I work in a regional facility that is sort of a hybrid. We do have residents, but we do more with our large private practice. So, we are a teaching hospital, but only to a point. I find that we have a whole lot of autonomy, and the MDs really rely on our judgment and skill. When it comes to the patients that belong to the medical school, we constantly are in a state of irritation because we could do it all so much faster! We must be proficient with vag exams. In fact, we are often expected (especially in July and August) to check behind the residents and verify how dilated the patients are. When we have 2 years experience we are expected to place our own IUPCs and FSEs. When I call one of the privates to tell them that their patient is having lates, they expect for me to already have done an exam, turned off Pit, put on O2, put on an FSE, repositioned, and done a fluid bolus. They expect me to know to do all of this without prompting from them. The private docs are there so much less, but they can do that because they know we are there. I would HATE working in a full teaching hospital. I've tried it before, and I was miserable. I felt like my hands were tied all the time. When we triage a patient, we monitor, do a vag exam, then do labs as we see fit (wet prep, ua, nitrazine) and call the private docs only after all the results are in. Many patients are triaged and discharged without the MD ever laying eyes on them. As for the patients, in our state, 48% of babies are born to unwed mothers, so it really doesn't matter who the doctor is, chances are the patient is going to be young and single. We do get the occasional married woman with husband in tow, carrying an insurance card, but it's one of those things like a four leaf clover. Nice when you run across one, but you don't expect it all the time!