Experience with an optional 4-year residency: the University of Arizona Family Medicine Residency.

BACKGROUND AND OBJECTIVES There has been declining interest by US medical students in the specialty of family medicine. Simultaneously, new data suggest that the length of training may be related to the decline in student interest. The new data have created a national debate over the appropriate length of training for family physicians. The Future of Family Medicine Report recommends conducting experiments with 4-year residency training programs. METHODS Since 1999--2000, the University of Arizona Family Medicine Residency Program has offered three fourth-year options: a fourth-year fellowship in sports medicine, an integrated third- and fourth-year experience in complementary and alternative medicine, and an option for a master's in public health degree. Data on applications to the residency program have been monitored to measure the effect of these options on the applicant pool. RESULTS National Resident Matching Program statistics, and the interest in the program expressed by US graduates, have improved for the University of Arizona program during a time when national interest in family medicine has continued to decline. DISCUSSION While cause and effect cannot be proven, offering an additional year of training did not decrease interest in the University of Arizona program and may have increased interest. Experiments with 4-year training programs are not possible in all programs because graduate medical education funding only covers the 3 years needed to complete the requirements for specialty certification.