Gaming intern year

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What is the best way to do as little work as possible during intern year? (serious question)

Originally Posted by Dumb

What is the best way to do as little work as possible during intern year? (serious question)

Dude, intern year is not that bad. If you matched at a community place, it's a slower pace. If you matched at an academic place = more work. Don't slack off, work hard dude. There is no way to "work as little as possible"-about all prelim/TY programs have basically the same requirements.

Originally Posted by Dumb

What is the best way to do as little work as possible during intern year? (serious question)

No idea. Good luck in your pursuit.

Originally Posted by Dumb

What is the best way to do as little work as possible during intern year? (serious question)

Match into a sweet-ass TY.

Originally Posted by GuyWhoDoesStuff

Match into a sweet-ass TY.

Done. What else?

Originally Posted by Dumb

What is the best way to do as little work as possible during intern year? (serious question)

If you have electives take easy electives. If you have any say in your schedule take anything pediatric in the summer and put your clinic month where you have a lot of holidays (especially december). If you're like most Interns and don't have any options then suck it up.

Originally Posted by Perrotfish

If you have electives take easy electives. If you have any say in your schedule take anything pediatric in the summer and put your clinic month where you have a lot of holidays (especially december). If you're like most Interns and don't have any options then suck it up.

Ok so I should give some context. I matched to a cu$hy TY and have scheduled easy electives, but I wanted to know day-to-day strategies for skipping out on work during my mandatory IM months.

Originally Posted by Dumb

Ok so I should give some context. I matched to a cu$hy TY and have scheduled easy electives, but I wanted to know day-to-day strategies for skipping out on work during my mandatory IM months.

Are you aware/fine with the fact that any work you skip out on lands on someone else?

Originally Posted by Perrotfish

Are you aware/fine with the fact that any work you skip out on lands on someone else?

I am fine with it if it lands on a well-compensated attending or an upper level IM resident set on a career as an internist who will actually use it, yes.

Originally Posted by Perrotfish

Are you aware/fine with the fact that any work you skip out on lands on someone else?

He seems to be.

Originally Posted by Dumb

I am fine with it if it lands on a well-compensated attending or an upper level IM resident set on a career as an internist who will actually use it, yes.

Set your pager to fwd to their pager #s. Easy game.

Originally Posted by DrBowtie

Set your pager to fwd to their pager #s. Easy game.

Not so sure that'll go over well, but... yeah. that's one way to do it. especially in the ICU while on night float

Originally Posted by Dumb

but I wanted to know day-to-day strategies for skipping out on work during my mandatory IM months.

Seriously? Just get your work done as efficiently as possible.

One legitimate way is to use your support staff (social work, nurses, medical students, etc...) effectively. I'm not saying you should be a lazy jerk and dump all your work onto everyone else, but that's one way you can legitimately have an impact.

Reality is: much of your work as an intern is scut and will not be educational to you seniors. The attendings don't want to do it. Feel glad you have a cushy TY program and do what's expected of you. These are people's lives you have in your hands you know. You may not have as many patients in the cushy TY and you may have better support and perks, but at the end of the day you are a doctor and are providing people care. Take care of those people as you would your own family.

Here's how I did it.

I showed up at 7:30, got sign out. Immediately began seeing my 6 patients and at that time would jot down quickly the "S" the "O." I'd do a quick chat with the nurse in case the NF intern missed something or didn't get paged for something. Then, I'd talk to case management and ensured the proper dispo was on board. Around 8:15am, I began working on my notes, looked at labs and analyzed 'em quickly. Repleted lytes prn. Ensured PT/OT eval prn, RT eval, etc. By 8:50am, I was done with all my notes and had my proposed A/P in place. I'd print 'em all out and have 'em ready to present on rounds. The "A" is the easy part. It's the "P" that takes thought. If something else was mentioned for the plans I'd jot that down in my note for that particular patient.

Most folks were JUST seeing their patients at 8am, so it'd be just me in the res workroom typing up my notes. Most don't have notes done by the time rounds start, and hence things take longer while on rounds.

Rounds from 9a-12p.

