HILARIOUS: Family Med Residency Should be 4 YEARS!

Just what we need! So that even more nurses can take over Primary Care with minimal education/training leaving these 4-year residency trained doctors with-what options exactly?

Jesus Christ, why not just make FM as long as neurosurgery. That way, we can have super duper PCPs running around curing everyone with a touch on the forehead.

I love how, at the same time nurses are taking over primary care and using the title of "doctor" for themselves, docs keep getting told they are increasingly incompetent and need extra training. I can't believe anyone would think that a 4 year family medicine residency makes sense. Sounds like a great way to scare off even more docs from the field (which might be for their own good at this rate - anyone who does go into family medicine nowadays is a true altruist).

LOL! It is as if they are actively trying to dissuade medical students from FM. NPs aren't they only threat to primary care, these chumps are too!

peppy said:

... anyone who does go into family medicine nowadays is a true altruist).

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Or truly naive, like myself.

And lets not go into the people who "have not choice".

If you read the entire article cited above, it does make sense... but that does not mean to say that it doesn't make sense to lengthen other residencies as well in order to put out better physicians.

Unfortunately Family Medicine (and the idea from the article) is a lot like Communism. Its a great idea on paper, but in reality, it falls a part.

Neuronix said:

Scholarly project?! This is FP! It's a highly clinical specialty. Of course students can go do academic fellowships if they want. Why make it mandatory that everyone start publishing in FP?!

As for economics, yes residents want more info about how healthcare works and how to build practices. But it doesn't take a whole freaking year to learn . Ok, maybe they can make some MBA built-in programs. Someone might actually do that.

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We already have to do a scholarly project before we graduate. I'm starting to wonder if this guy even knows what the rules are regarding things we have to do before we finish.

If he feels medical school training is not adequate enough to prepare the next generation of family physicians, someone should definitely inform him about the DNP program, im sure he'd have a field day.

1. The girl jumping for joy is hilarious.
2. It was just 2 seconds ago that they want FP's to be trained in 6 years, not 7. And, now they're talking about 8? Clearly people are just making up stuff as they go along. http://www.aafp.org/online/en/home/...nt-student-focus/20100408texas-tech-fmat.html
3. Not going to happen until FP's get paid more.

lowbudget said:

...
3. Not going to happen until FP's get paid more.

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This may be part of it. FP doesn't want to be looked at like an underachieving IM field, it wants to make IM look like they are a year shy of the credentials of an FP. The primary care fields for the most part battle head to head. Making practices more interested in hiring residents from FP than IM programs, due to being a year more polished, isn't such a bad thought in terms of competitive advantage. Sure it will scare away the folks in a rush to get out there and practice, but if the finished product is noticeably better, it will help FP in the long run.

4. Training of FP's is a continuum, starting from med school. And, just "kicking the can down the road" isn't the answer. If you can't do an adequate h&p, you shouldn't have graduated from medical school. Period. I don't care what specialty you go into. Residency was never meant for remedial teaching. It was meant for advanced learning.
5. If you want doctors to learn basics of economics, you don't ask doctors to teach it. Because you just said doctors suck at it. It's called undergraduate, remember? They have entire departments devoted to this stuff. In fact, you can major in it. Why don't you go back to basics and encourage a well-rounded education... starting in undergrad? If you're willing to add another year (plus interest compounded) to someone's education just to teach them economics, why don't you start with requiring economics (2 semesters) to the premed requirement? Doesn't that make more sense?

Law2Doc said:

This may be part of it. FP doesn't want to be looked at like an underachieving IM field, it wants to make IM look like they are a year shy of the credentials of an FP. The primary care fields for the most part battle head to head. Making practices more interested in hiring residents from FP than IM programs, due to being a year more polished, isn't such a bad thought in terms of competitive advantage. Sure it will scare away the folks in a rush to get out there and practice, but if the finished product is noticeably better, it will help FP in the long run.

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I don't know what you're talking about.

People don't go into IM to do primary care.

If we were to say, increase FP residency to 4 years; would they get C-section privileges without fuss?

Not so fast...

Check out this conversation: http://psotblog.typepad.com/psotblog/2009/06/ob-fellowship-vs-p4.html

(P4 is a FM experiment to increase FP education to 4 years. Many residents, as part of the P4 project, are already doing 4 years of residency training...)

nurses have not taken over of primary care if we doctors would have not allowed it, this is one more step towards nusing taken care over. I see all the time arrogant nurses running around thinking they know everything the doctors do since everytime the doctors order the same antibiotic for every cold that walks through his/her door and the nurse might as well can do that

Geeze.... when the 80 hour limit first came out, the people to scream about it affecting training the most were surgeons. Who knew the limit would impose such a burden on training FM docs that it would be the first residency to extend it's length?

