Training on the Clock: Family Medicine Residency Directors Responses to Resident Duty Hours Reform

Peterson, Lars E.; Johnson, Hillary MD, PhD; Pugno, Perry A. MD, MPH; Bazemore, Andrew MD, MPH; Phillips, Robert L. Jr MD, MSPH

Academic Medicine:
doi: 10.1097/01.ACM.0000246689.33152.52
Duty Hours

Purpose: The Accreditation Council for Graduate Medical Education’s 2003 restrictions on resident duty hours (RDH) raised concerns among educators about potential negative impacts on residents’ training. In the early wake of these restrictions, little is known about how RDH reform impacts training in primary care. The authors surveyed family medicine (FM) residency program directors (PDs) for their perceptions of the impact of RDH regulations on training in primary care.

Method: All PDs of 472 FM residency programs were asked via list-serve to complete an anonymous Internet-based survey in the fall of 2004. The survey solicited PDs’ opinions about changes in staff and in residents’ training experiences with respect to implementation of RDH regulations. Descriptive and qualitative analyses were conducted.

Results: There were 369 partial and 328 complete responses, for a response rate of 69% (328/472). Effects of the RDH regulations are varied. Fifty percent of FMPDs report increased patient-care duties for attendings, whereas 42% report no increase. Nearly 80% of programs hired no additional staff. Sixty percent of programs eliminated postcall clinics, and nearly 40% implemented a night-float system. Administrative hassles and losses of professionalism, educational opportunity, and continuity of care were common concerns, but a sizeable minority feel that residents will be better off under the new regulations.

Conclusions: Many FMPDs cited increased faculty burden and the risk of lower-quality educational experiences for their trainees. Innovations for increasing the effectiveness of teaching may ultimately compensate for lost educational time. If not, alternatives such as extending the length of residency must be considered.

Author Information

Mr. Peterson is a PhD candidate, Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio.

Dr. Johnson is a resident, Department of Dermatology, New York University, New York City, New York.

Dr. Pugno is director, Division of Medical Education of the American Academy of Family Physicians, Leawood, Kansas.

Dr. Bazemore is assistant director, Robert Graham Center, Washington, DC.

Dr. Phillips is director, Robert Graham Center, Washington, DC.

Editor’s Note: A Commentary on this Research Report appears on page 1017.

Correspondence should be addressed to Dr. Phillips, the Robert Graham Center: Policy Studies in Family Medicine and Primary Care, 1350 Connecticut Avenue NW, Suite 201, Washington, DC 20036, telephone: (202) 331-3360; fax: (202) 331-3374; e-mail: (

© 2006 Association of American Medical Colleges