The family medicine residency at Duke University, Durham, N.C., is closing, according to a May 25 announcement. The announcement was followed by a June 13 joint statement from the AAFP, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors and the Society of Teachers of Family Medicine. The associations said they were "disappointed" to learn of the decision to discontinue the program.
Duke University Closes Family Medicine Residency
AAFP, Other Groups 'Disappointed'
By Jane Stoever
6/14/2006
"There is clear and compelling evidence that primary care physicians, especially family physicians, are central to optimal and cost-effective health care for the American public," said the joint statement. "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."
Since its beginnings in the early 1970s, the Duke program has produced 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," said the joint statement.
The residency will stop accepting new residents after this year, will release residents who wish to leave and will continue training residents who stay in the program, said the announcement from FP Lloyd Michener, M.D., clinical professor and chair of the university's community and family medicine department.
"For us, the family medicine center is a test site for how to do care better," Michener said in an interview. "The Duke family medicine center's obligations are first to our patients, second to developing better methods of health care and then third to teaching residents what we've learned. Closing the residency calls into question whether family medicine residencies necessarily have a central role in academic departments."
Closing the residency was not a financial move, added Michener. "The department is doing well financially. The decision to close the residency was based on the internal conflict between what we're trying to do as a family medicine department and the needs of the residents for a stable training site. Many of our residents have said they want a training program like (that at) other training sites, where the program exists for them, the faculty are there for them and there's a rate of change that's not excessive."
Innovation can occur in tandem with education, said the AAFP, ADFM, AFMRD and STFM. "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 ? have been able to balance the priorities of patient care, research and teaching while maintaining the integrity of their residency training programs."
Duke announced it would expand its training programs for physician assistants and physical therapists and its fellowship programs. "Our goal is to continue to be one of the national models of how academic health centers can provide better care to our patients in our offices and in our communities," said the Duke announcement.
"It's a disappointment that Duke is closing the residency," said AAFP President Larry Fields, M.D., of Ashland, Ky. "It seems Duke wants to concentrate on developing alternatives to family doctors, wanting to train more physician assistants and physical therapists. It's hard for me to understand how anyone who appreciates the value of family medicine could think they could do more for the American people in our health care system by training less qualified, less cost-efficient providers than family doctors.
"Unfortunately, hospitals make money from doing procedures that are generally done by subspecialists, and academic health centers make a lot of income from research by basic scientists or subspecialists, and those two situations don't lend themselves to promoting family medicine," Fields added.
The news of the Duke residency closing follows a five-year period in which, according to the Accreditation Council for Graduate Medical Education, 49 family medicine residencies closed and 13 received approval to open, for a current total of 461 allopathic residencies in the United States. The Duke announcement recognized "the many excellent family medicine residency training programs in North Carolina" and listed two Duke-affiliated programs, with which the department will continue to work, and 11 other North Carolina residencies.
Fields noted AAFP's ongoing efforts to help residencies through the Residency Program Solutions (formerly the Residency Assistance Program) and encouraged the Duke community and the university's family medicine department to keep supporting residencies affiliated with the university. "I encourage the department to continue to provide quality experiences to medical students in family medicine so the students will choose the specialty" after their primary care rotations, Fields added.
Since its beginnings in the early 1970s, the Duke program has produced 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," said the joint statement.
The residency will stop accepting new residents after this year, will release residents who wish to leave and will continue training residents who stay in the program, said the announcement from FP Lloyd Michener, M.D., clinical professor and chair of the university's community and family medicine department.
"For us, the family medicine center is a test site for how to do care better," Michener said in an interview. "The Duke family medicine center's obligations are first to our patients, second to developing better methods of health care and then third to teaching residents what we've learned. Closing the residency calls into question whether family medicine residencies necessarily have a central role in academic departments."
Closing the residency was not a financial move, added Michener. "The department is doing well financially. The decision to close the residency was based on the internal conflict between what we're trying to do as a family medicine department and the needs of the residents for a stable training site. Many of our residents have said they want a training program like (that at) other training sites, where the program exists for them, the faculty are there for them and there's a rate of change that's not excessive."
Innovation can occur in tandem with education, said the AAFP, ADFM, AFMRD and STFM. "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 ? have been able to balance the priorities of patient care, research and teaching while maintaining the integrity of their residency training programs."
Duke announced it would expand its training programs for physician assistants and physical therapists and its fellowship programs. "Our goal is to continue to be one of the national models of how academic health centers can provide better care to our patients in our offices and in our communities," said the Duke announcement.
"It's a disappointment that Duke is closing the residency," said AAFP President Larry Fields, M.D., of Ashland, Ky. "It seems Duke wants to concentrate on developing alternatives to family doctors, wanting to train more physician assistants and physical therapists. It's hard for me to understand how anyone who appreciates the value of family medicine could think they could do more for the American people in our health care system by training less qualified, less cost-efficient providers than family doctors.
"Unfortunately, hospitals make money from doing procedures that are generally done by subspecialists, and academic health centers make a lot of income from research by basic scientists or subspecialists, and those two situations don't lend themselves to promoting family medicine," Fields added.
The news of the Duke residency closing follows a five-year period in which, according to the Accreditation Council for Graduate Medical Education, 49 family medicine residencies closed and 13 received approval to open, for a current total of 461 allopathic residencies in the United States. The Duke announcement recognized "the many excellent family medicine residency training programs in North Carolina" and listed two Duke-affiliated programs, with which the department will continue to work, and 11 other North Carolina residencies.
Fields noted AAFP's ongoing efforts to help residencies through the Residency Program Solutions (formerly the Residency Assistance Program) and encouraged the Duke community and the university's family medicine department to keep supporting residencies affiliated with the university. "I encourage the department to continue to provide quality experiences to medical students in family medicine so the students will choose the specialty" after their primary care rotations, Fields added.
