2005 APDS Spring meetingImpact of Resident Duty-Hour Reform on Faculty Clinical Productivity
Introduction
The implementation of the Accreditation Council for Graduate Medical Education’s (ACGME) mandated reduction in resident duty hours is now complete. Programs have dealt with these mandates in a variety of ways, and for some, the adaptation continues to evolve. Although many other groups have examined these changes with regard to resident impact, we have been interested in studying the impact of duty-hour reform on faculty.1, 2 Our previous work has shown that faculty work hours in our academic medical center did not significantly change after institution of the resident 80-hour workweek.1, 2
Before duty-hour reform, several authors predicted negative impacts on faculty. Weinstein3 predicted: “Attending physicians can be asked to take a more direct role in patient care. However, a substantial, systematic expansion of the clinical responsibilities of faculty members will inevitably curtail academic productivity.” Croasdale4 reported in early 2003 (before the July 2003 institution of duty-hour reform) that the impact would be more profound on younger faculty: “junior faculty … are fearing for their lives…if you are junior faculty with the pressure to publish or perish, that threatens your academic livelihood.” Fry5 reported, “…nearly 18 months into full compliance with the resident 80 hour work week…the dissatisfaction of the residents has been fully transferred to the dissatisfaction of the attending staff.” Despite this pessimism, we have been unable to demonstrate that the numbers of hours worked on a weekly basis by faculty has significantly changed as a result of duty-hour reform.2
Although our faculty hours seem to be preserved, how the faculty spent those hours may have significantly changed. The aim of this study was to examine faculty productivity, through surveying their duty hours this year, allowing comparison to work-hour data from prior survey periods spanning the time before and after resident duty-hour reform. We also sought faculty opinions on resident education, faculty workload, allocation of time, and productivity. We specifically hoped to quantify the clinical productivity of our faculty, using total relative value units (RVUs) as an indicator, comparing RVU data before and after resident duty-hour reform.
Section snippets
Survey
After obtaining Institutional Review Board (IRB) approval from the Washington University School of Medicine, a cross-sectional survey of surgical faculty from the Department of Surgery (including cardiothoracic, endocrine/oncology, hepatobiliary, vascular, colorectal, transplant, pediatrics, trauma/critical care, urology, and plastic surgery) was undertaken. Unlike our previous 2 studies, this survey did not include surgeons from otolaryngology, orthopedics, or neurosurgery, as the RVU database
Study Population
A total of 73 surveys were sent; 49 were returned, for a response rate of 67% (response rate for women: 78%; for men: 65%). Forty-two respondents were men (85%), and 7 respondents were women (15%). The sections of colorectal, vascular, cardiothoracic, hepatobiliary, and urology each had 5 respondents (10.2% of respondents); transplant 3 (6.1%), endocrine/oncology and trauma/critical care 6 (12.2%), plastics 7 (14.3%), and pediatric surgery 2 (4%). The mean number of years in practice was 11 ±
Discussion
Although the debate on the relative merits of resident duty-hour reform on residents may be abating, the impact of these reforms on faculty will likely continue to be the subject of focus and debate. We have shown that the weekly work hours of faculty are not significantly affected by limits on resident duty hours and that, at least during the period examined in our current survey, clinical productivity has not been adversely affected.
The responsibilities of academic surgeons are numerous, but
Acknowledgments
Assistance with RVU data was provided by Vivian Boyd, MBA, Department of Surgery.
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B.L.H. is supported by the Center for Health Policy at Washington University, with gratitude to Dr. William Peck, Director.