they're ususally not filled and u may be able to find out during interviews if the program ever kicked residents out in the past .Usually a good program does not have hi turnover and all residents stay. Besides, when I interviewed in the past for positions, I always asked how the call like, if intern do the calls solo, I mean no senior physically presents in hospital premises.this kind of qs help to eliminate the problematic ones.anyway, goodluck to u and ur colleague. BTW, where the program located?

 

[Blade28]

Sounds about right. On my various rotations so far, the upper-level resident or fellow usually only comes in for bad trauma cases or critically ill patients. I tend to average anywhere from 4-8 admissions per call night, with around 8-12 consults and between 20-50 patients on the floors/ICUs to cross-cover.

 

[A. Melanoleuca]

I just got done with an inpatient rotation. The call was about q4 with somewhere between five to ten admits between 6 PM and 6 AM. This is pretty reasonable. Whatever the case, the service was "capped" at 15 admits which, again, is pretty reasonable if you are expected to learn on a teaching service and not just to be cheap labor for somebody else's ambitions.

The upper level was always available and took her responsibities as the "admit resident" seriously. She was never angry if I called her with a question and actually saw every patient I admitted before signing off. I am a good guy and very dilligent but you'd have to be criminally negligant to trust your professional reputation and the heath of your patient to an intern just out of medical school.

I also got very little sleep on call but the service was very good about getting you out post-call before noon. Sure, you get tired on call but unless sleep is not your priority (in which case you have no one to blame but yourself) you can easily catch up on all your sleep before the next morning.

This is how a servce should be run. I feel sorry for you guys who matched into malignant program. I guess my only advice would be not to ignore the call schedule when selecting programs. It might not seem important during fourth year when you are working banker's hours but at 3AM, it can be pretty demoralizing to look ahead to the next year realizing it won't get any better.

 

[A. Melanoleuca]

TreeOflife, it sounds the program is pretty horrible/malignant!!!!How can an intern do all the admissions on their own without any senior guidiance??since u guys just started and still learning.Not to mentioned if more than 2 pts crash at the same time!!!!! Believe me, It can happen!!!!Not too long ago, I heard about this kind of programs do exist but not common and they're ususally not filled and u may be able to find out during interviews if the program ever kicked residents out in the past .Usually a good program does not have hi turnover and all residents stay. Besides, when I interviewed in the past for positions, I always asked how the call like, if intern do the calls solo, I mean no senior physically presents in hospital premises.this kind of qs help to eliminate the problematic ones.anyway, goodluck to u and ur colleague. BTW, where the program located?

Some admits are pretty routine. We have standard orders for a lot of common presentations like Asthma and "Rule Out Sepsis." On the other hand every patient is different, even with common diseases, so every patient has the potential to bite you on the ass.

Not to mention that from a liabilty standpoint, relying on the judgement of intern is probably indefensible.

 

[Obedeli]

Thanks for your responses. I have told my fellow intern to sign onto scutwork and read what you all have to say. It got me to thinking myself actually. Let's talk about the issue of "supervision" from an upper resident. I wonder what would be classified legally as "supervision"??? We are on-call solo. Once in a while throughout the call an attending may stroll through to check on his/her patient but otherwise we are there alone with only the nurses to sweat with. If I have issues that I feel I can't handle, I can page the R2 that is on-call. Their "on-call" is from home sleeping in their bed. I have paged them on several occasions and they will advise me how to handle certain difficult issues or how to write a particular order should I need the guidance. In the morning, our PD goes over all of the admissions from the evening before, looks at our notes and orders and will either adjust or sign off. This may be considered "supervision" being that he "looks over" the files but by this point, the orders were already put in the patient file and possibly dispensed to the patient. By morning I could have g-d forbid killed someone with my order possibly. With this being said I wonder what you all think about this level of "supervision"??? I never have felt real comfortable going these calls alone but I've sucked it up and handled it. On the otherhand, I see my co-intern really struggling being alone and I really don't blame her.

This is complete bullcrap. Your program or specifically, your director should be ready to appear on Prime Time live or some other news show after a patient's death. Tree of life - I wish the best to you in this horrible situation.

