Revision of Family Medicine Training Requirements: Request to Keep Integrated 4-Year Training Option

In the September 2019 issue of Family Medicine,¹ Dr Gravel and colleagues discuss the Accreditation Council of Graduate Medical Education (ACGME) Length of Training Pilot in considerable depth. As graduates of and core faculty in a four year residency program we hope that the ACGME and the American Board of Family medicine will include a length of training option to allow integrated 4-year residency programs to continue.

An integrated training model allows a learner to gain additional skills and expertise all while fortifying core family medicine knowledge.2 We both sought to obtain specialized clinical skills (in surgical obstetrics and HIV, respectively) and were able to complete that training within our residency, allowing us to practice as full-spectrum family physicians with specialized expertise. Many family physicians who pursue fellowship have minimal exposure to full-spectrum primary care during fellowship and consequently weaken these skills. In contrast, we are both able to manage complex chronic diseases at a high level with minimal specialist input. We are comfortable with a variety of gynecologic, dermatologic, and orthopedic procedures, as well as point-of-care ultrasound and group medical visits. We prescribe buprenorphine for opioid use disorder. Our panels include pregnant patients as well as children. We participate in quality improvement and original research. Furthermore, we are as comfortable in the hospital as we are in the clinic. We round regularly on adult inpatient medicine (including critically ill ICU patients), labor and delivery, maternity, and inpatient pediatric services. And while we enjoy this broad scope of practice for its own sake, we also recognize that it is protective against burnout.

Thanks to a broad and high-quality scope of training within a 4-year curriculum, we felt confident and competent enough to train residents early in our careers. Confidence in our knowledge base and ability to quickly problem solve were key skills that we suspect we would not have fully developed at the end of a third year of residency training. An integrated curriculum allows for increased time spent in teaching roles for senior residents. We believe that the future of family medicine includes mentoring midlevel clinicians, and we hope that fostering a teaching skill set will establish strong mentors in a variety of primary care careers.

Finally, we believe that enhanced training in family medicine sets physicians up to be exceptional leaders within the health care system. As primary care clinicians who are comfortable in multiple settings and across disciplines, family physicians are well poised to anticipate and resolve problems across the health care system. We each completed a 6-week clinical chief rotation in our fourth year that taught leadership skills that prepared us for our current leadership roles.

We have benefited significantly from our integrated training and are pleased to be the family physicians that our communities need. As Dr Gravel and his colleagues so rightly stated, students have seen “the elephant in the room” and have started to realize that comprehensive training in full-spectrum family medicine may require more than 3 years of training. We couldn’t agree more, and couldn’t imagine our practices without it.