Puscas L. Delegate's Report. JAMA. 1999;282(12):1196. doi:10.1001/jama.282.12.1196
Prepared by Ashish Bajaj, Department of Resident
and Fellow Services, American Medical Association.
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
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.