 

[ks622]

I think the issue is more in re: to the fact that we don't really have direct supervision when we are on-call. We have a resident that we can contact via telephone to ask questions to and who will come in in the event that something really intense happens that we can't handle. I am wondering how it works in other programs in this regard. Do programs have to have a supervising Resident "in-house" with the intern? Personally, I've been able to cope but my collegue needs the supervision.

Hi, what type of residency are you in? I'm in a peds residency (intern). We see all our admissions with a 2nd or 3rd year. If for some reason that cannot happen then the senior sees the patient on their own after I have evaluated them. Don't your 2nd and 3rd years take call? I've never heard of that before. As for your friend, she should sit down with your program directors and work out a plan of action to improve her deficiencies whatever they are. In our program, an intern from last year had to do 6 more months of intern year, which totally sucks but I guess beats having your contract non-renewed.

 

[ks622]

Some admits are pretty routine. We have standard orders for a lot of common presentations like Asthma and "Rule Out Sepsis." On the other hand every patient is different, even with common diseases, so every patient has the potential to bite you on the ass.

Not to mention that from a liabilty standpoint, relying on the judgement of intern is probably indefensible.

Our hospital has pathways for the routine diagnoses too, and we run our admissions by the attending of record for the patient before they get put in the chart, but that does not take the place of being supervised in house by a more senior resident. You can't call an attending every time you want to write an order and having a program director look at orders in the morning when you wrote the order at 1 AM is ridiculous. I would bet that if the residency accreditation boards found out about your program they'd have disciplinary action to take, at the very least! I bet programs like this get away with it because once you become a resident, you don't want your program to get in trouble because it jeopardizes your own medical career. It's such bull! When you interviewed and they told you that seniors take "house call" you probably thought, oh that's great! But you didn't think about what would happen when you are an intern and have to be alone on call.

 

[entropy2]

1. get an attorney
2. contact the rrc

 

[ORBITAL BEBOP]

hmmm, back in the day when i was an intern (2003-2004). we did about 6-7 admissions on average...but that's average. bad nights were 10-12 admissions for one intern.

now our hospital has new rules for interns...they cap at 5 admissions/night/intern. so guess who gets to do the rest? yup, the second year. the second year caps at 10. then the third year gets the rest. its never come down to the third year though. pretty funny. although, none of our interns (well, most) have not complained if they go a few over 5.

what i find interesting is that your interns are not supervised. i find that extremely scary (perhaps that's the same way in the rest of america). but our interns' admissions are always staffed by a second or third year. imagine your mother being admitted to the MICU or CCU by a dinky little med school graduate who doesn't even know how to wear a stethoscope or the upper limit of normal for troponins (ok, i exaggerate, but you know what i mean?!)

This is consistent with what I have seen for allopathic medical residency programs except for the ICU being staffed by second and third years. I was in a program where the upper level had a million other things to cover and would get mad if you needed them in the ICU for a difficult admission. There was only one upper level overnight covering the hospital, nursing home pages, ekg readings, etc.

 

[Mumpu]

Um... Scary?

My program covers five hospitals and has a separate in-house senior overnight for both the wards and the unit at every one of them. If your program is short on housestaff, it bites off more than it can chew in terms of coverage -- your job is to learn, not to be a scutmonkey.

Q3 call anywhere is basically a guaranteed violation of the 80-hour workweek.

 

[Blade28]

Generally we have anywhere from 5-8 admits/call and have to tend to 15-25 patients on the floor.

That's definitely not average at our county hospital. More like 8-20 admissions and we cover 60-120 patients.

 

[lvspro]

Hey all
Just found out today what my schedule is for my intern/med-prelim year, as well as what the calls are like. We have 7 call months, Q4, cap at 5 admits, cross cover 15-25 patients, and a senior resident is always available.
In comparison to your program, it seems like a cake-walk, but my call months are running pretty close to 80 hrs. So, as others have mentioned, it seems that not only are they violating the RRC 80 hr guideline, they are also not providing the proper level of oversight. Calling the RRC may suck, but so does that schedule/arrangement.

