EDUCATIONAL ADVANCES
Characteristics of Emergency Medicine Program Directors Michael S. Beeson, MD, MBA, Lowell W. Gerson, PhD, John V. Weigand, MD, Sharhabeel Jwayyed, MD, Gloria J. Kuhn, DO, PhD
Abstract Objectives: To characterize emergency medicine (EM) program directors (PDs) and compare the data, where possible, with those from other related published studies. Methods: An online survey was e-mailed in 2002 to all EM PDs of programs that were approved by the Accreditation Council of Graduate Medical Education. The survey included questions concerning demographics, work hours, support staff, potential problems and solutions, salary and expenses, and satisfaction. Results: One hundred nine of 124 (88%) PDs (69.7% university, 27.5% community, and 2.8% military) completed the survey; 85.3% were male. Mean age was 43.6 years (95% confidence interval [CI] = 42.6 to 44.7 yr). The mean time as a PD was 5.7 years (95% CI = 4.9 to 6.5 yr), with 56% serving five years or less. The mean time expected to remain as PD is an additional 6.0 years (95% CI = 5.2 to 6.8). A 1995 study noted that 50% of EM PDs had been in the position for less than three years, and 68% anticipated continuing in their position for less than five years. On a scale of 1 to 10 (with 10 as highest), the mean satisfaction with the position of PD was 8.0 (95% CI = 7.2 to 8.3). Those PDs who stated that the previous PD had mentored them planned to stay a mean of 2.0 years longer than did those who were not mentored (95% CI of difference of means = 0.53 to 3.53). Sixty-five percent of PDs had served previously as an associate PD. Most PDs (92%) have an associate or assistant PD, with 54% reporting one; 25%, two; and 9%, three associate or assistant PDs. A 1995 study noted that 62% had an associate PD. Ninety-two percent have a program coordinator, and 35% stated that they have both a residency secretary and a program coordinator. Program directors worked a median of 195 hours per month: clinical, 75 hours; scholarly activity, 20 hours; administrative, 80 hours; and teaching and residency conferences, 20 hours; compared with a median total hours of 220 previously reported. Lack of adequate time to do the job required, career needs interfering with family needs, and lack of adequate faculty help with residency matters were identified as the most important problems (means of 3.5 [95% CI = 3.2 to 3.7], 3.4 [95% CI = 3.2 to 3.6], and 3.1 [95% CI = 2.9 to 3.3], respectively, on a scale of 1 to 5, with 5 as maximum). This study identified multiple resources that were found to be useful by >50% of PDs, including national meetings, lectures, advice from others, and self-study. Conclusions: Emergency medicine PDs generally are very satisfied with the position of PD, perhaps because of increased support and resources. Although PD turnover remains an issue, PDs intend to remain in the position for a longer period of time than noted before this study. This may reflect the overall satisfaction with the position as well as the increased resources and support now available to the PD. PDs have greater satisfaction if they have been mentored for the position. ACADEMIC EMERGENCY MEDICINE 2006; 13:166–173 ª 2006 by the Society for Academic Emergency Medicine Keywords: medical education, residency directors, program directors, residency
From the Department of Emergency Medicine (MSB, JVW, SJ) and Department of Community Health Sciences (LWG), Northeastern Ohio Universities College of Medicine and Summa Health System, Akron, OH; Department of Emergency Medicine, Wayne State University (GJK), Detroit, MI. Received May 19, 2005; revision received August 6, 2005; accepted August 9, 2005. Address for correspondence and reprints: Michael S. Beeson, MD, MBA, Department of Emergency Medicine, Summa Health System, 41 Arch Street, Suite 521, Akron, OH 44304. Fax: 330375-4052; e-mail:
[email protected].
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ISSN 1069-6563 PII ISSN 1069-6563583
T
he Accreditation Council of Graduate Medical Education (ACGME) noted that there were 13.4% new program directors (PDs) across all specialties, and 13.6% (18 total) of the emergency medicine (EM) PDs were new in 2003–2004, with new programs accounting for 5 of the 18.1 This high turnover rate is a concern to medical education programs in all specialties and is not unique to EM. The PD occupies a vital role in academic departments. Much of the department’s mission revolves around the successful education and preparation of residents for future independent practice of the specialty.
