Gaming intern year

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Originally Posted by DrAwsome

How are you working so much?!

Originally Posted by DrBowtie

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

Yeah this. I went from 6 x 12-13 hrs nights to 6x 12-13 hrs days.

My next golden weekend is in 4 months

Originally Posted by xanthomondo

Yeah this. I went from 6 x 12-13 hrs nights to 6x 12-13 hrs days.

My next golden weekend is in 4 months

Why are your days so long?

From a surgeon, this just doesn't make sense. Intern hours were somewhere in the range of 4-5am til 6pm, 6 days a week. There are some days that one member of the team stayed to sign out at 6pm and the others got to leave, but that would be an hour or to less at the most. And several days it would end up being more. As a PGY2, I'd frequently get in slightly later (5-6ish) but sometimes have to stay even later if I was scrubbed in a case. Night float made leaving earlier harder for my interns last year (before the work hour change, it was a call system, so if you were finished at 5 you could just sign out then, but now you have to wait til the NF intern comes). Our Q3 rotations are even worse (SICU, Trauma) and for interns they have totally wacky schedules (Trauma the night shifts are 8pm til 10am, the day shifts are 6am til 8pm for about 5 days a week).

And to the commenter that said an NGT is an ancillary procedure that should be done by the ancillary staff, that baffles me. Most places I know, an ICU nurse won't even put in an NGT. The only "Ancillary" staff I know that does NGT placement (removal is different) are PA's and NP's, but they are few and far between.

Originally Posted by thedrjojo

And to the commenter that said an NGT is an ancillary procedure that should be done by the ancillary staff, that baffles me. Most places I know, an ICU nurse won't even put in an NGT. The only "Ancillary" staff I know that does NGT placement (removal is different) are PA's and NP's, but they are few and far between.

That is solely a nursing procedure here, only time one of the residents do it is if the nurses try and fail, or if it was placed in the OR by anesthesia.

Originally Posted by thedrjojo

And to the commenter that said an NGT is an ancillary procedure that should be done by the ancillary staff, that baffles me. Most places I know, an ICU nurse won't even put in an NGT. The only "Ancillary" staff I know that does NGT placement (removal is different) are PA's and NP's, but they are few and far between.

When I was in training, the policy was NGs on surgical patients had to be placed by residents or students, except when on our community hospital rotation or on ICU patients, where the nurses would do it.

In the real world (i.e. not academic training hospital which may have the above policy), nurses put in NG tubes unless you have a burning desire to do it yourself.

Nurses drop NGs at my hospital too. They basically do everything come to think of it. All I do is place a bunch of orders.

they basically do everything come to think of it. All i do is place a bunch of orders.

+1

So lucky. If it's not 6am/noon/6pm/midnight, we're drawing the labs... and I never drew blood in med school. Luckily one of my co-interns used to be a phlebotomist.

Originally Posted by choweee

So lucky. If it's not 6am/noon/6pm/midnight, we're drawing the labs... and I never drew blood in med school. Luckily one of my co-interns used to be a phlebotomist.

It's always embarrassing when you and your senior fail miserably after trying to get a vein for an hour or two, by which time the phlebotomist actually rolls around and sticks the pt in literally 3 seconds.

Originally Posted by TheLesPaul

It's always embarrassing when you and your senior fail miserably after trying to get a vein for an hour or two, by which time the phlebotomist actually rolls around and sticks the pt in literally 3 seconds.

Why are you drawing blood anyway? If they have phlebotomists on staff they should draw it. Its kinda unfair to a patient to get stuck over and over again by people with no experience just for the sake of "learning" how to draw blood especially if there are people whose only job is to draw blood.. You're going into ophtho right so the skill is totally useless anyway?

Remember the oath? Primum non nocere (First, do no harm)?

You don't want to be perceived as being too lazy or not doing your share - don't want to tick off your colleagues, even if you're only there for a year.

And definitely agree with the PRN advice - do it both for yourself and for your covering intern.

Almost everyone should have something PRN for pain, insomnia, sliding scale for diabetics, etc etc unless medically contraindicated.

Originally Posted by choweee

So lucky. If it's not 6am/noon/6pm/midnight, we're drawing the labs... and I never drew blood in med school. Luckily one of my co-interns used to be a phlebotomist.

