Differentially admitting

[Acoustic]

I'm an intern and have a question about whether I'm getting frustrated over nothing. I've done a few wards months now and I've noticed a trend over the last month or so. Almost every call day I've been differentially admitted to. By this I mean if there are two overnights I'll get both and then take the first new admit for the day. This seems to happen even when I'll have more total patients. Or I'll take three and the other intern will take one. By the end of the call day I always admit more or at least even, never less. It's true that sometimes the other intern will start out with more, but often it's because they have rocks that aren't going anywhere that aren't active. This doesn't stop the resident from saying "well they have more patients to start" even when I'm having more total encounters and more acuity throughout the day. So I feel like I'm constantly being taken advantage of AND get zero credit for it. It's almost a slap in the face really.

Part of me is concerned that this is even going to reflect badly on me. Its like I'm being told "do this extra work because you are doing nothing" rather than the reality is that I'm doing a lot of extra work. It's just really demoralizing. I don't "need" credit, but when I'm doing the work it sucks for it to be made that I'm not doing enough. I'm more than happy to help a fellow intern in need, but feel disheartened that it's not really seen as that. I feel like I'm starting to become jaded.

Anyone have advice? I thought I saw a recent thread on this but couldn't find it.

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[ArkansasMed]

I'm an intern and have a question about whether I'm getting frustrated over nothing. I've done a few wards months now and I've noticed a trend over the last month or so. Almost every call day I've been differentially admitted to. By this I mean if there are two overnights I'll get both and then take the first new admit for the day. This seems to happen even when I'll have more total patients. Or I'll take three and the other intern will take one. By the end of the call day I always admit more or at least even, never less. It's true that sometimes the other intern will start out with more, but often it's because they have rocks that aren't going anywhere that aren't active. This doesn't stop the resident from saying "well they have more patients to start" even when I'm having more total encounters and more acuity throughout the day. So I feel like I'm constantly being taken advantage of AND get zero credit for it. It's almost a slap in the face really.

Part of me is concerned that this is even going to reflect badly on me. Its like I'm being told "do this extra work because you are doing nothing" rather than the reality is that I'm doing a lot of extra work. It's just really demoralizing. I don't "need" credit, but when I'm doing the work it sucks for it to be made that I'm not doing enough. I'm more than happy to help a fellow intern in need, but feel disheartened that it's not really seen as that. I feel like I'm starting to become jaded.

Anyone have advice? I thought I saw a recent thread on this but couldn't find it.

I think you are thinking too much about it to be honest. It's the luck of the draw. Who knows the real reason. Maybe you are getting easier overall admits so they send more your way to make up for the disaster or two the other guy gets. Other way of looking at it, maybe the other intern totally sucks and you rock and they are giving them to you so the patients are taken care of. Either way, admitting 2, even 3 should be second nature come the end of the year. You are training right now and need the experience of 1. Figuring out how to manage different health conditions and 2. Figuring out how to actually come up with the correct overall plan in a short period of time. It totally blows and I can imagine wanting a breather, but keep your head up. Law of averages tends to work itself out with these sort of things.

 

[Acoustic]

Thanks for the reply. I know it'll all work out, I'm just still not seeing that happen for over a month now. And I'm talking like 5 total a day vs 2 or 3. Not outrageous numbers overall by any means, but it still feels bad when you're constantly told that's nothing when it's at least equal and often more. Ugh. It would feel better if just nothing was said at all. Maybe I just need to vent...

I do know that it'll be better training in the long run to see more, so that's good at least.

 

[gutonc]

You make it sound as if some mysterious unseen force is causing this. Your senior (presumably...possibly your attending) is doing this for one of three reasons.
1. S/he is an idiot and can't count (least likely)
2. S/he thinks your co-intern is weak and is trying to make sure that patient care is maintained...you get the short end of that stick
3. S/he thinks you are the weak intern and is trying to get you to step up your game by taking on more patients

 

[HelpPleaseMD]

I'm an intern and have a question about whether I'm getting frustrated over nothing. I've done a few wards months now and I've noticed a trend over the last month or so. Almost every call day I've been differentially admitted to. By this I mean if there are two overnights I'll get both and then take the first new admit for the day. This seems to happen even when I'll have more total patients. Or I'll take three and the other intern will take one. By the end of the call day I always admit more or at least even, never less. It's true that sometimes the other intern will start out with more, but often it's because they have rocks that aren't going anywhere that aren't active. This doesn't stop the resident from saying "well they have more patients to start" even when I'm having more total encounters and more acuity throughout the day. So I feel like I'm constantly being taken advantage of AND get zero credit for it. It's almost a slap in the face really.

Part of me is concerned that this is even going to reflect badly on me. Its like I'm being told "do this extra work because you are doing nothing" rather than the reality is that I'm doing a lot of extra work. It's just really demoralizing. I don't "need" credit, but when I'm doing the work it sucks for it to be made that I'm not doing enough. I'm more than happy to help a fellow intern in need, but feel disheartened that it's not really seen as that. I feel like I'm starting to become jaded.

Anyone have advice? I thought I saw a recent thread on this but couldn't find it.

