When patient care is rendered in a clinical teaching unit or other setting for clinical teaching by a
health care team, the supervising medical practitioner shall be identified to the patient at the earliest
possible moment. No fees may be charged in the name of the supervising staff physician for services
rendered by a trainee, resident or fellow prior to the identification taking place. Moreover, the
supervising staff physician must be available in person, by telephone or videoconferencing in a timely
manner appropriate to the acuity of the service being supervised.
For a medical practitioner who supervises two or more procedures or other services concurrently
through the use of trainees, residents, fellows or other members of the team, the total billings must not
exceed the amount that a medical practitioner could bill in the same time period in the absence of the
other team members. For example:
a) If an anesthesiologist is supervising two rooms simultaneously, the anesthetic
intensity/complexity units should only be billed for one of the two cases.
b) If a surgeon is operating in one room while his/her resident is operating in a second
room, charges should only be made for the case the surgeon performs.
c) In psychotherapy where direct supervision by the staff physician may distort the
psychotherapeutic milieu, the staff physician may claim for psychotherapy when a
record of the psychotherapeutic interview is carefully reviewed with the resident and the
procedure thus supervised. However, the time charged by the staff physician should
not exceed the lesser of the time spent by the resident in the psychotherapeutic
interview or the staff physician in the supervision of that interview.
d) For hospital visits and consultations rendered by the resident in the name of the staff
physician, the staff physician should only charge for services on the days when actual
supervision of that patient's care takes place through a physical visit to the patient by
the staff physician and/or a chart review is conducted with detailed discussion with the
other members of the health team within the next weekday workday.
