The Changing Environment Of Resident Physicians

Prologue: The education of a physician is a long and challenging process requiring years of classroom work with increasing exposure of students and physicians-in-training to the practice dimensions of patient care. After students graduate from medical school, intensive participation in patient care begins, usually in a hospital, as a part of graduate medical education, commonly known as residency training. This supervised “hands-on” training program is designed to offer residents increasing levels of responsibility and to prepare them for the independent practice of medicine. Recently, this training routine has become the subject of intense scrutiny because of a death in a New York City teaching hospital that might have been prevented by more systematic supervision of a junior resident. As a result of this tragedy, the New York State Department of Health is considering the imposition of more stringent requirements on residency programs as a way to protect patients. Several other states (including California, Massachusetts, and Pennsylvania) are considering legislation dealing with this issue. The Association of American Medical Colleges' policy-making board approved a statement March 3,1988, on resident supervision and hours, to which its president, Robert Petersdorf, makes reference in his interview in this issue. In this article, Anne Silberger, Sara Thran, and William Marder of the American Medical Association's Center for Health Policy Research discuss the results of their study of the working conditions of resident physicians. They suggest that the milieu of ate resident physician is changing, in large part because of changes in the payment mechanisms that reimburse hospitals for their services. Silberger, who holds a master's degree in health policy from the University of Chicago, is a staff associate at the center. Thran, with a master's degree in psychology, division of methodology and evaluation research, from Northwestern University, is a project director. Marder, who holds a master's degree in economics from the University of Chicago, is director of the center's department of manpower and demographic studies.