The UMMC has a non-private clinic of fairly substantial proportions. The URO-4 resident is the primary physician for these patients. All patients are either seen or discussed with an attending staff member. Surgical procedures are performed by the residents with attending supervision. Dr. Andrew Kramer is immediately available in the UMMC urology clinic for consultation and advice.
Private patients are admitted to the same service as the non-private patients. Residents have primary responsibility for their in-hospital care. Most operations on the private patients are performed by the resident staff with attending supervision. However, the attending staff has primary responsibility for deciding the treatment regimen both preoperatively and in the postoperative clinic.
Every effort is made to have the residents see the patients in the outpatient area for both pre-op planning and post-op follow-up. At the Veterans Administration Medical Center at Baltimore, basically all patients are considered the primary responsibility of the URO-4 resident. The URO-4 resident does all the pre- and post-operative patient and family communication. His/her decisions are discussed with the attending staff, but the URO-4 resident is viewed as the primary urologist within the institution.
At the Baltimore Washington Medical Center, there is a small non-private service for the URO-3 resident who discusses treatments with their attending of the month. However, most are private practice patients. By the nature of these patients, the resident is less responsible for decisions made, although responsible for the in-hospital care. The URO-3 resident is often consulted by some of the practicing urologists for advice, especially in newer areas of treatment.
At the Johns Hopkins Hospital, all patients are the private patients of Drs. Gearhart and Mathews. Although the residents have in-hospital responsibility for these pediatric patients, most families recognize that Drs. Gearhart, Mathews and Wang have ultimate decision-making responsibility.