Expectations

[rokshana]

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Then you were at a crappy, malignant program that probably has a ton of FMGs/IMGs. Like many others have said, in a normal program, it does not matter what time you come in as long as you get your work done.

well i guess academic university programs are a bit different from the private community program you were in…there they actually expect you to work.

 

[KnuxNole]

well i guess academic university programs are a bit different from the private community program you were in…there they actually expect you to work.

Some community programs expect you to work too 😉

Which is fine by me. I signed up for residency training so I won't be a half ass physician.

 

[rokshana]

Some community programs expect you to work too 😉

Which is fine by me. I signed up for residency training so I won't be a half ass physician.

true…didn't mean to offend you….but evidently the OP went to the cushiest program ever…guess that's why he is having to do another intern year??

 

[MDsuperstar]

What was suggested was that your advanced spot requires successful completion of an intern year.

Perhaps you did not understand this - I have already done an intern year so even if this did not work out, which is not the case, it would not be an issue. I think many many residents are miserable in residency because they are like many of you - fearful of consequences, as if programs are out to get us, and "do as you say" put your head down stuff. I have been in cush programs, and have never had an issue, and have done exceptionally well.

And I doubt many if any of you came into ward months before 7 am.

 

[MDsuperstar]

true…didn't mean to offend you….but evidently the OP went to the cushiest program ever…guess that's why he is having to do another intern year??

Again with assuming ridiculous things. Do you not read or do you have comprehension problems given that you are a foreign grad? Perhaps working on your English is the first thing to do. Just because you had no choice and were in a malignant FMG program, doesn't mean others of us are. If you used that mind?? of yours for a minute, perhaps you would think to ask or wonder why I'm doing this again. Common sense would prevail here, but perhaps you don't have much of that???

 

[drcrispmd]

To the OP: Realize you are in a different residency. It does not matter what your hours were at your previous program. You have to switch gears and follow the hours and expectations of your new program. Bringing up that your previous residency was so much better, better hours, and you are going to stick with the same hours will only be bad for you. They do not have to allow your to finish your inter year. You need to find out what the hours are and when things happen during the day. Will you have students rotating at your new residency? afternoon are great for your med student teaching (which as a resident you should be doing).

 

[KnuxNole]

Perhaps you did not understand this - I have already done an intern year so even if this did not work out, which is not the case, it would not be an issue. I think many many residents are miserable in residency because they are like many of you - fearful of consequences, as if programs are out to get us, and "do as you say" put your head down stuff. I have been in cush programs, and have never had an issue, and have done exceptionally well.

And I doubt many if any of you came into ward months before 7 am.

I came in at 6 during my inpatient wards months, gotta get **** done!

OB/Surg months, I'd be there at 5:30 on certain days 😛

Of course, you log that you were in a certain hour, but the reality of the situation is, getting the task done comes first. If you want to come in at 7, that's fine. You better bet your ass ALL the patients are seen, notes complete, ordered placed, etc. before morning rounds without any faults or gaps. That's the main thing. If you come late, your senior would roll their eyes, and expect you to still get everything done before the deadline of rounds with no gaps.

Also, your quote of I think I'm going to propose if we can come in at whatever time we need to finish our notes by rounding time won't cut it. You, especially as an intern, aren't in a position to bargain or negotiate. You might be laughed off by your senior. And definitely don't bring it up to any attendings unless you want to be the butt of the snarkiness!

 

[Gastrapathy]

OP is one of those painful interns who will find the line and do just enough to stay on that side of it. If he can see 9 patients in 3 hours, he isn't doing an adequate exam, spending any time teaching the patient or med studs (who exist to better his life) or otherwise making himself useful. His notes will be copied forward drivel. But...he's not a categorical intern so he'll survive because firing people is too much work. Then off he will go with the inflated opinion of himself and his new specialty and the medicine program will just roll on. It's sad but inevitable unless he is actually caught lying.

Or OP is a perfect archetype for that type of intern and a moderately talented troll. In which case, cheers.
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[DrBowtie]

Perhaps you did not understand this - I have already done an intern year so even if this did not work out, which is not the case, it would not be an issue. I think many many residents are miserable in residency because they are like many of you - fearful of consequences, as if programs are out to get us, and "do as you say" put your head down stuff. I have been in cush programs, and have never had an issue, and have done exceptionally well.

And I doubt many if any of you came into ward months before 7 am.

Then why subject yourself to repeating intern year?

