Limitation of private attending pediatricians' neonatal intensive care privileges in Level III institutions throughout the United States

Private attending pediatricians provide no or very limited treatment in most neonatal intensive care units (NICUs). A survey mailed in 1991 to 429 NICUs in the 48 states and the District of Columbia received a response from 301 (70%). Twenty-two hospitals had no private pediatricians. Of the rest, 96% restricted pediatrician care either partially or completely. In 70% of cases, restriction of privileges was determined partially or totally by the private pediatricians. Neonatologists have replaced pediatricians in caring for critically ill newborns. This has implications for the training of pediatricians. They still need to learn resuscitation and stabilization skills, and communicating with parents should become part of the pediatrician's expected role.
Objective. To determine the privileges of Private Attending Pediatricians (PAP) in caring for newborns requiring intensive (ITC), intermediate (IMC), or continuing (CC) care in Level III neonatal intensive care units (NICUS) throughout the United States. Design. A two-page mail questionnaire was sent to 429 Level III NICUs to obtain the statement best describing the PAPs' privileges, the number of PAP, and some of the PAPs' functions. Level III NICUs were classified by geographic region as Eastern, Central, or Western United States. Results. Responses were received from 301 NICUs (70%) representing 48 states, the District of Columbia, and >9000 PAP. Twenty-two institutions had no PAP. In the remaining 279 institutions, 96% (267/279) had restricted the PAPs' privileges partially or completely. In 32% (88/279), the PAP were not allowed to render any type of NICU care. In 18% (51/279) of the institutions, the PAP were allowed to render CC only. In 27% (76/279) of the institutions, the PAP were allowed to render IMC and CC only. Limitation of PAPs' privileges were reported in all geographic areas in the U.S., were more pronounced in the Eastern than the Central or Western sections of the country, and were noted in institutions with small ([less than or equal to] 10) as well as large ([greater than or equal to] 60) numbers of PAP. Limitation of PAPs' privileges was determined by the PAP him/herself in many institutions. Proficiency in resuscitation was considered to be a needed skill. Communication with parents of an infant under the care of a neonatologist was encouraged. Conclusions. The PAPs' privileges were limited partially or completely in most Level Ill NICUs. Knowledge of this restricted role impacts significantly on curriculum design for pediatric house officers, number and type of health care providers required for Level III NICUs and future house officer's career choices. Pediatrics 1994;94: 190-193; physician manpower, pediatric education, neonatal intensive care, attending pediatricians, health systems management.