13. Recommendation 8

There must be at least one core family physician faculty member, in addition to the program director, for every four residents in the program.

Justification

A 1:6 ratio of core family physician faculty to residents is not adequate to successfully perform all of the clinical and non-clinical responsibilities of core faculty given the breadth and depth of family medicine training. In the most recent member survey of the Society of the Teachers of Family Medicine, 36.4% of faculty report their greatest challenge is workload/administrative burden/competing priorities(8). That number increases to >50% for faculty in university based programs(8). A 2017 article in Family Medicine illustrated that compared to the year 2000, family medicine faculty are now responsible for preparing and presenting more of the didactic content to residents while facing increased clinical and administrative burdens (6). Academic physicians, across all specialties at Massachusetts General, spend about 25% of their time on clinical administrative work (5). Those in primary care at that institution spent more time on average than other specialties in administrative work and were found to be at an increased risk of burnout (5). Clinical faculty at an academic medical center on the west coast left their institution due to the competing demands of clinical work versus educational and administrative responsibilities (7). This is not a problem that is unique to family medicine, but also encountered in other specialty training programs. An article in the Annals of Emergency Medicine recommended that the solution to faculty being able to complete all of their clinical, research and teaching demands is to increase the number of faculty and vary their responsibilities (9).   Increasing the aggregate administrative time across more core faculty creates a more equitable distribution of workload, supporting faculty wellness and retention, and meaningful non-clinical time (1-7). A 1:4 ratio of core physician faculty to residents is more consistent with the RPS Criteria for Excellence, which recommends a core faculty to resident ratio between 1:3 and 1:4 depending on the program size (10). A recent survey of the residency programs in the WWAMI network showed that the 26 programs, which have on average 23 residents, have approximately a 1:3 faculty to resident ratio (2). This new ratio would accommodate the time needed by faculty to comply with the ACGME requirements for both clinical and non-clinical duties (10). Additionally, a ratio of at least one family physician for each four residents is more in line with other specialties with similar non-clinical administrative responsibilities, e.g. Dermatology at1:3; Emergency Medicine at 1:3; and Orthopedics at 1:4. Neurology, Psychiatry, Pediatrics, Obstetrics and Gynecology have all deferred changes in their ratio to upcoming focused revisions.