Where Does the Week Go? Parsing Trends in Program Director Workload.

Abstract

Background Program directors (PDs) play an important role in resident career development, and resident retention may be influenced by PD turnover and workload. Objective To examine PD tenure, work hours, and resident attrition. Methods A retrospective study of data from the Accreditation Council for Graduate Medical Education (ACGME) Data Resource Book from 2012 to 2021. Descriptive statistics were used to examine PD characteristics. Regression analyses were used to examine trends in PD tenure and work hours as well as the relationship between work hours, PD turnover, and resident attrition rate for anesthesiology, emergency medicine, family medicine, internal medicine, obstetrics and gynecology, pediatrics, psychiatry, general surgery, plastic surgery, orthopaedic surgery, otolaryngology, thoracic surgery, urology, and vascular surgery programs. Results Average PD tenure has decreased between 2012 and 2021 for most specialties, with an overall average decrease from 7.0 years to 6.6 years. Total weekly hours spent by PDs on job-related activities in all specialties decreased over time, from 51.3 hours to 44.2 hours. The proportion of weekly hours spent on teaching has decreased slightly, with a corresponding increase in time spent on clinical supervision and administrative duties. PDs in procedural specialties spend more time on clinical supervision, while PDs in non-procedural specialties devote more time to administration. Logistic regression showed a significant association between weekly hours spent by PDs on clinical supervision and resident attrition rate. Conclusions Length of PD tenure and total number of weekly hours devoted to residency-related activities has decreased across specialties. Proportions of time spent on teaching, clinical supervision, and administrative work vary.