How to Make Internship Easier

The idea of the ACGME changes in work hours is that if interns get more sleep and have shorter shifts, there will be improved patient safety and quality of care. Though intuitive, this has never really been proven. The side effect of this proposal is that internship will become "easier"; no longer will interns have war-stories of ridiculously long shifts devoid of sleep. That's a good thing. But in examining my own experience, I think that if I were to redesign the system to improve patient care and help interns, I'd take a different approach.

Currently, inpatient medicine interns admit up to five patients on call. Our personal caps are 10 patients total; each intern cannot be responsible for more than 10 people at one time. The admission cap of five is challenging but acceptable. In a single day (or 24 hour admitting cycle), I can be expected to learn about, talk to, examine, diagnose, and begin treatment for five new patients. When they come all at once, it's overwhelming, but usually I can manage it. However, I have trouble with the personal cap of 10. I know that senior residents and attendings take care of more patients than that, but for an intern who is responsible for all the "scut," 10 patients is a lot. When I'm in the middle of a procedure like a paracentesis, I will get paged over and over about half my other patients. It is not easy each day to see 10 patients, determine their plans, actualize it, and document everything.

I would propose decreasing personal caps simply to nine patients. Though minimal, I think this would decompress the hardest days - those with a full service. I think it'd improve patient care because when I'm running a full service, there are things I want to do for my patients that I don't have time to do. Even having one fewer person means fewer notes, fewer family meetings, fewer calls from pharmacy, fewer nursing pages, fifteen minutes of additional sleep in the morning. It adds up. And by decreasing the overall cap, the experience of residency would not be changed too much, only smoothed at the edges. However, hospitals run on interns, and this would be a burden to the system because more practitioners would be required to account for the same number of beds.