Noon conf. 12p-1a

I'd quickly ensure all consults done by 12ish and then go to noon conference. Most of the time, the topic wouldn't interest me and I'd grab the food and go back and do work (i.e. finish any orders, etc that was discussed on rounds) and then finalize my "P" and send 'em to my attending.

A quick thing you'll discover is that you can copy the previous day's notes and just edit with a new subjective, new PE finding if at all, new VS, most of the time the "A" remains the same unless a new problem occurs, and then put in the plan you finalized while on rounds. After that, submit the notes to the attendings... and you're done.

If you have a discharge, work on that first. Don't leave it til the end.

Most days I was done by 2-2:30pm and that left me time to tend to individual patient care prn if nursing paged, and other educational activities scheduled.

Sign out by 4pm at the latest unless on "short call" - worked like a charm. Like neuronix said, gotta be efficient.

Originally Posted by Dumb

What is the best way to do as little work as possible during intern year? (serious question)

The key is to project laziness and incompetence enough to where u won't be trusted with patient care. Don't overdo it because u don't want to get fired. Also sexual harrassment can help u get atleast 2-3 weeks off for an investigation. Do that during a tough month.

Originally Posted by Doctor4Life1769

Here's how I did it.

I showed up at 7:30, got sign out. Immediately began seeing my 6 patients and at that time would jot down quickly the "S" the "O." I'd do a quick chat with the nurse in case the NF intern missed something or didn't get paged for something. Then, I'd talk to case management and ensured the proper dispo was on board. Around 8:15am, I began working on my notes, looked at labs and analyzed 'em quickly. Repleted lytes prn. Ensured PT/OT eval prn, RT eval, etc. By 8:50am, I was done with all my notes and had my proposed A/P in place. I'd print 'em all out and have 'em ready to present on rounds. The "A" is the easy part. It's the "P" that takes thought. If something else was mentioned for the plans I'd jot that down in my note for that particular patient.

Most folks were JUST seeing their patients at 8am, so it'd be just me in the res workroom typing up my notes. Most don't have notes done by the time rounds start, and hence things take longer while on rounds.

Rounds from 9a-12p.

Noon conf. 12p-1a

I'd quickly ensure all consults done by 12ish and then go to noon conference. Most of the time, the topic wouldn't interest me and I'd grab the food and go back and do work (i.e. finish any orders, etc that was discussed on rounds) and then finalize my "P" and send 'em to my attending.

A quick thing you'll discover is that you can copy the previous day's notes and just edit with a new subjective, new PE finding if at all, new VS, most of the time the "A" remains the same unless a new problem occurs, and then put in the plan you finalized while on rounds. After that, submit the notes to the attendings... and you're done.

If you have a discharge, work on that first. Don't leave it til the end.

Most days I was done by 2-2:30pm and that left me time to tend to individual patient care prn if nursing paged, and other educational activities scheduled.

Sign out by 4pm at the latest unless on "short call" - worked like a charm. Like neuronix said, gotta be efficient.

Didn't you have morning report at 7am? We did, and PD would get pissed if we did not show up and were noticed that we were not there. During consult/elective months it was different, but during IM months you had to be there. Also, we usually had way more than 6 patients. Most work was done by around 10-11am, but the problem comes with consults coming in late, and/or late admissions-the time between 3:00-3:30 is the worse, because many of the ER nurses waited until shift changes to send up the new admissions, and that always delayed the leaving/sign out process. Not much you can do with that.

Originally Posted by omarsaleh66

The key is to project laziness and incompetence enough to where u won't be trusted with patient care. Don't overdo it because u don't want to get fired. Also sexual harrassment can help u get atleast 2-3 weeks off for an investigation. Do that during a tough month.

I'm now applying this strategy to my everyday life by being unreliable. Now nobody asks me to do anything! This strategy when used correctly works wonders

Originally Posted by Neuronix

Seriously? Just get your work done as efficiently as possible.

One legitimate way is to use your support staff (social work, nurses, medical students, etc...) effectively. I'm not saying you should be a lazy jerk and dump all your work onto everyone else, but that's one way you can legitimately have an impact.

