P2.F103: Neonatology Response to ACGME Residency Changes and Shortening of Shift Duration

Background: The ACGME has proposed significant reductions in the amount of time pediatric residents train in intensive care to be formally implemented by July 2025. Pediatric intensive care shift duration has been previously reduced in many centers. Both situations create significant challenges for neonatology. The Organization of Neonatal Training Program Directors (ONTPD) surveyed neonatal-perinatal medicine fellowship program leadership to describe program responses to these changes.

Methods: Program leadership of all US neonatal-perinatal fellowship programs were surveyed with a 90% response rate (N=97). Surveys were resent multiple times to achieve an excellent response rate and efforts were made to ensure one response per institution.

Results: The majority of programs report that they will hire more advanced practice providers (N=65) and hospitalists (N=21) to fill the clinical coverage gaps. Nearly half of programs will restructure clinical teams due to fewer residents working in the neonatal intensive care unit (N=48). Other changes regarding orientation and onboarding were reported (Table 1). Shift duration varies at different training levels. The majority of programs have at least some physician team members in house for 24hr calls (n=93, 95.9%). It was most common to have fellows do 24hr in-house calls (n=82, 84.5%), then attendings (n=65, 67%), and least often residents (n=30, 30.9%). Programs varied in their requirement to round post call from 24hr in-house call. Half of programs have attendings round post-call (n=47, 48.5%) whereas fellow and resident post-call rounding was less common (n=21, 21.7% fellows, n=10, 10.3% residents). The other 39 programs had no 24hr in house call or did not ask any physician team members to round post call.

Conclusion: Decreased pediatric residency training in intensive care coupled with shorter shift durations have created a need for neonatology divisions to devise ways to compensate for the loss of clinical care that pediatric residents have previously provided. With time, programs will understand how best to provide the best clinical care in the face of these challenges while optimizing the education of trainees. Changes in residency structure and shift duration may lead to new challenges in fellow training. Much is unknown about the true impact this will have on neonatal-perinatal medicine future physician recruitment.