I wonder if the med school grad who supposedly can't do H&P are AMG or IMG?

I'm pretty sure everyone who went to medical school should be able to do an H&P, AMG, FMG, DO even PA's are taught H&P's.It really just doesn't make sense
I guess if some family medicine docs are choosing to stay in 4 years of training there are some receptive to it. Maybe they will have 3 yr/4yr options and people can choose.

Good point about c/s privileges.

I think that extending FM to four years has good and bad points. I think the underlying problem is that the majority of FM grads aren't actually practicing what idealists would call "full scope family medicine"- adults and children, ob, inpatient/outpatient. I think if there were changes in malpractice insurance (esp OB related) and hospital privileging and lifestyle improvements, thus perhaps actually leading FM grads to practice what they're trained to do, a four year residency does not seem totally unreasonable.

However, extending the residency to four years so the vast majority of FM can continue to practice urgent care and private practice (primarily outpt adult and no OB) this is a terrible idea.

Rofl, medicine is becoming so ridiculous it's almost laughable. They'll let a DNP with a 2 year degree practice independently, but a 3 year residency trained physician is incapable? When does this nonsense stop? And when will primary care stop shooting itself in the foot?

"PCP shortage?! Let's train a bunch of half-assed nurses to do the same job, decrease physician pay, and THEN make them train another year! It's BRILLIANT!"

lowbudget said:

I don't know what you're talking about.

People don't go into IM to do primary care.

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Fair enough. It would potentially make FP more competitive as compared to "internists" rather than "IM". Any competitive advantage helps.

Slack3r said:

Rofl, medicine is becoming so ridiculous it's almost laughable. They'll let a DNP with a 2 year degree practice independently, but a 3 year residency trained physician is incapable? When does this nonsense stop? And when will primary care stop shooting itself in the foot?

"PCP shortage?! Let's train a bunch of half-assed nurses to do the same job, decrease physician pay, and THEN make them train another year! It's BRILLIANT!"

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Agree 100% with you. Its painful to see the NP at my clinic see pt independently but I as a 3rd year resident with one week to go still have to precept my patients with an attending.

Medicine is killing primary care.

This isn't a FM issue, per se. It's a primary care issue as it's been discussed for 4 years in IM & Peds as well (I don't have citation).

I don't think it's a DNP/PA issue either. Clearly, the argument is that 3 years (i.e. 7 years) is insufficient. Shortened midlevel training (regardless of how many clinical hours they've had before) would not compare. Midlevels in PC is a short term fix, just to get anyone with a pulse to take care of patients. The problem is that government (& thus the system) has created a shortage of PCP's because of an artificial ceiling on prices (i.e. everyone follows Medicare); thus everyone specializes. Once you fix PC MD's reimbursement, DNP/PA vying for independence will get destroyed, just like chiropracters. I don't worry about them.

My issue is with education on the medical school level. Are students not well prepared for intern year?

My issue is with education on the resident level. What the hell have you been doing with your 3-years in residency? Dodging work?

My issue is with a lack of cohesion of thought and lack of philosophical commitment to generalism. How can you criticize the evolution of "-ists" (hospitalists, laborists, intensivists) and the parsing of medical care under the section "Internal Drivers of Change"... then 10 paragraphs later, want "Areas of Concentrations" during residency under "A New Family Physician Education Model"? http://www.jabfm.org/cgi/content/full/23/Supplement/S23

My issue is that 4 years can't buy you the political or economic permission to do C-sections, EGD/colonoscopy, and emergency medicine. If GI simply refuses to teach FM residents colonoscopy, will 1 more year get me 1 more colonoscopy? This isn't about medicine. Or safety. (Minimum 50 colonoscopies or C/S's? or 150 colonoscopies or C/S's? WTF, really?) This is about money. And power.

