What's it like admitting patients in a university hospital?

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Captopril

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I'm wrapping up PGY3 year in a little community hospital on the West Coast. We are overworked and understaffed as a residency, and our ER is TERRIBLE. There's no ER residency at our place, so it's all attendings/PAs that give us consults. Never any workup done ("here's this lady with a right sided white out on xray, can you admit?"....no ABG, no CT Scan, no attempt to get some history). Now after 3 years of this, my colleagues and I have become accustomed to getting dumped on by ER physicians and mid-levels with patients who haven't been worked up at all. We also have gotten used to having the ER attending handing us 4 admits at once.

My question is, what is admitting like at a university center (one with an ER residency)? I would assume that for the sake of the ER resident's training, they would be expected to have a thorough workup done before consulting IM to admit? I ask because I plan on going to a major university for hospitalist work and wanted to hear real-world experiences with the admission process at these places. Anything is better than where I'm at now, just wondering what I can look forward to.

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Rather than asking for generic experiences (which vary widely by institution, presence or absence of an EM or IM residency, institutional culture and individial physicians), consider asking each place where you interview(ed) how things work there.

The good news is that, if you're already used to getting dumped on, things likely won't get any worse.
 
So, I don't know how helpful this information will be to you, but I used to work as an ER scribe at a small community hospital and now am an MS3 at a large university hospital with EM residency, and let me tell you from my perspective I found the community workups to be much more thorough. I think part of that is just because at the community hospital the ancillary staff were great so labs, CT, whatever was just "click" and 30 minutes later you have a result. Here (at the poor university hospital) getting anything done is like pulling teeth so radiology stuff tends to just get forgotten, ABGs are done by the residents so if its not gonna help them move patients it might not get ordered, etc. As gutonc said, the specific place will have more variability than community vs university.
 
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The dumping business is universal but it comes in different shapes and sizes. I did my IM residency in an academic university hospital with a huge EM residency program and briefly moonlighted as a nocturnist in small satellite community hospital in a rich part of town. As you'd expect in our university hospital, there were good EM residents and bad lazy EM residents. Same goes for EM attendings. if they get busy and the ER is full, you get called about patients with incomplete history and almost zero work up. The patients are definitely sicker and more complicated at the university hospital (our ER had an active observation unit managed by NPs so we rarely got the mild COPD or CHF or cellulitis or stupid Chest pain r/o).
At the community hospital, the ER was covered by people from different specialties between EM or FM or IM or CC fellows at times. So the experience was completely different based on who was downstairs. some people would literally admit every single patient who walks in at night.

At both places, we didn't have the right to say NO to an admission regardless of how stupid it was.
 
Thank you for insight, people. I didn't rotate in the US as a student, so my experience with ED is confined to my current program. I thought there might be some kind of pattern consistent among university programs with an ED residency, but it looks like it definitely varies from place to place. @gutonc, I definitely asked during my interview, but of course the people selling the program are going to sugar coat it.
 
Did you meet with and have lunch/dinner/drinks with a few of the "regular" docs, or just with the leadership? If everybody you met with, from the top to the bottom, told you the same story, it's either true or it's such a Stepford Wives situation that you should avoid it completely. When I interviewed with my group (outpatient subspecialty, not hospitalist), I met all of the other docs (9 at the time) individually and basically got to ask them all the same questions. I got a general vibe that was the same from all of them, with some different good and bad points from different people. It was pretty legit (and has been borne out in the last 3 years). If you don't feel like you got to meet with a representative sample, ask for some email addresses, make another trip out there, whatever. Do your due diligence.

And don't buy a house until you've been there at least 3 years.
 
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