Who Are Surgery Who Are Surgery Program Directors Program Directors and What Do They and What Do They

Need?Need?Tania K. Arora, MD, Brian J. Tania K. Arora, MD, Brian J.

Kaplan, MDKaplan, MDVirginia Commonwealth University Virginia Commonwealth University

Health SystemHealth SystemDepartment of SurgeryDepartment of Surgery

Richmond, VirginiaRichmond, Virginia

IntroductionIntroduction Program directors (PDs) play a pivotal role in Program directors (PDs) play a pivotal role in

the educational mission in residency the educational mission in residency programs.programs.

Several specialties have examined the role and Several specialties have examined the role and responsibilities of clerkship and program responsibilities of clerkship and program directors.directors.

Dr. Joseph Cofer conducted a national survey Dr. Joseph Cofer conducted a national survey of program directors and presented his results of program directors and presented his results at the annual Association of Program Directors at the annual Association of Program Directors in Surgery meeting in 2006.in Surgery meeting in 2006.

There is a void in the literature describing the There is a void in the literature describing the demographic profile of surgery program demographic profile of surgery program directors.directors.

There are new revisions to the ACGME There are new revisions to the ACGME program requirements for general surgery.program requirements for general surgery.

Methods: design, setting, Methods: design, setting, and participantsand participants

IRB approved. A confidential, internet-based survey was

administered to 252 PDs of surgery residencies in the US between October and December 2007.

49 questions configured based on existing literature.

Questions elicited information regarding personal and professional attributes.

Email follow-up.

ResultsResults

Age : 51 Age : 51 ± 8 ± 8 (36-75)(36-75) Gender: Gender:

Race:Race: Caucasian 86.9%Caucasian 86.9%

58% response rate (n=146, 27 partially complete).58% response rate (n=146, 27 partially complete).

Rank: Rank: Associate/Associate/

Assistant Assistant Professor 47.3%Professor 47.3%

Professor 41.8%Professor 41.8%

Female PDs, 10.3%

Male PDs, 89.7%

Administrative TitlesAdministrative Titles Concurrent Titles :Concurrent Titles :

1 additional admin. title: 56.1%1 additional admin. title: 56.1% 2 additional admin. titles: 8.9%2 additional admin. titles: 8.9%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

DepartmentChairman

DivisionChairman

ViceChairman

Dean ClerkshipDirector

DemographicsDemographicsFellowship Training 63.7%Fellowship Training 63.7%

Trauma 22.6% Trauma 22.6% Surgical Oncology 17.2%Surgical Oncology 17.2%

Background in educationBackground in education Attendance at teaching/education seminars 63%Attendance at teaching/education seminars 63% Attained previous teaching award 82.9%Attained previous teaching award 82.9% Currently conducting education research 52.0%Currently conducting education research 52.0%

Scholarly activityScholarly activity Currently conducting basic science or clinical Currently conducting basic science or clinical

research 82.9%research 82.9% Published peer-reviewed articles 96.6%Published peer-reviewed articles 96.6%

n=146

Years as current PDYears as current PD

0

10

20

30

40

50

<1 to 4 5 to 9 >10

Percent of PDs n=146

46.6% of current PDs are 46.6% of current PDs are relatively new having served < 5 relatively new having served < 5 years.years.

New revisions to the New revisions to the ACGME ACGME requirements:requirements: Duration of PD for Duration of PD for

at least the at least the duration of the duration of the program.program.

Our study revealed:Our study revealed: 6.7% of PDs 6.7% of PDs

estimated total estimated total duration is <5 duration is <5 years.years.

010

2030

4050

60

<5 5 to 7 8 to 10 >10

Percent of PDsn=119

Intended total duration of PDs= current duration + years of intent

Duration as PDDuration as PD

PD support: staffPD support: staff

Average number of staff 4.5 ±1.8 Average number of staff 4.5 ±1.8 New revisions to the ACGME New revisions to the ACGME

requirements:requirements: Programs with > 20 categorical residents Programs with > 20 categorical residents

require an Associate Program Directorrequire an Associate Program DirectorAt least one APD: 81.5%At least one APD: 81.5%6 programs with 26-45 residents 6 programs with 26-45 residents

have have nono APD APD

n=119

PD support: protected PD support: protected timetime New revisions to the ACGME requirements:New revisions to the ACGME requirements:

PDs should have 30% protected time- direct or indirect via PDs should have 30% protected time- direct or indirect via salary or release from clinical activities.salary or release from clinical activities.

