How does the five day cycle work?
Short Call:  Maximum six admissions (maximum three per intern)
                or until 3 p.m., whichever comes first.

Clinic Day:  No scheduled admissions
                Clinic begins at 1:45 p.m.

Long Call:   3 p.m. - 7 a.m.
                Maximum 10 admissions (maximum five per intern)
                Or until 7 a.m., whichever comes first.

Post Call:   No admissions
                Residents must sign out no later than 30 hours after their shift begins.

Clinic Day:  See previous - no scheduled admissions.

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 is that we get to do a great deal of diagnostic workups for previously undiagnosed disorders. It is very rare that you would have a patient admitted with the diagnosis already made. We don't have any subspecialty inpatient services - you will admit Gastroenterology patients, Cardiology patients, Heme-Onc, Neurology patients all are admitted to general medicine. You will see it all as it is meant to be and it will be how you admit patients once you begin your career. 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 an MRI or a PET scan, you simply write the order. You don't need a 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 you need to take care of your patients, with strong guidance and support from the faculty.

Who will I see in clinic?
When at our Myers Park facility, you will see your own continuity panel of patients who you will get to know during your time with us. We also encourage you to see your patients in hospital follow-up after they have been discharged for continuity of care. Interns will not see more than three or four patients in a half-day, and all their patients will be seen and examined by an attending for the first six months of the year.

What is the average inpatient census?
This will vary depending on the time of year. Often the busiest months of the year are the winter months, and the census will rarely be as high as 18 patients (9 per intern). Most of the time, however, the average census is usually six to 15, or three to seven patients per intern. The number may also 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 10 patients per intern.

Our inpatient censuses are actually significantly LOWER than ACGME's current requirements - from July 1 to October 1, we have team caps of 15 - so no more than 8 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 goes up to 18, or 9 per intern, which is still less than what ACGME requires.

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 others tend to have low numbers of patients in the hospital, and most of the patients are seen in the outpatient arena.

Have you investigated changing over to a float type schedule and eliminating overnight call?

Yes, we have discussed that issue frequently! Beginning in August 2009, we will begin a pilot study of shift work in the Medical ICU [eliminating traditional call and 30 hour shifts]. We have currently drawn up plans to expand that to the Medicine Ward Services and to the Coronary Care Unit, thus eliminating all 30 hour shifts and complying with all of the new ACGME regulatory requirements. Please be sure to ask about this on your interview day!!