ª 2006 by the Society for Academic Emergency Medicine doi: 10.1197/j.aem.2005.08.010
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Responsibility for the successful implementation of this mandate rests on the PD’s shoulders. This includes preparing all documents submitted to the ACGME that impact the accreditation of the program, recruiting candidates who can successfully graduate from the program, and fulfilling all specialty and institution requirements. Additionally, the ACGME continues to refine and add requirements for accreditation, adding to the potential stress of PDs. Studies of PDs have demonstrated that the job requirements of this position call for individuals who are competent clinicians, experienced educators, and effective administrators and personnel managers.2–4 Each of these roles calls for a different set of competencies and skills. In our experience, the learning curve for a PD is very steep, especially in the early years of filling the position, and peak levels of performance may only be attained after years in the position. The time spent learning to do the job may detract from time spent on scholarly activities. Experience in handling the vast array of problems that can arise, a good working knowledge of the culture of the institution, and an intimate knowledge of the ACGME program requirements are the practical ingredients necessary for success of the program. It can take years to acquire this experience and knowledge. Furthermore, curriculum development and implementation, resident formative evaluation, and revision of curricula require several years to develop the knowledge and skill necessary for maintaining a successful residency program.5 The combination of unique requirements for a PD, and the fact that nearly one in seven EM PDs were new in 2003–2004, highlight the need for a better understanding of the role of EM PD, the characteristics of the physicians who fill this position, and motivations for seeking and then leaving this position. Without this understanding, it is difficult to create programs of support that may be effective in lowering the turnover rate or to create faculty development programs to assist in the education of new PDs to ease the early learning curve. In 1995, a report was published of a survey of all EM PDs of ACGME-accredited programs that was conducted in 1992.4 This survey collected demographic information about EM PDs, identified problems that PDs may encounter, and reported potentially useful solutions for common problems. The results of the 1992 survey revealed that 68% of current PDs anticipated leaving the position within five years, but there is no information as to whether this rate of turnover did occur. The current descriptive study’s objectives are to characterize EM PDs, including job satisfaction, longevity, job stressors, resources, and work hours, and to compare them, where possible, with those reported in the 1995 study by Weigand et al.4
of Summa Health System. The survey was approved by the Council of Emergency Medicine Residency Directors (CORD) Board of Directors (BOD).
METHODS Study Design A confidential online survey was designed to characterize EM PD demographics, including longevity and prior experience, work patterns, resources, perceived problems, solutions to encountered problems, and satisfaction with the position. This study met the criteria for exemption from informed consent by the institutional review board
Survey Content and Administration The study population included all EM PDs from ACGMEapproved EM residencies as of January 2002. An e-mail list of the PDs was obtained from the Residency Catalog that is provided on the Society for Academic Emergency Medicine (SAEM) website (www.saem.org). In February 2002, each EM PD received an e-mail request for completion of an online confidential questionnaire (provided in Data Supplement 1, available at http:// www.aemj.org/cgi/content/full/j.aem.2005.08.010/DC1). Each EM PD was provided a unique identification number in this e-mail that was required to access the online questionnaire. Names, programs, and identification numbers were kept in a separate database and were used only to track nonresponders. A reminder e-mail was sent to the nonresponders two weeks after the initial e-mail and was sent every three weeks afterwards, for a total of five reminders. The questionnaire was modeled after the instrument used by Weigand and colleagues.4 Additional questions addressed salary, expenses, benefits, and overall satisfaction with the position of EM PD. The final online questionnaire contained 103 items (available in Data Supplement 2, at http://www.aemj.org/cgi/content/full/j.aem.2005.08. 010/DC2). Each EM PD was provided a unique identification number in this e-mail that was required to access the online questionnaire. Names, programs, and identification numbers were kept in a separate database and were used only to track nonresponders). The survey instrument was piloted by the authors (including three current or past EM PDs). Additionally, the CORD BOD reviewed the survey instrument. The final version was modified on the basis of the pilot trial and CORD BOD comments. Questions were short-essay, dichotomous, and were numerical (example: ‘‘What is your age?’’) or used a Likert scale (1–5, with 5 = highest) for participants to choose a response to questions relating to 27 potential problems that EM PDs may face. PD satisfaction was scored on a ten-point rating scale (10 = highest). Twenty-two potential resources for PDs were listed, including national meetings, lectures, advice from others, and self-study. Respondents were asked whether they were used and if so, whether the PD found them useful. Interpretation of survey questions was left to the respondents, with no examples given. The survey format required that all questions (with the exception of questions 10, 12, and 67, where there were programming errors) be answered before the response could be submitted. Data Analysis Data for all cases were analyzed using the SPSS-PC statistical software program (SPSS, Inc., Chicago, IL). Categorical values are reported as counts and percentages, with corresponding 95% confidence intervals (95% CIs). Continuous variables are reported as means with 95% CIs. Data, with 95% CIs where appropriate, are reported both in the aggregate and categorized by self-reported type of residency program: university, community, and military. Medians were used when the data did not
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Table 1 Program and Program Director Demographics Variable Number (%) Median number of residents Mean age of PD, yr (95% CI) Male gender, n (%) Mean tenure in PD position, yr (95% CI) How much longer expected to be PD, yr (95% CI)
University 76 (69.7) 30 44.0 (42.7, 45.3) 63/76 (83) 5.8 (4.9, 6.6) 5.7 (4.9, 6.6)
Community Teaching 30 (27.5) 29.5 43.3 (41.3, 45.3) 27/30 (90) 5.9 (4.2, 7.6) 6.9 (5.1, 8.6)
All* 109 (100) 43.6 (42.5, 44.7) 93/109 (85) 5.7 (4.9, 6.5) 6.0 (5.2, 6.8)
* Includes three directors of military programs, not included in the ‘‘Community’’ and ‘‘University’’ columns.
