Minimum Patients Interns/Senior Residents Should Carry?

[d01m167]

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Just curious what is considered the minimum amount of patients interns and senior residents should be seeing in order to not harm their training. Most programs said interns carry anywhere from 7/8 - 10, with a senior resident to intern ratio of 2:1. However, one program stated interns carry 5-6 on avg, and another program said interns carry 7-10 but its a 1:1 ratio of senior to intern, which seems like it might be too low for a senior. Can anyone comment on this? I know once I actually get started I am going to wish for fewer patients, just want to make sure this isn't a red flag for these programs.

 

[whoknows2012]

I've never heard of a "minimum" amount of patients but definitely anything for a sustained period below 5 for an intern or 8 for a resident could dilute the training. 7-8 for an intern and 15ish for a resident seems like the sweet spot

 

[Instatewaiter]

5-10 for intern

20ish for senior.

 

[QofQuimica]

It's really going to depend on the service and the hospital. I think that rather than focusing on absolute numbers, you'd likely be better off asking about the variety of patients (diagnoses, demographics, comorbidities, etc.) so that you can maximize your learning by seeing lots of different kinds of patients. And you also want to know how it's handled if your service is overtaxed, which, as you alluded to, is generally the greater concern.

 

[InvestingDoc]

I agree with QofQuimica that diversity counts. I think that anywhere between 5-10 patients per intern is a good amount and 14-20 for upper level residents on wards. In the ICU numbers will be dramatically different.

Any accredited residency will get you enough patient exposure to be a confident physician with standard medical problems upon graduation. When I was interviewing residencies I also looked into how many people were moonlighting. Moonlighting during residency allowed me to advance my skills at a much higher pace and I think become a much better physician because of it. If you have concerns email the chief resident and ask them how they feel about their training. Hopefully they will give you the courtesy of giving you a honest answer.

 

[Raryn]

The maximum primary patients allowed by the ACGME IM RRC for one intern is 10, and for a senior resident overseeing 2 interns is 20.

The lowest cap I've heard of for # of primary patients is some of the Kaiser programs in CA where the cap per intern was set at 7 and for a senior resident overseeing 2 interns was 14. Note that I interviewed at those programs 4 years ago, so it may have changed in the interim.

A good range to expect is probably from half the cap to the cap, so an intern carrying 5-10 on average at a program with caps set at ACGME levels. Sometimes you get lucky and dip below half the cap depending on how your programs call is set up, but don't expect to live there.

There's no cap on consults. There's no separate, lower cap on ICU (though many programs do set a lower cap on ICU, because an intern carrying 10 ICU patients is just asking for major trouble).

Personally, I think 10/20 is a perfectly fine cap towards the end of the year, but is a bit difficult for brand new PGY1/2s. I had the maximum caps all through my residency and a lot of us did have to stay pretty late the first few months of the year. My preference if I had been in charge would be to set up graduated caps, something like 8/16 the first 4 months, 9/18 the next 4 months, and 10/20 the last 4. But no one really asked me.

OTOH, 7/14 forever sounds way too cush to me to get a strong education, but what do I know?

 

[Crayola227]

The maximum primary patients allowed by the ACGME IM RRC for one intern is 10, and for a senior resident overseeing 2 interns is 20.

The lowest cap I've heard of for # of primary patients is some of the Kaiser programs in CA where the cap per intern was set at 7 and for a senior resident overseeing 2 interns was 14. Note that I interviewed at those programs 4 years ago, so it may have changed in the interim.

A good range to expect is probably from half the cap to the cap, so an intern carrying 5-10 on average at a program with caps set at ACGME levels. Sometimes you get lucky and dip below half the cap depending on how your programs call is set up, but don't expect to live there.

There's no cap on consults. There's no separate, lower cap on ICU (though many programs do set a lower cap on ICU, because an intern carrying 10 ICU patients is just asking for major trouble).

Personally, I think 10/20 is a perfectly fine cap towards the end of the year, but is a bit difficult for brand new PGY1/2s. I had the maximum caps all through my residency and a lot of us did have to stay pretty late the first few months of the year. My preference if I had been in charge would be to set up graduated caps, something like 8/16 the first 4 months, 9/18 the next 4 months, and 10/20 the last 4. But no one really asked me.

OTOH, 7/14 forever sounds way too cush to me to get a strong education, but what do I know?

Excellent points.

Some programs do have graduated caps. Also graduated clinic times & panel sizes. At least mine, and a few others I remember interviewing at, but that was a while ago.

 

[chadz]

The maximum primary patients allowed by the ACGME IM RRC for one intern is 10, and for a senior resident overseeing 2 interns is 20.

The lowest cap I've heard of for # of primary patients is some of the Kaiser programs in CA where the cap per intern was set at 7 and for a senior resident overseeing 2 interns was 14. Note that I interviewed at those programs 4 years ago, so it may have changed in the interim.

A good range to expect is probably from half the cap to the cap, so an intern carrying 5-10 on average at a program with caps set at ACGME levels. Sometimes you get lucky and dip below half the cap depending on how your programs call is set up, but don't expect to live there.

There's no cap on consults. There's no separate, lower cap on ICU (though many programs do set a lower cap on ICU, because an intern carrying 10 ICU patients is just asking for major trouble).

Personally, I think 10/20 is a perfectly fine cap towards the end of the year, but is a bit difficult for brand new PGY1/2s. I had the maximum caps all through my residency and a lot of us did have to stay pretty late the first few months of the year. My preference if I had been in charge would be to set up graduated caps, something like 8/16 the first 4 months, 9/18 the next 4 months, and 10/20 the last 4. But no one really asked me.

OTOH, 7/14 forever sounds way too cush to me to get a strong education, but what do I know?

Mayo is 6/12 on most of the wards. Is that a red flag?

 

[Raryn]

Mayo is 6/12 on most of the wards. Is that a red flag?

My personal opinion is that won't make you busy enough to develop the skills you'll need in a real-world setting, but that is just an opinion on my part. I'm sure the residents don't mind it.