**Abstract**

Starting a new ACGME approved residency program can positively impact patient care, medical education, hospital operations, and the community as whole. This requires a significant amount of commitment, time, and preparation. The initial application and accreditation process should start early and requires a thorough understanding on the ACGME requirements. Building a new residency program involves collaboration among various stakeholders, starting with the teaching hospital, ACGME, and the Center of Medicare and Medicaid services (CMS). It is prudent to also consider the operational and logistical issues such as budget, faculty and administrative staff hire, faculty time for administrative duties, and educational space for faculty and residents. It is vital to recognize how the institution's strengths and weaknesses match up to these requirements. A robust educational and clinical curriculum in line with ACGME's core competencies and useful educational collaboration among various programs is critical for effective program. Recruiting and developing the appropriate faculty members is another important aspect for a successful program. The final challenge is recruiting residents that will fit well into the new residency program. Lastly, we discuss the challenges and tips to mitigate the risks of disappointment in the process of starting and creating a flagship residency program.

**Keywords:** new residency program, ACGME accreditation, site visit, faculty development, faculty collaboration, residency curriculum, time line, marketing, benefits, challenges, tips

### **1. Introduction**

In a report released by the Association of American Medical Colleges in June of 2020, United States could see a projected shortage of between 54,100 and 139,000 physicians, including gaps in both primary and specialty care, by 2033 [1]. The report also emphasizes the systematic differences in the annual use of health-care services by urban-rural location, insured-uninsured status, and race and ethnicity. US population is projected to grow by 10.4% from about 327 million to 361 million during the period of 2018–2033 [1]. The challenge of having sufficient doctors to serve our communities will get even worse as the nation's population continues to grow and age [2]. In addition, COVID-19 pandemic is likely to have short- and long-term consequences on the nation's physician workforce. The gap between the country's increasing health-care demands and the supply of physicians to effectively fill has become even more palpable during COVID-19 pandemic [1]. Thus, it is incumbent upon governments, academic institutions, hospital systems, and us as educators to work diligently toward addressing this problem. One such way is to increase the number of quality training opportunities for medical school graduates by initiating a residency and fellowship training program. Very less has been published on the steps and benefits of starting a new residency program accredited by ACGME. The ACGME is a private, 501(c)(3), and not-for-profit organization that sets standards for US graduate medical education (residency and fellowship) programs [3]. The ACGME renders accreditation decisions based on compliance with these requirements. The process is not without challenges, however, we have tried to create a guide built on personal experiences.

### **2. Benefits of starting a new residency**

The community benefits of residency programs spread far outside the teaching hospital boundaries and provide profits far beyond the standard annual hospital reports. Graduate medical education residency programs provide an overall positive impact at various levels right from residents and institutions to communities and the nation as whole.

GME programs deliver a disproportionate share of the care to historically underserved minorities and patients requiring transfer from other institutions for advanced care [4, 5]. More than 50% of the nation's health-care "safety net" is provided by the GME training programs in the university and community-based institutions which is an important justification of the "not-for-profit" status of these institutes [6]. The probability of a family physician settling in an underserved community increases by three to four times if they train in a community health centers affiliated with a teaching hospital-based program [7].

Besides imparting the medical knowledge to resident physicians, GME residency programs support the institution by continuing the medical education of the faculty, nursing staff, and other members of the health-care team, thus improving an overall quality of care in teaching hospitals [6, 8]. Major teaching hospitals were associated with lower 30-day mortality rates for common medical and surgical conditions ranging from pneumonia to hip replacement among hospitalizations for US Medicare beneficiaries [8]. The findings in another study suggest that mortality rates for even low-severity patients seem to be lower at teaching hospitals [9]. The attention to detail inherent in a teaching setting with a focus on innovation, frequent use of current medical literature to guide clinical decision-making, and more frequent and thorough case reviews may contribute to a lower incidence of adverse occurrences [2, 4].

Resident physicians not only provide around-the-clock coverage but also provide an economic advantage with lower Medicare spending at 30 days compared with Medicare patients at nonteaching hospitals [10]. Academic medical centers had slightly lower overall total costs compared with nonteaching centers mainly because of lower spending on post-acute care and readmissions. Better intensity of care

#### *Starting New Accreditation Council for Graduate Medical Education (ACGME) Residency... DOI: http://dx.doi.org/10.5772/intechopen.93617*

during the index hospitalization, more integrated post-acute care, and/or more robust care management services during the period immediately after discharge in teaching hospitals could be the reasons for these differences [11].

The teaching clinics affiliated with the hospital can increase the referral, hospital-based outpatient services, hospital admissions, and eventually revenue of teaching hospitals [6, 12, 13]. It can also help retain and recruit physicians in the health systems, especially at places with physician shortage areas. By hiring their own residency program-trained physicians, the hospitals can not only save the recruitment costs but these new physicians can also hit the ground running, thus saving both time and money for the institutions.

Data from a recent American Hospital Association survey suggest that teaching hospitals tend to have superior adoption rates of telehealth [14]. Compared with nonteaching hospitals, teaching hospitals have better odds of offering telehealth visits, chronic care management remote patient monitoring, post-discharge remote patient monitoring, telepsychiatry, and tele stroke [15].

Teaching hospitals tend to attract and cultivate people who are at the top of their fields and deeply committed. Patient care, medical education, and research come together at teaching hospitals to generate an environment that not only innovates health care but also benefits individual patients.

Examining the benefits of GME programs to the institutions and communities that sponsor them can provide a fundamental approach for preparation, resource distribution, improvement, and quality impacts within those institutions [6].
