Protected Time for Program Administration among Nephrology Program Leadership in the United States

Abstract

Background: In 2022, the Accreditation Council for Graduate Medical Education (ACGME) reduced minimum program director protected time for program administration from 10 to 8 hours/week, with no core faculty requirement. We surveyed program leaders regarding the impact of these changes. Methods: Anonymous, on-line survey of all US adult nephrology program directors (March 2023), who forwarded core faculty/associate program director surveys. Questions included protected time in 2022-23 and 2021-22, whether it was sufficient, estimated time needed, and two validated single-item burnout measures (emotional exhaustion and depersonalization). Analysis was descriptive. Results: Program Directors: response was 62% (92/149), with geographic distribution/approved fellow positions similar to those nationally. Overall, protected time slightly increased from 2021-22, largely in >6-fellow programs, but 42% (13/31) of these were still not meeting minimum requirements. Only 37% (30/81) agreed that they had sufficient protected time. Those with ≤6 fellows estimated needing 11±4 hours/week (15±4 hours/week with >6 fellows). 25% (20/81) reported high levels of emotional exhaustion. Core Faculty: 57/149 (38%) of program directors forwarded the link to 454 faculty. 94% of associate program directors (49/52) responded, reported 3±3 hours/week protected time (42% had none), and estimated needing 6±3 hours/week, regardless of program size. 67/402 core faculty responded (17%), reported 2±3 hours/week (50% had none), and estimated needing 5±3 hours/week, regardless of program size. ≥85% of associate program directors and core faculty precepted clinical rotations, gave lectures, evaluated fellows, mentored scholarly work, and participated in recruitment. The majority assisted in fellow remediation. 34% (15/44) of associate program directors and 21% (13/61) of core faculty reported high levels of emotional exhaustion. Conclusions: Program leaders estimated minimum necessary program administration times (based on program size) that exceeded ACGME requirements. Associate program directors/core faculty contributed substantially to non-clinical training. 34% of associate program directors and 25% of program directors had a high likelihood of burnout.

Time is Money

“…3 In this issue of CJASN, Yuan et al publish findings from a followup survey performed in response to ACGME revisions. 4 The survey was sent to 149 PDs with a response rate of 62%. Forty percent of programs were noncompliant with the 2022-2023 ACGME minimum requirement.…”