A list of Four-year Family Medicine Residences

[elfmonkey]

Do y`all know if such a list is available now?
This is the announcement a couple of months ago on the aafp website.

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[DrAwsome]

Do y`all know if such a list is available now?
This is the announcement a couple of months ago on the aafp website.

I agree with a good number of the comments on the website that increasing the length of FM residency by an extra year is outrageous. It will do nothing to increase medical student interest in the field, quite the contrary. And as someone pointed out, NP are getting to practice in the field with much less training, while dr requirements are going up. Someone should step in and end this madness.

 

[deleted87716]

Bob Bowman is not a fan.

http://www.annfammed.org/content/10/1/84.full/reply#annalsfm_el_23595

Moving to 4 years of training results in at least a 3% loss of workforce for each family medicine residency graduate. One more year of training adds tens of thousands in costs and decreases the career length. The same mistake is being made by nurse practitioners who are forcing 2 more years of training to decrease length of career by 8 - 10% while adding 30% to the cost of training.

Why have we not been able to learn over the past 40 years? Each increase in length of formal training by family medicine, physician assistant, and nurse practitioner leaders has resulted in greater training cost, decreased career length, and decreased distribution to populations in most need in America.

No one who understands worsening shortages of primary care would do anything to decrease primary care delivery capacity further for the next 20 years, especially for the most important source of health access for the elderly who are doubling in the next 20 years and require 2 to 3 times more primary care (Ferrer). There is not a population or location in need that does not benefit from the family medicine multiplier - so why defeat needed workforce?

Why does family medicine remain hostage to poor designs for family medicine training? A real design is a 6 year family medicine medical school. Such a move would result in more specific training and longer careers. The six year accelerated family medicine model was associated with increased distribution - including urban origin and female graduates.

Medical education has failed for 30 years to supply the workforce needed by most Americans and more of the same will continue to fail. The 30 years of failure to expand the one source most needed by most Americans is a primary measure of medical education failure. Family medicine can present an instate permanent family practice plan to state legislatures that will actually allow them to specifically address their primary care deficits. Have we forgotten the important state level efforts that helped expand FM to 3000 annual graduates in a ten year period?

Family medicine can help solve one of the major problems facing most Americans. This is why family medicine was restored and what family medicine leaders have told us for 40 years. We should be more about family practice and basic health access and we should be less about academics and institutions and associations with locations that have top workforce concentrations already.

Real solutions would be a doubling of family medicine residency graduates, an increase in primary care delivery per graduate, a move away from training in top concentration locations, and success in achieving revenue for primary care that more than covers double digit increases in the cost of delivering primary care. These are solutions needed for the next 30 years for family physicians and for 200 million Americans behind by design

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[primadonna22274]

I had the good fortune of enjoying an email correspondence with Dr Bowman several years ago just as he was leaving Nebraska for ATSU. This is a man who knows rural health and knows family medicine workforce issues. Good guy... worth listening to.

Bob Bowman is not a fan.

http://www.annfammed.org/content/10/1/84.full/reply#annalsfm_el_23595


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[elfmonkey]

I agree with a good number of the comments on the website that increasing the length of FM residency by an extra year is outrageous. It will do nothing to increase medical student interest in the field, quite the contrary. And as someone pointed out, NP are getting to practice in the field with much less training, while dr requirements are going up. Someone should step in and end this madness.

So, are we suggesting the opposite ?
Then NPs, PAs will say they are not far away from FP training, hence they can do whatever FP`s are doing. Specialists will say FP`s are well compensated to their level of training.
And everyone would say, the FM spectrum is broad but it`s not deep.
It makes sense to extend the training with the exponentially increasing medical knowledge.
Look at the Brits, who are masters of the art of medicine and grandfathers of general practice .

 

[DrAwsome]

So, are we suggesting the opposite ?
Then NPs, PAs will say they are not far away from FP training, hence they can do whatever FP`s are doing. Specialists will say FP`s are well compensated to their level of training.
And everyone would say, the FM spectrum is broad but it`s not deep.
It makes sense to extend the training with the exponentially increasing medical knowledge.
Look at the Brits, who are masters of the art of medicine and grandfathers of general practice .

