Resident liability and credentialing

Residency Program Insider, August 15, 2006

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Resident liability and credentialing

The responsibility of resident credentialing and liability is no small burden for those involved in graduate medical education. It is important to be aware of legal risks involving resident credentialing and physician supervision of residents.

For instance, it may be unclear as to who must perform the credentialing of residents that are assigned to rotate through freestanding clinics. These residents are usually credentialed by their academic medical center. If residents are rotating through a clinic that is not affiliated with an academic medical center, that clinic should begin resident credentialing immediately. Alternatively, the clinic should seek contractual assurances from the academic medical center regarding the credentials of each resident assigned to the clinic.

The clinic should be sure that the academic medical center's professional liability coverage includes coverage for events that take place outside of the academic medical center. When residents are assigned to a rotation at another clinic, it is not considered a moonlighting activity by a resident (for which the physician would need to obtain separate coverage) but instead is part of his or her usual clinical rotation. Make sure there is sufficient liability coverage for residents.

In addition, Medicare has certain rules for physician supervision of residents. While a physician does not have to be physically present in an operating or procedure room at all times, there are limits on how many residents a physician can supervise as well as requirements for the attending physician to be in the operating room for the critical portion of a particular procedure. An attending physician should also be immediately available to return to the procedure if necessary.

Finally, a resident is a licensed physician and therefore can write orders and prescriptions and can dictate reports. As I've just described, there are requirements that teaching physicians must adhere to for Medicare in order to get reimbursed for his or her activities. Also, ensure that these issues are addressed in contractual form. Ensuring that these steps take place will protect everyone involved.

All the best,

Bruce D. Armon, Esq.

Bruce is a partner with the Philadelphia-based law firm Saul Ewing LLP. He specializes in healthcare law and frequently speaks to physician and health care audiences. He can be reached at

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