This is a great point. It seems like I'll have a lot of med student minions but I won't know until next week. I also have a lot of experience with leveraging support staff from med school. Hopefully I can have the students write notes and put in orders (for me to sign) on all of their pts... win-win.

Originally Posted by omarsaleh66

The key is to project laziness and incompetence enough to where u won't be trusted with patient care. Don't overdo it because u don't want to get fired. Also sexual harrassment can help u get atleast 2-3 weeks off for an investigation. Do that during a tough month.

Haha...you're my role model in more ways than one, brah. I know you're half-joking, but there's a lot of truth to that. I used to feign being stressed out and overworked in med school to avoid being assigned more (scut)work and it worked like a charm.

Originally Posted by Medstudentquest

Didn't you have morning report at 7am? We did, and PD would get pissed if we did not show up and were noticed that we were not there. During consult/elective months it was different, but during IM months you had to be there. Also, we usually had way more than 6 patients. Most work was done by around 10-11am, but the problem comes with consults coming in late, and/or late admissions-the time between 3:00-3:30 is the worse, because many of the ER nurses waited until shift changes to send up the new admissions, and that always delayed the leaving/sign out process. Not much you can do with that.

Well, I didn't mention "short call" days. Just the typical day.

also, off-service interns didn't need to show up to morning report.

We only carried 6 pts as interns, it goes up to 7 the 2nd semester of intern year, but i had all my medicine months knocked out the 1st 6 months....

Originally Posted by Doctor4Life1769

Well, I didn't mention "short call" days. Just the typical day.

also, off-service interns didn't need to show up to morning report.

We only carried 6 pts as interns, it goes up to 7 the 2nd semester of intern year, but i had all my medicine months knocked out the 1st 6 months....

Wow nice! I carried up to 12-13 patients even when going into call. You must have gone to a cush TY. How many electives did you have?

Originally Posted by Medstudentquest

Wow nice! I carried up to 12-13 patients even when going into call. You must have gone to a cush TY. How many electives did you have?

4 months

Originally Posted by Dumb

What is the best way to do as little work as possible during intern year? (serious question)

Same as med school minus shelf exams. You've heard of the "halo effect" right? You don't have to work that hard, just be nice and make sure everyone likes you. As long as they like you their subjective judgment will be positive regardless of your work load.

Originally Posted by RestoreSight

Same as med school minus shelf exams. You've heard of the "halo effect" right? You don't have to work that hard, just be nice and make sure everyone likes you. As long as they like you their subjective judgment will be positive regardless of your work load.

Good point...Strive to be more of a smooth-talking show pony than a workhorse.

Also, good news guys: I don't have tuberculosis. I also found out I'll be carrying 4-6 patients (bout the same as on my med sub-I)

great strategy

Originally Posted by Dumb

Good point...Strive to be more of a smooth-talking show pony than a workhorse.

Also, good news guys: I don't have tuberculosis. I also found out I'll be carrying 4-6 patients (bout the same as on my med sub-I)

whatcha going into for pgy2

Originally Posted by xanthomondo

whatcha going into for pgy2

rads

Originally Posted by Dumb

rads

here i thought you were going ortho. i'm disappointed.

Originally Posted by Doctor4Life1769

Here's how I did it.

I showed up at 7:30, got sign out. Immediately began seeing my 6 patients and at that time would jot down quickly the "S" the "O." I'd do a quick chat with the nurse in case the NF intern missed something or didn't get paged for something. Then, I'd talk to case management and ensured the proper dispo was on board. Around 8:15am, I began working on my notes, looked at labs and analyzed 'em quickly. Repleted lytes prn. Ensured PT/OT eval prn, RT eval, etc. By 8:50am, I was done with all my notes and had my proposed A/P in place. I'd print 'em all out and have 'em ready to present on rounds. The "A" is the easy part. It's the "P" that takes thought. If something else was mentioned for the plans I'd jot that down in my note for that particular patient.

Most folks were JUST seeing their patients at 8am, so it'd be just me in the res workroom typing up my notes. Most don't have notes done by the time rounds start, and hence things take longer while on rounds.

