Question for those in EM Residencies now

[DrQuinn]

Hey guys, quick question. Our PD wants us to see "at minimum, 1.5 pts an hour." Having only been 6 shifts into my first real EM month as an intern, I think this is a bit excessive. In 12 hours, I am averaging 15-17 patients (so around 1.3-1.4 an hour). I know compared to attendings this is nothing, but I end up almost exclusively seeing all the "urgent" patients that require closer monitoring, and being the only intern in the whole ED, I am responsible for all codes (medical and trauma) that come in... Sometimes I just yearn for a good old abdominal pain or a broken extremity, something quick and easy... but I never seem to get it.

What are you guys averaging per hour? I've asked several of my colleagues here at USF and they are hitting about the same number... I just want to see how I am comparing to those at programs that are established...

Q, DO

---

Members don't see this ad.

 

[Sessamoid]

I think we had a thread about this in the past. For interns, I think they're pushing you excessively if they expect 1.5 / hour out of you at a minimum. I'd say 1.5 /hour should be the maximum you should be expected to see. For interns, I'd expect more in the 1.0-1.2 / hour range. More than that and you're spending too much time running around and not enough thinking and reading about each case.

All this depends on acuity of course. If you're seeing mostly fast track crap then it should be higher. Lots of critical care should lower that number.

 

[EMIMG]

This is such a biased question. In other words, this is going to vary so much from place to place depending upon documentation, etc. For instance, a place that uses a T-system you would probably be able to see more patients than a place where dictation is the norm. It also depends on the acuity of things.

At our program, we dictate everything. Our attendings are expected to see about 2 patients per hour. So, if they have a bunch of residents on, they see very few on their own; however, it is expected that if needed, the attendings see one on their own for every 3-5 that the resident sees.

In addition, acuity is going to vary things. Perhaps a better judgments is RVUs per hour. This tends to indicate the acuity of patients.

Also, it depends on the ancillary staff. If you are pushing patients to X-ray, CT or starting your own IVs, you will not see as many patients per hour.

Another thing that impacts the number of patients you see is whether or not you have medical students/rotators that you are responsible for. I know that at our institution as 2nd and 3rd years we are responsible for supervising students and rotating interns. Yes, they see patients but then they present them to us and then we need to see the patients as well and we need to dictate the chart. It is nice to have them as they can do some of the work for you (i.e. checking X-Rays, starting lines); however, they can also slow you down.

Also depends on the admission percentage. I think that admitting patients takes a little longer than discharging patients.

So, it really varies from place to place. I know that our attendings will tell us if they feel that we are not pulling our weight. Many of our attendings will also just tell the residents to go out and do what they can and to let the attending know when we need to have help.

 

[Apollyon]

We just don't have the volume to see 1.5 an hour - the onus is to see the patients as soon as the ass is in the seat, and that happens. Moreover, the ED is inefficient. Even more, getting "air time" with the attendings is a problem, and we're on Wellsoft now to document. As a final insult, ours is not an admitting ED - we have to dig up an attending who will admit, and that can take a LOT of time.

 

[DrQuinn]

Originally posted by Apollyon
We just don't have the volume to see 1.5 an hour - the onus is to see the patients as soon as the ass is in the seat, and that happens. Moreover, the ED is inefficient. Even more, getting "air time" with the attendings is a problem, and we're on Wellsoft now to document. As a final insult, ours is not an admitting ED - we have to dig up an attending who will admit, and that can take a LOT of time.

Good enough, but how many patients are you seeing roughly each shift? I am seeing now between 15-17... more if traumas come in (and boy do they ever) but I have only a peripheral role... FAST exam, primary assessment, etc... so they don't really count.

I think I am just getting burnt out. Tomorrow will be my first day off in 21 days... in fact I am on Miller Lite numero tres and enjoying every minute of it (its bad when the ED nurses come up to you and say "Dr. Quinn, you need a day off."

Q, DO

 

[bcrosspac]

Quinn:

I am glad they at least call you "Dr.". Look forward to seeing you in December.