appear to follow a normal distribution and are so noted. Subgroup analysis was undertaken to identify factors that might be contributors to longevity and overall satisfaction. Data for these subgroups are presented as difference between means with 95% CIs. RESULTS One hundred nine surveys were returned, for an 88% response rate (109/124). The distribution of responses to each item on the survey is presented in Data Supplement 2 (available at http://www.aemj.org/cgi/content/full/j.aem. 2005.08.010/DC2). Demographics are shown in Table 1. The overwhelming majority of PDs were men in their mid-forties who practiced in a university setting. The overall mean job satisfaction was 8.0 (95% CI = 7.2 to 8.3) on a ten-point rating scale. Current PDs had been in the position for a mean of 5.7 years (95% CI = 4.9 to 6.5 yr), and a median of 5.0 years (Table 1). The range was wide, with a low of 1.7 years for military PDs and a high of 5.9 years for community PDs. The mean expectation for the number of years that respondents planned to remain PDs was 6.0 (95% CI = 5.2 to 6.8 yr) for all types of residencies, with a median
of 5.0 years (Table 1). Those PDs who stated that the previous PD had mentored them planned to stay a mean of 2.0 years longer than did those who were not mentored (95% CI = 0.53 to 3.53 yr; Table 2). Thirty-eight percent anticipated remaining in the position of PD for an additional six years, although changing institutions was possible. Sixty-five percent had previously served as assistant or associate PD, and 53.2% noted that the previous PD had mentored them before their assuming the position of PD. Emergency medicine PDs at university programs tended to have been assistant or associate EM PD more often than had those in community teaching programs, although this was not statistically significant (70% vs. 57%, 95% CI = ÿ7.5% to 34%). Most PDs (92%) had an associate or assistant PD, with 54% reporting one, 25% reporting two, and 9% reporting three associate or assistant PDs. The aggregate amount of full-time equivalent (FTE) protected time that was given to all associate or assistant PDs was 0 for 8%, 0.25 for 20%, 0.5 for 19%, 0.75 for 6%, and 1.0 for 22% of programs. Ninety-two percent of respondents reported that they had a program coordinator, and 35% stated that they had both a residency secretary and a program coordinator.
Table 2 Subgroup Analysis of Overall Satisfaction and Projected Additional Time as PD Subgrouping
n
Gender Male 96 Female 13 Accepted position because no other suitable candidate Yes 26 No 83 Previously served as assistant or associate PD Yes 71 No 38 Previous PD mentored you Yes 58 No 51 Have an assistant or associate PD Yes 100 No 9 Have a program coordinator Yes 100 No 9 * Scale of 1 to 10; 10 = best.