How is this more efficient than what anyone else does? You spent ~15 minutes per patient. You just happened to see them for the S/O in a batch rather than sequentially. It's just as much work, just more monotonous and less walking around I guess. I spend 15 minutes/pt doing it sequentially right now. I may switch to the batch method, but it seems annoying to take out notes from all of the separate charts and what not, which is probably why it doesn't save much time.

A quick thing you'll discover is that you can copy the previous day's notes and just edit with a new subjective, new PE finding if at all, new VS, most of the time the "A" remains the same unless a new problem occurs, and then put in the plan you finalized while on rounds. After that, submit the notes to the attendings... and you're done.

This is good, but basically the same tricks as med school.

If you have a discharge, work on that first. Don't leave it til the end.

I agree, although I still triage pts daily...i.e., see the sickest first. The d/c pts are, of course, the lowest priority in that sense.

Most days I was done by 2-2:30pm and that left me time to tend to individual patient care prn if nursing paged, and other educational activities scheduled.

Sign out by 4pm at the latest unless on "short call" - worked like a charm. Like neuronix said, gotta be efficient.

I'm not sure how your method is more efficient than any other. You're still coming in at 7:30 and leaving at 4. You're still spending 15 minutes per pt. And being in the physician's charting room with all of your notes done is actually a bad thing...we're punished with more work if we're more efficient. The seniors will definitely assign you more if they see you're just chilling and attending BS lectures to run the clock until sign out.

you have paper charts?

i have EMR. I simply take my sign out sheets given back to me and write my exam findings by each patient. once i've seen all my patients, I'm done and I go back to the work room and do all my notes at once.

i see patients first before doing anything immediately after sign out because it's noisy in the work room. folks are getting sign out, messing around looking at vitals and labs, etc on the computer. by the time i've seen all my patients, the room is quiet and i start methodically knocking them out one by one. Have the stack of notes printed and ready to present when it's my time to present my patients. It just allowed me to be more organized and forced me to think about the patient. Who cares if you finish everything if you don't have a clue you're doing? I'm not one who can pull sh!t outta my ass while rounding or keep all the info in my head straight.

7:30 isn't bad, most come in around 6:30-7am.

I left at 4pm because that was sign out time. I'm not sure how one can show up 30 mins before AM rounds and do well.

Originally Posted by Doctor4Life1769

you have paper charts?

i have EMR. I simply take my sign out sheets given back to me and write my exam findings by each patient. once i've seen all my patients, I'm done and I go back to the work room and do all my notes at once.

We have EMR, too. I thought you meant you quickly scribbled the S/O on paper notes and then later inputed into the EMR, which it sounds like you're doing...only with the signout papers. I'm considering switching to this method, but we have separate sign out and work rooms so noise is a non-issue and writing the stuff twice (on the signout paper and later in the EMR) is kind of annoying. I guess it doesn't make a big diff.

7:30 isn't bad, most come in around 6:30-7am.

It's only been a few days for me and I already hate it.

Originally Posted by Dumb

We have EMR, too. I thought you meant you quickly scribbled the S/O on paper notes and then later inputed into the EMR, which it sounds like you're doing...only with the signout papers. I'm considering switching to this method, but we have separate sign out and work rooms so noise is a non-issue and writing the stuff twice (on the signout paper and later in the EMR) is kind of annoying. I guess it doesn't make a big diff.




It's only been a few days for me and I already hate it.

Yeah, I never said I didn't hate it either. You just make do with it. Hell, it's what 8.5 hours/day and you're working half that time on most days. The other time is educational activities (at my program anyway). It drug on forever, and it sucked, but at the end of it all it was better than putting in 16 or sometimes more hours on surgical rotations where you round twice (albeit, a little faster).

We gave the night float intern our sign out, they returned it back to us when getting sign out back - i use this sheet b/c they often have comments on o/n events. thus, i can simply put in PE findings and subjective nonsense (quick jot down) and then have it all in the EMR. it really doesn't take that much longer to do. When half your patients have CHF exac or COPD exac or a stroke, it can get confusing at times.

