AAFP Statement: Joint Statement Regarding Closure of the Duke University Family Medicine Residency

The American Academy of Family Physicians, Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, and Society of Teachers of Family Medicine were disappointed to learn of the decision by Duke University and its Department of Community and Family Medicine to close its family medicine residency. As the Family Medicine organizations responsible for the intersection of clinical practice and medical education, we write to address the issues raised in the press release from Duke dated May 25.

Our organizations strongly believe that academic family medicine departments should create clinical environments where innovation, quality improvement and effective medical education take place concurrently. Most respected family medicine departments across the nation, including those at other top-tier private universities, have been able to balance the priorities of patient care, research and teaching while maintaining the integrity of their residency training programs. It is also critical that medical students have the opportunity to observe what the future of family medicine has to offer — innovations in practice, research that aims to improve the health of patients and communities — and excellent residents. The closure of the residency at Duke means that Duke medical students will not have that opportunity in their own institution, which we deeply regret.

The press release cites “declining interest in family medicine” as a major reason for the closure. Interest in family medicine residencies among fourth year U.S. medical students has indeed dropped substantially, despite much evidence for the need of the discipline. This is part of a trend defined by increased interest in more highly paid specialties, many of which also allow a perceived easier lifestyle. Decline of interest has been even more dramatic in general internal medicine, in which a recent study has documented that only 10% of interns in internal medicine now expect to go into general internal medicine. For family medicine, at least, the decline has stabilized and there are signs that interest is beginning to increase. There is no doubt, however, that these have been difficult times for residency programs. The challenge for educators like those at Duke is to innovate — to create training programs that are attractive to students and can convince prospective residents that the new model of family medicine is worth the investment of a career.

We also believe that it is important to continue training family physicians. There is clear and compelling evidence that primary care physicians, especially family physicians, are central to optimal and cost effective healthcare for the American public. Family physicians are essential to a health care delivery team that forms the foundation of patient-centered, technologically enhanced, community-based care for the 21st century. As one of the early family medicine residencies established in the nation in 1972, the Duke program itself has been evidence of the importance of family medicine, producing more than 350 family physicians for North Carolina and the nation, many of whom have gone on to distinguish themselves in academia and organized medicine. Closing the program means that that important contribution to the people of North Carolina and beyond will come to an end.

In 2004, the Robert Graham Center for Policy Studies in Family Medicine and Primary Care prepared a report on the role of family physicians in the U.S. healthcare workforce. That report was inappropriately cited by Duke as one justification for the decision to close its residency program. The Graham Center has expressed dismay that its work, which clearly does not espouse a reduction in the production of family physicians, should be used to justify, even in part, the closure of this family medicine residency.

We wish to re-affirm our commitment to the students, residents and sponsoring institutions of family medicine graduate education. As the nation’s need and demand for family physicians continues to grow, we stand firm in our dedication to develop, maintain, and grow those training programs committed to quality in care and education. Our organizations work diligently to ensure that every young physician who aspires to become a family physician has both the opportunity and support to achieve that goal. We look forward to further dialogue with Duke University's leadership.