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We have the same cap...and no, we never get >10. I think we accidentally got 11 once because the census was off but we just called and had a patient transferred to another team.
The cap is 6? That's pretty good. I usually had 5-9 or 12 usually.
Are you categorical and at a university program? 15 seems like way too much. Your senior should be seeing some of those patients.
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From my understanding
1 senior + 1 intern = 14 pts cap
1 senior + 2 interns = 20 pts cap
Intern cap = 10 pts
Intern on admitting day = Max 5 new admissions + 2 inhouse transfers (Discharges from the ER do NOT count towards this)
All these need notes and orders. Lots of them.
Besides that, the afternoon is spent doing admits, discharges and answering pages.
It's really fun!!!
How can you see 10 patients before rounds? Don't you do sign outs and lecture in the AM?
Yeah that's hilarious, because everybody knows the workload associated with an IM pt = NSGY pt = psych pt = ER pt = ...
Community IM categorical program. One PGY1 and one PGY2 together deal with around 15 patients, with the PGY1 doing all the paperwork, running all the errands and being required to know everything about patients.
one intern and one PGY2 should cap at 14 or 15 but the problem lies in what the intern does when the PGY2 has a day off, which is where we always got the shaft. On those days we were just expected to round on the list, which exceeds our cap. if you complained or mentioned you were violating the cap, well the next thing you know your getting a page from the PD or chief resident telling you that you are going to violate your cap "just this once", which turned out to be once a week.......The ACGME put in place pretend limits and a pretend method of policing residency programs. get used to it. Until people grow the balls to get together and make a change ie unionize (CIR/SEIU is gaining momentum), we will continue to be abused. ...
Is CIR/SEIU a powerful organization?
I would like to unionize for sure. How would that be done?
SEIU? Yes...for the custodial staff at the hospital. CIR? You're kidding, right? They are beyond useless.
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i see 12-14 pts per day but it's only me and the attending. I basically get treated like a medical student and only write progress notes. The attending writes all the orders, H&Ps, discharges, and consults. I feel though that the rotation that I am currently on is very atypical because this is not how teaching teams function in all the other hospitals I have rotated in. I feel really guilty because I seriously want to help out but the attending does not delegate anything to me. 🙁 I dont know what to do.
I would say, enjoy it, unless you are a categorical IM intern.
You get a union rep (usually from CIR, but theoretically from anywhere) and organize. There's a bunch of specific steps that need to be taken, and there may be differences based on state law.
The important thing to understand is that you can only form a union at your own institution. So, if you can convince at least half of the other residents at your program to unionize, and go through all the steps, then you can do so.
Whether a union will make your life better or not is unclear. The union will mostly work on issues that face all residents, not something that is specific to your program/field.
The important thing to understand is that you can only form a union at your own institution. So, if you can convince at least half of the other residents at your program to unionize, and go through all the steps, then you can do so.
Whether a union will make your life better or not is unclear. The union will mostly work on issues that face all residents, not something that is specific to your program/field.
CIR/SEIU is gaining momentum. The more residency programs that join the more lobbying power and leverage they will have.
http://www.cirseiu.org/
Ive never eaten beyond useless myself......
Unions are voluntary, membership-based organisations, and vary enormously in their aims, culture and set-up (local laws on unions also differ enormously). There are lots of them, and all are interested in increasing membership, so if anyone wants to join/set up a local branch, they should pick the most appropriate to their situation and ask that union what it could do for you.
A union should be able to provide a local rep with employment law knowledge and expertise in negotiating with employers. An individual who has problems, or a group of people who want to change their working set-up, is more likely to succeed, and less likely to be victimised, if someone like that negotiates on their behalf. A union may also be able to provide access to specialist employment lawyers, cheap insurance deals, and so on.
An individual joining a big organisation is automatically vulnerable to being on the losing side in any dispute: they don't have the expertise, the back-up, the resiliance and the ability to hold out for years that a big organisation has. Being part of a union can help make the workplace a more equal playing field. Dues can be pretty small, as they are mostly paid by ordinary working people.
