An epidemic has swept across radiology. Its principal victims are radiology residency and fellowship program directors. Its symptoms are often vague and nonspecific but include fatigue, disorientation, frustration, and burnout. Most victims report a loss of enthusiasm for their job, and some have become so discouraged that they have resigned. This, in turn, inflicts collateral damage on the programs and trainees for whom they are responsible. We have dubbed this malady change overload.
Of course, change overload is not restricted to program directors. Many radiologists feel dizzied, even sickened by the seemingly ever-accelerating pace of change in health care today. But because most radiologists have little or no direct contract with graduate training program and radiology residency and fellowship program directors, they may lack a thorough understanding of the complex etiology of this malady.
In an effort to correct this, we present an account of the changes that have taken place in the life of a single residency program director who has now been on the job just over 6 years. Although no single program director’s experience is entirely representative, the challenges this individual has faced reflect many of the same sorts of changes that have confronted program directors across the country over the same period.
One of the most important changes has been the necessity of adding multiple new associate and assistant program director positions. As we detail in the following, the amount of work that a residency or fellowship program needs to do to maintain its accreditation has skyrocketed to the point that no single person in a medium- or large-size program can hope to cope alone. This in turn increases the amount of time the program director must spend meeting and communicating about the program with colleagues.
Running a residency or fellowship program has become much more time and labor intensive than it used to be. Program directors (and their coordinators) are spending hundreds more hours collecting data and filling out forms. This draws them away from other important activities, such as actually teaching residents, participating in research projects, and caring for patients. Furthermore, it means they have less time to get to know and counsel their trainees.
Program directors have also found it necessary to tap additional faculty members to serve on clinical competency committees, which include representatives from each section in a department. In some departments, this amounts to 18 or more faculty members, who are charged with evaluating each and every trainee’s progress on the new Accreditation Council for Graduate Medical Education (ACGME) milestones. Program directors must ensure that they have the voluminous quantities of information they need and then act on their recommendations.
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