Zervano's response is this... and it's plain & simple:

However, I don't think this is necessary or even desirable for the following reasons:
1. Residents maintain continuity with a sufficient number of their patients during 3 years.
2. The "team" concept within the patient-centered medical home is already in place and adds another level of continuity.
3. The integration of the electronic medical record has enhanced the coordination of preventive medical services.
4. Certificates of added qualifications in Geriatrics, Adolescent Medicine, Sports Medicine, Sleep Medicine, or Hospice and Palliative Medicine already add a fourth year and opportunities for customized education.
5. A certificate of added qualification in Maternity Care should be created and the requirements in obstetrics and gynecology should be revised to accommodate those residents who choose to deliver or not to deliver babies.
6. Teaching does occur and scholarly activity is required. I suggest it begin in the middle of the first year and completed by the middle of the third year.
7. Experience tells me that residents are ready to enter practice by the time they complete a 3-year residency.
8. Finally, and perhaps most importantly, 4 years of residency training not only increases the cost of graduate medical education but it delays by one more year a needed family physician entering community practice, and hence accentuates the physician shortage.

Seven years have lapsed since I stepped down after 33 years as a program director, but I hope that does not make me a "fuddy-duddy" and that you will consider my apology to retain the 3-year residency as apropos.

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http://www.jabfm.org/cgi/content/full/23/Supplement/S28

Duane's response is more muted but makes as much sense; especially the comments on scholarly projects. http://www.jabfm.org/cgi/content/full/23/Supplement/S30

Look, here's bottom line:

If you want to reform Family Medicine (& primary care education in IM & Peds & on every other Tuesdays, OB/Gyn... when convenient), you need to go to Congress and change the way Family Medicine is funded.

You need to tell them that it's time that CMS (Medicare/Medicaid) pay residency programs DIRECTLY and NOT the middle-man (i.e. hospital).

That, CMS should no longer pay hospitals and leave it up to hospitals (& it's political structure) to figure out how much to give family medicine (uh, zero) and how much to give neurosurgery (uh, a lot)... (see Baylor's FM program getting shut down because St. Luke wanted more neurosurgery residents... IN THE FACE of a primary care shortage: http://www.tafp.org/news/TFP/10No1/cover.asp)

You need to pay community attendings (specialists & generalist's) so they can actually teach residents how to practice in the community! Why is it that our outpatient attendings are volunteer? & that CMS only pay if residents are inpatient? No crap, outpatient education suffers (listen up, PM&R!). What the hell is volunteerism anyways? It doesn't exist. And so until you start paying outpatient community attendings to teach residents, no outpatient community attending will do it, which means, outpatient education is going to suck. This is true for all specialties with any outpatient component. Pay the program, so they can pay outpatient attendings. Pay the hospital, trust, outpatient attendings will get nothing; unless they are directly using the hospital's OR, cath lab, NICU incubators/ventilators, or MRI machines.

None of this will happen so long as the locus of power & money rest on the shoulders of teaching hospitals.

Pugno's article has some good points. But, it just misses the boat. Because, unfortunately, the rest of the medical community is not listening.

Slack3r said:

Rofl, medicine is becoming so ridiculous it's almost laughable. They'll let a DNP with a 2 year degree practice independently, but a 3 year residency trained physician is incapable? When does this nonsense stop? And when will primary care stop shooting itself in the foot?

"PCP shortage?! Let's train a bunch of half-assed nurses to do the same job, decrease physician pay, and THEN make them train another year! It's BRILLIANT!"

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i think this is one of the bests posts in this thread!!!!!

lowbudget said:

This isn't a FM issue, per se. It's a primary care issue as it's been discussed for 4 years in IM & Peds as well (I don't have citation).

I don't think it's a DNP/PA issue either. Clearly, the argument is that 3 years (i.e. 7 years) is insufficient. Shortened midlevel training (regardless of how many clinical hours they've had before) would not compare. Midlevels in PC is a short term fix, just to get anyone with a pulse to take care of patients. The problem is that government (& thus the system) has created a shortage of PCP's because of an artificial ceiling on prices (i.e. everyone follows Medicare); thus everyone specializes. Once you fix PC MD's reimbursement, DNP/PA vying for independence will get destroyed, just like chiropracters. I don't worry about them.

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are you sure about that? you really think the reimbursement will be fixed? i cannot see this changing at all.

PharmaTope said:

are you sure about that? you really think the reimbursement will be fixed? i cannot see this changing at all.

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Either that or the government will take more control of medicine, possibly even granting med school admission to some with the caveat that you must do primary care.

VA Hopeful Dr said:

Either that or the government will take more control of medicine, possibly even granting med school admission to some with the caveat that you must do primary care.

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considering how out of control our government is, i say they try to take control of medicine.

heck gov is involved in banks business etc. too much involvement in everything IMO. this is where i see healthcare going. the bigger machine needs fuel, perfect target is healthcare where people cannot fight against it without jeopardizing the patients.