PDs that reduced clinical hours when hired: PDs that reduced clinical hours when hired: 55.5%55.5%

PDs with protected time: 38.7%PDs with protected time: 38.7% % Protected time: 32.5 ±20.6 % Protected time: 32.5 ±20.6 PDs working beyond protected time: PDs working beyond protected time:

84.8%84.8% PDs PDs withoutwithout protected time: 61.3% protected time: 61.3%

% of time spent on PD duties: 29.3 ±14.4 % of time spent on PD duties: 29.3 ±14.4 PD protected time and Total weekly work hoursPD protected time and Total weekly work hours

Pearson coefficient= -0.299, p=0.0181Pearson coefficient= -0.299, p=0.0181 n=119

New revisions to the ACGME requirements:New revisions to the ACGME requirements: PDs should have 30% protected time- direct or indirect via PDs should have 30% protected time- direct or indirect via

salary or release from clinical activities.salary or release from clinical activities.PDs with % salary compensation: 78.6 %PDs with % salary compensation: 78.6 %

Average % salary derived for PD position: 32.9 Average % salary derived for PD position: 32.9 (26.3)(26.3)

PDs with NO clinical hour reduction, NO PDs with NO clinical hour reduction, NO protected time and <30% salary protected time and <30% salary compensation:compensation: 28.6%28.6%

PDs with NO clinical hour reduction, NO PDs with NO clinical hour reduction, NO protected time, and NO salary compensation:protected time, and NO salary compensation: 15.1%15.1%

PD support: salary PD support: salary compensationcompensation

PD support: salary PD support: salary compensationcompensation

PD % salary compensation (n=119) Mean (SD) p

Resident # ≤27 34.8 (31.5) .0006 Resident # >27 17 (17.8)

With protected time 32.9 (25.9) .0015 Without protected time 21.2 (26.1)

Current duration as PD> 5 years 31.5(30.1) .026Current duration as PD≤ 5 years 20.8(22.8)

Male PD 26.2(27.6) .89Female PD 22.6(21.1)

Age >50 29.7 (29.4) .15Age≤50 21.8(23.6)

Job PerceptionsJob PerceptionsIdeal % protected time: Ideal % protected time:

41.4 ±19.141.4 ±19.1Feel support for professional Feel support for professional

development: 90.8%development: 90.8%Feel supported by their Feel supported by their

chairman: 94.1%chairman: 94.1% Non-chairmen PDs: 92.1%Non-chairmen PDs: 92.1%

Intent to remain as PD≥ 5 years: Intent to remain as PD≥ 5 years: 57.9% 57.9%

LimitationsLimitations

58% response rate58% response rateWording of questions may have Wording of questions may have

been open to misinterpretation been open to misinterpretation or may have had a limited scope.or may have had a limited scope.

Programs may have been in the Programs may have been in the process of meeting the new process of meeting the new ACGME guidelines that came ACGME guidelines that came into effect January 1, 2008. into effect January 1, 2008.

ConclusionsConclusions Demographically, PDs are somewhat Demographically, PDs are somewhat

homogenous.homogenous. Most PDs Most PDs

are fellowship trainedare fellowship trained have other administrative titleshave other administrative titles

They are accomplished in teaching and They are accomplished in teaching and scholarly activity.scholarly activity.

There are inconsistencies in salary and There are inconsistencies in salary and protected time that PDs have.protected time that PDs have.

The ‘ideal’ protected time is 10% higher The ‘ideal’ protected time is 10% higher than current guidelines stipulate.than current guidelines stipulate.

AcknowledgementsAcknowledgementsLuke Wolfe, MSLuke Wolfe, MSWendy Coates, MDWendy Coates, MDDebra DaRosa, PhDDebra DaRosa, PhD