The Attending Physician on the Wards: Finding a New Homeostasis

The attending cadre is now far younger and much more clinically engaged than 15 years ago. Pressures to improve quality and safety, greater documentation requirements, and increasingly complex logistics of the clinical environment have upped the ante for an attending's involvement. Moreover, Accreditation Council for Graduate Medical Education standards now maildate fewer house staff hours and far greater attending oversight. The job of attending can no longer be handled in relatively brief visits by itinerant subspecialists. Here, Wachter and Verghese describe the reasons for this marked shift in attending physician demographics, consider its effects on education and clinical care, and suggest interventions that may help improve the experience of trainees as well as attendings. They focus on the ward experience and thus on hospitalists--who have taken over the bulk of ward attending responsibilities at teaching hospitals--as well as the lion's share of physician staffing on nonresident medical services.