How many patients you see in clinic in fellowship?

[heme_doc]

Hello everyone,

What is the average number of patients you have seen in clinic per day as a fellow in first, 2nd and 3rd year?

I'm a fellow in a academic/community hybrid program. We are seeing 7-10 in first year, ~15 in second year and upto 20 in third year. This is not a fellow run clinic. It is very busy and always thought to be as 'more patients you see more learning you'll get', which is true but it seems to increase work load/documentation at the same time which cuts down on study time.

I was wondering what other fellowship programs are doing.

Thank you

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[HemeOncHopeful19]

That sounds like a reasonable workload to me but I went to a supposedly crazy busy program, whatever that means.

We would have 11-15 in Heme on a half day or 7-10 Onc.

You’ll probably see somewhere like 18-20 a day in practice when you graduate.

 

[whoknows2012]

In an academic fellowship program in fellows clinic it was 3-5 1st year 5-7 2nd year and 8-10 3rd year

 

[gutonc]

@whoknows2012 experience mirrors mine in fellowship.

While it’s certainly true that the more you see the more you learn, there’s definitely a point of diminishing returns as a trainee.

20-ish is a nice comfortable day for me as an attending. 15 is slow and kind of boring unless half of them are new and complicated and 25 is about as busy as I want to be. I can see more in a day, I just don’t want to.

 

[Ubba]

How does a non-fellow-run clinic work? You see random patients each time but still end up formulating plans and writing the notes?

 

[gutonc]

How does a non-fellow-run clinic work? You see random patients each time but still end up formulating plans and writing the notes?

I was kind of wondering this myself. Is it just the faculty clinic and you're the workhorse?

 

[dozitgetchahi]

I was kind of wondering this myself. Is it just the faculty clinic and you're the workhorse?

Yes. At least in some rheumatology programs, that’s how a “non fellow run clinic” works. Sometimes (at, say, a VA or county hospital) it’s just a wide open clinic and a fellow grabs whichever patient is scheduled next (whom they likely have never seen before) and rolls with it. Or it could be a faculty clinic where you’re largely the chart writing monkey. (In my fellowship, the policy in faculty clinics was often that if you saw a faculty clinic patient, it somehow became “your patient” - but it continued to appear on the faculty in question’s schedule, which made it harder to follow the patient because they may be scheduled to come back at some time where you are scheduled to do something else etc. We also had our own fellow run continuity clinics where our own patients were scheduled with a revolving door of attendings. You can see the potential for confusion amidst all this.) Neither of these situations is necessarily so great for education and/or continuity of patient care, and the massive number of handoffs almost guarantees that errors will be made and/or important things will fall through the cracks.

 

[HemeOncHopeful19]

I was kind of wondering this myself. Is it just the faculty clinic and you're the workhorse?

We had a few rotations in our attending clinics (not for our continuity clinic) and that is sorta how it worked. I mean you will end up seeing the same people every few weeks just like in your fellows clinic but yes it is your attending's panel overall.

You guys saying you saw 8-10 in 3rd year are talking about half day clinics, right? Not a full workday?

 

[Mehena]

Having 20 patients during the third year is really atrocious, especially if you have to staff each patient with an attending, especially if the attending is managing multiple fellows or is slow, or both. If I'm not mistaken, the ACGME may have rules or recommendations on the maximum number of patients per half or full day of fellows' clinics.

 

[geniusindisguise]

8-10 per half day fellow’s clinic in 2nd and 3rd year. Attending clinic variable 5-10 per half day clinic.

 

[heme_doc]

So how it works is that, attendings have 25 to 30 patients, sometimes even more scheduled in their clinic. We are either the ‘continuity fellow’ or on rotation and we grab patients as they show up, try to maintain continuity as much as we can by picking up the patients that we saw before to maintain continuity. If there are 2 fellows in clinic we will probably end up seeing all patients and attending would see none or a couple on their own.

It’s quite overwhelming for first and second years typically, maybe by third year you catch up and become more efficient but still there is all that charting to do on top of studying and all other responsibilities that are there.

 

[Ubba]

The number that can be seen depends on the start/end times of the clinic and on the fellow:attending ratio. A clinic that runs from 7:30-12:30 can allow for 10 pts/fellow, but there's no way a fellow can see that number and staff each one with an attending if the clinic is from 9-12. Especially if the fellows all have the same clinic day and it's just a few attendings having to manage all the fellows.

 

[swamprider]

@whoknows2012 experience mirrors mine in fellowship.

While it’s certainly true that the more you see the more you learn, there’s definitely a point of diminishing returns as a trainee.

20-ish is a nice comfortable day for me as an attending. 15 is slow and kind of boring unless half of them are new and complicated and 25 is about as busy as I want to be. I can see more in a day, I just don’t want to.

Hi @gutonc! I just finished fellowship and am looking at different jobs. how long did it take you to feel comfortable seeing 20 patients per day? and how many days a week are you seeing patients? a job I've interviewed is suggesting that after a ramp up of 2-3 months, they are expecting me to see18-20 patients per day, and up to 25 on busy days. That seems like a rapid ramp up to me, especially as a new attending. Would you agree or am I being squeamish?

 

[gutonc]

Hi @gutonc! I just finished fellowship and am looking at different jobs. how long did it take you to feel comfortable seeing 20 patients per day? and how many days a week are you seeing patients? a job I've interviewed is suggesting that after a ramp up of 2-3 months, they are expecting me to see18-20 patients per day, and up to 25 on busy days. That seems like a rapid ramp up to me, especially as a new attending. Would you agree or am I being squeamish?

It took me a few years to be comfortable with that volume. Some of that was me and some was lack of support in the clinic. That does seem like a pretty rapid ramp up and a recipe for failure/burnout.

 

[swamprider]

It took me a few years to be comfortable with that volume. Some of that was me and some was lack of support in the clinic. That does seem like a pretty rapid ramp up and a recipe for failure/burnout.

Thank you for your insight!

 

[Ubba]

Hi @gutonc! I just finished fellowship and am looking at different jobs. how long did it take you to feel comfortable seeing 20 patients per day? and how many days a week are you seeing patients? a job I've interviewed is suggesting that after a ramp up of 2-3 months, they are expecting me to see18-20 patients per day, and up to 25 on busy days. That seems like a rapid ramp up to me, especially as a new attending. Would you agree or am I being squeamish?

Maybe ask the practice whether they've ever heard of these things called the Hematology and Medical Oncology board exams.