Sounds like you're at a crap community program.

Originally Posted by RestoreSight

Why are you drawing blood anyway? If they have phlebotomists on staff they should draw it. Its kinda unfair to a patient to get stuck over and over again by people with no experience just for the sake of "learning" how to draw blood especially if there are people whose only job is to draw blood.. You're going into ophtho right so the skill is totally useless anyway?

Remember the oath? Primum non nocere (First, do no harm)?

There's a gap in the timings of phlebotomy from 930pm to 11pm where you can't get stat lab draws until you do them yourself. It's usually not a problem, but sometimes you just have to do it yourself.

Perplexingly, if the nurses can't get the IV after a few tries, they page you to do it. Because of your massive phlebotomy experience.

Originally Posted by TheLesPaul

There's a gap in the timings of phlebotomy from 930pm to 11pm where you can't get stat lab draws until you do them yourself. It's usually not a problem, but sometimes you just have to do it yourself.

Perplexingly, if the nurses can't get the IV after a few tries, they page you to do it. Because of your massive phlebotomy experience.

Aren't stat draws always MD? That's been the policy everywhere I've been so far.

Originally Posted by johnnydrama

Aren't stat draws always MD? That's been the policy everywhere I've been so far.

Not where I did internship. All blood draws were done by phlebotomy, and if phlebotomy was not available, nurses would do the draws. Neither I nor any of my fellow residents ever did a blood draw.

Originally Posted by DrAwsome

Not where I did internship. All blood draws were done by phlebotomy, and if phlebotomy was not available, nurses would do the draws. Neither I nor any of my fellow residents ever did a blood draw.

Yup...that's how it is here, too.

Originally Posted by Dumb

Yup...that's how it is here, too.

Hm, oh well, guess it's an NY thing.

Here if it's important enough it needs to be stat, the MD needs to do it.

Originally Posted by johnnydrama

Hm, oh well, guess it's an NY thing.

Here if it's important enough it needs to be stat, the MD needs to do it.

Wow, that kind of sucks. Particularly for the really sick patients. I know that I did very few blood draws in med school, so it would not have been the best of experiences for my patients to have me draw their blood. It's a skill that definitely takes some practice.

Originally Posted by DrAwsome

Wow, that kind of sucks. Particularly for the really sick patients. I know that I did very few blood draws in med school, so it would not have been the best of experiences for my patients to have me draw their blood. It's a skill that definitely takes some practice.

I don't like drawing blood on my own patients, but have no issues with doing it for coverage patients. (I think that it can interfere with the doctor-patient relationship and if it the patient is a hard stick can undermine your credibility.)

Originally Posted by johnnydrama

Hm, oh well, guess it's an NY thing.

Here if it's important enough it needs to be stat, the MD needs to do it.

Yes, it's very much a NYC thing. Once you get away from there you will find that people are more likely to perform the functions of the job for which they are getting paid. It's pretty sweet.

Originally Posted by gutonc

Yes, it's very much a NYC thing. Once you get away from there you will find that people are more likely to perform the functions of the job for which they are getting paid. It's pretty sweet.

I was under the impression that nurses in NYC are unionized or some such thing, resulting in basically them doing nothing and you (the doc) having to do everything.

Originally Posted by GuyWhoDoesStuff

I was under the impression that nurses in NYC are unionized or some such thing, resulting in basically them doing nothing and you (the doc) having to do everything.

Yep.

Another reason not to do residency in NYC. Another reason why NYC sucks.

Originally Posted by Doctor4Life1769

Yep.

Another reason not to do residency in NYC. Another reason why NYC sucks.

Meh, I've still only drawn blood a few times.

It's not bad at all.

Definitely beats living some place else.

Originally Posted by TheLesPaul

There's a gap in the timings of phlebotomy from 930pm to 11pm where you can't get stat lab draws until you do them yourself. It's usually not a problem, but sometimes you just have to do it yourself.

Perplexingly, if the nurses can't get the IV after a few tries, they page you to do it. Because of your massive phlebotomy experience.