 

[drcrispmd]

Our Family Medicine service check-out was a 6:45am regardless of how many (or few) patients were on the board. The IM service did not have a checkout, but notes and order had to be done by 9am for rounds.

afternoons for both were used for checking up on patients. answering floor calls, getting d/c ready with case management, talking with specialist, admitting patients, teaching students, etc. we were there till 5pm when night float came in (this is on our FM service). IM you could leave when your stuff was done, but we FM residents had clinic the afternoons we were not post call or on call.

Have a good attitude. It is very unlikely that they will change the timing for 1 person or make exceptions. Just get through the year, or quit since you really do not need it. What residency did you do before? just curious.

 

[gutonc]

Thank you for actually having knowledge and realizing that IM has caps. Another voice of reason.

 

[KnuxNole]

I'm sure this might be pulling our legs, but another peeve:

1) Why do you have notes done before 9am rounds? Because it's the bare minimum expectation of an intern....no debate or question necessary. Don't ever utter these words to the senior or attending.

2) Why discharge stuff before noon? So you can be a decent physician and not a lame buttmuncher who waits till 4:59 to discharge the patient, making the patient upset. Getting the patients discharge stuff faster allows follow up appointments to be made faster, discharge stuff arranged, and most importantly, the patient can actually get into their home instead of staying in an icky hospital!

 

[MDsuperstar]

Our Family Medicine service check-out was a 6:45am regardless of how many (or few) patients were on the board. The IM service did not have a checkout, but notes and order had to be done by 9am for rounds.

afternoons for both were used for checking up on patients. answering floor calls, getting d/c ready with case management, talking with specialist, admitting patients, teaching students, etc. we were there till 5pm when night float came in (this is on our FM service). IM you could leave when your stuff was done, but we FM residents had clinic the afternoons we were not post call or on call.

Have a good attitude. It is very unlikely that they will change the timing for 1 person or make exceptions. Just get through the year, or quit since you really do not need it. What residency did you do before? just curious.

6:45am, umm interesting. so 6:45am is pretty darn close to 7am isn't it? so you somehow are suggesting that it's not ok to complain to come in at 6am but you came in at almost 7am. Just like i figured, a bunch of hypocrites.

 

[MDsuperstar]

I'm sure this might be pulling our legs, but another peeve:

1) Why do you have notes done before 9am rounds? Because it's the bare minimum expectation of an intern....no debate or question necessary. Don't ever utter these words to the senior or attending.

2) Why discharge stuff before noon? So you can be a decent physician and not a lame buttmuncher who waits till 4:59 to discharge the patient, making the patient upset. Getting the patients discharge stuff faster allows follow up appointments to be made faster, discharge stuff arranged, and most importantly, the patient can actually get into their home instead of staying in an icky hospital!

This is ridiculous beyond belief. Notes get done when labs are done, patients are seen, pertinent information is available, etc. So do notes get done by 9am? No, of course not, only in programs where "thigns are done because they are done this way" type of zombie mode. Even in med school, our attendings typically rounded in the afternoon, so there is absolutely no reason to get notes done by 9am. D/c by 12 noon? Please. Patients get d/c'ed when they are ready to be d'ced not based on some random time frame. Only when appropriate dc, consults, labs, etc are done and complete do patients get d/ced.

 

[MDsuperstar]

Then why subject yourself to repeating intern year?

When someone decides to change fields, the match goes how it goes, and if you don't realize some programs are categorical and some are advanced, well perhaps you should get a deeper knowledge of other fields. Certain things I don't have a choice. Certain things, however, I'm not willing to do.

 

[KnuxNole]

This is ridiculous beyond belief. Notes get done when labs are done, patients are seen, pertinent information is available, etc. So do notes get done by 9am? No, of course not, only in programs where "thigns are done because they are done this way" type of zombie mode. Even in med school, our attendings typically rounded in the afternoon, so there is absolutely no reason to get notes done by 9am. D/c by 12 noon? Please. Patients get d/c'ed when they are ready to be d'ced not based on some random time frame. Only when appropriate dc, consults, labs, etc are done and complete do patients get d/ced.

Girl, you cray cray.

Labs ARE done in the morning, unless your phlebotomists have the same mentality as you to come in whenever. So, yeah, dropping a note should be EASY PEASY and 100% expected. Remember, don't EVER be surprised if it's the case. Remember, you cannot change how your program will function. They won't listen to you, a lowly widdle intern. Things are done because it's how it's done. You'll breath that mentality for 1 year, and for the ENTIRE DURATION of your advanced program.

