Residency training directors (TDs) and associate training directors (ATDs) assume a vital role in academic departments and require considerable competency and skill to carry out a variety of multifaceted tasks (1–3). In order to maintain stability in residency training and continuity in leadership, the Residency Review Committee for psychiatry has established 5 years as the minimum term of appointment for directors who oversee training programs in general adult psychiatry (4). Similar time-commitment standards for ATDs have not been established.

Our recent survey of ATDs in psychiatry found that most (71.3%) were in their current position for 3 years or less (3). This may, in part, be due to the relatively new guidelines regarding the establishment of ATD positions (4). Alternatively, the ATD position may be an inherently transitional step in the pathway toward becoming a TD. Approximately two-thirds of TDs in emergency medicine and half of the TDs in surgery reported that they had previously held ATD positions (1, 5). However, it is also possible that ATDs are at increased risk for burn-out and early job turnover. In order to identify factors that might be associated with longevity in the ATD role, we conducted an exploratory, secondary analysis of job satisfaction among ATDs, based upon the amount of time they spent in the position.

As previously described (3), we conducted an IRB-approved, anonymous, web-based survey of all ATDs in 2009. Respondents were grouped into one of three categories, based on the amount of time they had been in their current ATD position (≤3 years, 4–5 years, or ≥6 years). Differences between the mean Likert responses to statements related to job satisfaction and career goals (with a rating of 1 indicating Strongly Disagree and 5 indicating Strongly Agree) were determined using a one-way ANOVA. Data were also compared by calculating the percentage of ATDs who agreed or strongly agreed with each statement, and we calculated odds ratios (ORs) with associated 95% confidence intervals (CIs). A probability value of <0.05 was considered significant.

In all, 73 of 170 ATDs (42.9%) completed the survey. Seasoned ATDs (≥6 years in the job; N=12) responded most positively to job satisfaction items, as compared with new (≤3 years; N=52) or midrange (4–5 years; N=9) ATDs. However, a bimodal distribution in job satisfaction was noted, with new and seasoned ATDs having relatively higher job satisfaction than those who had been in the position for 4–5 years (Figure 1). Differences between the three groups were significant when comparing responses regarding adequate time for the position (F[2,70]=4.9; p=0.01), adequate time to perform scholarly work in the area of medical education (F[2,70]=4.2; p=0.019), adequate authority to ensure that responsibilities are fulfilled (F[2,70]=3.8; p=0.027) and adequate independence to initiate projects “I deem worthy” within the program (F[2,70]=3.3; p=0.045).

These differences were particularly striking when comparing those ATDs who had been in the position for 4–5 years with those in the position for ≥6 years. For example, 91.7% of ATDs in the position ≥6 years agreed that they had adequate time for the position, versus 22.2% of ATDs in the position for 4–5 years (OR: 38.5; 95% CI: 2.9–508; p=0.002). Similarly, 91.7% of ATDs in the position for ≥6 years felt that they had adequate authority, whereas only 33.3% of ATDs in the position for 4–5 years agreed with this item (OR: 22; 95% CI: 1.9–261; p=0.02).

Statements related to career goals also differed between the three groups. Those in the position for ≥6 years had higher agreement ratings indicating that they were generally satisfied with being an ATD and not interested in becoming a TD (F[2,70]=4.5; p=0.015). These ATDs were also less likely to agree that it is important that they advance in academic rank (F[2,70]=7.2; p=0.001).

The finding that ATDs in the position for ≥6 years were the most satisfied with their positions is not surprising. Job satisfaction has been noted to be highest among TDs in obstetrics and gynecology with more than 5 years of experience in the role (6). Naturally, those most dissatisfied are unlikely to continue in the position long-term. However, the results of this study also suggest that ATDs may be particularly vulnerable to burn-out after 3 years in the position.

Within this study, it is unlikely that those ATDs in the position for 4–5 years are occupying positions with inherently different qualities. More likely, expectations regarding the position evolve, and the same circumstances become sources of dissatisfaction. Those new in the position may be focusing on mastering the many task-oriented aspects of the job. As ATDs become more skilled, their attention shifts toward long-term career goals.

Although inadequate time and limited opportunities to pursue scholarly activity are concerns frequently noted by TDs (1), ATDs are often junior faculty members (3) and may be particularly susceptible to challenges pertaining to authority and independence. ATDs who continue in their positions for 6 years or more may occupy positions that provide substantial protected time, authority, and independence, or they may have unique career goals that allow them to be satisfied with less authority and independence.

This study is limited by the small sample size of those ATDs in the position for longer than 3 years (N=21). Although the data in this study are cross-sectional, the results suggest that job satisfaction may change over time. Without opportunities and protected time to develop scholarly work, independence, and authority, ATDs may be at substantial risk for burn-out. Future prospective, longitudinal studies are warranted. For example, it would be particularly informative to know what percentage of ATDs go on to become TDs, pursue other administrative positions, or leave the field of administration and medical education altogether. This study could also be augmented with more in- depth, qualitative interviews of ATDs to investigate how satisfaction with the position may evolve over time and to clarify the association between various aspects of the position and personal career goals with long-term success.

The authors express gratitude to Lucille Meinsler and AADPRT for their support and Claire Pouncey, M.D., Ph.D., and Debbie Miller, Ph.D., for their contributions in development of the survey.

The study was approved by Institutional Review Boards at the New York State Psychiatric Institute and University of Miami. The institutional review boards at Stanford University and the University of Texas Southwestern Medical Center made the determination that this project was exempt from human subjects review.

The authors have no competing interests to disclose.