Resident Well-Being, the Future of GME, and a Shrinking Marketplace

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Much is happening in the world of graduate medical education (GME) right now, particularly in emergency medicine. While the AOA and ACGME merger1 is one of the most prominent events, it is not the only hot topic at hand. As direct stakeholders in the training process, it is incumbent upon all trainees to know the major issues affecting the growth of our specialty.

September 2015 CRCR Meeting Updates

The Council of Review Committee Residents (CRCR) met in September. A significant emphasis was placed on the impending residency shortage and the ACGME image among residents.

The residency pipeline shortage is also a concern, as the increasing number of medical students may lead to increased competition for the same number of residency positions – a number that has been stagnant since the Balanced Budget Act of 1997 essentially froze funding for resident positions at 1996 levels.2 With few exceptions, the teaching institutions must fund any further programs beyond this cap. It’s a tall order in this day of nationwide budgetary concerns. The shortage of positions is expected to be exacerbated over the next 5 years as the students from the Association of American Medical Colleges (AAMC) campaign to increase medical school graduates by 30% begin to match. 3 The CRCR is investigating recommendations to put forward to the ACGME.

The ACGME wants residents to have a better understanding of what the organization does. They want to be seen as a collaborative and protective entity, not a burdensome, bureaucratic, duty hours watchdog. Take the time to learn about the ACGME and you’ll see it advocates tirelessly for residents to ensure a superb clinical education and resident personal development in training, while striving to emphasize patient safety and quality. They work on behalf of residents and the patients we will serve as the clinicians of tomorrow. Stay tuned for a developing outreach campaign.

November 2015 Well-Being Symposium

In light of recent resident suicides, the ACGME created a task force of senior educators intent on finding strategies to promote and enhance resident well-being.

The task force hosted a symposium in November for program directors, Designated Institutional Officials (DIOs – oversee all GME programs at their respective institutions), and other leaders. A report of their findings is forthcoming. Please read it and encourage your respective programs to adopt some of the recommendations as we work to develop training that supports the mental health of future physicians. The link will be published in EM Resident once it is available.

ABEM Board Eligibility Summit

The American Board of Medical Specialties (ABMS) has tasked all 24 member boards with developing a board-specific policy on how long after completion of residency a graduate can remain “Board Eligible” without successfully passing board examinations and becoming “Board Certified.”4

EMRA, along with representatives from all major leadership organizations in emergency medicine, participated in a summit last November to discuss this issue. EMRA’s invitation is a testament that residents are valued and have a seat at the table in the house of medicine.

As of Jan. 1, 2015, graduates have 5 years from the time of residency graduation to pass both the written qualifying exam and the oral exam. A second 5-year period beyond the initial period is currently possible if certain requirements are met. 5 Failure to do so will result in a residency graduate to no longer be considered “Board Eligible.”5

At this time, a specific policy does not exist for emergency medicine regarding what would be required to have board eligibility reinstated, and the summit was the precursor to drafting this policy. Many issues were debated, however, no consensus ultimately materialized. This multifaceted issue is being actively evaluated and will continue to develop in the coming months.

January 2016 RRC

The Residency Review Committee for Emergency Medicine (RRC-EM) met Jan. 14-16 in Atlanta to discuss applications for new programs in emergency medicine and its subspecialties. During each meeting, new programs are considered by the RRC-EM, which now reviews both allopathic and osteopathic programs. The committee approved the following programs for initial accreditation:

  • Kendall Regional Medical Center, Miami, FL: Emergency Medicine residency
  • University of Louisville, Louisville, KY: Emergency Medical Services (EMS) Fellowship
  • Indiana University School of Medicine, Indianapolis, IN: Pediatric Emergency Medicine Fellowship

Congratulations to these programs. As they develop, please be on the lookout for updated information on EMRA Match.

Stay tuned for further details – 2016 will certainly be a productive year for GME.

References

  1. Stallings L, Little AG. The Graduate Medical Educational Merger: Dispelling the Myths. EM Resident. 2015;42(5):8-9. Available at http://www.emresident.org/the-graduate-medical-educational-merger-dispelling-the-myths/.
  2. AAMC. Medical Resident Limits (“Caps”). https://www.aamc.org/advocacy/gme/71178/gme_gme0012.html. Accessed Feb. 17, 2016.
  3. AAMC. Medical School Enrollment to Approach 30 Percent Increase by 2019. https://www.aamc.org/newsroom/newsreleases/431036/20150430.html. Accessed Feb. 17, 2016.
  4. ABMS. Board Eligibility Policy & FAQs. http://www.abms.org/board-certification/board-eligibility/. Accessed Feb. 17, 2016.
  5. ABEM. Board Eligibility. https://www.abem.org/public/emergency-medicine-(em)-initial-certification/abem-board-eligibility/board-eligibility. Accessed Feb. 17, 2016.
Leonard Stallings, MD

Leonard Stallings, MD

EMRA RRC-EM Representative, East Carolina University, EM/IM/CC Residency, Greenville, NC
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