Rounds in the afternoon? I dunno what place you went to(which you can share!), but rounds at 95% of residencies occur in the morning which make sense. You have admits in the afternoon, clinic in the afternoon, etc. If rounds occur in the afternoon, what time are your patients being discharged? And Yes, homeslice, d/c by noon is easy to manage. Our rounds get done at 11 the latest(I love me some table rounds!). It takes literally a few minutes to get a patient discharged...and these are people who are ready to go, have been discussed with the attending, and set to get out the door. Efficiency is getting all work done, and patient care streamlined in a timely manner.

 

[MDsuperstar]

Girl, you cray cray.

Labs ARE done in the morning, unless your phlebotomists have the same mentality as you to come in whenever. So, yeah, dropping a note should be EASY PEASY and 100% expected. Remember, don't EVER be surprised if it's the case. Remember, you cannot change how your program will function. They won't listen to you, a lowly widdle intern. Things are done because it's how it's done. You'll breath that mentality for 1 year, and for the ENTIRE DURATION of your advanced program.

Rounds in the afternoon? I dunno what place you went to(which you can share!), but rounds at 95% of residencies occur in the morning which make sense. You have admits in the afternoon, clinic in the afternoon, etc. If rounds occur in the afternoon, what time are your patients being discharged? And Yes, homeslice, d/c by noon is easy to manage. Our rounds get done at 11 the latest(I love me some table rounds!). It takes literally a few minutes to get a patient discharged...and these are people who are ready to go, have been discussed with the attending, and set to get out the door. Efficiency is getting all work done, and patient care streamlined in a timely manner.

YOU may have clinic as a CATEGORICAL intern, I don't. I only admit on call days, not on other days, in this residency and previous ones. Tons of busy places, especially where attendings have MORNING clinics have rounds in the PM. Patients are dc'ed whent hey are ready, not at some pre-specified time. I have d'ced patients at 8am, and at 6pm and everytime in between. When ready, they are d'ced. Your insistence that patients have to be d'ced at noon is absurd. YOU are cray cray.

And if you are taking only a few minutes to dc patients, you are doing a crappy job. DCs take thought, coordination of other appts, making sure all labs, imaging, consults are done, social work stuff is ready to go, transfer/home stuff is ready, etc.

I don't know what you think 12noon is so magical for dc. I don't know where you practice, maybe rural Iowa, but having been in major cities in major academic centers, this is non-existent. Heck, when I was recently post-surgery, the attending surgeon did not come to round/see me until past 7pm, and he's at a major medical center and one of the best hospitals in the country. I guess he was slacking too! *eye roll*

 

[Top Gun]

My resident has no clue that I'm not a typical intern so she is assuming that this is my first day of clinical work as a doctor. Do you think that a first year intern has any clinical skills to carry MORE THAN 9 patients on their first day? Certainly not. In time, sure, but not on their firstday.

And I would have less of a problem if they said hey come in at whatever time you come, just like in your residency. But we are being required to come in really early which I'm not very ok with. You clearly think it's perfectly ok for your residency program for residents to come in whenever. Why is it not ok for me to think the same?

Well, considering that interns often carried 12 patients before the rules changed (the 10 patient cap you refer to), its really not that unusual. And I would think being advised to come in really early does make sense if you are carrying a lot of patients. So I really don't see what the problem is here. Oh, and now that you're at a different program, remember the saying, "When in Rome...."

 

[KnuxNole]

They don't have to, but it's not unheard of or surprising. And yes girlfriend, once all the discharge stuff is done, it takes a moment to get the actual discharge taken care of.

Do these attendings have morning clinic? Certainly not faculty for residency, maybe private practice. You are in a internal medicine intership, so focus on that!

Remember, your job is to shut your mouth(keep these thoughts to yourself), get the job done and move on. I mean, there is literally nothing you as a person can do to change how your program function. And you don't need to change a thing. Don't be a weak intern and complain to people about coming in early, seeing a lot of patients...cause noone will care. Be a normal intern, and learn, work hard, and have fun! After all, think of the fun banter moments you'll have with your senior. And the after work drinking 🙂

 

[Winged Scapula]

FFS guys… I couldn't take that trolling anymore.

 

[KnuxNole]

FFS guys… I couldn't take that trolling anymore.

Sadly, there will be people IRL that have the same personality/attitude.

