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In June 2019, the new ACGME standards for Family Medicine eliminated the requirement for protected time for residency core faculty and reduced the time required for program directors, while adding an associate director. Have these changes in standards about faculty time had any practical impact on your residency in the last year? If YES, please specify what—discussions with hospital leadership, change in faculty time allocation or budget, clinical supervision, faculty development, or other aspects. The 2019 Family Medicine program requirements also reduced the standard for graduates passing a board exam from 90% to 80% and eliminated the requirement that 95% of residents take a board exam. Have these changes had any impact on your residency or your residency administrative procedures? If YES, what changes? ACGME, Accreditation Council for Graduate Medical Education.
- Table 2.
Adverse Impact of ACGME 2019 Changes: Key Themes, Frequency, and Representative Quotations
Kind of Impact Frequency Absolute Number and % of Residencies with Adverse Impact Representative Quotations Direct impact on budget/faculty time allocation 108 (69.9%) Reduction in the amount of faculty time allocated for education by 4 to 6 hours per week per faculty member.
Expectation “do more with less” —Budget slashed since “only want clinical” very minimal admin time for PD/APD/Faculty!!!
(Administrators) state that if the need were truly real, then ACGME would not have removed language.
Increasing faculty burnout 40 (27.4%) • Most faculty do these tasks at night and on weekends and are feeling burned out. I have lost 2 faculty over the last year due to burn out.
• Increased stress and burnout at a time we can least afford it.
Faculty participation in didactics, curriculum, culture 34 (23.3%) • My faculty and I have less time for advising, curriculum development, didactic development, chart reviews.
• Shrinking the breadth of our faculty affects learning opportunities for residents and richness of discussions around residency curriculum.
• Being a new program director, having the PD time cut and increased… clinical care has made it difficult to give the attention necessary to the curriculum.
Increasing program director burnout 19 (13.0%) • (as a) PD that I am left to figure all of these things out on my own…I am burning out quickly and have terrible job satisfaction … no one else has time to help due to their clinical obligations. I am also being pushed to increase my clinical duties and it leaves very little time and energy to further develop curriculum, which is something that needs some attention according to our internal resident survey.
Clinical supervision 14 (9.6%) • Reduction in direct observation of the residents.
• Quality of supervision decreases.
• Pressure to generate more visits…and the protected time cuts make supervision … and mentoring residents impossible.
Assessment, evaluation, mentoring, remediation 13 (8.9%) • Pressure to generate more visits for faculty and the protected time cuts make supervision … and mentoring residents impossible.
Challenges managing faculty 13 (6.3%) • Finding coverage for resident clinics has been much more of a challenge.
• Our faculty … salaries are being challenged. Given the lack of required protected time, the expectation of RVU production has increased. The expectation is that they need to increase their RVU generating time in order to maintain their salary.
Resident and faculty scholarship 11 (6.9%) • We have less organizational support for residency work and scholarly activity as a result.
• Faculty is also having difficult time meeting their scholarly and administrative goals.
• It has been extremely difficult to get core faculty and APD protected time to … work on scholarly projects for themselves and with residents and attend conferences.
Faculty development 10 (6.8%) • Discussions with hospital leadership led to change in faculty time allocation…and reduction in faculty development opportunities.
• Pressure to generate more visits for faculty … and the protected time cuts make … assistance with research, faculty development and mentoring residents impossible.
Challenges with APD implementation 10 (6.8%) • We had to pay new APD more while decreasing their clinical time and productivity.
• With a small faculty - burdensome not helpful.
• When extra supervision time is needed, the core faculty lose their admin time and they see that the PD and APD keep their time.
Loss of faculty/difficulty replacing 8 (5.5%) • We lost 2 FTE core faculty this year directly because of the requirement change.
• It will impact (us) in future years…due to inability to recruit an adequate number of faculty members.
ACGME, Accreditation Council for Graduate Medical Education; APD, associate program director; FTE, full time equivalent; PD, program director; RVU, relative value unit.
Note: Many comments included more than one adverse impact.
