Why Everyone Needs an Intern

Hospitals run on interns. With the new work hour changes, the hospital has started creating specialty services without house staff (residents). This is not necessarily new; for a long time, we've had a dedicated cystic fibrosis team made up of an attending and nurse practitioners which worked seamlessly. However, as resident hours are more restricted but the overall patient load has remained the same, house staff are covering fewer patients. In fact, the liver transplant team I was on in June no longer has interns and residents; it is run by physician assistants and nurse practitioners. Other services, such as lung transplant or even our chronic pain service, are run by fellows.

Like all system changes, this has its issues. Interns and residents are good at the day-to-day busy work. We know how to order the CT scan on a weekend, how to use the computer system, how to look up who's on call. These details - which have little to do with clinical medicine - have everything to do with how a hospital runs. Services with nurse practitioners and physician assistants often get up to speed pretty quickly; the NPs and PAs learn the nuts and bolts. However, clinical fellows have a harder time because they often switch; the rotation for our fellow is 2 weeks long (done twice a year) and this doesn't allow much time to learn the basics.

The last thing that worries me is that patients on housestaff teams always have a covering intern, someone on call and in house who has information about the patient. If an issue comes up or a code is called, the covering physician always comes to the bedside. If the patient is on a team run by nurse practitioners, physician assistants, or fellows, those practitioners don't stay in house. While many problems can be addressed from home and fellows will come in if needed, in an emergency situation, the people who know the patient the best may not be available.

I don't think there's a perfect system, and I think what we have works fairly reasonably. However, I wanted to point out the complexities of covering every patient in the hospital.