Jump to content
Sign in to follow this  
charlotte

45+ patients/8 hour day in internal med?

Recommended Posts

My internal med rotation has a patient volume around 45 patients per 8 hour shift. This includes new patients, annual exams, etc. As a student, I'm bound to miss something in the 10 minutes I have with the patient. 

Anybody do a similar patient volume? This is more than I saw in the ED, for sure. These are not URI patients. These are diabetics with complications, patients with brain tumors, cirrhosis with ascites, COPD, CHF, etc. patients. 

Share this post


Link to post
Share on other sites

That's just poor patient care and not good for the provider to see that many patients.  You are either always running behind or the patients leave feeling the appointment was rushed and their needs not met. 

  • Upvote 3

Share this post


Link to post
Share on other sites

That is insanity and poor medical practice.  Is this just you (student) and one internal medicine doctor?  You will learn very little, get stressed out, have scrambled eggs for a brain, and burnout before you graduate.   Talk to your program director asap.

  • Upvote 2

Share this post


Link to post
Share on other sites
29 minutes ago, TWR said:

That is insanity and poor medical practice.  Is this just you (student) and one internal medicine doctor?  You will learn very little, get stressed out, have scrambled eggs for a brain, and burnout before you graduate.   Talk to your program director asap.

Thank you for assuring that I'm not overreacting. Yes, it is just one internal med doc and I. I am unable to ask any questions and there is no feedback on how I am doing as we are zooming from room to room. I am disappointed with my school. This is my last rotation and I was interested in inpatient internal med, which is very much different than outpatient internal med. 

Share this post


Link to post
Share on other sites

You are not overreacting, this is abuse (if you are working there) and poor patient care. I'd tell your program director and tell every PA you know not to work there.

IMO, 15 is the most you should see in true IM per day (and that's if you are experienced, not a student). Many private groups will see 20+, but it's a highway to burnout and medical errors.

  • Upvote 3

Share this post


Link to post
Share on other sites

What you are describing is simply wrong.

Many of us old timers on this forum have talked about our volumes at 20+ YEARS in the business.

There is no such thing as quantity in good medicine.

In an 8 hr day, I freak if I get over 20 and I have done this 25 years. Just bad medicine. Can hardly get the patient in the room with vitals in 10 minutes and my dumb office uses 10 and 20 minute appt slots with the majority getting 10.

As a student - I think 10 in a WHOLE DAY is the max I would ever want and that is with a mentor, guide, lots and lots of feedback and interaction.

Please talk to your program director and have them look at this. Education by immersion is one thing. Stupidity and volume is another.

Your heart and desire is in the right place - patient first and do the right thing. Kudos

  • Upvote 2

Share this post


Link to post
Share on other sites
5 hours ago, Reality Check 2 said:

What you are describing is simply wrong.

Many of us old timers on this forum have talked about our volumes at 20+ YEARS in the business.

There is no such thing as quantity in good medicine.

In an 8 hr day, I freak if I get over 20 and I have done this 25 years. Just bad medicine. Can hardly get the patient in the room with vitals in 10 minutes and my dumb office uses 10 and 20 minute appt slots with the majority getting 10.

As a student - I think 10 in a WHOLE DAY is the max I would ever want and that is with a mentor, guide, lots and lots of feedback and interaction.

Please talk to your program director and have them look at this. Education by immersion is one thing. Stupidity and volume is another.

Your heart and desire is in the right place - patient first and do the right thing. Kudos

Thank you for your reassurance. I agree that it is suboptimal.

  • Upvote 1

Share this post


Link to post
Share on other sites

You are also not alone.  One of the IM rotations for my program schedules up to 32 patients at 15 min intervals (usually 30 mins for a new patient), and has 2-3 PA students on his service, 7:30-4:30.  32 slots, typically no more than 4 slots remain open for possible 'same-day / sick' visits.  

The 2 paracticing PAs will have some of their schedules with more of a mix of 30 min appts, but usuallly at least 24 pts. per day.  

The students are expected to complete the entire encounter in <15 mins before he comes in to assess.  He drops in on the PAs pts too.   

It is NOT up for discussion with program leadership.  Many have tried.  

Share this post


Link to post
Share on other sites

45+ Pts per day in 8 hours??? That's crazy. If these are true/typical IM patients, you can't even do their med recs and VS in 10 minutes. I usually see 15-18 and sometimes feel that may be too much. 

 

Share this post


Link to post
Share on other sites
On Wednesday, June 28, 2017 at 8:29 PM, lauraashley1 said:

My internal med rotation has a patient volume around 45 patients per 8 hour shift. This includes new patients, annual exams, etc. As a student, I'm bound to miss something in the 10 minutes I have with the patient.

Anybody do a similar patient volume? This is more than I saw in the ED, for sure. These are not URI patients. These are diabetics with complications, patients with brain tumors, cirrhosis with ascites, COPD, CHF, etc. patients.

That is, quite frankly, insane and unsafe. First of all as a student you shouldn't be rushed. You are supposed to be learning not generating revenue for the practice. I have been doing this for 30 years and had a PRN job with an internist that booked 40 a day. I finally told him no more....it was a bad schedule that, at the least, made everyone mad becuase they were sitting for hours, or was just unsafe and impractcal.

Talk to someone at your program about this. It isn't up to you as a student to sort it out.

Share this post


Link to post
Share on other sites

I hate to say this, but this rotation is probably the closest to real life as you are going to get.  If you are working for a corporation, if you have an "administrator" with a high school education, if you have a "dual leadership", if your clinic has fancy logos, if they subscribe to press-ganey, then your job is primarily making money for XYC system; practicing is secondary, and not what they hired you for. 

I went to school to help people, to guide them through their health concerns, not to look at my watch and then usher them out.  The best job I ever had was at the VA- there I had the feeling I was practicing REAL medicine, with patients who needed me. 

Anyways, yeah, it's unsafe; yeah, its not how it's supposed to be.  But I don't see it changing.  In fact, I had a VP tell me the other day that "patients WANT 'burger king' style medicine" as he was talking about rolling out an electronic visit service.  Do they now?  They also want antibiotics for every damn thing, but get upset when c-diff and MRSA eats them. 

Share this post


Link to post
Share on other sites

This whole ongoing issue has placed hospital administrators above attorneys and even insurance adjusters on my list of undesirable people in society.

I have a mental list of horrible things I would do to these folks if I were truly evil - one involves an ant pile and strawberry jam.

At some point the whole corporate medicine thing will likely implode and we might go back to small practices or small groups - seems to be a cycle to these kinds of disaster.

We should educate our future PAs better and really try not to normalize the idea of Burger King assembly line medicine and stick to our roots.

RESIST - stay true to the ART of medicine.

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Sign in to follow this  

×
×
  • Create New...

Important Information

Welcome to the Physician Assistant Forum! This website uses cookies to ensure you get the best experience on our website. Learn More