What Drives Residency Program Directors to Consider Resigning?

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A substantial proportion of US medical education program directors reported considering resignation at some point in their careers.

A substantial proportion of United States medical education program directors reported considering resignation at some point in their careers, according to study data published in the American Journal of Medicine. Burnout and program director turnover were strongly associated with consideration of resigning, as were worries surrounding the ability of graduated residents to practice independently.

The Association of Program Directors in Internal Medicine (APDIM) administers a web-based survey to directors of 379 internal medicine programs in the US each year. Investigators abstracted data from the 2012-2018 iterations of the survey. Each survey queried program directors as to whether they had considered resigning in the past year. In the 2017 survey, respondents were also asked to rate how likely they were to resign and to describe their reasoning. Program director burnout was ascertained using the Maslach Burnout Inventory. The 2016 survey also asked participants if they had ever graduated a student about whom they had concerns. Investigators performed Chi-square or Fisher’s Exact tests to identify relationships between program characteristics and self-reported consideration of resignation. Survey data from 2016 and 2017 were used to enumerate potential reasons for considering resignation.

Of 369 program directors solicited for participation, 266 (70%) completed the 2017 survey. No significant differences were observed between responders and nonresponders by key director and program characteristics. Mean tenure length of respondents was 6.3 years in 2017. Over the past 7 survey years, a mean of 48.3% of directors reported considering resignation (range, 40% [2012] to 53% [2014, 2018]). Of the 116 (44.1%) participants who reported considering resignation during the 2017 survey, 30.2% indicated that they were “somewhat” or “very” likely to resign in the next 12 months. However, 50.0% reported that they were unlikely to resign. Of the 2017 respondents who were deemed to have symptoms of burnout (n=75; 28.5%), 67.6% reported that they had considered resigning in the past year, compared with just 35.1% of participants without burnout (P <.001). Of the 107 participants who provided free-text responses for the 2017 survey, the most commonly cited reasons for considering resignation included institutional/departmental factors (n=60), nature of the work (n=37), and personal factors (n=20). Nearly a third (30%) expressed feeling frustration or exhaustion.

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Per 2016 survey data, a significant association between considering resignation and graduating a resident of concern was observed (P <.001). Similarly, directors who reported ever promoting a resident about whom they had concerns were more likely to consider resignation than directors who had not (56.5% vs 38.7%; P <.006). No significant associations were observed between resignation reasons and gender, program type, program size, Census Bureau region, tenure, or other key program characteristics.

These data confirm an association between burnout and consideration of resigning among program directors. Additional reasons for consideration included program-level factors and concerns about the abilities of graduated residents. “Interventions such as leadership training and networking opportunities could provide a way forward to keep program directors in their roles longer, allowing for greater programmatic stability,” investigators wrote.

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Fletcher KE, O’Connor AB, Kisielewski M, Willett LL. Why do residency program directors consider resigning? A mixed-methods analysis of a national program director survey [published online March 9, 2020]. Am J Med. doi: 10.1016/j.amjmed.2020.02.016