 

[Annoyances]

Hey all
Just found out today what my schedule is for my intern/med-prelim year, as well as what the calls are like. We have 7 call months, Q4, cap at 5 admits, cross cover 15-25 patients, and a senior resident is always available.
In comparison to your program, it seems like a cake-walk, but my call months are running pretty close to 80 hrs. So, as others have mentioned, it seems that not only are they violating the RRC 80 hr guideline, they are also not providing the proper level of oversight. Calling the RRC may suck, but so does that schedule/arrangement.

Well when I am on call I cover more than 15-25 patients I wish I only covered that much. I cover 60-125 patients and can get up to 8 admissions before I cap for new patients for the day. However, I can only carry 12 patients a day. Meaning if I have 7 I can get 5 new patients that day when I am not on call. Confusing system at our hospital but really sucks and we've had poor guidance the whole year. Our upper levels often get annoyed if u call them has been happening the whole year nothing new. Anyhow, at least thank god the year is almost over. I know during nightfloat also one intern covers upt to 140 patients alone. It gets very crazy at times. On weekends for example I cover three units alone in addition to having of course manage my own 12 patients. Its lousy system...

 

[lvspro]

Well when I am on call I cover more than 15-25 patients I wish I only covered that much. I cover 60-125 patients and can get up to 8 admissions before I cap for new patients for the day. However, I can only carry 12 patients a day. Meaning if I have 7 I can get 5 new patients that day when I am not on call. Confusing system at our hospital but really sucks and we've had poor guidance the whole year. Our upper levels often get annoyed if u call them has been happening the whole year nothing new. Anyhow, at least thank god the year is almost over. I know during nightfloat also one intern covers upt to 140 patients alone. It gets very crazy at times. On weekends for example I cover three units alone in addition to having of course manage my own 12 patients. Its lousy system...

That blows. So, just out of curiosity, when do you read?

 

[JackBauERfan]

Well when I am on call I cover more than 15-25 patients I wish I only covered that much. I cover 60-125 patients and can get up to 8 admissions before I cap for new patients for the day. However, I can only carry 12 patients a day. Meaning if I have 7 I can get 5 new patients that day when I am not on call. Confusing system at our hospital but really sucks and we've had poor guidance the whole year. Our upper levels often get annoyed if u call them has been happening the whole year nothing new. Anyhow, at least thank god the year is almost over. I know during nightfloat also one intern covers upt to 140 patients alone. It gets very crazy at times. On weekends for example I cover three units alone in addition to having of course manage my own 12 patients. Its lousy system...

wow that is a lot.

I'm sure you have some help though...

 

[Annoyances]

Actually no never did get much help and reading? Hmm was there such a thing my intern year was hell.

 

[sepsis]

we have a 12pt cap as well. I think it's impossible to see pt, check labs, write note and do orders on 12pts in a day - notes my first month sometimes did not get done till after noon conference - some people did not get them done until 4pm.

We have no overnight call, which I thought was great B U T there are T O N S of downsides to this system. We have a short-call (8-330) and long call (330-8) and then night float. We take pts from night float 2 max per intern starting with long call. We take max 5 admits per intern per call. On short call it esp. sucks as you are admitting when you are rounding on your pts. We are 'on call' every other day with this system. It is utterly draining. We have 5 teams 1 senior and two interns and it is NOT enough. People capped constantly and jeorpardy kept getting called in to cover admits.

Not only this but we continually were given admits at 2:30, 3pm and so on when we were on short call and scheduled to be done at 3:30. Practically this meant you went home at 6 or 7 when oftentimes long call would be sitting about on thier thumbs.

I was mentally, physically and emotionally exhausted after 1 week. I did not enjoy any part of the work - which is a shame because I truly enjoy learning.

Morning report cuts an hour out, noon conf another hour and 3 hours of "teaching rounds" 3xper week. So if you are admitting and seeing pts and have 5 hours chopped out of your day 3 days a week - how ever can you get your work done in a timely manner???

80 hours is an average and thank god because I would be seriously over. We were told our hours would be 60 on the floors - ha!

I can only wait for the year to be over, for vacation and those random electives that allow you to breathe.