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I wanted to start a pediatric-specific thread and see if it goes anywhere. Please add your own thoughts on various issues if you see one. I am hoping to stay away from brief comments that don't add to the discussion, such as "This is bad, we will have to make residency 4-5 years," without any further explanation.
This post will be about requirements for supervision and PGY-1 residents. I wanted to set the duty hours issue aside for this post, because you could have night float to accommodate work hours. The requirement for supervision is that the supervising physician must be either present in the room, or present on-site, for PGY-1 residents.
Scenario A - Subspecialty Service: When the supervising physician is either a subspecialist (e.g., neurology), not all places are going to have an attending available on-site for direct supervision. Even in places that have fellows, who might be able to be defined as a "supervising physician" for the patient, do all fellowship programs (e.g., ID? others?) make sure that there is a fellow or attending in-house 24/7? During the daytime, at least on weekdays, the supervising attending and/or fellow is probably somewhere close enough to provide that direct supervision to interns.
Scenario B - Community Pediatrician: Similar situation, but this time with general pediatrics patients who are being admitted under their regular pediatrician. In most cases, they are not going to be staying overnight in the hospital and, unless they have their office located in a building within the medical center, they are not going to be available for in-person supervision during the daytime, either.
Scenario C - Community Pediatrician and the Well-Baby Nursery: Same as above, but this time with babies. Residents are always in-house, community pediatricians are not. If a baby is tachypneic and the nurse wants to know if it's ok to let the baby go to the mom's room and only a PGY-1 is in-house for nursery call, will they call the attending to come into the hospital to evaluate the baby?
Discussion: How would this impact PGY-1 residents and their patient load when the supervising physicians, at least right now, are not always going to be in-house? If there is an issue that happens overnight with a patient, can the PGY-1 resident only provide care to those patients who have a supervising physician in the hospital? Would the PGY-2 or 3 resident have to be the person to evaluate those patients and call the attending on the phone, because phone supervision is not allowed for PGY-1 residents?
Also, what is the impact on the faculty hospitalist service? Will that affect which subspecialty services or community pediatricians still serve as the supervising physician for particular patients? Will they choose to have the hospitalist service serve as the attending instead? In subspecialty patients, that would mean the subspecialist would now become the consultant.
This post will be about requirements for supervision and PGY-1 residents. I wanted to set the duty hours issue aside for this post, because you could have night float to accommodate work hours. The requirement for supervision is that the supervising physician must be either present in the room, or present on-site, for PGY-1 residents.
Scenario A - Subspecialty Service: When the supervising physician is either a subspecialist (e.g., neurology), not all places are going to have an attending available on-site for direct supervision. Even in places that have fellows, who might be able to be defined as a "supervising physician" for the patient, do all fellowship programs (e.g., ID? others?) make sure that there is a fellow or attending in-house 24/7? During the daytime, at least on weekdays, the supervising attending and/or fellow is probably somewhere close enough to provide that direct supervision to interns.
Scenario B - Community Pediatrician: Similar situation, but this time with general pediatrics patients who are being admitted under their regular pediatrician. In most cases, they are not going to be staying overnight in the hospital and, unless they have their office located in a building within the medical center, they are not going to be available for in-person supervision during the daytime, either.
Scenario C - Community Pediatrician and the Well-Baby Nursery: Same as above, but this time with babies. Residents are always in-house, community pediatricians are not. If a baby is tachypneic and the nurse wants to know if it's ok to let the baby go to the mom's room and only a PGY-1 is in-house for nursery call, will they call the attending to come into the hospital to evaluate the baby?
Discussion: How would this impact PGY-1 residents and their patient load when the supervising physicians, at least right now, are not always going to be in-house? If there is an issue that happens overnight with a patient, can the PGY-1 resident only provide care to those patients who have a supervising physician in the hospital? Would the PGY-2 or 3 resident have to be the person to evaluate those patients and call the attending on the phone, because phone supervision is not allowed for PGY-1 residents?
Also, what is the impact on the faculty hospitalist service? Will that affect which subspecialty services or community pediatricians still serve as the supervising physician for particular patients? Will they choose to have the hospitalist service serve as the attending instead? In subspecialty patients, that would mean the subspecialist would now become the consultant.
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