Residency Training Leading to Dual Board Certification

The preferred mode of training family physicians is through a three-year residency program leading to board certification in family medicine. Dual track residency programs leading to certification in family medicine and another specialty may meet the needs of a limited number of physicians who desire expertise in a specialty in addition to family medicine. In any combined family medicine residency program, the integrity of the specialty of family medicine must be upheld, and the requirements of family medicine residency training must not be reduced or compromised.

Combined residency programs with family medicine should be developed only in specialty areas where accredited fellowships are not available to graduates of family medicine residency programs. The second specialty should complement the tenets of family medicine, including comprehensive coordinated care throughout the life cycle. The Accreditation Council for Graduate Medical Education (ACGME) must accredit both participating residency programs.

Each proposed combined residency program should address a demonstrated social need, demonstrate its capacity to expand access to care; and/or enhance academic qualifications of its trainees, and describe the efforts the program will undertake to ensure that its graduates fulfill the intent of dual training.

Examples of potential need for dual training include training physicians for geographic areas without a population density to support a subspecialty practice, enhancing specific skills of physicians teaching in residency programs, and meeting the needs of special practice situations, such as public health departments, military or other public sector settings. Examples of compliance efforts to ensure that graduates are fulfilling the intent of the program include reporting requirements that focus on the practice location of graduates, the number of graduates serving specific and/or vulnerable populations, and the number of graduates who join the National Health Services Corps (NHSC).

In order to discourage financial incentives that would promote the unchecked growth of combined residency programs, full graduate medical education funding should support the training of individual residents for the minimum number of months necessary to meet the training requirements of only one certifying board, regardless of the number of months actually experienced by the resident during training.

Financial support for combined residency programs should not adversely affect family medicine residency training in individual programs or in the nation.

Combined residency programs should be wholly in compliance with the ACGME program requirements for residency training in family medicine.

The Academy should continue to monitor the development of combined programs and their impact on the training of family physicians for the nation. (1997) (2009 COD)