Inpatient Load in Practice

[RangerBob]

What kind of inpatient load do most of the inpatient attendings here carry, and what are your hours with that load? 12 or more patients in residency often seemed like a lot, but we had all the inefficiencies of residency built in (as a resident I was slower than an attending, I'm confined by the attendings' rounding/teaching schedules, have to wait around to staff consults with the attending, etc.)

I'm trying to get an idea of what kind of what my workday might look like. If you were carrying 10 patients, is 5 hours per day a reasonable estimate of how long it would take you to mange those patients per day, on average (rounds, discharges, admits, team meetings, etc). I get team meetings will make a particular day last longer, but I was hearing from another attending they thought and ADC of 7-10 patients would take much of the day. This seemed odd to me as I worked with a community rehab doc my intern year and he managed 14 patients daily and had two half days of clinic, and was the medical director. On days where we had a low census, we were leaving closer to 2:00-3:00.

I anticipate carrying roughly 9-10 patients per day, and will have the flexibility/freedom to start a consult service or clinic if I am interested. There is hospitalist support for more medically complicated patients. No medical director responsibilities. I am not the most efficient person and do enjoy taking my time to talk with patients, staff, etc. Once I get accustomed to the unit, would it be unreasonable to assume I could accomplish all my duties within a half day (on non team meeting days)?

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[j4pac]

I think that patient acuity is a pretty big deal as well. If you have 8 patients that are sick as ****...well...you're going to be busy. But if your patients are pretty straight forward, it's much more doable to consistently be in the double digits and don't burn out. I guess that you just have to believe in the process...the docs that are out there managing 20+ patients a day were once residents or young attendings just like us. They became more efficient with their time and they are able to pull it off...and patient selection is pretty important when determining a patient cap.

 

[DMBandFan86]

I have attendings that sometimes take on many patients. But they basically walk in the room, sort of wave at the patients and then head out for the day. Plenty of time for clinic or whatever else.

 

[RangerBob]

I have attendings that sometimes take on many patients. But they basically walk in the room, sort of wave at the patients and then head out for the day. Plenty of time for clinic or whatever else.

Unfortunately I won't have the luxury of having residents, so I'll have to do more than wave!

Still, I am really looking forward to being in full control of how much time I spend with my patients. I had a lot of autonomy in residency (and fellowship), but still much of the day is dependent on how my attending wants to run things.

J4pac--some of my patients may be higher acuity, but for those patients I'd likely have the hospitalist on-board. So I don't expect to be spending 4hours trying to handle complex work-ups like I did in residency. But we'll see--I also don't want to lose those skills!

 

[AndyDufrane]

depends on what kind of model you are set up with. if you are the physiatry consultant on the rehab unit, it is pretty cush, but if your the attending, it will be slower because you will managing the medical issues as well, dealing with alot more stress (transferring out an unstable patient, discharges, etc), if you are the attending, 10-12 is an ok number, but if your the consultant, you want to be at the 12-15 range, again I am talking about private practice, but if your employed , it will depend on what your employer expects of you to meet your salary, overhead expectations.

 

[RangerBob]

depends on what kind of model you are set up with. if you are the physiatry consultant on the rehab unit, it is pretty cush, but if your the attending, it will be slower because you will managing the medical issues as well, dealing with alot more stress (transferring out an unstable patient, discharges, etc), if you are the attending, 10-12 is an ok number, but if your the consultant, you want to be at the 12-15 range, again I am talking about private practice, but if your employed , it will depend on what your employer expects of you to meet your salary, overhead expectations.

I would be the attending, as an independent contractor. No overhead (for me). I can work as much or as little as I want, which includes doing consults at local hospitals, starting a clinic, etc. We have hospitalist support specifically on the unit for much of the month, otherwise hosptialists can be consulted for patients that are more medically complex. When a hospitalist is following the patient, they are the ones that will get paged with medical questions, and will be the ones who would transfer the patient (typically to their service, otherwise to the ICU, etc.)