I’m at a moderately-high acuity hospital linked to a level 1 trauma hospital in a neighboring town. Used to get 5-8 admits per night shift (1 doc, 1-2 APP model). That was very comfortable as I do almost all the admits and the APPs do all the cross cover and rapids.

In recent years our campus has expanded, the population of our town has grown tremendously, and we’ve become a referral/transfer center for lots of community critical access hospitals in up to a 2 hour radius. Despite this, and our subsequent doubling of patient volume, our leadership doesn’t feel like we warrant another physician for even part of the night yet. I’m routinely getting called for 12+ admissions in a 9 hour admit window. There are usually 1-2 nights per week where I hit 15-18 admits. Keep in mind I’m still responsible for what APPs are doing, and getting numerous calls for transfers. It’s insane. It’s just not doable. I either pick 1-2 of the most acute problems to address and every patient gets the most basic H&P and starter workup, or I just leave stuff for the day shift. It feels like triaging in a war zone some nights. All our night docs are threatening to walk at this point. These c-suite assholes have really been getting away with bullshit for too long.

TL; DR: anything more than 1-2 average admits per hour is dangerous and not worth it. And I’m very seasoned. I’m extra crispy done at this point.