The effect of the teaching physician rule on residency education

In 1996, the Health Care Finance Administration implemented the Teaching Physician Rule (TPR) to clarify the responsibilities of attending physicians when they are supervising residents and billing Medicare for that service. We measured some of the effects of the TPR on family practice residency training.

After pilot testing, a questionnaire was mailed to the directors of all family practice residency programs in the United States. The directors were asked to provide a similar questionnaire to a senior resident.

Of 449 residency directors, 310 (69%) responded. Eighty percent of residencies apply the TPR to at least some patient encounters. Residency directors reported that the TPR had an overall negative effect on their residency. Residents reported a more negative impression of the rule than did the directors. On average, residency directors reported that the mandated level of supervision in the outpatient setting increased faculty attending time by .24 FTE.

The TPR was perceived by residency directors and senior residents to have some negative effect on family practice residency programs, at least in part by increasing the need for more faculty time for supervision.