I must admit that I am not a fan of inpatient medicine. I started out with it as my first rotation of my MS3 year and immediately decided I had to get as far away from internal medicine as possible.
As a new MS3, I remember sitting in radiology rounds and, at the end, the radiologist stood up and declared that he was on the hunt for some hot cocoa before heading back to the reading room. My senior resident leaned over to me and whispered, “You need to go do a rectal exam on our new admit.”
That was my first firm nudge towards radiology.
When I was comparing transitional year programs, I had a section of my spreadsheet dedicated to tracking the required number of months I would spend on a hospitalist service. Guess how many months are required at the program I matched with? That’s right, just one.
I honestly don’t know why I dislike it so much, but I do. I dreaded my month of “house-staff” all year. Having just finished, I wanted to outline my typical day because as a certified “nervous Nelly” I know I would’ve been curious to hear the perspective of someone who has recently been through it. And not from someone who is a die-hard IM genius.
Hospital setting and general team organization
I am training at a community hospital with several residency programs affiliated with it. Bit of a hybrid community and academic center. We have 648 beds. There are two house-staff teams (green and orange) that take care of 14 patients each. There are two interns per team, a senior, and an attending. 1-2 Medical students frequently rotate through as well. While the cap is set at 14, or 7 patients per intern, there is extra room for the residency’s clinic patients if needed. So, there’s a hard cap of 20 patients per team. I never saw this happen. Our census was more commonly 10-16 patients.
The day teams don’t admit patients. You get new patients from admits over-night or the morning after an admission from the purple team (a resident admitting team). All you have to do is round and discharge.
Typical daily schedule
- 5:45AM Show up, start chart review; All the savvy IM interns show up at 6:20. I came early because I like to see everyone early in the morning before they are awake enough to cause me problems.
- 6:30AM Sign-out from night team
- 6:45-7:15AM More chart review and start prepping notes
- 7:15-7:30AM Start seeing patients starting with my difficult patients first and saving the long-winded patients for last
- 8:30-9:00AM finalize plans for patients, check in with senior about action items that need to happen before rounds, figure out who will be discharging today, start working on discharges
- 9:00AM Start rounds; style depends on attending. Computer rounding in resident room and bedside rounding on new patients or difficult patients. Only a few attendings try to bedside round on everyone. Never had this during my month luckily.
- 10:30AM-12:15PM Rounds end. Sometimes rounds run longer but generally last 1.5 hours. Quickly put in all the orders for the day, work on any discharges, blitz through notes as fast as possible, senior calls consults (so nice).
- 12:15-1:15PM Lunch and noon conference; the hospital food is pretty solid. I would grab some hospital sushi frequently. I understand this seems like a gamble, but I’ve rolled those dice about 50 times and have only been acutely diarrheal once. I don’t think it was the sushi.
- 2:15-3:30 finish up notes, put out fires, check in with senior, bounce
And there you have it. This was a very typical day in my life on house-staff. I ended up staying until sign-out with the night team (5:30PM) for a few days during the first week as I was trying to get my workflow figured out. On the weekend days you end up seeing 10 patients yourself, but the hours were roughly the same. You round faster on the weekend and just try to survive.
I have to admit, this time I really didn’t mind medicine that much. I wouldn’t say that I enjoyed the work or the rounding or the difficult patients. But because the senior residents and attendings in my program are such fantastic people, it really made all the other stuff perfectly bearable. My seniors were involved enough to make sure that my patients were safe and that I wasn’t missing anything but still let me do my own thing. They were always asking how they could help me out so I could go home. The attendings were kind, patient, and were willing to help me improve however I wanted to. They didn’t nit-pick my notes or presentations and they tried to keep teaching points brief so that we could get all of our work done.
If you are looking for an excellent TY experience or IM residency, I would highly recommend the Spokane Teaching Health Center’s TY and IM residency programs. I’m happy to answer any other questions you have about the program if you would like.
I completed an IM rotation and didn’t hate it. There. I said it. I feel better getting that off my chest.