Training for family physicians is a process that begins with medical school and continues through residency. During their time in medical school, students take two “step” exams, called the United States Medical Licensing Examination (USMLE)(www.usmle.org), and must take core clerkships, or periods of clinical instruction. Passing both exams and the clerkships grants students the “Medical Doctor” (MD) degree, which entitles them to start full clinical training in a residency program.
In the 2014-15 academic year, 480 accredited programs were training more than 10,700 family medicine residents across the country. Family medicine residency programs, which are accredited by the Accreditation Council for Graduate Medical Education (ACGME)(www.acgme.org), require three years of training. As with other specialties, family medicine residency programs have specific requirements with certain numbers of hours that must be completed for board certification. They are designed to provide integrated experiences in ambulatory, community and inpatient environments during three years of concentrated study and hands-on training.
The first year of residency, called the internship year, is when the final “step” of the USMLE (Step 3 exam) is taken. This time includes rotations in the major medical disciplines with time allotted each week to the family medicine continuity clinic to provide ongoing care to a panel of patients. In the second and third years of residency, additional exposure is given to the major specialty and subspecialty areas, with increased time spent in the family medicine continuity clinic.
During their three years of training, residents must meet the program requirements for both residency education in family medicine and certification by the American Board of Family Medicine (ABFM)(www.theabfm.org). Specific requirements for family medicine residency training vary by program, although several months are spent in required rotations in each of the following areas: obstetrics, pediatrics, general surgery and inpatient hospital care in CCUs or ICUs. Each resident spends a few nights per month “on call” and on rotation throughout the hospital.
After three “program years” of training are completed and all requirements are met, residents are eligible to take the certification exam by the ABFM. Toward the end of residency, physicians also apply for licensure from their state medical boards(www.fsmb.org), which determines where they can practice as a board-certified family physician. Although each state is different in their requirements for initial medical licensure, it is a necessity that physicians pass Step 3 of the USMLE.
For more information on specific program requirements, visit the AAFP’s Residency Directory.
Currently, there are three types of dual degree residency programs for family medicine (FM), which require extended training – typically five years total:
- FM-Emergency Medicine
- FM-Internal Medicine
Dual degree programs are designed to provide residents who complete them with certifications from both boards; they also must recertify with each board.
Additional opportunities are available to residents who seek advanced training in areas of family medicine. Many people choose a fellowship as a post-residency option because it offers more concentrated training in fields such as:
- Faculty development
- Preventive medicine
- Rural medicine
- Sports medicine
Generally, fellowships last an additional 12 months after residency training (although they vary by program) and are run through existing residency programs. Some are strictly for educational purposes, while others lead to Certificates of Added Qualifications (CAQs), which are offered in conjunction with other medical specialty boards.
The ABFM currently offers CAQs in the follow areas:
- Adolescent medicine
- Geriatric Medicine
- Hospice and palliative medicine
- Sleep medicine
- Sports medicine
While other specialties offer Certificates of Special Qualifications, these physicians are not required to uphold their primary certification. Family medicine, on the other hand, requires that its physicians maintain certification in both fields. CAQs are valid for 10 years and physicians must apply for recertification to renew the certificate (in addition to recertifying in family medicine after seven years). The AAFP supports CAQs as a way to improve physicians’ academic and administrative development.