Haha. When in doubt give the responsibility (and liability) to an intern.

crap that sucks that you have to do your own lab draws. that is an ancillary staff job. i've never had to draw blood. i order things stat (electronic orders) and it gets done immediately. poor nyc.

Originally Posted by badasshairday

crap that sucks that you have to do your own lab draws. that is an ancillary staff job. i've never had to draw blood. i order things stat (electronic orders) and it gets done immediately. poor nyc.

Only if the lab absolutely has to be drawn in the next few minutes to half hour (without a prior order) and it needs to be evaluated immediately.

Really only things like an H&H or an ABG fall into category. Everything else can usually wait an hour or two (or can be scheduled).

Originally Posted by johnnydrama

Only if the lab absolutely has to be drawn in the next few minutes to half hour (without a prior order) and it needs to be evaluated immediately.

Really only things like an H&H or an ABG fall into category. Everything else can usually wait an hour or two (or can be scheduled).

What about cardiac enzymes or lactic acid?

Originally Posted by GuyWhoDoesStuff

I was under the impression that nurses in NYC are unionized or some such thing, resulting in basically them doing nothing and you (the doc) having to do everything.

Well they are pretty brilliant, don't you think? They have a 2 year associates and make close to 80-90k, while working 3 12 hour shifts? They don't do much of anything, have no liability, and have great PR where people think they should get paid that and more!!!

I still don't get why "we" don't unionize.

Originally Posted by badasshairday

What about cardiac enzymes or lactic acid?

Tropinins are usually done in the ER and then scheduled for trending. If a patient is having an MI on the floor though, yes, those too.

Lactate falls under ABG.

Originally Posted by johnnydrama

Meh, I've still only drawn blood a few times.

It's not bad at all.

Definitely beats living some place else.

This highlights the differences in personal opinions. NYC is one of the very last places in this country in which I would want to live. Terrible nursing is just one more reason to add to the list.

Originally Posted by GuyWhoDoesStuff

This highlights the differences in personal opinions. NYC is one of the very last places in this country in which I would want to live. Terrible nursing is just one more reason to add to the list.

Agreed. NYC, great place to visit. But IMO, I would not want to live or work there. But different strokes for different folks.

We have the best nursing at our hospital. Need outside records? Just write or put in the electronic order. Need stat labs, again just put in the order. No wasting time on the phone on hold trying to get records. No BS of wasting time sticking a patient for a stat troponin when you just got slammed by 2 or 3 admissions at one time.

No social work BS either. Just tell the social worker what is needed medically. Can't afford lovenox to bridge to comadin as an outpatient, just let the SW know. The SW automatically get involved with every admit at my hospital and go over whether the patient needs a PCP or financial/social support/issues.

I <3 my program, especially after hearing and seeing things at my friends instituations or from my experiences in med school.

Is there any way to fire those nurses or slash their pay intensely? If they are that fat and useless, what's the point of them even having a job there...?

Originally Posted by KnuxNole

Is there any way to fire those nurses or slash their pay intensely? If they are that fat and useless, what's the point of them even having a job there...?

Their pay should definitely be lowered. It's insane that people would make that kind of $$ for the days worked. And their benefits and pay just keeps getting better. why we are unable to fight for our rights like they do is beyond me. They also claim to be like us and know as much as us, yet they are able to strike at the drop of a hat. So how come we can't then if we are the same?

Originally Posted by badasshairday

Agreed. NYC, great place to visit. But IMO, I would not want to live or work there. But different strokes for different folks.

We have the best nursing at our hospital. Need outside records? Just write or put in the electronic order. Need stat labs, again just put in the order. No wasting time on the phone on hold trying to get records. No BS of wasting time sticking a patient for a stat troponin when you just got slammed by 2 or 3 admissions at one time.

No social work BS either. Just tell the social worker what is needed medically. Can't afford lovenox to bridge to comadin as an outpatient, just let the SW know. The SW automatically get involved with every admit at my hospital and go over whether the patient needs a PCP or financial/social support/issues.

I <3 my program, especially after hearing and seeing things at my friends instituations or from my experiences in med school.

I really thought this is the way it is at most places until I started talking to others. And yet even with excellent ancillary support, low pt volume, short call, and amazing perks, I still hate the floors.