Bill

 

[The White Coat Investor]

Now I don't know how this compares, as I work 9s (only pick up for 7.5) not 12s. We are told to aim for 1/hour as interns. In the fast track I'll do 12-18. In the ED I'll do 7-10 (6 when we've got tons of boarders taking up space). Not quite 1.5 as you can see. Push yourself right up to the point where you feel "at your limit." Spending too much time over the limit makes me feel burnt out too.

P.S. First day off in 21? I'm calling the ACGME!

 

[DrQuinn]

Originally posted by Desperado
Now I don't know how this compares, as I work 9s (only pick up for 7.5) not 12s. We are told to aim for 1/hour as interns. In the fast track I'll do 12-18. In the ED I'll do 7-10 (6 when we've got tons of boarders taking up space). Not quite 1.5 as you can see. Push yourself right up to the point where you feel "at your limit." Spending too much time over the limit makes me feel burnt out too.

P.S. First day off in 21? I'm calling the ACGME!

My technically first 24 hour period off. Did two weeks of trauma, had one day off where I only worked 6 hours (midnight - 6 A), but I don't consider those 18 hours a true day off since I had to sleep about 8 hours. Then did a week straight of ER shifts (normally would have two days off during that week but I moved two shifts from Thanksgiving week up so I can have a week off with the fam).

I asked some of the other people at my program, and they're seeing about the same... 1.2-1.4 an hour. I think if it were more fast-track type patients I could see more (x-ray a wrist, dispo in a splint, ten minutes tops), but I end up getting all the sick patients, whihc is good, I guess. I was just feeling burnt out last week, felt like I didn' tknow what I was doing, and was looking for some reassurance.

Gotta love SDN (and Desperado/Sessamoid)

Q, DO

 

[spyderdoc]

Remember too Quinn, that you are in your learning years. You should not be expected to crank out patients until your senior year(s) of residency...You should be able to see your patients, present them to the attending, and perhaps even look something up on them, ie management of DKA...This way you are learning how to manage these patients. Your senior year should be dedicated to learning how to manage patient flow through the ED (moving the meat). This will prepare you well for entering the real world...
Spend your early years learning as much as you can...And keep a positive outlook, otherwise youare setting yourself up for the ole burnout...

 

[Scrubbs]

I'm not in the ED right now, but I have been averaging around 1 pt/hr. More when I see a lot of psych/fast track, less when I get a bunch of difficult cases. We aren't expected to move the meat, just see the sickest patients and learn how to treat them.

As for burnout... all I can say is 1 more month and I will FINALLY get my first week of va-k. Yes boys and girls, my first time since June with more than 48 hours in a row off - I CANNOT WAIT!

 

[DrQuinn]

Strong work Scrubbs... I have 5 days off at the end of this month for Thanksgiving, got my bro flying into town. I was scheduled tow shifts during those days (so I would have had two days off for t-giving) but shifted some shifts around (gotta love EM) so I will haev FIVE DAYS OFF STRAIGHT!! I also have a week coming ot me for Christmas. Yippee!!!!!!!!!

Q, DO

 

[Scrubbs]

So-oo jealous Quinn... I'm working Thansgiving, but I have off the following 2 days. My mom is actually planning on making Thanksgiving on Friday, so I can be there! How much does my mom rock?!?!?!

 

[roja]

I have done a total of 6 weeks in the main ED and 4 weeks in Peds ED. I agree that it really depends on the acuity of patients. On days where I have alot of privates and less acute stuff, I can crank out 2 an hour. On other days where they are all service and I have high acuity, I see more like 12.

I had an attending tell me as an intern, you should really be shooting for 12/12hour shift. I think this is pretty reasonable. The point of internship is to learn. I don't consider it my job as an intern to be a meat mover. I am there to learn so that in another year or two, I can move patients. But you have to learn before you can move them.

I have found that my ability to move patients is also highly dependent on the attending I am presenting to. Some are easier to present to in an efficient manner and still teach. Others get really bogged down.


All I have to say is thank god for the bell commission.. 21 days in a row? good lord.