In these days of consumerism, muckraking, and public distrust of established institutions, more attention than we might like has been turned to the question of who does an operation. Itinerant surgery and "ghost" surgery (where a physician claims credit and often the fee for an operation done by someone else) remain reprehensible practices and deserve to be exposed and eliminated as soon as possible.
But what about the situation in a teaching hospital, where interns and residents participate in the care of the patient to the point that the surgeon-of-record never writes an order in the order book nor holds the knife in the operating room? Can this degree of responsibility justify a fee? Or, more important, is it ethical and is it in the best interest of the patient? Surgeons need to answer these questions openly and to the satisfaction of the public, before lawyers and consumer advocates become