Nephrology program directors report needing more protected time for administration

Keith Bellovich, DO

As a reader of this publication, I imagine you share the same pressures on your time as all of us in health care during the last several years during the COVID-19 pandemic. But colleagues in the practice of nephrology have felt this pressure on our clinical services more acutely even prior to the pandemic.

Despite the waning interest among internal medicine specialists in choosing nephrology careers and the decreasing number of fellows matching in nephrology programs, the need for clinical care, particularly of an acute nature, persisted or even increased. To meet the demand for clinical nephrology services, organizations in private practice turned to advanced practice providers and consolidation of practices into larger organizations. For academic centers, the primary workforce consistently falls upon trainees to provide clinical care during the course of their education. With the decline in interest among internal medicine graduates in nephrology as a career, the need for acute care fell upon the clinical faculty within our training programs.

Based on the above forces at work, it is not surprising what Yuan discovered in her anonymous survey of 151 U.S. adult nephrology program directors. Her intent was to assess the amount of protected time they receive, how much they think is necessary and the division of their professional time in an effort to assess program response to new ACGME requirements that programs with more than seven fellows afford 10 to 20 hours per week of protected time for training program directors (8 hours per week if fewer than seven fellows) for program administration.

The response rate was robust at 66% of the programs surveyed, and the programs were of appropriate size (59% with fewer than seven fellows) and had geographic distribution consistent with the national size and distribution of all existing programs.

The results revealed that almost half of the program directors (48%) report that they did not receive the ACGME standard for protected time of 10 hours per week to administer their program.

The primary reason attributed to not meeting the standard was clinical obligations.

In The Seven Habits of Highly Effective People, Steven Covey uses the expression of “sharpening the saw” as a critical step in continually improving your administration skill and enhancing the efficient operation of any organization (even yourself). My concern as we emerge from the “dark ages” where we suffered from a lagging interest in our profession because in the trainees’ own words, we “work too hard on the most complex cases,” is that we fail to revere the educator and inspire the next generation to pursue the vocation we call nephrology.

Medical education must evolve and adapt to increasingly expanding knowledge and the unique learning styles of our trainees which requires the vital time and administration of our faculty and training program directors.

Fortunately, based on the performance of nephrology programs in the last 2 years of Electronic Residency Application Service  match cycles, we have witnessed an increase in the number of applicants and number of trainees matching in nephrology programs. It is essential that we advocate within our divisions and health systems to support our training programs and invest in the most precious resource of our gifted faculty members and program directors — their time. This time to sharpen their saws and continually refine our educational programs to train the next generation of nephrologists is going to be essential to efficiently meet the increasing demand of kidney care within our communities and promote their health.