At its Annual Meeting in June, the American Medical Association-House of Delegates (AMA-HOD) discussed many resolutions and reports of interest to resident and fellow physicians. Several of the actions HOD adopted regarding residency education and supervision are presented below. A summary of HOD's actions regarding graduate medical education funding will appear in next week's Resident Forum. A complete summary of all HOD actions is available through the AMA Web page at: http://www.ama-assn.org/meetings/public/annual99/reports/reports.htm.
Physician Workforce Planning and Physician Retraining asked the AMA to include physician retraining in its discussions on physician workforce planning and to conduct a survey of residency programs to identify the number of residents who are retraining in a second specialty.
Clinical Supervision of Resident Physicians by Nonphysicians recommended that AMA policy state that responsibility for the treatment of each patient and the education of resident and fellow physicians lies with the attending physician to whom the patient is assigned and who supervises all care rendered to that patient. This report by the AMA's Council on Medical Education was prepared in response to concerns expressed by the Resident and Fellow Section that many residents were being supervised in patient care activities by physician's assistants and nurse practitioners instead of by attending physicians.
Training of Physicians Under Managed Care reaffirms AMA policy that supports collaboration between teaching institutions and managed care organizations in the development of educational opportunities for students and residents. This report also calls on the Liaison Committee on Medical Education to conduct a survey to determine how often medical students and resident physicians are being excluded from patient care and educational opportunities in managed care settings.
The Emerging Use of Hospitalists: Implications for Medical Education report contained several recommendations regarding this category of physicians. Hospitalists only work with inpatients, usually taking over from a primary care physician after the patient is admitted. The report recommended that the AMA collect data on the emergence of educational opportunities for hospitalist physicians at the residency level, and that the AMA monitor the evolution of hospitalist programs with the goal of identifying successful models. The HOD also adopted the policy that the use of a hospitalist as the physician of record must be voluntary and based on the consent of the patient and the patient's personal physician. To cut costs, some managed care organizations mandate the use of a hospitalist as the physician of record.
Grievance and Appeals Process for Residents asked the AMA and medical specialty sections to study resident contracts and develop model language for the grievance and appeals procedures in these contracts.
Annual Contracts for Continuing Residents asked the AMA to urge the Accreditation Council on Graduate Medical Education to require residency programs to provide residents who can continue in the program with an annual written contract at least 4 months before the end of their current contract. Some residency programs have not informed residents in advance that their contracts would not be renewed, and residents did not have enough time to find another training opportunity.