Overall Satisfaction* Difference Additional Time Expected in Difference (95% CI) in Means (95% CI) PD Position, in Years (95% CI) in Means (95% CI) 8.03 (7.73, 8.33) 7.75 (7.12, 8.38)
0.28 (ÿ0.51, 1.07)
6.15 (5.32, 6.98) 5.13 (3.23, 7.03)
1.02 (ÿ1.03, 3.07)
7.19 (6.53, 7.85) 8.24 (7.97, 8.51)
1.05 (0.43, 1.67)
4.62 (3.65, 5.59) 6.43 (5.49, 7.37)
1.81 (0.02, 3.60)
7.86 (7.52, 8.20) 8.24 (7.79, 8.69)
0.38 (ÿ0.20, 0.96)
6.35 (5.33, 7.37) 5.34 (3.64, 7.04)
1.01 (ÿ0.61, 2.63)
8.21 (7.92, 8.50) 7.75 (7.28, 8.22)
0.46 (ÿ0.09, 1.01)
6.95 (5.75, 8.15) 4.92 (4.10, 5.74)
2.03 (0.53, 3.53)
7.99 (7.70, 8.28) 8.00 (7.02, 8.98)
0.01 (ÿ1.00, 1.02)
5.91 (5.12, 6.70) 7.00 (4.08, 9.92)
1.09 (ÿ1.72, 3.90)
7.98 (7.69, 8.27) 8.11 (7.35, 8.87)
0.13 (ÿ0.88, 1.14)
6.03 (5.23, 6.83) 5.67 (3.00, 8.34)
0.36 (ÿ2.46, 3.18)
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Table 3 Median Time for EM PD Activities per Month
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Table 5 Top Five Identified PD Problems
Median time spent (h)
All* (N = 109)
University (n = 76)
Community (n = 30)
Clinical Teaching Scholarly activity Administrative Total professional time
75 20 20 80 195
80 20 20 80 200
66.5 24.5 24.5 80 195.5
* Includes 3 directors of military programs, not included in the ‘‘Community’’ and ‘‘University’’ columns.
Respondents worked a median of 195 hours per month. Distribution of hours is shown in Table 3. Emergency PDs expected to attend four conferences or meetings that required an anticipated 20 days out of town during the 2002 calendar year. The salary range, exclusive of benefits, was wide (Table 4), with PDs in community settings having a higher salary on average than those in university settings. Seventy-six percent of EM PDs believed that becoming a PD was an advancement in their career. Sixty-five percent who had acted as an assistant or associate EM PD before assuming the position of PD viewed the change as a promotion to a higher position. Twenty-four percent accepted the position because no other suitable candidate was available. If a PD accepted the position because no other suitable candidate was available, there was a difference of 1.05 (scale of 1–10; 95% CI = 0.43 to 1.67) in overall satisfaction, compared with those who answered no to this question (7.19 vs. 8.24), and such PDs planned to stay 1.8 years less in the PD position (95% CI = 0.02 to 3.60) than did those who actively sought the position. No PD indicated intention to leave. Sixty-four percent said that they would leave the position of EM PD for a promotion. Twenty-nine percent said that they would leave their current position for a lateral move to another program. Seventy-five percent said that they would leave the position because of job interference with their personal life, whereas 56% said that they would leave the position if the job became boring and repetitious. PD Potential Problem Five of the 27 potential problems scored higher than 3 on the Likert scale (Table 5). These potential problems were
Table 4 Salary of Program Directors Salary Range ($)
Community (n = 30)
University (n = 76)
All* (N = 109)
120,000–150,000 151,000–175,000 176,000–200,000 201,000–225,000 226,000–250,000 251,000–275,000 276,000–300,000 >300,000
0.0 6.7 23.3 16.7 20.0 10.0 20.0 3.3
5.4 31.1 36.5 20.3 6.8 1.4 1.4 0.0
6.5 23.4 31.8 18.7 10.3 3.7 6.5 0.9
All data are percentages. * Includes 3 directors of military programs, not included in the ‘‘Community’’ and ‘‘University’’ columns.
Problem Lack of adequate time to do the job required Career needs interfere with family needs Lack of adequate faculty help with residency matters Budget concerns for support of residency activities Inadequate release time for scholarly activity
Likert Score Average*
Standard Deviation
3.46
1.23
3.39
1.22
3.09
1.17
3.25
1.29
3.28
1.30
* Scale of 1 to 5. All other potential problems scored less than 3.
lack of adequate time to do the job, career needs interfering with family needs, lack of adequate faculty help with residency matters, budget concerns to support residency activities, and inadequate release time for scholarly activity. PD Resources and Solutions The resources that were used by >50% of the responding PDs are listed in Table 6. These were valued in each case by more than 75% of the PDs. Seventy-seven percent of all responding EM PDs (107) endorsed the need for increased clinical service dollars to support the residency.
