Replacing the work of pediatric residents: strategies and issues

Nine hospital pediatric departments that had either discontinued or reduced their residency programs were examined to determine how services were maintained. Hospital location, preferences of community physicians and hospital staff, and the availability of other types of personnel influenced the choice of staff to replace residents. Moonlighters were used in more than half of the study hospitals, with increased responsibilities for nurses as the second most frequently used strategy. The addition of full-time attending staff, neonatal specialists, and family practice residents was used by one third of the study hospitals. All but one hospital used more than one type of personnel to do residents' work. Some substitution methods seem more stable than others, but all situations in which the staff available was barely able to provide necessary services appear unstable. Physicians generally agreed that residents are the optimal hospital staff provider.