How long does it take to become a competent family physician?

No one knows for sure how long it takes to train a competent family physician. Family medicine, internal medicine, and pediatrics all require a 3-year residency before board certification in the United States. In Canada, only 2 years are required for family medicine board certification. Before 1969, general practice training in the United States was also only a 2-year curriculum before it was extended to 3 years as it evolved into family medicine. Health care has changed dramatically since 1969, with an explosion of medical knowledge and new technology that challenges us to once again question the proper length of a family medicine residency education. Marguerite Duane, Larry Green, Susan Dovey, and their coauthors try to answer this question in 2 articles on the length and content of family medicine residency training. The first, published in 2002, was based on a simultaneous survey of family medicine residency directors, first-year residents in the programs of the sampled residency directors, and family physicians due for their first board recertification examination. The survey solicited their opinions about the length and content of family medicine residencies. The majority of respondents in each group favored the current 3-year model. However, 27% of residency directors, 32% of first-year residents, and 28% of recertifying family physicians supported adding a fourth year to residency training. All 3 groups agreed that the breadth and depth of the residency experience would have to be expanded to justify adding another year, but the only topics that they agreed warranted more training were officebased procedures and sports medicine. The most significant barriers they identified to adding a fourth year to residency education included the lack of agreement that it is necessary, financing the expansion, and lost opportunity costs for residents during the fourth year. For the follow-up study, Duane et al chose to resurvey only the resident group from their 2002 article. As first-year residents, this group had the largest percentage of respondents interested in a 4-year residency (32%), and they wanted to determine whether their opinions had changed as thirdyear residents. One of the weaknesses of the follow-up study is that it includes responses from only 280 of the original 533 respondents from the 2002 study. The responders in the current study have similar demographics compared with those lost to follow-up and the nonresponders. However, the current study’s findings represent only 52.3% of the 2002 study’s first-year resident responders, and only 28% of the 997 first-year residents initially surveyed for the 2002 study. Apart from this limitation, the follow-up study found remarkable consistency from first to third year in the residents’ opinions concerning the length of their training. As third-year residents, 37% of the respondents favored 4-year family medicine residency programs compared with 32% as first-year residents. The third-year residents supported a fourth year of training because of the broad scope of family medicine, the perceived need for more training in certain clinical areas, such as office procedures, and the longer duration of training for other medical specialists. However, this modest increase in support by third-year residents for a 4-year curriculum may represent the natural insecurity of graduating residents facing independent practice. This insecurity could still be present after a fourth year of training. Financial barriers and the negative impact of having to commit to a fourth year of residency were still seen as significant impediments to adding a fourth year of training. Submitted, revised, 9 July, 2004. From the JFK Family Practice Residency, UMDNJ– Robert Wood Johnson Medical School, Edison, New Jersey. Address correspondence to Robin O. Winter, MD, MMM, JFK Family Practice Residency Program, 65 James St., Edison, NJ 08818. E-mail: [email protected].