Average number of patients.

[mjl1717]

what is the average number of patients that a medical or F.P intern is responsible for in one day..

---

Members don't see this ad.

 

[Winged Scapula]

Moving to the Internship forum...you've posted in the Job Openings forum.

 

[justwondering]

at our program, that is about 8 pts on the FM svc per intern. it was a little different from med schl IM because our seniors do not round on our pts in person since our svc usually has about 20-25 pts on avg

 

[gutonc]

IM Here:
VA - 8 pts/intern
Univ - 12 pts/intern
CCU - technically 22 patients divided b/w 1-3 residents (depending on the day of the week) but this cap is never actually followed and I've seen 30+...not just for cross-cover, for full management and split between the tele floor and ICU which can get hairy.

Units are variable and don't technically have a cap but w/ 3 teams and only 30-ish beds in each unit, it's always <10/intern.

These are caps, not daily census necessarily but you'll never be upset at a smaller census than expected so assume the max.

 

[pillowhead]

what is the average number of patients that a medical or F.P intern is responsible for in one day..

It's the same at all of our hospitals (and there are 4 of them). 12 patients per intern, no more than 5 new admits on a long call day or 3 on a short call day. Usually we end up carrying the most and capping at the VA.

 

[Winged Scapula]

at our program, that is about 8 pts on the FM svc per intern. it was a little different from med schl IM because our seniors do not round on our pts in person since our svc usually has about 20-25 pts on avg

Really? So who sees all the patients every day?

 

[justwondering]

Really? So who sees all the patients every day?

as far as residents: the interns and 2nd yr see the pts in person. the senior keeps an eye on all the patients "from afar" (looking at labs, etc) and sees the patients they are more concerned abt.

 

[Pir8DeacDoc]

they either trust their residents more than my program or they don't have very sick patients.

Hell we rounded as a team on our trauma service daily which typically had a 20-40 person census (I came from a VERY trauma heavy med school so I realize that this isn't actually all that many trauma patients).

 

[Winged Scapula]

they either trust their residents more than my program or they don't have very sick patients.

Hell we rounded as a team on our trauma service daily which typically had a 20-40 person census (I came from a VERY trauma heavy med school so I realize that this isn't actually all that many trauma patients).

That's what I was thinking. Our attendings expected that the senior, if not the Chief saw every patient.

I'll admit that I sometimes skipped a few of the dead wood laying around waiting for placement, but only if they had been seen by the 4th year.

 

[Blade28]

Hell we rounded as a team on our trauma service daily which typically had a 20-40 person census (I came from a VERY trauma heavy med school so I realize that this isn't actually all that many trauma patients).

Yeah, I would have killed for a census like that!

Here, we'll often have 20+ patients on ONE HALLWAY of one floor.

 

[Pir8DeacDoc]

Yeah, I would have killed for a census like that!

Here, we'll often have 20+ patients on ONE HALLWAY of one floor.

I certainly don't live in the crime riddled streets of Atlanta. Most of our trauma involves motorcycles or some type of farm machinery, not guns or knives.


Quick story. One of my attending plastic surgeons in medical school did his GS at Emory. He said he'd carry a gun from the parking lot to the hospital on his way in in the mornings. I have no idea if he was exagerrating but he didn't seem to be joking.

 

[Blade28]

I certainly don't live in the crime riddled streets of Atlanta. Most of our trauma involves motorcycles or some type of farm machinery, not guns or knives.

It's not just the knife-and-gun club, it's a multitude of terrible drivers. So it's MVCs and MCCs galore.

Quick story. One of my attending plastic surgeons in medical school did his GS at Emory. He said he'd carry a gun from the parking lot to the hospital on his way in in the mornings. I have no idea if he was exagerrating but he didn't seem to be joking.

Yeah, the worst is when finishing your ER rotation (where us off-service-rotators always get stuck with the 5 pm - 3 am shift). You're leaving the ER at 3:30 am, walking back to the parking lot through a VERY shady area.

It's bad enough walking back to your car at the end of a busy day (anywhere from 8 - 10 pm).

 

[justwondering]

yeah, these arent trauma patients. FM (the OP asked about FM/IM pt loads)

 

[Blade28]

yeah, these arent trauma patients. FM (the OP asked about FM/IM pt loads)

I was just briefly responding to a prior post on trauma patients. No need to worry about us.

 

[Winged Scapula]

yeah, these arent trauma patients. FM (the OP asked about FM/IM pt loads)

Oh we know, but it still seems strange not to have a senior/Chief resident see the patients every day, regardless of your census, at least to me.

 

[Anka]

The IM program here has services where the intern sees the patient and writes the note, a JAR will also usually but not always see the patient (but doesn't have anything to do with a note) and the attending sees all the patients every day himself and writes an addendum to the Intern note. Basically, there is no real "cheif resident" or senior role like there is on all of the surgical services, and the attending is basically an eternal chief resident who doesn't get to operate. It's not more trust, it's less -- they wouldn't trust a SAR to see the patient without an attending also seeing them anyway.

