Each of the 16 Canadian medical schools has a psychiatry. Canadian Psychiatry Residency Training Programs: A Glance at the Management Structure

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1 Brief Communication Canadian Psychiatry Residency Training Programs: A Glance at the Management Structure Louis T van Zyl, MB, ChB, MMedPsych, FRCPC 1, Paul R Davidson, PhD, CPsych 2 Objectives: To describe the administrative functioning of all current Canadian psychiatry residency training programs (RTPs) and to suggest available improvements to existing systems. Method: We obtained data about the 2004 RTPs by distributing 2 questionnaires to all Canadian psychiatry RTPs. Results: Residency program committees (RPCs) are mainly consultative and carry only a small amount of the workload of managing a residency program. Program directors (PDs) manage more than 80% of the work and report that the time allowance to perform their duties is suboptimal. PDs remain in office for about 5 years, departing during or at the end of a predetermined second term. Conclusion: RPCs bear only a small amount of the workload generated by the RTP. We piloted administrative changes that led to more equitable work distribution. (Can J Psychiatry 2006;51: ) Information on funding and support and author affiliations appears at the end of the article. Clinical Implications Owing to its focus on issues of residency program administration, there are no clinical implications related to this paper. Limitations Reported workload measures are subjective. Generalizing this data beyond Canadian jurisdictions is problematic. Limited information regarding terms of office of past PDs is available. Key Words: physician executives, program development, professional staff committees, organization and administration, stress (psychological), internship and residency (organization and administration) Each of the 16 Canadian medical schools has a psychiatry RTP. These vary in size according to the number of residents in training. Every program is overseen by a PD and an RPC. The Royal College of Physicians and Surgeons of Canada sets standards and guidelines for residency programs and outlines the responsibilities of a PD and a supportive RPC (1). We collected information about general administrative structures for RPCs at Canadian psychiatry training programs, using a questionnaire that was circulated in person or by mail in 2004 to all PDs. We had a response rate of 100%. To obtain specific information about current and past PDs, we mailed a second questionnaire several months later. The follow-up survey had an 81% response rate. We have elsewhere presented parts of this data in summary format (2) but did not include data from the individual programs. The complete data are important to Canadian psychiatry RTPs because they allow specific comparisons among Can J Psychiatry, Vol 51, No 6, May

2 The Canadian Journal of Psychiatry Brief Communication individual schools. Accordingly, in this study we present the complete data and highlight several issues across programs. Survey Results and Discussion Program Size and Structure of the RPC In Canada, there are 6 small programs (that is, fewer than 25 residents), 6 medium-sized programs (that is, 26 to 40 residents), and 4 large programs (that is, more than 40 residents). The size of the RPC does not appear to be related to the number of residents (Table 1); however, the size of the program is related to the number of standing subcommittees. Of the 16 programs, 12 reported at least one standing subcommittee (range = 1 to 10), with smaller programs reporting a mean of 1.5 committees, medium-sized programs a mean of 4.0 committees, and large programs reporting a mean of 6.3 committees. All programs reported specific work roles for some members of the RPC, but these varied between programs. RPCs of small programs had an average of 1.8 work roles, medium-sized programs had an average of 2.0 roles, and large programs had an average of 3.5 roles assigned for each RPC. The overall average was 2.3. Roles included managing rotation evaluation forms, psychotherapy, individual program and site matters, curriculum development, developing training objectives, funding resident activities, research, core program management, safety and security, Canadian residency matching service, PGY1 issues, and continuing professional development. The PD and the RPC: Sharing the Burden Of the 16 directors, 14 reported that their RPC functioned mainly as a consultant. On average, it was estimated that the PDs performed 84% of the committee s duties (range 67% to 90%). PDs carry the brunt of the work generated by RTPs. However, the fact that most RPCs have standing committees suggests the intent to divide the workload between the committees and the PDs. Table 1 indicates that the PD carried 90% or more of Abbreviations used in this article FTE full-time equivalent PD program director PGY1 postgraduate Year 1 RPC residency program committee RTP residency training program the work in programs with no subcommittees, whereas the work of the PD was less in programs with many subcommittees. Of PDs total work time, 38% or 0.38 FTE was allocated to the RTP duties. This is well below Beresin s recommendation of about 50% of full-time or 0.5 FTE (3). Only 3 of the programs met this target. This was not well accepted and one-half of the 16 PDs stated that they required more time than was available to perform their duties. PD s Term of Office PDs reported having served an average of 3.5 years (range 1 to 10 years). In 2 cases, the appointments are indeterminate in. In the remainder, the average term is 4.0 years (range 3 to 5 years). In two-thirds of the cases, the term appointment is renewable, and at most schools, the renewals are limited to one time. The data indicate that historically PDs have remained in office about 5 years (range 1 to 10 years). The role of the PD is difficult, and there is a high rate of turnover. At some US schools, high turnover in PDs is related to administrative problems, lack of institution support for the RTP, loss of job satisfaction, little hope of promotion, a desire to spend more time teaching or doing clinical work, and plans to take a less demanding job (4). These issues may account for the relatively short times that Canadian PDs are in office (mean 4.8 years, Table 2). We did not collect the data necessary to examine this possibility. Addressing the Problem Queen s University has addressed the inequity of the workload between the PD and the RPC. We have recently described a novel approach to streamline the administration of our psychiatry RTP, leading to a PD:RPC workload ratio shift from 90:10 to 60:40. This resulted in a more efficient RPC and RTP (2). According to our system, each member of the RPC has a portfolio of responsibilities. This resulted in a substantial decrease in the workload carried by the PD, which enabled the PD to stay current with major areas of the RTP without bearing the brunt of the administrative work. Funding and Support This study received no funding or support. Acknowledgements We thank the directors of postgraduate education of the various departments of psychiatry across Canada who participated in this survey and we acknowledge their contributions. We also acknowledge contributions to earlier work on this project by Dr Susan Filch and Dr J Arboleda-Florez. 378 Can J Psychiatry, Vol 51, No 6, May 2006

