For those committed to the training of residents, the issue of who performs the surgery is an important one. The ethical question involved in persons placing themselves under the responsibility of a surgeon of their choice only to discover that the operation is performed, albeit under direct supervision, by a resident in training, can be difficult to resolve. Central to a free-enterprise philosophy is the belief that fee payment secures particular rights for the buyer (the patient), as well as somehow increasing his bond with the seller (the surgeon). If the surgeon is to depart from this implied relationship, such a move must be well understood by all parties. Additionally, pressure is presently being exerted on many urban teaching hospitals by the recent implementation of Section 227 of the Social Security Amendments of 1972 (Public Law 92-603), which potentially limits payments for surgery performed by the resident staff.1,2
TILNEY NL. In Support of Having Your Operation Where There Is Training of Surgical Residents. Arch Surg. 1981;116(3):269–270. doi:10.1001/archsurg.1981.01380150005001
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