The critical legal issue in working with a teaching program is ensuring that the patient’s care is always supervised by a properly trained and licensed physician. No matter how many residents, fellows, or medical students are participating in the care of a patient, it is the staff physician who is responsible. All the rules that apply to working with a consultant apply to staff physicians. If the patient is not referred to the teaching service for all care, then the original physician should be careful to supervise the patient’s care personally.

When private physicians refer patients to a teaching hospital, they should make sure that the referral is to a fully licensed physician, not to a resident or a medical student. It may be a student who takes the telephone call, but the referral is to that student’s supervising physician. If the referring physician is not certain who is taking the referral, then this should be determined or the patient should be referred elsewhere. If a physician refers a patient to a student or a resident without proper authority, and the supervising physician does not accept the patient, the referring physician has abandoned the patient and is liable for any problems that arise.

If a physician requests a consultation from a teaching service, both the physician and the patient should know who on the service will be primarily responsible for the work and who is the supervising staff physician. If problems arise during the consultation, these should be worked out between the attending physician and the supervising staff physician.