3 Canadian Psychiatry Residency Training Programs: A Glance at the Management Structure Table 1 Individual program responses to first questionnaire University RTP Average Toronto Montreal Laval British Columbia Dalhousie Manitoba McMaster McGill Ottawa Alberta Memorial Western Calgary Sherbrooke Saskatchewan Queen s a N N N N N N Y N N N Y N N N N N Y 2/ 16 PD assisted by a codirector? Secretarial support (percentage of full time)? Percentage of PD s time dedicated to program? If not sufficient, what percentage is ideal? Residents in program (n)? Members on RPC (n)? Residents on RPC (n)? Y Y Y Y Y Y Y N Y Y Y Y N Y Y - Y 13/15 Chief resident a member? Meeting frequency? M M M M M M M M M M M M 2 W M M M M 15/16 N Y Y Y N N Y Y Y Y Y N Y Y Y Y Y 12/16 Any RPC standing committees? How many standing committees? Y Y Y Y N Y Y N Y Y Y Y Y Y Y Y Y 14/16 RPC role mainly consulting? N Y N N N N N Y Y N N N Y Y Y Y Y 7/ 16 Do RPC members carry a substantial portion of workload? N = no; M = monthly; W = weekly; Y = yes a The responses for Queen s University were collected prior to the implementation of the new administrative system. Can J Psychiatry, Vol 51, No 6, May

4 The Canadian Journal of Psychiatry Brief Communication Table 2 Program Directors terms in office: responses to follow-up questionnaire Psychiatry RTPs Average Toronto Montreal Laval British Columbia Dalhousie Manitoba McMaster McGill Ottawa Alberta Memorial Western Calgary Sherbrooke Saskatchewan Queen s a PD information as of January 15, Year assumed office Years in office NR NR NR NR 3.0 IN IN IN IN 5.0 NR NR Appointment term (years) N N NR Y NA NA NA Y Y Y Y NA Y NR NR Y Y 6/ 12, N 3/ 12, NA 3 /12 If term appointment, is it renewable? NA NA NR 2.0 NA NA NA IN NA 1.0 NR NR If renewable, how many times? Term in office 1 1 NR NR NR Past PDs NR NR NR Years in office Immediate predecessor NR NR NR Number of terms in office a Queen s University prior to 2001 IN = indeterminate; N = no; NA = not applicable; NR = no reply received; Y = yes 380 Can J Psychiatry, Vol 51, No 6, May 2006

5 Canadian Psychiatry Residency Training Programs: A Glance at the Management Structure References 1. Royal College of Physicians and Surgeons of Canada. Accreditation of residency programs: specific standards of accreditation for residency programs in psychiatry. Royal College of Physicians and Surgeons of Canada. Available: Accessed 2005 June van Zyl LT, Finch SJ, Davidson PR, Arboleda-Florez J. Administrative restructuring of a residency training program for improved efficiency and output. Acad Psychiatry 2005;29: Beresin EV. The administration of residency training programs. Child Adolesc Psychiatr Clin N Am 2002 Jan;11: Barton LL, Friedman AD. Stress and the residency program director. Arch Pediatr Adolesc Med 1994;148: Manuscript received July 2005, revised, and accepted January Past Director, Residency Training Program, Department of Psychiatry, Queen s University, Kingston, Ontario. 2 Codirector, Anxiety Disorders Program, Department of Psychiatry, Queen s University, Kingston, Ontario; Psychologist and Clinical Supervisor, Department of Psychology, Queen s University, Kingston, Ontario. Address for correspondence: Dr LT van Zyl, Division of Consultation-Liaison Psychiatry Connell-4, Suite 2-489, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7; Résumé : Les programmes canadiens de résidence en psychiatrie : un coup d œil sur la structure de gestion Objectif : Décrire le fonctionnement administratif de tous les programmes canadiens actuels de résidence (PR) en psychiatrie et suggérer des améliorations disponibles aux systèmes existants. Méthode : Nous avons obtenu des données sur les PR de 2004 en distribuant 2 questionnaires à tous les PR canadiens en psychiatrie. Résultats : Les comités des programmes de résidence (CPR) sont principalement consultatifs et n effectuent qu une petite partie de la charge de travail que comporte la gestion d un programme de résidence. Les directeurs de programmes (DP) gèrent plus de 80 % du travail et déclarent que le temps alloué à l exécution de leurs fonctions est sous-optimal. Les DP demeurent en poste environ 5 ans, quittant pendant ou après un deuxième terme prédéterminé. Conclusion : Les CPR n effectuent qu une petite partie de la charge de travail que comporte un PR. Nous avons mis à l essai des changements administratifs qui ont mené à une répartition des tâches plus équitable Can J Psychiatry, Vol 51, No 6, May

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