The system of residency training in the United States has at its core a perpetual tension between service and education. Graduate medical education (GME) is financed through prospective payments to teaching hospitals, where house officers compose a significant portion of the health care workforce. Numerous changes have occurred during the past 20 years that have put increasing pressure on this delicate balance. Radical transformation in the structure and process of GME training, most notably duty hour limitations, has led to compression of work, coupled with increasing emphasis on patient safety and quality. Hospitals have simultaneously undergone equally radical changes resulting from economic forces that have intensified pressure on faculty to increase clinical productivity to generate revenue. As a result, less time is available for faculty to teach and for trainees to learn.
Turner TL, Fielder E, Ward MA. Balancing Service and Education in Residency TrainingA Logical Fallacy. JAMA Pediatr. 2016;170(2):101-102. doi:10.1001/jamapediatrics.2015.3816