Nephrology Program Director Protected Time for Program Administration in the United States

Background and objectives The Accreditation Council for Graduate Medical Education (ACGME) required that program directors receive 10–20 h/wk of protected time for program administration (including didactic teaching). In July 2022, this was reduced for all internal medicine subspecialties on the basis of program size, with 8 h/wk required for programs with fewer than seven fellows, the majority of nephrology programs. Design, setting, participants, & measurements We surveyed all 151 US adult nephrology program directors (ACGME Public List of Programs 2021–2022) to determine how much protected time they receive, how much they think is necessary, and the division of their professional time. The anonymous 20-question online survey was administered from March 31 to April 30, 2022. The analysis was descriptive. Results Response rate was 66% (99 of 151). Geographic distribution and approved fellow positions were similar to programs nationally; 59% had fewer than seven approved positions. Median protected time was 10 h/wk (interquartile range, 5–10), with 8 h/wk (interquartile range, 5–10) for those with fewer than seven positions. Program directors estimated needing 12 h/wk (interquartile range, 10–16) to effectively administer programs, including those with fewer than seven positions, a median 5 h/wk (interquartile range, 0–7) more than received. Of program directors reporting <10 h/wk for program administration, 62% provided >20 hours of direct patient care. Thirty-nine percent had no protected time for core faculty. Fellow recruitment (68%) was the most time-consuming task, and didactic teaching (80%) was the most professionally rewarding. Conclusions Approximately half of the nephrology programs surveyed were not in compliance with the ACGME-stipulated 10-h/wk minimum protected time for the 2021–2022 training year. Program directors estimated a median of 12 h/wk are needed to effectively manage programs.