Originally Posted by GuyWhoDoesStuff

This highlights the differences in personal opinions. NYC is one of the very last places in this country in which I would want to live. Terrible nursing is just one more reason to add to the list.

Agreed! I interviewed there and found it $$, terrible traffic, rude people, dirty, and overwhelmingly big. I never understood the appeal. I personally also had a pretty good program where nurses where for the most part except a few respectful and helpful and knew their place, as well as the PT/OTs, dietary staff, etc. Social work was also very active and helpful in discharging people and involved from the get go so that patients did not linger for days due to last minute social things. But sometimes you have to be more aggressive and put your foot down as far as staff. Not everyone knows their place.

Y'all are nuts.

I agree ancillary services suck here, but the city more than makes up for it.

Originally Posted by johnnydrama

Y'all are nuts.

I agree ancillary services suck here, but the city more than makes up for it.

Out of curiosity, what do you think is so great about NYC? Maybe the job markets will improve with the decreased interest in living in NYC!

Originally Posted by Dermpath

Out of curiosity, what do you think is so great about NYC? Maybe the job markets will improve with the decreased interest in living in NYC!

There is no decreased interest in living in NYC, sadly. (Although good for the city.)

I know I'll probably need to leave after residency, but not looking forward to it.

Originally Posted by johnnydrama

There is no decreased interest in living in NYC, sadly. (Although good for the city.)

I know I'll probably need to leave after residency, but not looking forward to it.

What do you like so much about NYC? I was kidding re: the job market, I'm sure you can find a job by the time you graduate.

Originally Posted by Dermpath

What do you like so much about NYC? I was kidding re: the job market, I'm sure you can find a job by the time you graduate.

Going into radiology, so not so sure. :/

A lot of it would be hard to explain I suppose. But the number of smart and driven people here + the availability of pretty much anything 24/7 are pretty generic selling points.

Not having to own a car is a plus too for me - few other cities can truly say that, particularly the sprawl ones like LA or Atlanta.

I'd probably be happy in Chicago or San Francisco, but I have personal ties to NYC too.

Originally Posted by johnnydrama

Going into radiology, so not so sure. :/

A lot of it would be hard to explain I suppose. But the number of smart and driven people here + the availability of pretty much anything 24/7 are pretty generic selling points.

Not having to own a car is a plus too for me - few other cities can truly say that, particularly the sprawl ones like LA or Atlanta.

I'd probably be happy in Chicago or San Francisco, but I have personal ties to NYC too.

Ya, I'm going into rads too. I wish you hadn't said that, that just ignites my anxiety more regarding the job market!! I hope you are kidding about that!

Originally Posted by Dermpath

Ya, I'm going into rads too. I wish you hadn't said that, that just ignites my anxiety more regarding the job market!! I hope you are kidding about that!

Sadly not kidding. I'm hoping the market is cyclical and will be better for my class, but it will always be tight in NYC. That's true for most specialties.

Originally Posted by johnnydrama

I know I'll probably need to leave after residency, but not looking forward to it.

I say this with no ill will intended whatsoever, but I think it will be very good for you to get out of that bubble.

As an added bonus, you'll be amazed at how much farther your dollar goes pretty much anywhere else you end up.

Originally Posted by GuyWhoDoesStuff

I say this with no ill will intended whatsoever, but I think it will be very good for you to get out of that bubble.

As an added bonus, you'll be amazed at how much farther your dollar goes pretty much anywhere else you end up.

I am aware real estate is expensive here, but I'll be fine - don't need a house (don't even really want one).

I would argue NYC is less of a bubble than the rest of the country - there is so much diversity here, it's a truly international city.

I've lived other places and visited many other places for interviews, aside from sports involving mountains/wilderness and cheaper housing, any other selling point for someplace else could be found somewhere in NYC.

Originally Posted by badasshairday

Agreed. NYC, great place to visit. But IMO, I would not want to live or work there. But different strokes for different folks.

We have the best nursing at our hospital. Need outside records? Just write or put in the electronic order. Need stat labs, again just put in the order. No wasting time on the phone on hold trying to get records. No BS of wasting time sticking a patient for a stat troponin when you just got slammed by 2 or 3 admissions at one time.

