Recognizing the Work and Well-Being of Residency and Fellowship Program Coordinators

Program coordinators are a vital segment of the graduate medical education workforce. Program coordinators play an invaluable role in physician training by ensuring that education requirements are fulfilled, arranging lectures and clinical schedules, maintaining accurate documentation, organizing recruitment functions, and assuring policy adherence, among other duties.1 Many of these activities are high-stakes, such as interacting with accreditation bodies, human resources offices, and legal or compliance offices, and nearly all of them are high-impact in that they affect daily work and work–life balance for many dozens of people.2 Moreover, as they welcome, listen, advise, organize, and mobilize, coordinators often are the face, heart, and soul of a graduate medical education program. Over the past 26 years since the introduction of the competency-based model for graduate training by the Accreditation Council for Graduate Medical Education (ACGME), program coordinators’ roles have become much more complex.3 The program coordinator plays a crucial part in supporting the ability of program directors and other faculty members to train future clinicians who will demonstrate the ACGME’s 6 core competencies for graduate medical education and often takes on crucial administrative functions.4 As noted by Stuckelman et al,3 “Our role has evolved from a coordinator of tasks and resources to a manager of people, policies, and outcomes.” Indeed, with the evolution of health professions education, clinical medicine, and health systems, the administration of residency and fellowship programs increasingly relies upon the expanded responsibilities and growing professional and leadership capabilities of program coordinators.1,5 Activities associated with the role vary according to different clinical and training needs and institutional environments, including community-based and academic medical settings.6 The ACGME recently described the importance of program coordinators, stating that each is “a key member of the leadership team” and “critical to the success” of postgraduate physician training.4 Work satisfaction and well-being of program and institutional coordinators are the focus of a national survey conducted in 2022 by Slavin et al7 and reported in this issue of Academic Medicine. Nearly 12,000 coordinators identified via the ACGME database were invited to participate. A total of 6,372 responses were received, with the majority of respondents (82.4%) serving in the role of program coordinator or manager. The survey produced some encouraging results as well as some worrisome findings. The analyses and recommendations proffered in this report provide valuable insights for education leaders who work closely with program coordinators and the organizations that have residents and fellows in training. The good news is that most of the respondents (62.2%) in the study reported being satisfied or very satisfied with their current work situation, and nearly half (47.5%) indicated they were unlikely or very unlikely to leave their position in the next year. Positive interactions with residents and fellows, program leaders, administrative staff, faculty, and program leaders were endorsed as the leading sources of satisfaction in their work. Other satisfiers included having a sense of self-efficacy, finding meaning in their work, taking on challenges, as well as specific aspects of their employment, such as being able to set priorities, having a flexible schedule, and receiving benefits and compensation. Of particular concern, though, were the mental health symptoms and rates of emotional exhaustion and depersonalization reported by a number of the program coordinator respondents. Nearly half (48.0%) indicated depression symptoms, for example, and more than half (57.9%) indicated anxiety symptoms. More than one-third reported experiencing emotional exhaustion (“burned out”) and about one-fifth reported depersonalization (“becoming callous toward people”) at least once per week. It is not surprising, then, that 20.4% of the program or institutional coordinators in the Slavin et al7 study expressed dissatisfaction with work. A larger proportion (27.9%) indicated that they were likely or very likely to leave their jobs in the coming year. The greatest drivers of unhappiness in the role included their overall workload, compensation for their work, and tracking and reminding faculty and residents to complete tasks. The work experiences of program coordinators and other administrative staff engaged with training programs have received limited attention in the education literature.6–11 A recent national cross-sectional study10 of more than 900 residency and fellowship program administrators asked about access to organizational wellness resources and assessed 3 types of burnout (i.e., personal, work-related, and client-related) using the Copenhagen Burnout Inventory (CBI). Just 14% of respondents reported that their institutions offered wellness activities for individuals in coordinator roles. Elevated burnout levels across all 3 CBI subscales were documented, as well as variation across geographic regions and timing across the academic year.10,11 Interestingly, the burnout patterns found among program coordinators may resemble those of physicians working in the same specialty areas that the coordinators do.10 It seems that the concerns of program coordinators may to some extent mirror those of residents, fellows, and attending physicians who also report symptoms of depression and anxiety, feelings of burnout, and dissatisfaction with work or work–life balance.11–16 It should also be noted that program coordinators often help residents and fellows navigate mental health and workplace concerns17 while often facing similar issues themselves. Such experiences were heightened during the pandemic and the immediate postpandemic period, and additional study is needed to understand whether these issues will continue at similar levels into the future.18,19 In terms of solutions, the broader literatures concerning work satisfaction and well-being have identified factors that may have relevance for improving the workplace experiences of program coordinators. These factors include the leadership environment, social support, alignment between work objectives and skillset, availability of resources for contribution and growth, fair and respectful ways of measuring work performance, work–life balance, and fair compensation and benefits.11–15 Feeling that one is valued—including the sense of being valued as a person, of not feeling taken for granted, and not being discriminated against due to personal characteristics—is also critical to job satisfaction.13 Intentional efforts to address sources of dissatisfaction, burnout, and turnover among program coordinators are important in supporting their personal well-being and may serve to strengthen the quality of physician training programs. Ideally, program coordinators should be offered access to clinical and wellness resources as well as professional development opportunities, such as mentorship programs, leadership training, and structured peer support networks. As is the case for other employees, fair and transparent approaches related to work expectations and performance, compensation, benefits, and promotion structure are undoubtedly important for program coordinators. Moreover, findings from the Slavin et al7 study also suggest that respectful interactions with learners, peers, faculty, and leaders in the workplace are crucial and serve to demonstrate that program coordinators are fully recognized and deeply regarded as people, as contributors, and as members of the training leadership team. Every individual and every role in academic medicine bring tremendous value to our field. The graduate medical education workforce in the United States includes more than 10,000 residency and fellowship program coordinators—individuals who serve in vital and expanded roles to support excellence in physician training. Program coordinators have specialized knowledge and skills and are highly accountable, but their concerns may be underrecognized. We are learning that many program coordinators experience significant distress and encounter barriers to satisfaction and sustainability in their roles. As we endeavor to improve institutional efforts to support program coordinators, let us start with something simple but meaningful: a few kind words.