The effect of the teaching physician rule on residency education

Background and Objectives: In 1996 the Health Care Finance Administration i mplemented the Teaching Physician Rule (TPR) to clarify the responsibilitie s of attending physicians when they are supervising residents and billing M edicare for that service. We measured some of the effects of the TPR an fam ily practice residency training. Methods: After pilot testing, a questionna ire was mailed to the directors of all family practice residency programs i n the United States. The directors were asked to provide a similar question naire to a senior resident. Results: Of 449 residency directors, 310 (69%) responded. Eighty percent of residencies apply the TPR to at least some pat ient encounters. Residency directors reported that the TPR had an overall n egative effect on their residency. Residents reported a more negative impre ssion of the rule than did the directors. On average, residency directors r eported that the mandated level of supervision in the outpatient setting in creased faculty attending time by .24 FTE. Conclusions: The TPR was perceiv ed 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.