 

[Winged Scapula]

Sadly, there will be people IRL that have the same personality/attitude.

Oh I know...but obvious troll was getting a little too obvious.

 

[rokshana]

YOU may have clinic as a CATEGORICAL intern, I don't. I only admit on call days, not on other days, in this residency and previous ones. Tons of busy places, especially where attendings have MORNING clinics have rounds in the PM. Patients are dc'ed whent hey are ready, not at some pre-specified time. I have d'ced patients at 8am, and at 6pm and everytime in between. When ready, they are d'ced. Your insistence that patients have to be d'ced at noon is absurd. YOU are cray cray.

And if you are taking only a few minutes to dc patients, you are doing a crappy job. DCs take thought, coordination of other appts, making sure all labs, imaging, consults are done, social work stuff is ready to go, transfer/home stuff is ready, etc.

I don't know what you think 12noon is so magical for dc. I don't know where you practice, maybe rural Iowa, but having been in major cities in major academic centers, this is non-existent. Heck, when I was recently post-surgery, the attending surgeon did not come to round/see me until past 7pm, and he's at a major medical center and one of the best hospitals in the country. I guess he was slacking too! *eye roll*

because its a JACHO mandate that pt's be discharged by noon…and every VA hospital makes this push as well….heck my program has a prize of a 100 bucks per member of the team to the team with then highest % out by noon..

 

[drcrispmd]

6:45am, umm interesting. so 6:45am is pretty darn close to 7am isn't it? so you somehow are suggesting that it's not ok to complain to come in at 6am but you came in at almost 7am. Just like i figured, a bunch of hypocrites.

Those were family medicine rounds. If our census was heavy our attending a would do rounds at 10 instead of 9 since there is only an intern and 3rd year on the service. Our ICU was also open so we took care of our patients (which was usually 1/3 of the census) as well. We had to do admissions during the day every day.

IM was different. We did not have a set time to come in as long as notes were done and on the chart. We order daily labs the day before so they get don't first thing in the morning. Our IM attending rounded in the AM because they were in clinic in the afternoon. Again, we had ICU patients on the board too. The attending were very upset if anyone was late to rounds or if notes were not in the chart when they came around to see the patient. Also you should be able to anticipate if your patient is getting discharged and have med list, appoints being made, case manager working on that before rounds so all you have to do is put in the order to d/c after rounds.

You mentioned previous residencies? Exactly how any have you done and if so why are you doing another prelim for you advanced position?

You will not get your program to change because you want it. In their eyes you are an intern, regardless of how many prelims you have done.

 

[drcrispmd]

Forgot to mention, we had to be there for check out at 6:45 even if there were only 2 in the board (both senior and intern) for family medicine service.

 

[Raryn]

no….10 is your limit so yes you are a bit on the high side there, but an intern can have 10 on their service and when you are on call you can admit up to 5 new patients…though of course you can have only a max of 10….so if you are on call tomorrow, then most you can admit is 1.

I see the OP got banned, but I did want to address this point: This isn't quite right. The cap is on 10 OLD patients. The admission cap is 5 NEW patients. You can (and at some point in the year, probably will) admit to the point you have >10 patients on your list. Some of them may be discharged later that afternoon or you may have to redistribute in the morning so you only have 10 patients the next day, but the two caps are actually unrelated. There's actually also a separate cap of 2/intern on transfers, either from the night team or from a different service (such as the ICU), so an intern could (for example, never seen this happen) see 17 patients in a day, being 10 old patients, 5 admits, 2 ICU transfers. No rule violation there at all.

As well, 9 patients is somewhat rough to start with, but the thing is, someone has to see those patients. If the team census is 20 because you're starting out post call, well, at least you're hitting the ground running.

The note thing is pretty institution dependent. At my program they just want notes done at some point in the day, they didn't care when, so it was usually the last thing we addressed in our working day. We had to have all the information gathered before rounds, orders placed asap, consults called, discharges done, but the notes themselves were more of a formality. Heck, I'd do them at home remotely after I had a chance to have dinner half the time.