Anka

 

[justwondering]

Oh we know, but it still seems strange not to have a senior/Chief resident see the patients every day, regardless of your census, at least to me.

our attending is really good (i admit that reluctantly because i dont really like him much personally) even without seeing each pt. still, i admit it is strange ( i was concerned abt this until i actually started on svc with im and saw how it went), but personally i dont think our floor patients are missing anything by not seeing him. our floor pt's exams arent that complicated. we have other attendings that personally round on our patients when he is out of town and i still think our original attending does a much better job.

 

[Winged Scapula]

Thanks for the explanation.

My concern wasn't that a senior or Chief resident needs to see all of the patients every day IF the attending is seeing ALL of the patients EVERY DAY.

The concern was more that the patients were only being seen by an intern or junior resident, who will undoubtedly make mistakes in their exam and assessment (that's why we have residency), and if there is no one else verifying those findings, patients can get into trouble.

MOST of the time, patients will do fine...but there are always exceptions which can be costly. Not to mention the fact, that if they are documenting that visit (ie, signing the charge slip) without seeing the patient, they are guilty of insurance fraud.

 

[gutonc]

The concern was more that the patients were only being seen by an intern or junior resident, who will undoubtedly make mistakes in their exam and assessment (that's why we have residency), and if there is no one else verifying those findings, patients can get into trouble.

MOST of the time, patients will do fine...but there are always exceptions which can be costly. Not to mention the fact, that if they are documenting that visit (ie, signing the charge slip) without seeing the patient, they are guilty of insurance fraud.

One other thing to keep in mind is that, in IM and FM (unlike surg in my experience), oftentimes the attending will go and see the patients w/o the team. This is particularly the case w/ many of our hospitalists. We'll do chart rounds on everybody (who have already been seen by both the intern or student and senior) and discuss changes/updates/plans and then bedside round on the new/interesting/discharging folks as a team. While the house staff are then busy doing the work of the day (orders, discharges, consults, conference, clinic, etc) the attending will go around, see folks and write notes. The upside of this IMHO is that it tends to decrease the interminable rounding that IM is deservedly infamous for.

This is in contrast to the surgical model where the whole team rounds in the AM, they split up (interns to the scut, everyone else to the OR) then round again in the PM as a team (chart or bedside).

Neither model is necessarily better, just different.

 

[Winged Scapula]

One other thing to keep in mind is that, in IM and FM (unlike surg in my experience), oftentimes the attending will go and see the patients w/o the team. This is particularly the case w/ many of our hospitalists. We'll do chart rounds on everybody (who have already been seen by both the intern or student and senior) and discuss changes/updates/plans and then bedside round on the new/interesting/discharging folks as a team. While the house staff are then busy doing the work of the day (orders, discharges, consults, conference, clinic, etc) the attending will go around, see folks and write notes. The upside of this IMHO is that it tends to decrease the interminable rounding that IM is deservedly infamous for.

This is in contrast to the surgical model where the whole team rounds in the AM, they split up (interns to the scut, everyone else to the OR) then round again in the PM as a team (chart or bedside).

Neither model is necessarily better, just different.

Again, I understand all that....after years of working in a hospital I know how the others services work (mostly). Surgery may do it the same way as well. I've done team rounds with the attending, I've done rounds JUST with the attending, and I've told the attending what was going on and they've seen the patient's themselves. So there is no hard and fast rule either.

But the OP did not make it clear, nor did the user above (justwondering) to whom I was responding, that the attending actually saw the patient. As a matter of fact, he said this particular attending DID NOT see patients every day. THAT was my issue..not that I misunderstood that perhaps the attending saw the patient later on his/her own.

The users discussing this are making statements that the attendings are NOT seeing the patients every day, nor is a senior resident...therefore, the patient is ONLY being seeing by the intern or junior resident and just being reported to the rest of the team, and NOT being seen by the more senior members.

 

[dpmd]

I guess it is location dependent. When I was in med school there were times when I was the only person who laid hands on the patient that day (at least as far as I knew-a resident co-signed my note after glancing at it, then the attending co-signed it after hearing my spiel). Granted, this was not on the sick ones, and there was no fraud issue since most of our patients had no funding source. It was a little strange that my only source of feedback on the accuracy of my exam was if I specifically asked someone to check a finding for me. It did make me much more careful and thorough.

 

[gutonc]

The users discussing this are making statements that the attendings are NOT seeing the patients every day, nor is a senior resident...therefore, the patient is ONLY being seeing by the intern or junior resident and just being reported to the rest of the team, and NOT being seen by the more senior members.

I guess my point is that there may be times that the attending is seeing the patients w/o the rest of the team (and perhaps w/o them really even knowing) either before or after rounds.

But I agree, somebody senior to the intern should be seeing the patients every day.

 

[justwondering]

our attending does see some of the patients (without us). my guess is that hes not seeing all of them. most of our pts do not have insurance. he's a pretty law-savvy guy, so he probably does see the rare pt with insurance even when they're uncomplicated.