What Makes Family Medicine Residency the Best Training for Primary Care Doctors?
Because Family Medicine residencies concentrate learners’ time and experience on the activities which are most relevant to primary care practice: Train for What You Plan to Do!
- Emphasis on the Art of Outpatient Medicine: Since the majority of Primary Care Physicians’ time is devoted to caring for patients in an outpatient setting, Family Medicine residency programs train young physicians extensively and continuously in the art of outpatient medicine. FM residents see continuity outpatients in the office 2 sessions weekly in 1st year (1/2 day sessions), and 3-5 sessions weekly in the 2nd and 3rd years. On average, they will see patients between 400-500 sessions over a 3 year period, more than double the other types of residency training. In addition, FM residents participate in a variety of outpatient rotations during their training. Internal Medicine, Pediatrics and Med-Peds residents generally see patients in their continuity clinics only one session a week throughout their training, or in short ambulatory blocks which average to one session a week of outpatient care. As a result, IM and Peds residents generally graduate with only about 150 sessions of outpatient continuity clinic experience over 3 years, and Med-Peds residents graduate with only about 200 sessions over 4 years. They all participate in a variety of other outpatient rotations, depending on their career interests.
- Continuity Outpatient Experience is Superior for Learning Outpatient Medicine: Outpatient rotations can be helpful for learning, but because these rotations generally involve seeing someone else’s patients, and because they don’t involve much follow up, residents’ learning in these settings is more superficial and does not include the development of judgement and responsibility that care for their own continuity patients does. From a learning perspective, there really is no substitute for the commitment to an extensive continuity practice throughout the residency experience which Family Medicine Residency offers.
- The Right Inpatient Training Experience: Primary Care Physicians typically include general adult inpatient medicine, and newborn nursery care as their two main hospital activities. Family Medicine Residents on average get an equal number of months of general adult inpatient experience compared to Internal Medicine and Med-Peds Residents. Family Medicine Residents on average have more months of newborn nursery experience than Pediatrics and Med-Peds residents: they all take a 4-6 week rotation in newborn nursery, but only FM residents have an additional 2 months on the OB service in which they daily round on and care for newborns.
- Emphasis on Procedures: Surgical training, hands-on experience in the continuity clinic, and a culture of encouragement for learning and performing procedures means that Family Medicine trained physicians are ready to do skin biopsies, joint injections, colposcopy, laceration repair, circumcisions, I & D’s, endometrial biopsies, diaphragm fittings, IUD & Nexplanon placement and so many more of the outpatient procedures which mean that their patients can receive the vast majority of their care right in the primary care office, without requiring referral. It is much more difficult for IM, Peds or Med-Peds residents to build experience and confidence in these procedures because of a lack of opportunity in the continuity clinic and a culture in which many of their preceptors prefer to refer procedures out to specialists.
- Strong Primary Care Psychiatry Training: A huge fraction of primary care outpatient visits include a psychiatric component. Family Medicine Residencies focus teaching on Psychiatry and Behavioral Health on a continuous basis throughout their 3 year curriculum, in addition to often requiring a month rotation in psychiatry. This is not a focus in any of the other primary care residencies.
- Strong Women’s Health Training: Family Medicine Residencies’ continuity clinics are set up to accommodate gyne issues and appointments on a daily basis. Preceptors are all comfortable with gyne and prenatal care. As a result, FM residents have the opportunity to develop both comfort and skill over a wide range of women’s health issues as a part of their core curriculum. IM, Peds and Med-Peds residents have to go out of their way to seek out opportunities to learn this care outside of the usual curriculum, and generally have limited access to learning gyne procedures.
- Strong Traditions in Sports Medicine: Primary care orthopedics has been a focus in the Family Medicine Community for many years, and Primary Care Sports Medicine Fellowships are overwhelmingly affiliated with Family Medicine Residency programs. Sports Medicine teaching in Family Medicine Residencies is significantly more robust compared to the other primary care residencies.
- Training in Care of the Pregnant Patient: While the majority of Family Medicine residents do not go on to deliver babies, they all are well-trained in the care of the pregnant patient through their continuity prenatal patients. All PCP’s routinely have pregnant patients referred to them from OB/Gyn for care of their asthma, allergies, back pain, joint pain, sinusitis, conjunctivitis, rashes, etc. Only Family Physicians have enough experience with these issues and the rhythm of prenatal care to feel truly comfortable with these issues after graduation.
- Residency Culture and Focus: 90% of Family Medicine Residents will go on to practice Primary Care after completing their training, while only 50% of Med-Peds, 40% of Pediatrics and 20% of Internal Medicine graduates will do the same. As a result, training in Family Medicine means that you will be surrounded by people who are enthusiastic about learning and teaching Primary Care.
But What if I Feel Like Three Years is Not Enough?
- If you are a thorough sort, and it bothers you to spend only seven years training to be a broad generalist physician, there are a number of 4 year Family Medicine Residencies across the country, which have all the advantages listed above, but with an additional year of experience.
What if I’d Like to Keep Fellowship Options Open?
- Family Medicine Residents have a wide variety of Fellowship options including Sportsmedicine, Geriatrics, OB, Sleep Medicine, Adolescent Medicine, Emergency Medicine, Palliative Care, Hospitalist Medicine, International Medicine, Preventive Medicine, Faculty Development, Wilderness Medicine, Rural Medicine, Substance Abuse, and Women’s Health.
What About Opportunities in Academic Medicine for Family Medicine Physicians?
- There are Family Medicine Residencies in every state in the nation, and there are more Family Medicine Residencies than any other type of residency. As a result, Family Physicians have more opportunities to be Program Directors and faculty, and they can do this from a wider variety of communities than other types of physicians.
Do I Have to Worry About Nurse Practitioners and Physician Assistants Taking Over My Work?
- Mid-level providers always need physician collaborators and supervisors. Because their training is less extensive, it is much easier for them to focus on a specific skill set. Family Physicians are uniquely qualified to lead a diverse group of mid-level providers to provide care for an entire community: one mid-level practitioner might focus on doing routine gyne care, another might focus on well child care, another might focus on chronic care for hypertension and diabetes. The Family Physician can lead and collaborate with the entire team, handle complex cases in pediatrics, adult medicine and gyne, performing colpos for abnormal paps, psychiatric care, and other hands-on procedures.
What Kind of Job Prospects are there in Family Medicine?
- Due to the flexibility and breadth of the Family Medicine Residency training, Family Physicians have been the most recruited specialty for many years. Business managers generally prefer to hire Family Physicians when possible because they can see every patient who walks in the door.
What is it Like to be Part of the Family Medicine Community?
- Family Physicians are idealistic, intelligent and compassionate. Come to one of our many Family Medicine conferences and experience our enthusiasm for excellent primary care and for our communities!