Dual Director: Serving as Program Director and Sports Medicine Fellowship Director

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James Tytko, MD recently joined the AFMRD. He serves as director of a family medicine residency program and a primary care sports medicine fellowship program. Dr. Tytko shares his experiences below.   


Background

I am currently both the director of a family medicine residency program and a primary care sports medicine fellowship program. Initially, I was unaware that the ACGME would allow an individual to assume both positions, and I imagine that most faculty members and directors of other programs are also unaware of this possibility. I would like to explain how this can be successfully achieved and what are the advantages and disadvantages of being a dual director.

In 1983, I became a faculty member of a family medicine program. At that time my hospital started a sports medicine center, and I began seeing patients there with a sports fellowship trained orthopedic surgeon.  After 5 years of clinical experience and adequate CME hours I was able to sit and pass the sports medicine CAQ exam.  In 1994, I started a primary care sports medicine fellowship program and became its first and only program director. The program has always been fully accredited and although we changed sponsoring institutions, I remained the director.

In the summer of 2016 I was approached to become the director of a new family medicine residency program.  Unaware I could maintain both positions, I reviewed the requirements of the ACGME for both programs and realized it was possible. The application and site visit were completed, and we received initial accreditation in January 2017.  We matched with 6 residents, built a new family medicine clinic, hired an associate director and a full- time faculty member, and began the residency July 1, 2017.  In April 2018, both programs became fully accredited.

ACGME requirements

 The specific requirements for residency program directors, fellowship program directors, and common program requirements are completely detailed on the ACGME website.

Program Director for the Family Medicine Residency

Program Directors must be board certified, licensed and have 5 years teaching/administrative experience.  He/she is obligated to spend 28 hours per week with the residency and has to see a parcel of patients in addition, to maintain clinical skills.  Most directors spend a half day or 4 hours a week seeing their own patients, which equates to 32 total hours a week.

Sports Medicine Fellowship Director

 Fellowship Directors must be board certified in their primary specialty and have passed the CAQ exam for sports medicine.  He/she must spend 10 hours a week involved in the fellowship program.

Dual Role

Therefore, to satisfy the ACGME requirements, the dual director must spend 42 hours per week between the two programs.  Other family medicine sponsored fellowships have various requirements of the program director by the ACGME. Geriatric fellowship directors must spend 20 hours per week with their program.  Clinical informatics program directors must spend 20% of their time with the program. (minimum 8hours per week).  Addiction- medicine fellowship directors are not required to spend a specific amount of time per week with the program.  Hospice and Palliative Medicine fellowship directors must devote 20-50% of their time to the program.

Advantages of Being a Dual Director

There are many advantages to being a dual director. For example, recruitment to both programs is enhanced.  Applicants to the family medicine program are excited about the potential of a fellowship after residency. Even those who are not interested in the fellowship realize that they could have an enhanced sports medicine, musculoskeletal experience during the residency. The fellowship director can recruit the fellows “in house” from the residency and begin to prepare the resident for the fellowship. An original research project combining family medicine and sports medicine could begin during the residency and be carried over in the fellowship, satisfying scholarly activity requirements for both programs. 

A dual director can expect to be compensated higher than a director of a single program.  The sponsoring institution would favor this arrangement since the dual director would only receive one set of benefits. Requests to subsidize annual conferences in both specialties can be made by the dual director. The ACGME common program requirements are essentially the same for both programs, so the director has a relatively straightforward job of maintaining accreditation for both programs. In addition, the interview season and match dates are different for both programs and therefore the interview sessions can be separated.  The sports fellow (if family medicine) will spend 10% of their time seeing patients in the family medicine clinic.

Disadvantages of Being a Dual Director

 One disadvantage of being a dual director is the length of time required to run both programs. Additionally, there is the potential of having to be in two places at the same time.  If you are unable to recruit the fellows from the residency you will have two interview seasons and two Match days. The dual director has to complete all the evaluations for both programs and has to prepare for two site visits, which can be back to back.

Starting two programs simultaneously would be extremely difficult. It would make more sense to add a second program to an existing, accredited program. Although being a director of two programs has had many challenges, I have found it to be very personally and professionally rewarding.  If anyone is interested in pursuing a similar opportunity I would happy to be a resource.

--James M. Tytko, MD, FAAFP, Beavercreek, Ohio 

References

  1. ACGME Program Requirements for Graduate Medical Education in Family Medicine. July 1, 2018.
  2. ACGME Program Requirements for Graduate Medical Education in Sports Medicine. July1,2017.
  3. ACGME Program Requirements for Graduate Medical Education in Geriatric Medicine. July 1, 2017.
  4. ACGME Program Requirements for Graduate Medical Education in Clinical Informatics. July 1, 2017.
  5. ACGME Program Requirements for Graduate Medical Education in Addiction Medicine. February 5, 2018.
  6. ACGME Program Requirements for Graduate Medical Education in Hospice and Palliative Medicine. July 1, 2018.