Authors’ Response to “Revision of Family Medicine Training Requirements: Request to Keep Integrated 4-Year Training Option”

On behalf of my coauthors, I thank Drs St Louis and LaFlamme for their personal testimony to the numerous benefits of a 4-year length of training for family medicine. Our specialty has an upcoming decision to make: whether the option for a 4-year integrated training model this letter’s authors have experienced should be eliminated or continued. Eliminating the 4-year option would limit student choice to either a 3-year training period or a nonintegrated 1-year, add-on, clinical fellowship model that more often serves to narrow rather than broaden scope of practice. Our crucial discussion would be enriched and better-informed if the voices of those who have actually chosen and/or completed a 4-year integrated family medicine residency were heard. This letter’s direct narrative form is powerful evidence that goes far beyond edited responses to study questions that often miss important nuances.

We all should support at least some of our residency programs being able to offer more breadth and (as importantly) depth as described by the authors. Prioritizing workforce quantity over scope is a losing strategy for our specialty; others will be more successful at producing a lower-quality, narrower-scope, but more quickly and cheaply-trained workforce than our 52-year-old 3-year model. Cost-effective quality (deriving from preserved and/or enhanced scope) needs to be our focus; we get diverted and distracted by other considerations at our own peril.

Students do see the elephant in the room, even if we as educators do not. Many potential family medicine residents are choosing other disciplines every year. Students experiencing what Drs St Louis and LaFlamme describe in a 4-year program are attracted to family medicine when the program answers the value proposition with specific, valuable additional skills and knowledge in many different practice areas inherently not obtained in add-on fellowships. This rising tide, providing more space to innovate, would in fact lift all boats if a length-of-training accreditation dam is not built to prevent it.