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. This is not always possible, however, because of the residents' other duties. At the VA, basically all patients are considered the primary responsibility of the URO-4 resident. His decisions are discussed with the attending staff, but he is viewed as the primary urologist within the institution.
Most patients are, however, private.
By the nature of these patients, the resident is less responsible for decisions made, although he is responsible for in-hospital care. The URO-3 resident is often consulted by some of the practicing urologists for his advice, especially in newer areas of treatment. At Johns Hopkins Hospital, all patients are the private patients of Drs. Gearhart and Docimo. Although the residents have in-hospital responsibility for these pediatric patients, most families recognize that Drs.