 

[Law2Doc]

I think the OP is either a troll or a lost cause. But lest anyone is reading this thread who is actually starting intern year this week: (1) your schedule us what your program tell you it is. If they want you there by 5 and leaving at 7 they can do so. The ACGME doesn't gave rules as to how early they like to round. There is no expected normal or average. So you have to talk to your seniors. If they want to tell you on the first day -- surprise -- you are coming in super early, or staying late tonight, or surprise tomorrow you start night float, they can. (2) Second -- you can start with a full slate of patients, even on the first day. You are likely inheriting them from your predecessor, and sadly some teams have a lot of "rocks" who never seem to get off te service. Such is life. (3) most of intern year is keeping your head down and making the best of tough situations. You don't run and talk to chiefs or seniors about things that are work volume related unless there's a clear ACGME violation. And even then you probably think long and hard before you rouse a sleeping tiger. (4) most of us who had decent times intern year had one big secret -- it's all about your attitude. If you have a good outlook and don't let every little thing upset you, or constantly worry about this or that being unfair or unreasonable, or not good learning experience, you'll have a much better time of it. And probably get a lot more out of it. The days fly by, especially if you are always crazy busy from dawn to dusk. Don't fight it, embrace it.

 

[mvenus929]

Caps do not apply to all fields; it does apply to IM. I've been on services with only 2 interns and over 40 patients.

no….10 is your limit so yes you are a bit on the high side there, but an intern can have 10 on their service and when you are on call you can admit up to 5 new patients…though of course you can have only a max of 10….so if you are on call tomorrow, then most you can admit is 1.

IM has mandated caps? Whoa. I interviewed at programs that had caps (usually at 10/intern, maybe 12), but my program doesn't have them. So, I think some of my cointerns who started on nursery today had on the order of 15 patients to round on.

Good to know.

 

[Raryn]

IM has mandated caps? Whoa. I interviewed at programs that had caps (usually at 10/intern, maybe 12), but my program doesn't have them. So, I think some of my cointerns who started on nursery today had on the order of 15 patients to round on.

Good to know.

All IM ACGME programs abide by the caps. DO programs (at least for the next 0-5 years while the merger happens) don't.

 

[rokshana]

I see the OP got banned, but I did want to address this point: This isn't quite right. The cap is on 10 OLD patients. The admission cap is 5 NEW patients. You can (and at some point in the year, probably will) admit to the point you have >10 patients on your list. Some of them may be discharged later that afternoon or you may have to redistribute in the morning so you only have 10 patients the next day, but the two caps are actually unrelated. There's actually also a separate cap of 2/intern on transfers, either from the night team or from a different service (such as the ICU), so an intern could (for example, never seen this happen) see 17 patients in a day, being 10 old patients, 5 admits, 2 ICU transfers. No rule violation there at all.

As well, 9 patients is somewhat rough to start with, but the thing is, someone has to see those patients. If the team census is 20 because you're starting out post call, well, at least you're hitting the ground running.

The note thing is pretty institution dependent. At my program they just want notes done at some point in the day, they didn't care when, so it was usually the last thing we addressed in our working day. We had to have all the information gathered before rounds, orders placed asap, consults called, discharges done, but the notes themselves were more of a formality. Heck, I'd do them at home remotely after I had a chance to have dinner half the time.

mmm…i don't think that is correct, but the ACGME rules are always a bit fuzzy in things (i'm sure on purpose)…but at my program, your census was set the morning you were on call… if you had 10 pts, and no one discharged, then you didn't admit any new pts…but you could take up to 2 transfers from the ICU (so 12 really the max there)….NOW if you discharged someone and your team was still on call, then you would take an admission once the pt d/c…so could you discharge 5 and admit 5 and take 2 icu transfers? yeah…but at the end of the day you would still have 10-12 pts on your census…I would imagine if an intern had 17 pts on their census at the end of the day and IF it was reported, that would be an ACGME violation.

 

[mvenus929]

All IM ACGME programs abide by the caps. DO programs (at least for the next 0-5 years while the merger happens) don't.

I'm not sure if you were implying that I'm in a DO program or not, but to clarify, I'm Peds, not IM. Hence my confusion. Wonder why they made the caps for IM specifically.

 

[Raryn]

I'm not sure if you were implying that I'm in a DO program or not, but to clarify, I'm Peds, not IM. Hence my confusion. Wonder why they made the caps for IM specifically.

Because the caps are rules from the internal medicine residency review committee. Any of the RRCs are welcome to put their own rules in place.

