HealthNovember 15, 2022

Alleviating burnout in internal medicine program directors

Institutions with internal medicine residency programs have an opportunity to reduce the obstacles faced by the directors of those programs to help alleviate burnout.

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.”

“There’s not much that I could tap quickly and easily for my residents to conveniently access, particularly visual materials that could assist them in learning medical procedures. Going to YouTube is not the best option.”
Dr. Amy Eddy, Director, Internal Medicine Residency Program, Spokane Teaching Health Center

Besides the hands-on training that interns and residents receive by providing patient care, there’s a certain amount of didactic learning included in their program. Finding the time and resources to support this part of their education is another challenge for PDs, according to Dr. Neeral Shah, former internal medicine residency associate program director at UVA Health. “There’s not much that I could tap quickly and easily for my residents to conveniently access, particularly visual materials that could assist them in learning medical procedures. Going to YouTube is not the best option.”

Dr. Shah points out that there’s little opportunity for the instructive portion of the IM resident program during their busy clinical workday. “PD burnout changed overnight because of COVID-19. We had to ask residents to do extra work, which was anxiety-producing for us and for them. As clinical work becomes busier, education initiatives fall by the wayside. Plus, if the faculty has less time to teach residents how to do procedures, it’s up to the program director to figure out how they’re going to best learn these skills.”

Easing the burdens for program directors

Dr. Eddy and Dr. Shah both recommend that PDs connect with their peers to help alleviate the stress of being a residency program director. “What has helped me immensely is great mentorship, as well as great faculty colleagues who are invested in the success of our residents and program,” asserts Dr. Eddy. She also appreciates that her institution paid for her to have a leadership coach and take a physician leadership course. Dr. Shah adds, “I find the most therapeutic discussions are with other faculty, and other PDs, where we can talk about issues. It’s important to be able to run a situation by someone who understands it, looking for reassurance.”

Even though she hopes to be in her IM PD position for at least 20 years, Dr. Eddy says having a succession plan helps reduce the overwhelming feelings that lead to burnout. “I already have my eye on a possible replacement. It’s important to prepare someone to transition into this job, as I did, especially because a PD faces so many different challenges on any given day.”

Dr. Shah and Dr. Eddy believe the availability of more resident-friendly learning resources not only improves the residents’ skills, but also takes some of the pressure off program directors and faculty. “I’m very excited about standardized, clinician-produced video solutions like Lippincott Medical Procedures,” notes Dr. Shah. “They’re much more instructive than reading information cards or an online description. They complement the residents’ patient care experience, and help them perfect their procedural skills.” Dr. Eddy adds, “Besides access to the university library, and teaching each other, the residents can benefit from clinically relevant video instruction that’s available 24x7. It helps them and us prepare for the credentialing process and their board exams.”

Institutions with internal medicine residency programs have an opportunity to reduce the obstacles faced by the directors of those programs. They must provide more support from the top down, and invest in technology and other measures. Otherwise, PD burnout — and the revolving door of new directors — will continue to plague residency programs. It’s a reputation your hospital will find hard to shake.

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