MD & DO ACGME Changes to FM Residency (going into effect July 2023)

[LendMeYourDeers]

Surprised I saw no thread about this! So FM residency fundemental requirements are changing in 2023. It's a pretty big deal as it's the fairly large overhaul.

Here is a link to the direct changes (scroll down, one is also a tracked changes copy where you can see the before and after) - https://www.acgme.org/.../program-requirements-and-faqs.../

I thought I would sum up some major changes:

• The "1650 FM clinic encounters" and maintaining a minimum 40 weeks of being in the clinic is replaced with "1,000 hours of caring for one's panel", and the 40 week is now a should rather than a must.
  
  
• 165 patients in a residents panel must be under the age of 10 is now replaced with at least 10% of their panel must be under the age of 18.
  
  
• 40 encounters with newborns (including well and sick) is replaced with no required minimum - instead "an experience"
  
  
• 200 hours/2 months AND 250 encounters of sick kids (75 inpatient, 75 ED) is now replaced with less - 100 hours/1 month, and 50/50.
  
  
• 200 hours/2 months AND 250 encounters for kiddos and teens in the ambulatory setting is changed to just 200 hours/2 months "of all ages".
  
  
• 100 hours/1 month OR 125 gyn encounters is replaced with just the 100 hours/1 month.
  
  
• 200 hours/2 months for OB is sort of expanded? - either do that (with at least 20 experiences in vaginal deliveries) OR (if you wanna do OB) 400 hours/4 months of LnD and 80 deliveries min.
  
  
• 100 hours/1 month in the ICU OR 15 ICU enounters is changed to no longer being required.
  
  
• 200 hours/ 2 months in adult ED OR 250 adult ED encounters is lessened to 100 hours in the ED AND 125 encounters.
  
  
• 100 hours/ 1 month on geri OR 125 geri encounters is now changed to be BOTH 100 hours AND 125 encounters.
  
  
• 100 hours/1 month on gen surg is replaced to no requirement - instead "an experience".
  
  
• 200 hours/2 months in MSK/Sports Med is replaced to no minimum requirement.
  
  
• Derm is changed to no minimum requirement.
  
  
• Behavioral Health is changed from "integration into resident's education" to "dedicated experiences" involving Motivational Interviewing, CBT, diagnosis of common psychiatric conditions, psychopharm, and addiction.
  
  
• Procedural training is now much more vague in terms of requirements.
  
  
• Rads - the curriculum should include training in common diagnostic imaging interpretation relevant to FM is changed to now no longer being required, and instead encouraging it.
  
  
• 3 months of elective time is increased to 6 months.
  
  
• Min protected teaching time for faculty is reduced to 10%.

Some thoughts I've gathered talking to other FM residents and faculty online.

• FM is becoming a "choose your own adventure" (pros and cons)
• FM is becoming "IM-Lite, without fellowships" considering the loss of pediatric training and lack of fellowships
• Less pediatric training (pros and cons)
• More elective time means a resident can really mold their career early on (ie taking on electives in more concentrated endocrine, psychiatry, rheum, etc)
• FM is being pushed to be ambulatory primary care only (pros and cons)
• Concern over competency in acuity and complexity
• The changes allow weak FM programs to continue to exist, and allow opening up new FM programs much easier
• More social work emphasis on FM training
• Less clinical skill training in FM - more care coordination
• Less required teaching time for faculty could mean less dedicated education for residents (health system may push faculty to be more patient facing)

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[wholeheartedly]

Surprised I saw no thread about this! So FM residency fundemental requirements are changing in 2023. It's a pretty big deal as it's the fairly large overhaul.

Here is a link to the direct changes (scroll down, one is also a tracked changes copy where you can see the before and after) - https://www.acgme.org/.../program-requirements-and-faqs.../

I thought I would sum up some major changes:

• The "1650 FM clinic encounters" and maintaining a minimum 40 weeks of being in the clinic is replaced with "1,000 hours of caring for one's panel", and the 40 week is now a should rather than a must.
  
  
• 165 patients in a residents panel must be under the age of 10 is now replaced with at least 10% of their panel must be under the age of 18.
  
  
• 40 encounters with newborns (including well and sick) is replaced with no required minimum - instead "an experience"
  
  
• 200 hours/2 months AND 250 encounters of sick kids (75 inpatient, 75 ED) is now replaced with less - 100 hours/1 month, and 50/50.
  
  
• 200 hours/2 months AND 250 encounters for kiddos and teens in the ambulatory setting is changed to just 200 hours/2 months "of all ages".
  
  
• 100 hours/1 month OR 125 gyn encounters is replaced with just the 100 hours/1 month.
  