DISCUSSION Our study highlights several important changes that have occurred during the last decade. These include longer tenure in the position of PD and an anticipated continuation in the position for a longer period of time. We found a number of factors that may contribute to this. These include improved preparation for the position; greater support in terms of faculty assistants and support staff; and extensive use of resources, including national meetings, lectures, advice from others, and self-study. The mean age of all EM PDs has increased to 43.6 years, compared with the mean age of 40 years that was reported by Weigand et al.4 (Difference in means of 3.6, 95% CI = 2.0 to 5.2.) The higher age of current EM PDs is consistent with age increases seen in internal medicine and obstetrics PDs.2,6 The increase in age that we found likely is caused by increased duration in the position. This age of 43.6 years compares with a reported overall average age of 42.6 years for emergency physicians.7 We found that 44%, compared with 30.7% in the earlier Weigand study, have had the position longer than six years. The male preponderance that we report is seen in other specialties. In obstetrics, 73.8% of PDs were male,6 whereas in internal medicine, that number was even higher, with fully 84% of positions occupied by men.2 Our finding of PDs being 85% male compares with an overall gender percentage among emergency physicians of 83% male.7 The Weigand and colleagues4 study reported that 68% of EM PDs anticipated continuing as PD for less than five
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Table 6 PD Resources and Solutions Attended by More Than 50% of EM PDs Resources and Solutions
Number (%) Using Resource
Number (%) Who Found Resource Useful
Attend CORD meetings Seek advice from significant other Attend resident education lectures at SAEM Seek advice from department chair Self-reading in educational techniques Seek advice from local ED colleagues Seek advice from national ED colleagues Attend CORD PD workshop Seek advice from director of medical education Self-reading in time management Self-reading in management
109/109 (100) 97/109 (89.0) 97/109 (89.0) 91/109 (83.5) 90/109 (82.6) 88/109 (80.7) 86/109 (78.9) 74/109 (67.9) 66/109 (60.6) 60/109 (55.0) 57/109 (52.3)
96/105 (91.4) 91/95 (98.9) 92/97 (94.8) 81/88 (92.0) 78/85 (91.8) 82/83 (98.8) 82/82 (100) 67/74 (90.5) 59/65 (90.8) 46/57 (80.7) 52/57 (91.2)
years, whereas our study showed that PDs who had actively sought the position anticipated remaining as PD for a mean of 6.0 additional years, with a median of 5.0 years. This represents a change in attitude toward the relative permanence of the position in a relatively short period of time. Potential explanations for this change include improved mentorship as well as increased resources available to EM PDs documented in our study. PDs are now much better prepared for the position. Two thirds had served previously as associate or assistant PD and presumably thus had previously learned a significant amount of the job’s mechanics and requirements. One fourth said that they took the position because no other suitable candidate was available, and these candidates had much less overall satisfaction with the position of PD. This is reflected also in greater anticipated time as PD by those who had been mentored compared with those who were not. This study result implies that EM organizations could foster greater satisfaction and intended length of time as PD if mentoring of junior faculty is formalized before those faculty become PDs. An additional factor in increased PD longevity may be related to work hours. The ACGME recognizes clinical workload as a significant issue, as evidenced by the program requirements stipulating that PDs may not work more than 20 hours a week clinically. Weigand et al. found a median of 220 hours per month for all activities.4 Our study found a median of 195 hours per month for all activities. Our study demonstrated that the majority of PDs (92%) had an associate or assistant PD, and a third had two or more. This is an increase from 62% documented in 1995. The observation that university programs are more likely to have associate or assistant directors who then move on to assume the position of PD suggests that the specialty is training a cadre of educators who will be available to take the place of current PDs as they leave, thus making the transition from one leader to another less disruptive to the program. This in turn better prepares future EM PDs for the position, decreasing the steep learning curve, and may contribute to greater satisfaction with the position as well as increased longevity in the position. The value of this prior administrative and personnel management experience as associate or assistant PDs is of even more importance because the PD frequently is
coordinating the efforts of a team of individuals who are involved in administering the program. Changes in administrative and secretarial support that are reported by current PDs reflect the complexity of residency management and documentation, which has increased during the last 10 years. The PDs now are required to teach and evaluate the ACGME-defined General Competencies and track duty hours, as well as to fulfill all of the other ACGME-required activities, such as procedure tracking, conference tracking, and so on. Three quarters of EM PDs support the concept of using clinical service dollars to support the residency, which may reflect increasing contraction of residency support dollars from other sources. Martin et al.8 reported that only 6% of EM residencies were supported in part with practice plan dollars. As teaching hospitals continue to have a contraction of federal dollars that support residency training, PDs may feel the burden of expanding requirements without additional financial support. This is an added stress to the position of EM PD and may contribute to EM PD turnover. Motivations to Become PD and to Leave the Position The survey results indicate that PDs feel strongly about the need to act as resident and residency advocates. It is not known whether this attitude causes self-selection in individuals who gravitate toward the position, or whether this feeling develops after the position of PD is assumed. Although our survey noted that EM PD satisfaction was very high, PDs are prepared to leave the position in a number of situations. The prime motivation to leave the current position is opportunity for promotion, although family, institutional, and departmental support are also important factors in a PD’s decision to stay or leave the position. It is unclear what positions would represent promotions, but such opportunities presumably could include becoming chairman of the department or assuming other health system administrative positions. The position of PD is clearly perceived to be a midlevel position, other than in the case of dual appointment as both chair and PD, a situation which is not uncommon in other specialties.2,6 It is clear that although the position of PD is considered to be a promotion when initially achieved, it is not viewed as a final career goal. If the specialty or institution or department wishes to retain a PD for as long as possible, the perception of the position as a midlevel
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position must be altered. This may need to be done on an individual PD basis, emphasizing and developing the needs of that individual so that the position remains highly desirable.
