There is the possibility the rule change could turn out to be a boon to HMGs, Dr. Feldman says. Programs without hospitalists may hire them; small groups may expand, increasing job opportunities. Additionally, teaching opportunities for hospitalist attendings may improve with the decreased number of patients on a service residents follow. “Hopefully, this will increase opportunities for teaching residents and increase the satisfaction of those involved in teaching,” he says. “Ultimately, it may result in improved resident education while creating more job opportunities for hospitalists―a win-win for both groups.”
Will Training Suffer?
Dr. Kealey has concerns about the long-term effects on the training residents who become hospitalists. “First, they won’t get enough experience to be competent hospitalists on graduation. Second, the number of patients is being capped, but the number of ACGME-required outpatient clinic sessions is rising, increasing from about 108 to 130 over a 30-month period,” he says. “Residency programs will to have to figure out how to fit these sessions into training, and that may squeeze out inpatient time.”
Third, with the work hours and caseload restrictions on residents, educators are concerned residents will not receive an adequate level of training.
Kenneth P. Patrick, MD, director of the hospitalist program at Chestnut Hill Hospital in Philadelphia, is worried, too, especially when it comes to the educational implications. As a former residency program director, one who shares concerns about residents’ large workloads, Dr. Patrick believes strongly in medical education and is wary of the path it seems to be taking. “What a hospital medicine group can provide to residents is the opportunity to learn from a smaller patient load,” Dr. Patrick says, “and regulatory agencies should carefully address that. Cutting back on the number of service hours and patients can have both a positive and negative effect. Most people are only adjusting the numbers of hours and patients, and not viewing the whole picture.”
Another likely result of the rules change is the mindset residents could be developing, an issue that rings true with most HMG directors. “I worry that our residents will be sheltered during training and will emerge into a real world where there won’t be caps,” Dr. Kealey says. “They will be in systems where people have to cooperate with each other in order to handle patient surges and large patient volumes. Though they may graduate, join a group, and become acculturated, it concerns me that their initial primary training, rather than encouraging them to think as part of a system, may be training them to think of ‘my restrictions, my needs, my limitation.’ ”