How to know "inpatient heavy" vs not

[Dr. Rafiki]

I realize some FM programs are inpatient heavy whereas others focus less on being a hospitalist. My question is how do I tell this on paper? Obviously on interview day I will see for myself/ask residents, but as for knowing where to apply - what is the number of inpatient rotations that you would consider to be "heavy" on inpatient vs normal vs light?

---

Members don't see this ad.

 

[deleted951662]

You can ask what the census the inpatient service typically is, and Compare that to the size of the team to get a rough estimate. Also, while in residency you have to log your inpatient encounters, so you can ask the residents about their numbers. Also, ask about graduating residents jobs; are they taking jobs as hospitalist?
If they have a night float system you can ask how many admissions to they average per night; how many pt’s do the cross cover, etc...

Edit: Sorry I just saw that your question was asking about where to apply prior to interview. That’s a more difficult question; I suppose that unopposed programs would tend to have a stronger inpatient experience but that can vary. On many residency websites they have lists of where graduates are working, you may want to look through those And see if any have a significant number working as hospitalists

 

[SXMMD]

I realize some FM programs are inpatient heavy whereas others focus less on being a hospitalist. My question is how do I tell this on paper? Obviously on interview day I will see for myself/ask residents, but as for knowing where to apply - what is the number of inpatient rotations that you would consider to be "heavy" on inpatient vs normal vs light?

What's "normal" look like???


Anyways, look at the curriculum. How many months of inpatient? Look at the night float structure. Pick for yourself what you find to be doable for you. There is no "standard normal." There are peogram and regional differences influenced by local factors including needs. Look at list of alumni and see what they are doing after residency.

Don't psych yourself out trying to extrapolate too much from too little. At some point you need to iv at the program, meet people and ask questions. You can't tell everything from the website. If you want to iv less inpt heavy programs, look at the programs in your geography of choice and rank them based on most to least inpt months and prioritize from there. Hopefully you guess right.

 

[MedicineZ0Z]

Stuff you might be able to tell from the website:
- Higher number of inpatient medicine blocks (you'll get a feel for what's a lot and what's not when you look at a bunch. Generally I'd say 1/3-1/2 of your time should be inpatient adult medicine)
- Couple months of dedicated ICU blocks or open ICU
- Current residents "about me" things list inpatient as an interest
- Decent number of faculty/alumni doing inpatient
- Unopposed program - generally speaking, not always, but more likely to represent strong training when there are a decent amount of specialist services available so that patients don't have to be referred/transferred out for like a GI consult or routine surgery, for instance.
- Residents running codes, RATs, etc. and working nights and weekends

Stuff you'll probably need to ask in person:
- Quality of inpatient teaching
- Number of patients each resident carries (I'd say interns should get ~5, give or take depending on complexity/other commitments/how close to July 1 it is)
- Level of responsibility for interns and residents - are you basically shadowing attendings and putting in their orders/writing their notes, or are you calling the shots with input from your seniors and attendings?
- Complexity of patient care - are you taking care of ICU patients regularly? How much do you consult for stuff that could reasonably be managed by the primary team? What gets shipped out to a higher level of care? What types of cases do you manage?

Agree although I think interns should have more in the 7-9 patient range. Being able to juggle multiple complex patients at once is very important and is a key ability to develop if you want to do inpatient care later on.

I'd also add procedures. Some of the staff being able to supervise paras/thoras/LPs is a big perk rather than consulting IR for those things. And culturally, letting residents do lines and tubes in the ICU and ED is another thing to look for. If unopposed, it's a cultural thing. Either they're all in or they don't like residents. If opposed, depends how FM friendly they are.

I realize some FM programs are inpatient heavy whereas others focus less on being a hospitalist. My question is how do I tell this on paper? Obviously on interview day I will see for myself/ask residents, but as for knowing where to apply - what is the number of inpatient rotations that you would consider to be "heavy" on inpatient vs normal vs light?

Aside from what's mentioned already, I'd also make sure you emphasize census volume and complexity and not just look at the number of blocks. You could do 3 full years of treating CAP/COPD and putting in orders/writing notes with no decision making and come out less competent than a early PGY2.

 

[brianmartin]

so, do you want an inpatient heavy program? Or are you trying to avoid that.

 

[Dr. Rafiki]

so, do you want an inpatient heavy program? Or are you trying to avoid that.

Avoid, actually. I want a good and thorough education but the home program is about 29 months of hospitalist medicine and all the residents (even 3rd years) are miserable and look like they wish death.

The advice on this thread has been good and I appreciate it. My home program PUMPS out hospitalists each year so looking at where graduates work is definitely something I'll do.

 

[hallowmann]

Avoid, actually. I want a good and thorough education but the home program is about 29 months of hospitalist medicine and all the residents (even 3rd years) are miserable and look like they wish death.

The advice on this thread has been good and I appreciate it. My home program PUMPS out hospitalists each year so looking at where graduates work is definitely something I'll do.

29 mos? Out of 36? That's like more than most (all?) IM programs. I'm hoping that's an exaggeration.

 

[Dr. Rafiki]

29 mos? Out of 36? That's like more than most (all?) IM programs. I'm hoping that's an exaggeration.

Sadly no exaggeration. I rotated there and was quite sad to learn the truth about their education, which is what sprung my original question: if there is any way to know what a programs intensity is like BEFORE showing up on interview day. Something tells me even my home program can fool applicants for 6 hours on interview day.

 

[hallowmann]

Sadly no exaggeration. I rotated there and was quite sad to learn the truth about their education, which is what sprung my original question: if there is any way to know what a programs intensity is like BEFORE showing up on interview day. Something tells me even my home program can fool applicants for 6 hours on interview day.

How many half days of clinic were they doing while on inpatient? You really have to do quite a bit to still reach the COC requirements.

That's honestly atypical. Most inpatient heavy FM programs are doing 17-21 mos of inpatient. Most places have a curriculum on their website. It should be obvious how much time they spend where.

 

[AMEHigh]

Sadly no exaggeration. I rotated there and was quite sad to learn the truth about their education, which is what sprung my original question: if there is any way to know what a programs intensity is like BEFORE showing up on interview day. Something tells me even my home program can fool applicants for 6 hours on interview day.

How is that even possible?
The other acgme required rotations are 2 months of adult ED, 1 month ICU, 2 months of peds inpatient, 1 month gyn and 3 months of electives. There might be another month or 2 of required rotations. So with that schedule of 29 months of inpatient, that only leaves 7 months for other stuff, which clearly doesn't fit. I'd stay far far from that program.

 

[MedicineZ0Z]

How is that even possible?
The other acgme required rotations are 2 months of adult ED, 1 month ICU, 2 months of peds inpatient, 1 month gyn and 3 months of electives. There might be another month or 2 of required rotations. So with that schedule of 29 months of inpatient, that only leaves 7 months for other stuff, which clearly doesn't fit. I'd stay far far from that program.

I'm assuming they're including everything except gyn in those 29 months and must have a crazy amount of clinic half days + high patient volumes on those days.