Bw. Beasley et al., Job turnover and its correlates among residency program directors in internal medicine: A three-year cohort study, ACAD MED, 76(11), 2001, pp. 1127-1135
Purpose. In 1983, 43% of internal medicine residency program directors had
held their positions for less than three years. The purposes of this study
were to determine the job turnover rate for internal medicine program direc
tors, and the characteristics of program directors and residency programs t
hat are associated with job turnover.
Method. In October 1996, questionnaires were sent to all non-military inter
nal medicine residency program directors in the continental United States l
isted by the Accreditation Council for Graduate Medical Education (ACGME).
The questionnaire covered demographics, program characteristics, and job sa
tisfaction. In October 1999, an updated ACGME list was used to contact prog
rams to verify changes in program directors and determine the dates of chan
ge.
Results. A total of 262 usable responses were received. At the beginning of
the study, 49% of the respondents had been on the job for three years or l
ess, and 74 (29%) were no longer program directors three years later. Overa
ll job satisfaction was highly associated (p<.01) with turnover. Multivaria
te Cox regression modeling yielded four variables independently associated
with turnover: low satisfaction with colleague relationships (hazard ratio
= 3.2, 95% CI=1.6-6.4), a high percentage of administrative work time (HR=2
.9, 95% CI=1.4-6.2), perceiving the job as a "steppingstone" (HR=1.8, 95% C
I=1.0-3.2), and having had formal training to deal with problem residents (
HR=0.6, 95% CI=0.4-1.1). Respondents with burnout, with the titles of progr
am director and chair or department chief, and with less than two years on
the job had nonsignificant trends toward job turnover. Variables not associ
ated with turnover included gender, rank, salary, and program size.
Conclusions. Yearly turnover for internal medicine residency program direct
ors is substantial. The four independent predictors of turnover identified
in this study should be of interest to institutions recruiting or retaining
program directors and to aspiring program directors.