Public Health Law Map - Beta 5 - Medical and Public Health Law Site

exercise independent medical judgment. This is often the case for first-year
residents in states that require one year of postgraduate training for licensure. Since
these residents are part of a properly supervised training program, there are seldom
legal questions about their status.
The legal status of residents and fellows becomes an issue when an academic
appointment is used to shelter the practice of an improperly trained or unlicensable
individual: foreign medical graduates with questionable credentials, physicians
with substance abuse problems, or physicians who have been disciplined by the
board of medical examiners in another state. Juries and boards of medical
examiners take a jaundiced view of subterfuges that allow unqualified physicians
to practice on unsuspecting patients. Such personnel are not proper candidates for
standard training programs. They should be accommodated in programs that
explicitly recognize their disabilities and provide close supervision.
A physician receiving postgraduate training may be practicing under an
institutional license, either formal or informal. Most states allow or tolerate limited
medical practice by residents and fellows within a formal teaching system and
under supervision. The terms of this institutional licensure are very limiting. The
practice must be under genuine supervision and be limited to the institution.
Institutional licensees frequently get into trouble by writing prescriptions for
outpatients. Although state law may allow the physician to write medication orders
on inpatients, this privilege seldom extends to outpatients. When such physicians
work in a clinic, their prescription must be signed by a fully licensed physician
with appropriate state and federal drug licenses.
Physicians and organizations outside the teaching institution should be careful to
confirm that residents are practicing within the law before accepting them into a
practice. If there is any question about the scope of the institutional licensure,
practitioners should allow only independently licensed residents in their private
practices and then only to the extent approved by their malpractice insurance
carrier.
Besides externships, many residents accept short locum tenens, weekend call, or
emergency room coverage to make extra money. Candidates for such jobs should
be treated like any other physician seeking work. They must have an independent
license to practice medicine and privileges that are extensive enough to cover
foreseeable circumstances at any hospital at which they practice. The employing
physician should ensure that they have adequate malpractice insurance coverage
for the job. If a physician or hospital routinely uses moonlighting residents to
provide emergency coverage, it is also a good idea to limit the amount of time the
resident works in the combined programs. If the residents look upon the
moonlighting as a paid rest, they are not going to be able to provide proper
emergency coverage. Eventually, an overtired resident will face a major emergency
with unfortunate results.
b) Medical Students
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