The Benefits of Having Surgery at a Teaching Hospital

Why having resident physicians in the OR is a boon – not a hazard – to the patient.

teaching hospital surgeons | University of Colorado OB/GYN | doctors in operating room

In my years practicing medicine at two large teaching hospitals, I’ve encountered a recurring concern among some of my surgical patients. They sometimes worry that having a resident in the operating room alongside the attending physician might pose a threat to their safety, or at the very least compromise their chances of a positive surgical outcome.

Now, I should start by saying that this is a completely understandable line of thinking. Having an operation is stressful enough in itself without the added worry of a trainee’s mistake. Residents, after all, have less experience than fully-licensed physicians.

Residents are medical doctors completing post-graduate education in a specialized area, part student and part healthcare provider. One could therefore think that teaching hospitals, which employ resident physicians by the dozen, have a greater incidence of surgical errors, complications or mortality rates.

As I will demonstrate, this is simply not true. But I’d like to take it one step further. I’d also like to suggest that the presence of resident physicians in operating rooms serves as a great benefit to a patient needing surgery, particularly when compared with receiving surgery at a private or non-teaching hospital.

Don’t take my word for it

First, peer-reviewed research demonstrates that teaching hospitals have lower overall mortality rates than other types of hospitals. An extensive study published in the New England Journal of Medicine examined clinical outcomes for Medicare patients across multiple hospitals. The study concluded, “In the pooled analysis, the mortality rate for patients treated at teaching hospitals was 25 percent lower than that for patients treated at for-profit hospitals.”

Also consider a study published in the American Journal of Obstetrics & Gynecology entitled “Analysis of surgical complications and patient outcomes in a residency training program.” It found no increased risk for negative outcomes in surgeries performed by residents, except for a “slightly prolonged operative time.”

Findings published in Surgical Laparoscopy & Endoscopy saw similar conclusions, noting that resident surgeons did not jeopardize the safety of patients.

Lastly, an extensive data analysis involving more than 17,000 women published in the Journal of Maternal-Fetal and Neonatal Medicine examined contributing factors to obstetric rectal injuries following labor and delivery. The study’s authors ultimately concluded that, “the risk factors for rectal injury were present regardless of operator status.” In other words, the risk for this complication of labor and delivery was not increased if the patient was treated by a resident instead of an attending physician.

Residents in teaching hospitals ultimately benefit patients

So multiple studies demonstrate that residents do not pose a threat to the safety of patients receiving treatment at teaching hospitals. Let’s talk briefly about the role residents play in surgeries and caring for patients after their operation.

First, patients should know that the attending physician is still the one orchestrating each operation when residents are present. The attending physician does not stand idly by while residents do the bulk of the surgical work. Instead, he or she plays the leading role, incorporating the assistance of residents where necessary and appropriate.

Second, it is important to know that many surgical procedures require more than one set of hands. In many hospital settings, these helping hands are provided by a surgical assistant. Assistants may or may not have more experience than a resident physician, but they almost certainly have less formal training and education.

A resident physician is – by definition – a full-fledged doctor on the final step of obtaining an unrestricted medical license. This added expertise in the OR can only serve to benefit a patient having surgery at a teaching hospital.

Lastly, at any given time in a teaching hospital there are usually a good number of on-call resident physicians. This means that if a patient is experiencing a complication in recovery or their case takes an unexpected turn, a fully-trained doctor is just a phone call away.

For these reasons (and others, which extend beyond the scope of this particular blog), I say there is no better place for a surgical patient to be than in a teaching hospital under the watchful, well-trained hands of a resident physician team and its supervising doctors.