Family physicians fill gap when residents go home

For 50% of family medicine attendings, more time is being spent taking care of patients at the expense of teaching residents, according to a survey in the December 2006 issue of Academic Medicine.

The study confirms anecdotal reports to that effect that have circulated since duty-hour reforms were introduced in 2003. But the survey did not track whether more time in patient care meant that attendings were logging more hours.

Perry Pugno, MD, MPH, co-author of the report and director of medical education at the American Academy of Family Physicians, said that from what he hears, attendings are working more hours.

"When patients need care on busy services and residents hit their duty-hour thresholds, unless they want to be cited by their RRC [residency review committee], they are sent home, and the supervising faculty has to stay," Dr. Pugno said.

The survey of family medicine program directors took place in the first year of resident work-hour limits. Although programs might operate more smoothly after almost four years with the reforms, Dr. Pugno said concerns remained regarding lost teaching time. "More effective teaching techniques can balance that somewhat, but probably not entirely," he said.

Dr. Pugno stressed that programs are not turning out unprepared physicians but that residents' depth of experience might be less. Continuity of care is of particular importance to family medicine training, he said, and 58% of programs have had to reduce the time residents spend in clinics.

Mark D. Robinson, MD, director of the Cabarrus Family Medicine residency in Concord, N.C., said the increase in faculty work was minor compared with residents' lost education time. His biggest concern is the six hours lost after residents finish their 24 hours on call. Before the reforms, residents would see patients, which is no longer allowed.

"In our particular situation, residents are losing clinical experience," Dr. Robinson said. "It's for a good reason, but they're still losing it."