possibility of shorter residencies

[Dharma]

The ACGME's recent competency report has been stirring the drink so to speak as of late. While their report in the NEJM did not directly mention any reductions in residency training time, the AMA did state the following on it's webpage

http://www.ama-assn.org/ama/pub/meded/2012-march/2012-march.shtml

"For physicians, one of the attractive features of the milestones concept and the focus on outcomes is the possibility of more flexibility in residency length. If, say, a family medicine resident can meet all the milestones in two years rather than three, there's no reason the doctor could not complete the residency and enter into practice."

To play devils advocate to a statement like this (and doing so from the perspective of an inexperienced medstudent-to-be, so please excuse any naivety) I would argue that the breadth of knowledge and skill necessary to become a competent FP requires equally diversified training that may be tough to accomplish in 2 years. Should this not make FM one of the last specialities to implement reduction in training?

A few questions for the interested:

Let's say the option for two years was on the table, is it realistic to say that a FM resident could accomplish all the necessary milestones to become a competent FP in 2 years?

Did your third year of residency provide training that would not have been possible during your first year on the job elsewhere?

Will they water down competencies to increase the chances of finishing in 2 years so that 2 years becomes the norm, while 3 is frowned upon (but in the process produce less competent physicians)?

How do you feel that FM is the first speciality the AMA singled out?

Here's a link to the ACGME report in the NEJM:
http://www.acgme-nas.org/assets/pdf/NEJMfinal.pdf

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[Dharma]

Interesting article in favor of shorter residencies:

http://virtualmentor.ama-assn.org/2005/06/oped2-0506.html

 

[rickygbv]

This is old. June 2005

 

[Dharma]

This is old. June 2005

Did you check out the first two links? They're weeks old.

 

[Dharma]

http://blogs.aafp.org/cfr/leadervoices/entry/shrinking_scope_of_practice_raises

Thanks for the link elftown! I liked the article, even though it's geared towards the opposite end of the spectrum, that being of those who are considering the possibility of longer residencies. The push towards outcome-based residencies has people on the political end talking of shorter residencies. Do you think implementing longer residencies could become a trend in the current political climate with clamors of cut, cut, cut?

Interesting article though. The comment following it was eye-opening as well. He really hits it on the head in terms of concerns of heavy debt and practice options. Starting medical school in a few months, one can't help but to think about these things at least a little bit, regardless of how many times one hears "don't worry about it."

 

[Zback]

Actually there is a article on AAFP about starting pilot programs in July 2013 with 25 programs becoming 4 year programs.

 

[Dharma]

Actually there is a article on AAFP about starting pilot programs in July 2013 with 25 programs becoming 4 year programs.

Actually... Elftown already commented on this and posted the link to this AAFP article yesterday (scroll up a few posts)

Still, this has no bearing on the current talk of the move towards outcome based residencies.

 

[tryp]

In Canada the FP residency is already 2 years - it's the only one that's shorter in Canada because all the specialities are 5 years up here.

 

[ghost dog]

In Canada the FP residency is already 2 years - it's the only one that's shorter in Canada because all the specialities are 5 years up here.

Your logic is faulty, will robinson. What does the length of FRCP / specialty training have to do with CCFP / family medicine training ? Absolutely nothing.

In regards to shortening a residency program - bureaucracy moves with the pace of a turtle on smack. I wouldn't look for a shortened program in the near future.

 

[MoskD]

I think the better solution is what many osteopathic schools are implementing - a 3 year medical school curriculum followed by FM residency. Shaves off a relatively useless year rather than a year of residency

 

[Dharma]

I think the better solution is what many osteopathic schools are implementing - a 3 year medical school curriculum followed by FM residency. Shaves off a relatively useless year rather than a year of residency

That would be cool if you weren't limited to the residency the school offers, especially if their gig isn't exactly up to par. (Again, I say this with limited knowledge/experience).

 

[grayscaleart]

i dont think you need 3 years to do clinic work. i support cutting FM to 2 years or give credit to 4th year electives to satisfy PGY1 requirements similar to what Texas Tech is doing. If you want to further your knowledge such as inpatient work, do an extra 1 year hospitalist fellowship. most of med school is geared towards primary care/generalist training anyway.

 

[Emergent]

Aren't you a rads resident?

 

[tryp]

Your logic is faulty, will robinson. What does the length of FRCP / specialty training have to do with CCFP / family medicine training ? Absolutely nothing.

In regards to shortening a residency program - bureaucracy moves with the pace of a turtle on smack. I wouldn't look for a shortened program in the near future.

Umm...I was just pointing out that while speciality residencies in the US can be many different lengths (IM at 3 years, psychiatry at 4 years etc), in Canada they are all 5 years long, so are often longer than the US counterpart, in contrast to the FP residency which is shorter in Canada.

It was really just a comparative comment.

 

[andwhat]

The ACGME's recent competency report has been stirring the drink so to speak as of late. While their report in the NEJM did not directly mention any reductions in residency training time, the AMA did state the following on it's webpage

http://www.ama-assn.org/ama/pub/meded/2012-march/2012-march.shtml

"For physicians, one of the attractive features of the milestones concept and the focus on outcomes is the possibility of more flexibility in residency length. If, say, a family medicine resident can meet all the milestones in two years rather than three, there's no reason the doctor could not complete the residency and enter into practice."

To play devils advocate to a statement like this (and doing so from the perspective of an inexperienced medstudent-to-be, so please excuse any naivety) I would argue that the breadth of knowledge and skill necessary to become a competent FP requires equally diversified training that may be tough to accomplish in 2 years. Should this not make FM one of the last specialities to implement reduction in training?

A few questions for the interested:

Let's say the option for two years was on the table, is it realistic to say that a FM resident could accomplish all the necessary milestones to become a competent FP in 2 years?

Did your third year of residency provide training that would not have been possible during your first year on the job elsewhere?

Will they water down competencies to increase the chances of finishing in 2 years so that 2 years becomes the norm, while 3 is frowned upon (but in the process produce less competent physicians)?

How do you feel that FM is the first speciality the AMA singled out?

Here's a link to the ACGME report in the NEJM:
http://www.acgme-nas.org/assets/pdf/NEJMfinal.pdf

I dont like the idea of a shorter residency If anything, substitute with more elective time

 

[montessori2md]

I agree with andwhat. Sure, I could go out and practice in a clinic after 2 years, but residency is a time to learn -it's hard to go back once you are out in practice and add-on to your training. I'd much rather have the elective time to pick up skills I think I'll be able to use.
I also believe strongly that ambulatory practice physicians benefit from being trained in an inpatient setting -it helps you to understand the larger picture.
Once upon a time lots of folks went out to be GPs after an internship. I think what we're doing now is better for our patients.
I only see training getting longer. If GME is cut/eliminated, hospitals/programs are going to need to get more work out of us to make it worthwhile.

 

[elfmonkey]

I dont like the idea of a shorter residency If anything, substitute with more elective time

More electives