Let's keep residents out of community hospitals.

Attracted by the prestige and higher insurance reimbursements that a university affiliation is likely to bring, community hospital boards have been encouraging the growth of residency programs within community hospitals. The author (who remains anonymous) states that besides increasing the cost of health care, this has compromised the quality of patient care and medical education by requiring physicians who are not trained as educators to asssume responsibility for the educational needs of residents. In hospitals having short residency rotations, the problems are compounded because teaching programs require residents to perform a certain number of procedures in a given period of time. This requirement forces some residents to perform procedures before they obtain the kind of exposure and practice that would otherwise take place. The author believes university hospitals shold train residents for board certification and community hospitals shold concentrate on serving the communities. Conversely, rotating residents through community hospitals exposes them to common medical problems and routine procedures and techniques.