 

[Raryn]

mmm…i don't think that is correct, but the ACGME rules are always a bit fuzzy in things (i'm sure on purpose)…but at my program, your census was set the morning you were on call… if you had 10 pts, and no one discharged, then you didn't admit any new pts…but you could take up to 2 transfers from the ICU (so 12 really the max there)….NOW if you discharged someone and your team was still on call, then you would take an admission once the pt d/c…so could you discharge 5 and admit 5 and take 2 icu transfers? yeah…but at the end of the day you would still have 10-12 pts on your census…I would imagine if an intern had 17 pts on their census at the end of the day and IF it was reported, that would be an ACGME violation.

I'm almost entirely sure that the 10 old patients (for which you provide "ongoing care") and the 5 new patients (whom you "admit") are separate caps. If they total more than 10 in the am, you have to redistribute so that the intern only has 10. Obviously, a situation where you regularly end the day with more than 10 patients is less than ideal and your program may have had specific policies to avoid it, but that's not an acgme rule.

Now, I could be wrong. @IMPD ? @aProgDirector ?

 

[DreamLover]

Residency doesn't start until July 1, so of course i did not *get sign out from the outgoing intern." I will be doing 0 work until July 1 in the morning. Why on earth would anyone think that any normal resident do any work before then?

I did not start rounding on patients until July 1 of my prelim med intern year either but we had a week of BLS/ACLS training/testing and orientation and I DID get a sign out from the outgoing intern.

I know you feel fast and efficient and that's great, but just go with the flow for a few days and get a feel of the land before you decide to tell people how they've been doing it wrong all along-that'll go over like a ton of bricks and you don't want to start off that way.

It all sounds overwhelming I know, but in reality, if you really are that fast and efficient without any expense to the patient, then you'll have it all figured out in no time.

My intern year was 7 years ago and I still have some PTSD from my MICU months (I prefer SICU any day). Good luck!

 

[Law2Doc]

I still remember overnight calls intern year when I was cross covering like 30+ patients and wearing three pagers, and that was back when we did 30 hour shifts... Coming in to a list of 10 patients, some undoubtedly low maintenance rocks, somehow doesn't seem that unmanageable.

 

[DreamLover]

I still remember overnight calls intern year when I was cross covering like 30+ patients and wearing three pagers, and that was back when we did 30 hour shifts... Coming in to a list of 10 patients, some undoubtedly low maintenance rocks, somehow doesn't seem that unmanageable.

Right? If I left the hospital by 2pm post call that was a win. I don't miss that at all. Q 2, 3 or 4...they all kinda sucked.

 

[NotAProgDirector]

I'm almost entirely sure that the 10 old patients (for which you provide "ongoing care") and the 5 new patients (whom you "admit") are separate caps. If they total more than 10 in the am, you have to redistribute so that the intern only has 10. Obviously, a situation where you regularly end the day with more than 10 patients is less than ideal and your program may have had specific policies to avoid it, but that's not an acgme rule.

Now, I could be wrong. @IMPD ? @aProgDirector ?

a first-year resident must not be assigned more
than five new patients per admitting day; an
additional two patients may be assigned if they are
in-house transfers from the medical services; (Core)


I.A.2.h).(6).(b) a first-year resident must not be assigned more
than eight new patients in a 48-hour period; (Core)


I.A.2.h).(6).(c) a first-year resident must not be responsible for the
ongoing care of more than 10 patients; (Core)


I.A.2.h).(6).(d) when supervising more than one first-year resident,
the supervising resident must not be responsible for
the supervision or admission of more than 10 new
patients and four transfer patients per admitting day
or more than 16 new patients in a 48-hour period;
(Core)


I.A.2.h).(6).(e) when supervising one first-year resident, the
supervising resident must not be responsible for the
ongoing care of more than 14 patients; (Core)

I read this as a hard cap at 10 patients, not 10 old patient and then some number of new patients. I expect some programs allow their teams to admit while waiting for someone to go home later in the day.

 

[gutonc]

What my program used to do was allow up to the 5 (or 8 on 2 intern teams) regardless of number on the service. The senior resident would either pick up the rest or they would be redistributed at attending/chief resident discretion. It was fortunately a program where the seniors would, for the most part, actually do this.

They have now gone to a "trickle admit" system where every team picks up patients every day in a rotation so this rarely becomes a serious issue.

 

[Siggy]

To the OP... please... cry us a river. I'm in a TRI and started out as the trauma call intern with 8 or 9 patients (we started on the 24th) and did relatively fine (no one died). So buck up princess.

the adage of the squeaky wheel…not a good one in residency…but go ahead and as gutonc said…let us know how that goes...

The adage best describes residency. You know... the squeaky wheel gets replaced.