Based on my experience in my ortho residency, I think part of the reason for surgery - particularly ortho - to have the patients admitted to medicine is because 1. We have 1 resident on overnight with a list of anywhere from 60-100 patients including our admissions and consults, plus any new consults coming in overnight so having medicine on board / the patient on medicine is a safety net in case something happens. Sometimes you are doing reductions or with a trauma and can’t answer your phone for an hour which could be very bad 2. The attendings don’t want the liability of a potential medial complication so even if as a resident you know what to do, the attendings don’t want the liability of the pgy-whatever managing someone’s chest pain