patient cap

[MrChance2]

What are the ACGME rules of this for psychiatry? Does anyone have a link? Is it common to be routinely asked to see more than 10 patients as a second year resident both on weekdays and weekends?

Are the cap limits different for psychiatry than for medicine? Are there any rules for amount of time to see a patient 3rd year for evaluation or follow up?

---

Members don't see this ad.

 

[OldPsychDoc]

No rules--it's really up to the program to determine what the optimal numbers are for training value on a given rotation or service.

 

[clausewitz2]

Basically the only restriction seems to be that you can't pick up a new patient if you have been working for 24 hours straight.

 

[DisorderedDoc417]

What are the ACGME rules of this for psychiatry? Does anyone have a link? Is it common to be routinely asked to see more than 10 patients as a second year resident both on weekdays and weekends?

Are the cap limits different for psychiatry than for medicine? Are there any rules for amount of time to see a patient 3rd year for evaluation or follow up?

It is definitely commonplace to be asked to routinely see more than 10 a day as a second year. We typically see around 10-12 a day and then of course there are days the hospital is swamped, perhaps after a full moon for example, and you might need to slog through 14-16. I don’t see the point in artificially capping to be honest. Unless you’re going into academics and expecting a lighter work load, the working sector is seeing many more patients and you want to be prepared for what that will require of you — at least in my mind.

 

[Salpingo]

What are the ACGME rules of this for psychiatry? Does anyone have a link? Is it common to be routinely asked to see more than 10 patients as a second year resident both on weekdays and weekends?

Are the cap limits different for psychiatry than for medicine? Are there any rules for amount of time to see a patient 3rd year for evaluation or follow up?

The original question was answered (no ACGME guidelines, just the profoundly vague "residents must have major responsibility for the care of a sufficient number of patients to demonstrate competence with acute and chronic psychiatric illnesses.")

In practice, I think it was common to hit 10+ patients at most programs on a typical inpatient day 10 years ago, but the high and mid-tier programs have changed since then, mostly with the expectation that you have close faculty/attending supervision, and they'll typically speak up if they're getting that high. Even in internal medicine there's a push to reduce inpatient census to 14 or even <10 by providing non-academic teams staffed by hospitalists and NPs (personally, I was able to carry twice as many medicine patients as psych because I found it generally more algorithmic with a linear path, but maybe I was doing it wrong).

So I would say capping at 6 psych inpatient or consults is common (which I think is the sweet spot between having enough psychopathology to build "competence" vs. checking off boxes), but easily going over 10 when on call or in the emergency room where the expectation is more triage and putting out fires vs. diagnosis and close management. For outpatient, I know the census can range from 40 to over 150, and some places fill your schedule with 10+ patients/day -- personally, I would avoid those programs like the plague. If you're getting good training for psychotherapy, which includes time for supervision and didactics in addition to a handful of weekly, hour-long sessions w/ patients, I would also expect 6 to 8 patients/day, hopefully not more than 2 or 3 new evals a week, which probably translates to carrying 60 to 70 patients, but I realize I was probably spoiled in my program.

 

[FlowRate]

I think @Salpingo is spot-on.

I'll add that IM RESIDENTS (not interns) have no hard cap. Neither do psychiatry residents.

Regarding your question, it's not clear what setting you're talking about. Even then, there are variables such as support staff, patient acuity, hospital workflow, and resource availability that can significantly change that answer.

 

[bisell26]

It is definitely commonplace to be asked to routinely see more than 10 a day as a second year. We typically see around 10-12 a day and then of course there are days the hospital is swamped, perhaps after a full moon for example, and you might need to slog through 14-16. I don’t see the point in artificially capping to be honest. Unless you’re going into academics and expecting a lighter work load, the working sector is seeing many more patients and you want to be prepared for what that will require of you — at least in my mind.

I agree. But also keep in mind, that in those types of settings, you won't be having to handle medical issues and may have more Social work support. As a resident, during inpatient, there was a lot of scutwork that I had to do as a 2nd year, that I don't think would be the norm in the working sector.

 

[NickNaylor]

I agree. But also keep in mind, that in those types of settings, you won't be having to handle medical issues and may have more Social work support. As a resident, during inpatient, there was a lot of scutwork that I had to do as a 2nd year, that I don't think would be the norm in the working sector.

Probably true as once you're working in a business setting and/or actually being paid market rates for your labor, your employer will want you spending your time doing things that actually make them money, not arranging outpatient follow-up, which can be done by lower paid staff.

At my program we're fortunate to have support staff to handle just about all of these issues - outpatient follow-up, collateral, etc. We typically only get involved if needed.

 

[Mad Jack]

I think @Salpingo is spot-on.

I'll add that IM RESIDENTS (not interns) have no hard cap. Neither do psychiatry residents.

Regarding your question, it's not clear what setting you're talking about. Even then, there are variables such as support staff, patient acuity, hospital workflow, and resource availability that can significantly change that answer.

IM residents have a cap of 14, interns 10, per the residents that I'm sitting right next to.

 

[FlowRate]

IM residents have a cap of 14, interns 10, per the residents that I'm sitting right next to.

Ah, I thought I had remembered correctly, but here's the actual ACGME rules:

Policies - Admission Caps - UW Internal Medicine Residency Program