PURPOSE: Researchers have found mixed results about the risk to patient safety 
in July, when newly minted physicians enter U.S. hospitals to begin their 
clinical training, the so-called "July effect." However, patient and family 
satisfaction and perception of physician competence during summer months remain 
unknown.
METHOD: The authors conducted a retrospective observational cohort study of 815 
family members of adult intensive care unit (ICU) patients who completed the 
Family Satisfaction with Care in the Intensive Care Unit instrument from eight 
ICUs at Beth Israel Deaconess Medical Center, Boston, Massachusetts, between 
April 2008 and June 2011. The association of ICU care in the summer months 
(July-September) versus other seasons and family perception of physician 
competence was examined in univariable and multivariable analyses.
RESULTS: A greater proportion of family members described physicians as 
competent in summer months as compared with winter months (odds ratio [OR] 1.9; 
95% confidence interval [CI] 1.2-3.0; P = .003). After adjustment for patient 
and proxy demographics, severity of illness, comorbidities, and features of the 
admission in a multivariable model, seasonal variation of family perception of 
physician competence persisted (summer versus winter, OR of judging physicians 
competent 2.4; 95% CI 1.3-4.4; P = .004).
CONCLUSIONS: Seasonal variation exists in family perception of physician 
competence in the ICU, but opposite to the "July effect." The reasons for this 
variation are not well understood. Further research is necessary to explore the 
role of senior provider involvement, trainee factors, system factors such as 
handoffs, or other possible contributors.