Does Increased Schedule Flexibility Lead to Change? A National Survey of Program Directors on 2017 Work Hours Requiremen
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Internal Medicine Residency Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 2Internal Medicine Residency Program, Department of Medicine, Mayo Clinic, Rochester, MN, USA; 3Office of Academic Affairs, Memorial Healthcare System, Hollywood, FL, USA; 4School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 5Internal Medicine Residency Program, John H. Stroger Hospital of Cook County Health, Chicago, IL, USA; 6Internal Medicine Residency, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA; 7Tinsley Harrison Internal Medicine Residency, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 8Internal Medicine Residency Program, Duke University School of Medicine, Durham, NC, USA.
BACKGROUND: The learning and working environment for resident physicians shifted dramatically over the past two decades, with increased focus on work hours, resident wellness, and patient safety. Following two multicenter randomized trials comparing 16-h work limits for PGY-1 trainees to more flexible rules, the ACGME implemented new flexible work hours standards in 2017. OBJECTIVE: We sought to determine program directors’ (PDs) support for the work hour changes and programmatic response. DESIGN: In 2017, US Internal Medicine PDs were surveyed about their degree of support for extension of PGY-1 work hour limits, whether they adopted the new maximum continuous work hours permitted, and reasons for their decisions. KEY RESULTS: The response rate was 70% (266/379). Fifty-seven percent of PDs (n = 151) somewhat/strongly support the new work hour rules for PGY-1 residents, while only 25% of programs (N = 66) introduced work periods greater than 16-h on any rotation. Higher rates of adopting change were seen in PDs who strongly/ somewhat supported the change (56/151 [37%], P < 0.001), had tenure of 6+ years (33/93 [35%], P = 0.005), were of non-general internal medicine subspecialty (30/80 [38%], P = 0.003), at university-based programs (35/101 [35%], P = 0.009), and with increasing number of approved positions (< 38, 10/63 [16%]; 38–58, 13/69 [19%]; 59–100, 15/64 [23%]; > 100, 28/68 [41%], P = 0.005). Areas with the greatest influence for PDs not extending work hours were the 16-h rule working well (56%) and risk to PGY1 well-being (47%). CONCLUSIONS: Although the majority of PDs support the ACGME 2017 work hours rules, only 25% of programs
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-06109-1) contains supplementary material, which is available to authorized users. Received December 24, 2019 Accepted August 4, 2020
made immediate changes to extend hours. These data reveal that complex, often competing, forces influence PDs’ decisions to change trainee schedules. KEY WORDS: resident work hours; internal medicine program directors; resident schedules J Gen Intern Med DOI: 10.1007/s11606-020-06109-1 © Society of General Internal Medicine 2020
INTRODUCTION
The learni
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