No social work BS either. Just tell the social worker what is needed medically. Can't afford lovenox to bridge to comadin as an outpatient, just let the SW know. The SW automatically get involved with every admit at my hospital and go over whether the patient needs a PCP or financial/social support/issues.

I <3 my program, especially after hearing and seeing things at my friends instituations or from my experiences in med school.

That's how it is at my program. We put in orders and/or make a quick page/call to SW and bam sh!t gets done. It's like we're the puppet masters and they're our lil scut puppets.

I think there is way too much emphasis on number of hours in this thread. Unless you have a family or a needy significant other, hours do not matter. It's all about the QUALITY of the time you spend in the hospital.

Right now I "work" 75-80 hours a week. I'm "working" right now. Yet I spend maybe 2-3 hours per 12-13 hour shift actually performing tasks related to patient care. The rest of my time I spend watching the Olympics on the resident lounge flatscreen, eating free food, or sleeping. Admits take me about an hour, pronouncing someone 15 minutes, and normal pages less than 2 minutes. On an average night I do not even have to see a patient in person after midnight. Yes I do get paged a lot (15-20 times per night), especially when the other intern is off and I'm on double cross-cover. But I actually like getting paged. It makes me feel important and wanted. Is that pathetic?

Anyway don't worry about the hours. If you're having a good time, they pass quickly. I've never worked less hard in my life, though this is the first real job I've had.

tl;dr: I'd rather do 80 hours of night float than 40 hours of clinic. I'd rather do 40 hours of clinic than 20 hours of manual labor. We have it good. Stop complaining.

Originally Posted by Asp

I think there is way too much emphasis on number of hours in this thread. Unless you have a family or a needy significant other, hours do not matter. It's all about the QUALITY of the time you spend in the hospital.

Why would I want to waste time in a hospital? If you don't realize what can be done with time outside, I feel sorry for you.

But I actually like getting paged. It makes me feel important and wanted. Is that pathetic?

Yes.

I agree hours aren't everything, but I'd much rather have a tough 4 hour day than a boring 16 hour day.

Originally Posted by Asp

I think there is way too much emphasis on number of hours in this thread. Unless you have a family or a needy significant other, hours do not matter. It's all about the QUALITY of the time you spend in the hospital.

Right now I "work" 75-80 hours a week. I'm "working" right now. Yet I spend maybe 2-3 hours per 12-13 hour shift actually performing tasks related to patient care. The rest of my time I spend watching the Olympics on the resident lounge flatscreen, eating free food, or sleeping. Admits take me about an hour, pronouncing someone 15 minutes, and normal pages less than 2 minutes. On an average night I do not even have to see a patient in person after midnight. Yes I do get paged a lot (15-20 times per night), especially when the other intern is off and I'm on double cross-cover. But I actually like getting paged. It makes me feel important and wanted. Is that pathetic?

Anyway don't worry about the hours. If you're having a good time, they pass quickly. I've never worked less hard in my life, though this is the first real job I've had.

tl;dr: I'd rather do 80 hours of night float than 40 hours of clinic. I'd rather do 40 hours of clinic than 20 hours of manual labor. We have it good. Stop complaining.

I don't get it -- who does the actual work then? The attending? There's no way to completely work up a complicated patient in 1 hour as a July intern.

Originally Posted by johnnydrama

Why would I want to waste time in a hospital? If you don't realize what can be done with time outside, I feel sorry for you.

My bottleneck to the fun quotient outside the hospital has never been time. Typically it's money and the quality of my personal relationships.

You may be right in implying that your life outside the hospital is more exciting than mine, but that may be a blessing in disguise given the rigors of residency.

I think we all spend a lot of time with passive entertainment such as the Internet and television. This can be enjoyed in the hospital as well.

Personally I think the key to happiness is having some absolute experiential highs, but also elevating the floor. A minimax strategy if you will.

I also keep the joy quotient throttled voluntarily a little. The psyche adapts quickly. The shock of the new becomes passe. I don't want to peak too early. Life isn't a race to the end. You only get a few shots on goal.

Originally Posted by TheLesPaul

I don't get it -- who does the actual work then? The attending? There's no way to completely work up a complicated patient in 1 hour as a July intern.

Medicine isn't complicated. It's easy.