It will make you a stronger resident down the line. I agree with what everyone else has said already. Nightfloat tries to distribute the teams fairly. You may be picking up more patients because the patients on your census is overall less sick and thus your team discharges faster ... or they felt bad for giving a med/pscy disaster case to the other team the night before. . If you are overwhelmed... speak to your senior and ask for help. Its early.

I dunno what to say except to suck it up and don't compare. You will get more efficient and look back on this post as a laughable moment next year.

 

[visari]

You would understand why these things happen when you become a senior. most of the times you manage to keep things even but sometimes you just can't for different reasons. The most common one is if you have two interns that are working on two different levels. one is a rock star and the other is a slacker who takes hours to admit a patient and is late calling consults or getting pts out or you don't trust him/her taking care of a sick pt ...etc
Now your job as a senior is to talk to him/her to step it up but in the meanwhile (or if they can't step it up because they are built to be inefficient), you just want to get s*** done and you give more pts to the better intern for that reason. I know it sucks but it's ok. internship is supposed to suck. it'll pass quickly.

 

[Acoustic]

I'm totally on board for all these reasons and am more than happy to help. I just had another call day where I got slammed and the other intern was cruising all day numbers wise. And then little off hand remarks come by that leave the impression that it was even, when it clearly wasn't. Just disheartening, feel like I can't win. I appreciate all the comments.

 

[HelpPleaseMD]

hang in there. we have or will all go through this at some point. I hated 1 whole ward month last year as an intern. had this really crappy senior resident. didn't know much considering his year of training. probably put in 90-100 hrs for those 4 weeks. Just keep in mind, you want to be stressed during training. You will come out stronger and understand what we mean by the tail end of first year. Cruising every day as a new intern is cool and all, but you won't learn jack ****.

 

[Siggy]

Is the other intern an off service intern?

 

[Acoustic]

One was, the other wasn't.

 

[gutonc]

I'm totally on board for all these reasons and am more than happy to help. I just had another call day where I got slammed and the other intern was cruising all day numbers wise. And then little off hand remarks come by that leave the impression that it was even, when it clearly wasn't. Just disheartening, feel like I can't win. I appreciate all the comments.

I forgot option 4:

Your senior is banging the other intern.

 

[ArkansasMed]

I forgot option 4:

Your senior is banging the other intern.

Haha that's great. True sage. Haha, I'd like to see a top 10 list.

 

[Siggy]

One was, the other wasn't.

Option 5. Your senior wants to make sure that his service's intern (i.e. you) gets the best experience possible and best preparation to be a senior. That means giving the on-service intern (you) the most patients and the sicker patients while sticking the off-service intern with the chaff.

 

[Doctor Bob]

Option 6: the patients specifically requested you when they got admitted. Are you on Yelp? Angie's list?


Craigslist?

 

[jdh71]

I'm an intern and have a question about whether I'm getting frustrated over nothing. I've done a few wards months now and I've noticed a trend over the last month or so. Almost every call day I've been differentially admitted to. By this I mean if there are two overnights I'll get both and then take the first new admit for the day. This seems to happen even when I'll have more total patients. Or I'll take three and the other intern will take one. By the end of the call day I always admit more or at least even, never less. It's true that sometimes the other intern will start out with more, but often it's because they have rocks that aren't going anywhere that aren't active. This doesn't stop the resident from saying "well they have more patients to start" even when I'm having more total encounters and more acuity throughout the day. So I feel like I'm constantly being taken advantage of AND get zero credit for it. It's almost a slap in the face really.

Part of me is concerned that this is even going to reflect badly on me. Its like I'm being told "do this extra work because you are doing nothing" rather than the reality is that I'm doing a lot of extra work. It's just really demoralizing. I don't "need" credit, but when I'm doing the work it sucks for it to be made that I'm not doing enough. I'm more than happy to help a fellow intern in need, but feel disheartened that it's not really seen as that. I feel like I'm starting to become jaded.

Anyone have advice? I thought I saw a recent thread on this but couldn't find it.

This is Sparta.

Lots of possibilities. My guess is your senior is just an idiot and not paying enough attention. I suggest this because I never as a senior decided that it was my job to give some people more or less work. You know. To "help them".

It a big machine. It grinds indiscriminately for the most part. Blindly. You'll probably have months where it's the opposite. Goes around. Comes around.

Just get through.

And jaded you will become. Embrace it and then regulate it as best you can. Know it's there. Don't pretend it's not. Refuse to let it be all you are. Leave it behind when you're done.

Good luck. Even when it doesn't feel like it, you are right where you are supposed to be.

 

[gutonc]

Option 6: the patients specifically requested you when they got admitted. Are you on Yelp? Angie's list?


Craigslist?

Grindr?

 

[Siggy]

Grindr?

That gives me an idea for April Fools Day...

 

[Acoustic]

Haha I actually did have one patient specifically request me on an admitting day that made the count 4 and 1 for the day.

 

[LoudBark]

Haha I actually did have one patient specifically request me on an admitting day that made the count 4 and 1 for the day.

A patient specifically requesting you typically only happens if you have a reputation for handing out IV dilaudid every time a nurse pages you for "10 out of 10 pain".