An internal medicine residency program director must ensure that interns and resident physicians obtain the knowledge, skills, and attitudes necessary to practice their chosen specialty independently and competently.
What else do residency program directors have on their plates?- Organize and implement curricula
- Evaluate trainee performance
- Provide meaningful instruction
- Serve as important role models
- Advocate for trainee's interests
- Ensure compliance with program requirements
- Cultivate and maintain relationships with leadership and faculty
- Define program objectives and goals
- Research opportunities to improve the quality of care
So it’s no wonder the Alliance for Academic Internal Medicine says one-third of internal medicine (IM) residency program directors (PDs) are burned out. It’s also not surprising that less than half of those who were PDs in 2012 were still holding that job in 2016. A survey of IM program directors in 2020, reported in the Journal of Graduate Medical Education, showed that 45% of those responding had considered resigning in the past year. While the study concluded that the prevalence of burnout before and after the pandemic began was similar, it indicated that PDs with supportive leadership were less likely to feel burned out.
The Association of American Medical Colleges estimates that there will be a shortage of 37,800 to 124,000 physicians within 12 years! Given that dire prediction, the pressure is on medical schools and residency programs to train and graduate as many skilled doctors as possible. However, the challenges of managing internal medicine internships and residencies should not be driving program directors out the door.
Let’s look at how IM residency programs have evolved, what keeps PDs up at night, and how some of the burdens they face can be reduced or eliminated.
A larger knowledge base, plus more requirements and regulations
As the study and practice of medicine continue to transform at lightning speed, the training for aspiring physicians has understandably evolved as well. The American Journal of Medicine® notes that IM residents worked in hospitals 90+ hours per week for two of the three years of residency in 1980. Yet while the three-year curriculum remains the same all these years later, residents now must digest much more information — from more medications used for common diseases to new testing and treatment modalities.
What are some of the other changes in internal medicine residency programs?
- Program requirements have grown exponentially,
- Duty hours have decreased by mandate, decree, and legislation,
- Outpatient mandates have expanded excessively versus inpatient requirements,
- Subspecialties have become both more complex and increasingly attractive, and
- Higher percentages of graduating residents are selecting hospital-based careers.
And what has changed for IM residency program directors? Their list of responsibilities, both large and small, continues to grow as does the number of people and groups to which they are beholden. Dr. Amy Eddy, internal medicine residency program director at Spokane Teaching Health Center, puts it simply: “It’s like going to med school all over again, drinking from a fire hose.”
Harried days, sleepless nights for residency program directors
While Dr. Eddy enthusiastically admits that she’s attached to her residents, and invested in their success, she concedes that program directors wear more hats every day, “We are the one where the buck stops for any situation or problem.” She cites everything from institutional requirements to the ACGME to CMS billing as “always evolving, always becoming more complex.”
Dr. Eddy also notes that PDs often find that there’s not a clear path to navigate when issues do arise. “Many people don’t understand what a residency program is, the ups and downs and needs of graduate medical education — that can add to the challenge. PDs have a lot of masters to please who may not be communicating with each other, and sometimes have different priorities than we do. We’re always figuring out how to navigate the system to get our needs met.”