The constant advice on these boards for any resident having trouble is "suck it up and see it out". Once it's past that stage, the advice is "move on with the best reputation you can get and hope for better somewhere else". The trouble usually comes out of the blue, at least from the resident's perspective. Having an expert to talk to early on, and someone who can check that proper procedures are being followed without it becoming personal to the resident, can be invaluable.
(waiting for the hating)
A union should be able to provide a local rep with employment law knowledge and expertise in negotiating with employers. An individual who has problems, or a group of people who want to change their working set-up, is more likely to succeed, and less likely to be victimised, if someone like that negotiates on their behalf. A union may also be able to provide access to specialist employment lawyers, cheap insurance deals, and so on.
An individual joining a big organisation is automatically vulnerable to being on the losing side in any dispute: they don't have the expertise, the back-up, the resiliance and the ability to hold out for years that a big organisation has. Being part of a union can help make the workplace a more equal playing field. Dues can be pretty small, as they are mostly paid by ordinary working people.
The constant advice on these boards for any resident having trouble is "suck it up and see it out". Once it's past that stage, the advice is "move on with the best reputation you can get and hope for better somewhere else". The trouble usually comes out of the blue, at least from the resident's perspective. Having an expert to talk to early on, and someone who can check that proper procedures are being followed without it becoming personal to the resident, can be invaluable.
(waiting for the hating)
You realize that unionization is antithetical to the concept of a "profession," right?
Professions have specific & advanced bodies of knowledge, and as such are afforded certain rights/responsibilities in terms of self-determination.
Unionization negates that, and is one step closer to demeaning the value of a true medical education and the importance of earning a medical degree & specialty board certification.
I'm not saying "suck it up" is a viable alternative, and the ACGME frequently performs direct sigmoid visualization on itself; but be very wary of the slippery slope that is certification/unionization.
-d
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I would agree if this were 50 years ago in the glorious era of paternalistic medicine. What
ights/responsibilities do physicians have any more. There is no self determination in medicine. As far as I can see, physicians are just worker bees anymore . And I would say that they are well paid worker bees, but when you start looking at hours worked, the pay aint that great (and debt). I feel like modern medicine is forcing a movement towards unionization in an attempt to protect our fleeting rights. -R
I don't disagree on those points; we are being forced into it... partially our own fault, and partially not.
But, unionization isn't the way to go. Think about it - the #1 tool in a union's playbook is a strike. Any code of medical ethics would prohibit that. So, you're now saddled with union rules & policies that can be dictated by admin/lawyers/etc without any fear of repercussion because we wouldn't (and shouldn't) do that.
Furthermore, do you think you'd have any defense at trial if a STEMI came along and they died b/c the ED doc, cards guy, or intensivist said "but we were on strike, so it's not our fault." Nope. Our defenses lie in standards of care, promulgated by our specialty societies - which would go the way of the dodo under a union system.
So, physicians as union members would automatically be scabs (and if not, oughtn't be practicing anyway), with even less protection as before?
No thanks.
I don't pretend to have a solution otherwise (at least one that's actually feasible); but the various alphabet soup of unions out there ain't it.
[/hijack]. Now back to your regularly scheduled thread.
-d
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Example of a neurosurg note:
S: alive
O: vitals = stable
A: pt w/ brain injury, s/p *insert procedure*
P: continue to follow (as real attending and senior resident do the real surgery)
We're a community IM program, interns capped at following 10 pts. Usually don't rounding late morning or just after lunch and then usually a handful of admits in afternoon split among the teams.
Overnight and weekend call there are usually 2 interns and a senior on.... Admits vary anywhere from a few overnight to 12-16 on a busy night. And on call folks cover floor and unit patients on the teaching service, as well as any rapid responses or codes in the hospital (except those in the ER).
Overnight and weekend call there are usually 2 interns and a senior on.... Admits vary anywhere from a few overnight to 12-16 on a busy night. And on call folks cover floor and unit patients on the teaching service, as well as any rapid responses or codes in the hospital (except those in the ER).