and a venue for networking. Educational programs also are offered by the Society for Academic Emergency Medicine (SAEM) and were found useful by 95% of those respondents attending them. A survey of Canadian physicians showed that a major source of job satisfaction was the respondents’ relationships with their colleagues.10 This was shown by Beasley et al.2 in his study of PDs in internal medicine. Networking with other colleagues and education-related lectures clearly are seen as beneficial by many PDs, including those in EM. Professional resources do not appear to provide all the advice sought by PDs, as demonstrated by the fact that PDs in our study cited their significant other as the second most valued resource, 89% compared to 80% as reported in 1995.4 This finding may suggest the unique nature of problems routinely faced by PDs. Because PDs’ significant others are cited as resources, it may behoove interested parties to develop special sessions for that group. It is interesting to note that the ACGME-sponsored Program Directors Workshop was used by only 34.9% of EM PDs, reflecting perhaps a lack of awareness of this program, a perception of low value, sufficient fulfillment of needs by CORD and SAEM educational programs, or unwillingness or inability to commit time to yet another meeting. It is not known whether this is unique for the specialty of EM or is similar to the case in other specialties. The only literature that has reported a positive effect on decreasing the short tenure of PDs was conducted in family practice. The Association of Family Practice Residency Directors developed an educational institute to help train individuals for the position of PD; that program includes topics that demonstrate exemplary methods of residency management. A survey of PDs attending this training noted an increase in PD tenure and an overall positive impact on family practice residency programs.3 Our findings parallel reports from other specialties in many ways, including demographics, longevity, and problems (Table 7). This highlights the commonality of issues that PDs from all specialties face and raises the
PD Problems The 5 items that were noted to score highest of all 27 potential problems encountered by PDs point towards frustrations that the time required to administer the residency, pursue scholarly activity, and fulfill clinical service obligations interferes with family needs (Table 4). The first three items are identical to the top three PD problems that are identified in the study by Weigand et al.4 The study by Beasley et al.2 showed four factors (low satisfaction with colleagues, high percentage of administrative work time, job perceived as stepping stone, lacking formal training to deal with problem residents) to be associated with high turnover. There may be a feeling that the burden of responsibility rests solely with the PD, as indicated by the feeling that there is a lack of adequate faculty help with residency matters, despite formal appointment of physicians to share in the administration of the program. As residency management requirements continue to increase without budgeted dollars to support this increase, such as the ACGME-mandated but unfunded requirements for increasing documentation, core competency training, and so on, there is further stress on the PD and support personnel to fulfill all requirements, a problem that is encountered in other specialties, including pediatrics, internal medicine, and obstetrics and gynecology.2,6,9 PD Resources and Solutions Our study demonstrates that EM PDs tend to seek external help with residency issues. The most frequently cited sources of advice were local and national EM colleagues, the department chair, and their significant other. The CORD meetings are used by 100% of those EM PDs who responded to our survey and were found to be of value by 91%. These meetings provide formal educational offerings, small group discussions of common problems,
Table 7 Comparison of Findings from Studies on Program Directors in Emergency Medicine, Obstetrics and Gynecology, and Internal Medicine Beeson: EM Department
Weigand4: EM Department
Monga6: Obstetrics and Gynecology Department
Beasley2: IM Department
% Response rate Age (yr) (mean SD)
88 (43.6 5.77)
93.5 (40 5.3)
78 47.4 (mean)
% Male gender Years in position (%) [mean yr]
385