I am suggesting that the length of FP training is fine at 3 years is fine and increasing to 4 is pointless and crazy. NP/PAs can say what they'd like but the matter of the fact is that if they want to be doctors they should go to medical school. They simply dn't have the level of knowledge that FPs have, period. Compensation discussion has been beaten to death.
If anything, I think we should be reducing training length not expanding it.

For example, eliminating most of undergrad would make sense, just like it is in most other countries. Spending 4 years getting a degree in who knows what for the sake of just applying to medical school is pretty pointless. Not only does it lead to more debt, but shortens careers as well in a pointless fashion.

 

[elfmonkey]

I am suggesting that the length of FP training is fine at 3 years is fine and increasing to 4 is pointless and crazy. NP/PAs can say what they'd like but the matter of the fact is that if they want to be doctors they should go to medical school. They simply dn't have the level of knowledge that FPs have, period. Compensation discussion has been beaten to death.
If anything, I think we should be reducing training length not expanding it.

For example, eliminating most of undergrad would make sense, just like it is in most other countries. Spending 4 years getting a degree in who knows what for the sake of just applying to medical school is pretty pointless. Not only does it lead to more debt, but shortens careers as well in a pointless fashion.

You guys are more experienced than I am and definitely know the system better. I still think 4 years is a good idea.
3 years is good if they decrease Ob/Gyn and Paeds blocks and increase the electives, i.e. more Derm, Ophth, ENT and perhaps tailoring training pathway according to individuals` interest. Until then, 4 years is a viable solution.
However, I agree with you on ending the undergrad part, it`s rubbish !
So, no body heard of the "list" ?

 

[AlmostJesus]

If the perceived problem is midlevel takeover, why not look into making the 4th year into a fellowship year to do something like a rural procedures fellowship? Midlevels arent likely going to encroach on doing things like scopes and specialists may not care to be tied up doing things like regular screening colonoscopies in otherwise healthy individuals. This could be a way to increase compensation and maintain the specialty. The obvious disadvantage would be the response from other specialities about losing some of their easy compensation.
The 4th year could be used to augment the interests of the particular physician in order to gain experience you may not have the opportunity to get once you get into practice such as ultrasound, derm, sports medicine, EM, etc.
I agree that making it 4 years would make the speciality look less lucrative, but maybe if there is the ability to augment your practice with your interests, you may be more likely to go FP. Maybe it could be like rads where a fellowship is not required, but it is highly encouraged/highly sought after.
One of the small hospitals I work at as a medic has 10 FPs and it seems as though most of them have a sub interest such as derm, sports medicine, OB, etc that they utilize to keep their practice interesting and it allows services to be offered in a small town that aren't regularly available. To my knowledge, the speciality clinic providers do not feel encroached upon, because the docs will refer when needed.
Of course, I do not have much experience being pre-med, but having an interest in going into FP, I look at the thought of augmenting my practice through a fellowship to allow for offering things such as scopes as a way to keep practice interesting and diverse enough that I won't get bored (or at least turned off from the speciality).

 

[deleted87716]

They're likely all part of the P4 program (a subset, anyway). One of them is Middlesex, in CT.

http://www.transformed.com/p4-participants.cfm

http://www.middlesexfmrp.org/go/about-the-program/p4-program

 

[elfmonkey]

They're likely all part of the P4 program (a subset, anyway). One of them is Middlesex, in CT.

http://www.transformed.com/p4-participants.cfm

http://www.middlesexfmrp.org/go/about-the-program/p4-program

Yeah, I know about these websites, I just thought there is a new list somewhere. Thank you all.

 

[Smokemont]

Expanding to a 4th year is only a good idea if something is done about debt. Perhaps making the 4th year resident salary much higher or forgiving part of loans.

 

[elfmonkey]

Expanding to a 4th year is only a good idea if something is done about debt. Perhaps making the 4th year resident salary much higher or forgiving part of loans.

A higher salary would be unfair to AMG`s, especially those going to other specialties.. I think loan forgiveness would be a much better idea, more appropriate and can target local grads who are willing to go to primary care..
I say this and I didnt even go to med school in this continent.

 

[lowbudget]

It's not an issue of 4 or 3 or 6 years or whatever. What matters the most is what you're doing, what you've accomplished during the time you're training that's most important.

Let learners learn and teachers teach, and cut out all the BS in between.