  
• 200 hours/2 months for OB is sort of expanded? - either do that (with at least 20 experiences in vaginal deliveries) OR (if you wanna do OB) 400 hours/4 months of LnD and 80 deliveries min.
  
  
• 100 hours/1 month in the ICU OR 15 ICU enounters is changed to no longer being required.
  
  
• 200 hours/ 2 months in adult ED OR 250 adult ED encounters is lessened to 100 hours in the ED AND 125 encounters.
  
  
• 100 hours/ 1 month on geri OR 125 geri encounters is now changed to be BOTH 100 hours AND 125 encounters.
  
  
• 100 hours/1 month on gen surg is replaced to no requirement - instead "an experience".
  
  
• 200 hours/2 months in MSK/Sports Med is replaced to no minimum requirement.
  
  
• Derm is changed to no minimum requirement.
  
  
• Behavioral Health is changed from "integration into resident's education" to "dedicated experiences" involving Motivational Interviewing, CBT, diagnosis of common psychiatric conditions, psychopharm, and addiction.
  
  
• Procedural training is now much more vague in terms of requirements.
  
  
• Rads - the curriculum should include training in common diagnostic imaging interpretation relevant to FM is changed to now no longer being required, and instead encouraging it.
  
  
• 3 months of elective time is increased to 6 months.
  
  
• Min protected teaching time for faculty is reduced to 10%.

Some thoughts I've gathered talking to other FM residents and faculty online.

• FM is becoming a "choose your own adventure" (pros and cons)
• FM is becoming "IM-Lite, without fellowships" considering the loss of pediatric training and lack of fellowships
• Less pediatric training (pros and cons)
• More elective time means a resident can really mold their career early on (ie taking on electives in more concentrated endocrine, psychiatry, rheum, etc)
• FM is being pushed to be ambulatory primary care only (pros and cons)
• Concern over competency in acuity and complexity
• The changes allow weak FM programs to continue to exist, and allow opening up new FM programs much easier
• More social work emphasis on FM training
• Less clinical skill training in FM - more care coordination
• Less required teaching time for faculty could mean less dedicated education for residents (health system may push faculty to be more patient facing)

There was a discussion about this somewhere on here when it was announced they were looking to change this. Can’t remember where though.

 

[Captain_Falcon]

Check the FM sub forum

 

[LendMeYourDeers]

There was a discussion about this somewhere on here when it was announced they were looking to change this. Can’t remember where though.

Check the FM sub forum

Yep I know which one you guys are referring to! It was a while back, and it was linking to proposed changes during an open comment period. These are the finalized changes, however, that are going into effect that came out recently this past September.

I placed the thread here as I thought it would be good for everyone to read about this, not just the FM sub-forum members. Would be interesting to know FM, non FM, and student thoughts.

 

[cj_cregg]

Agree that this is a continued watering down of full scope family practice and it makes me sad. I think it is happening because so many programs struggle to get adequate peds, OB, and inpatient training to begin with. I'm also disappointed that the clinic numbers requirement is a bit less rigorous...especially as FM is increasingly outpatient primary care, it seems important to maintain that 1650 total/250 kids requirement.

That said, I think the programs that are good at training for full scope practice will continue to be, and the programs that aren't will continue to not be. I'm not sure I see anything that suggests to me that FM training is turning more to "social work" or "coordination of care" - they've loosened up some clinical requirements, certainly, but I don't see anything that says you have to instead do nonclinical/social work-y type things. There's no reason that additional elective time couldn't be used to gain more clinical experience in whatever niche someone wants to get into.

 

[Prehealth1011]

• FM is becoming "IM-Lite, without fellowships" considering the loss of pediatric training and lack of fellowship
• More social work emphasis on FM training
• Less clinical skill training in FM - more care coordination

Sounds like IM alright

 

[NotAProgDirector]

The RRC's have, across the board, made training for most programs more flexible with less defined requirements and more individual customization based upon resident interests.

 

[GoSpursGo]

I agree that these changes likely are to be more lenient on some of the less academic programs that struggle to incorporate the full range of peds, OB and inpatient.

In general in the short term this is probably upside. Helps keep the lights on at programs that struggled to meet the old requirements, and more programs is (mostly) good. the programs that already had good exposure in those areas will probably keep that as part of their curriculum and use that as a selling point, or allow more electives (and use that as a selling point too). Long term a little harder to predict, IMO. I wonder if it may become harder for programs to “protect” those experiences now that they aren’t required.

 

[futureapppsy2]

Long term a little harder to predict, IMO. I wonder if it may become harder for programs to “protect” those experiences now that they aren’t required.

I think that would be a primary concern—“recommended” is often interpreted by administration to mean “we aren’t doing that.”