LIMITATION OF PRIVATE ATTENDING PEDIATRICIANS NEONATAL INTENSIVE-CAREPRIVILEGES IN LEVEL-III INSTITUTIONS THROUGHOUT THE UNITED-STATES

Objective. To determine the privileges of Private Attending Pediatrici ans (PAP) in caring for newborns requiring intensive (ITC), intermedia te (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUs) throughout the United States. Design. A two-page mail q uestionnaire was sent to 429 Level III NICUs to obtain the statement b est describing the PAPs' privileges, the number of PAP, and some of th e PAPs' functions. Level III NICUs were classified by geographic regio n as Eastern, Central, or Western United States. Results. Responses we re received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' pr ivileges partially or completely. In 32% (88/279), the PAP were not al lowed to render any type of NICU care. In 18% (51/279) of the institut ions, the PAP were allowed to render CC only. In 27% (76/279) of the i nstitutions, the PAP were allowed to render IMC and CC only. Limitatio n of PAPs' privileges were reported in all geographic areas in the U.S ., were more pronounced in the Eastern than the Central or Western sec tions of the country, and were noted in institutions with small (less than or equal to 10) as well as large (less than or equal to 60) numbe rs of PAP. Limitation of PAPs' privileges was determined by the PAP hi m/herself in many institutions. Proficiency in resuscitation was consi dered to be a needed skill. Communication with parents of an infant un der the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level III NIC Us. Knowledge of this restricted role impacts significantly on curricu lum design for pediatric house officers, number and type of health car e providers required for Level IH NICUs and future house officer's car eer choices.