Perceived surplus of subspecialists may decrease the availability of subspecialty trainees. In Subspecialty areas such as Neonatal - Perinatal Medicine which traditionally involves a substantial clinical workload such decreases in workforce could adversely impact the educational experience of the trainees if fewer trainees were required to carry increased clinical responsibilities. A survey of Fellowship Directors was conducted by electronic mail and Fax to assess the current clinical workload of Fellows with particular attention to on-call schedules and to explore the attitudes of Program Directors toward the role of Fellows in patient care delivery. Responses were received from 41/65 programs (63%) that were successfully contacted. The mean number of Fellows per program was 4.5 (range 1-12). Contrary to expectations, the majority of programs anticipated no change in the number of Fellows in 1998. Current on-call frequency ranged from 1/3 to 1/8 nights in the first year (mean 1/4.9), 1/4 to 1/15 (mean 1/6.3) in year 2 and 1/4 to none in the third year (mean 1/6.6 in programs with on-call responsibility in year 3). Twenty-five programs do not allow Fellows to provide more than 24-36 hours of continuous coverage (such as covering an entire weekend) because of issues related to provider as well as patient safety, while 6 allow such coverage occasionally at the election of the Fellows. Seven programs do so routinely, but generally indicated that this is not in-house coverage. Only 4 of 41 programs (10%) planned to increase on-call frequency if the number of Fellows in the program were to decrease, with 31 programs indicating that attending physicians would take up the additional workload. Other solutions included hiring outside “moonlighters”, nurse practitioners or junior faculty to cover the on-call vacancies. However, 25/41 programs (61%) indicated that they would (or do already) allow their Fellows to provide additional on-call coverage for extra compensation(in-house moonlighting). A solid majority of Program Directors felt that Fellow availability should not affect their clinical workload in order to avoid adverse effects on the learning process. However, the widespread practice of additional compensated voluntary clinical duties (moonlighting) may have just such consequences. Limits should be placed on the amount of such voluntary activity because of the potential for conflict between monetary compensation and the educational process.
