Who makes up my team?
Your team is usually made up of your attending, a PGY2 or 3 resident, two interns, and either a third or fourth year medical student.
What is the patient population?
We see a variety of medical illnesses. One of the great things about our patient mix is that we do a great deal of diagnostic workups for previously undiagnosed disorders. It is rare that you would have a patient admitted with the diagnosis already made. All of our inpatient services are generalist admitting teams. This allows you to care for an incredible diversity of patients and disease states. It is up to your team to decide if you want a subspecialty consultant to assist you with patient management. We do not have mandatory consultation for any service.
Who gives me approval to order diagnostic tests, etc.?
Your team, led by your attending, will make these decisions. If you feel a patient needs an important radiologic study, such as a MRI or a PET scan, you simply write the order. You don't need radiology approval for these studies. If you feel a certain antibiotic is indicated, you order it. We don't require ID approval, etc. We pride ourselves on giving you the autonomy that you need to take care of your patients along with strong guidance and support from the faculty.
Who will I see in clinic?
When at our Myers Park facility, our categorical residents will see their own continuity panel of patients. They serve as a primary care provider and get to know their panel of patients quite well over the course of their residency training. Our preliminary residents rotate through Myers Park clinic as well but primarily see hospital follow-up and urgent care type visits. Interns will not see more than three to five patients in a half-day, and all their patients will be seen and examined by an attending for at least the first six months of the year.
What is the average inpatient census?
This will vary somewhat depending on the time of year. Often the busiest months of the year are the winter months, and the census will occasionally be as high as 18 patients (nine patients per intern). Most of the time, however, the average census is 6 to 16 (or three to eight patients per intern) depending on where your team falls within the five day call cycle. The number of patients per intern may be less if you have a fourth year medical student working as an Acting Intern on your team.
Of course, we comply fully with ACGME (Accreditation Council for Graduate Medical Education) patient care caps, which as of July 2009, require that services be under 20 patients, with no more than ten patients per intern.
Our inpatient censuses are actually LOWER than ACGME's current requirements. From July 1 to October 1, we have team caps of 16 - so no more than eight patients per intern. This allows new interns to learn the process of operations and work on improving their efficiency with a more manageable patient census. From October 1 to June 30, the team census or cap increases to 18, or 9 per intern, which is still less than what ACGME requires. We believe our team caps provide an ideal balance between service and education and foster an excellent learning environment.
In general, the inpatient consult services have very reasonable census numbers. Gastroenterology and Infectious Disease tend to be the busiest - with average numbers running from ten to sixteen. Many of the other services tend to have lower numbers of patients in the hospital with the majority of the patient care delivered in the outpatient setting.