Policy on Number of Admissions—“Admission Caps”

revised December, 2009

The Accreditation Council for Graduate Medical Education Requirements for Residency Education in Internal Medicine specify that on inpatient rotations:

  • An R1 must not be responsible for admitting more than 5 new patients per admitting day; an additional 2 patients may be assigned if they are in-house transfers from the medical services.
  • An R1 must not be assigned more than 8 patients in a 48-hour period.
  • An R1 must not be responsible for the ongoing care of more than 10 patients.
  • An R2 or R3, when supervising more than one R1, must not be responsible for the supervision or admission of more than 10 new patients and 4 transfer patients per admitting day or more than 16 patients in a 48-hour period.
  • The R2 or R3, when supervising one R1, must not be responsible for the ongoing care of more than 14 patients.
  • The R2 or R3, when supervising more that one R1, must not be responsible for the ongoing care of more than 20 patients.

The Residency Program is committed to seeing that excessive reliance is not placed on residents to meet the service needs of participating training sites.

  • The Chief of the Medicine Service at each site monitors housestaff workloads closely throughout the year.
  • Workload information is reviewed regularly by the Residency Program Director and Associate Director. They in turn present it periodically throughout the academic year to the Housestaff Representatives Committee for review and comment.
  • When workloads are found to be consistently inappropriate for optimal resident education and/or patient care, corrective action is initiated in consultation with housestaff, Service Chiefs, and the Chairman of the Department of Medicine.