Originally Posted by Dumb

rads

im guessing you've already got the phrase "correlate clinically" assigned to a shortcut on your keyboard

Originally Posted by xanthomondo

im guessing you've already got the phrase "correlate clinically" assigned to a shortcut on your keyboard

Eh...by the time I graduate fellowship, keyboards will be obsolete

Most of these suggestions improve efficiency, but don't really make you work any less. Its the hospital you work at that determines the number of patients you will see. Also luck. I'm working all day 4th of July. I drew the small straw. My 3 co-interns on the service have the day off.

Use the ancillary staff for anything that a doctor really shouldn't be doing, which includes:

1. faxing things to anyone
2. getting things faxed to you from anyone
3. arranging follow-up appointments with the patient's primary physician and other specialists upon discharge
4. bed management issues
5. nursing home transfer issues
6. Routine vitals, IVs, NG tubes etc.

Where I've been, lots of residents take it upon themselves to do this. It's not in your job description so get the person who is being paid to do that (the ward clerk, nurse, social worker, etc.) to actually do it. Be firm and/or flirt.

Another thing you can do is prn stuff and be liberal in your uses of sliding scales so that the nurses won't page you with crap.

Leaving early on ward IM is tough due to "sign out" but you can certainly get all of your work done by noon and then disappear somewhere until then, fielding pages as they come.

Originally Posted by RestoreSight

Most of these suggestions improve efficiency, but don't really make you work any less. Its the hospital you work at that determines the number of patients you will see. Also luck. I'm working all day 4th of July. I drew the small straw. My 3 co-interns on the service have the day off.

How many hours are you guys working weekly? I'm doing 45-50 now.

Originally Posted by Dumb

How many hours are you guys working weekly? I'm doing 45-50 now.

80ish so far every week

Originally Posted by xanthomondo

80ish so far every week

How are you working so much?!

Originally Posted by xanthomondo

80ish so far every week

That sucks

I'm working about 50. 60 now that I'm on nightfloat.

I was working 40 on endocrine, now 65-70 on night float.

Originally Posted by RestoreSight

That sucks

I'm working about 50. 60 now that I'm on nightfloat.

60 on night float is a blessing. Ours is 78 but I'm doing a real medicine prelim year.

Jealous of those in cush TYs right now.

Originally Posted by DrBowtie

60 on night float is a blessing. Ours is 78 but I'm doing a real medicine prelim year.

Jealous of those in cush TYs right now.

I don't understand how you guys are working so much. I did a prelim year, and would go home usually by 4pm except on call days.

Originally Posted by DrAwsome

I don't understand how you guys are working so much. I did a prelim year, and would go home usually by 4pm except on call days.

Well our NF is scheduled for 13 hrs x 6 days/wk. You can't leave early obviously.

Dude, this is just not OK. I am also in a cush TY - but skipping out on YOUR work for which you voluntarily signed up, and having it land on ANYONE else is just not OK. I just hope you are not in my program - not here, not anyplace else.

Originally Posted by DrBowtie

Well our NF is scheduled for 13 hrs x 6 days/wk. You can't leave early obviously.

Ok, I get that, but night float is just a few weeks I guess. Otherwise you shouldn't be working anywhere near that.

Currently averaging 8-10 hours/week. Getting a lot of sun by the pool.

Originally Posted by GuyWhoDoesStuff

Currently averaging 8-10 hours/week. Getting a lot of sun by the pool.

Haha...can't wait to start my electives. But as a budding dermie, you should know not to get a lot of sun bro (even if SPFing)

Originally Posted by Carotenoid

Dude, this is just not OK. I am also in a cush TY - but skipping out on YOUR work for which you voluntarily signed up, and having it land on ANYONE else is just not OK. I just hope you are not in my program - not here, not anyplace else.

Dude, chill out.

My NF is one week at a time, 10 hrs x6 days. Total of about 3 wks during the year.

Subspecialty outpatient. 25hrs/wk. Actually doing something other than hanging out after morning report or before noon conference. 15hrs/wk.

Sorry guys. Tough to beat TY elective hours.