January 21, 2022, 5:26 p.m. — The Accreditation Council for Graduate Medical Education recently released its new proposed requirements for family medicine residency training. A summary and impact statement on the proposed changes is also available. The last time family medicine residency requirements underwent such a major revision was more than 10 years ago. Now all members of the public have the opportunity to review and provide feedback on the proposed requirements by downloading the comment form and submitting the completed form to firstname.lastname@example.org by Feb. 11. This is our chance to shape the future of family medicine.
As Class of 2021 residency graduates, we stand at a unique intersection between reflecting on our own residency experiences and our current roles as early career family physicians. When we started residency, there was a nationwide collaborative to increase the proportion of U.S. medical school graduates who choose family medicine to 25% by 2030. We were inspired by the #FMRevolution campaign, and we entered the field with vigor for the specialty’s future. Halfway through residency, we faced the onset of the COVID-19 pandemic, which significantly impacted our training. We witnessed firsthand the value of family medicine’s adaptable nature — caring across all populations, adopting telemedicine, partnering with the community and maintaining continuity and patient advocacy during unprecedented times.
George Floyd's death ignited a national movement for racial justice and inspired many institutions to examine their diversity, equity and inclusion initiatives. We saw family medicine trainees, physicians, residencies and organizations become even more intentional in incorporating social determinants of health in practice and improving health equity. Residency was the most formative time of our lives, and these pivotal experiences during our training directly impacted our views on the ACGME’s proposal.
The proposal has changed specific metrics for certain experiences, such as removing the required 1,650 patient clinic encounters and decreasing hourly requirements of some rotations. This flexibility would permit new requirements for increased elective time and individualized learning plans, which in turn would improve resident education by focusing on the quality of practice experience rather than quantity of time. We anticipate that this would reduce the stress of “meeting numbers” when situations such as medical leave and unexpected deficiencies (e.g., pandemic effects, patient census fluctuations and cross-coverage needs) can arise. Finally, the flexibility would allow for residents to choose their own career path as they work to mold what their version of “full spectrum” will be — whether that is treating HIV and hepatitis C in a clinic, seeing inpatient pediatric patients, delivering babies in a rural hospital or caring for patients at a long-term care facility.
We are also enthusiastic about the new emphasis on overall panel management rather than face-to-face visit numbers. By providing each resident with their own unique patient panel, core family medicine skills of continuity, comprehensive care and care coordination would be attained. Our broad residency training taught us the importance of family medicine’s versatility and adapting to practice innovations. We strongly support ACGME’s explicit inclusion of telehealth, point-of-care ultrasound, substance use management and integrated behavioral health in the requirements because it would diversify resident experience and qualifications for future practice.
The proposal stress the importance of family medicine practices being conduits through which to understand and address the needs of the population(s) the practice serves. Family medicine as a discipline is uniquely poised to bring health and health care into the communities outside the confines of a clinic or hospital building. Resident participation in building and supporting patient advisory boards, conducting community needs assessments, engaging in meaningful advocacy initiatives and integrating social determinants of health into clinical care is invaluable. The ACGME proposal would call on programs to design the structure, faculty, coursework and clinical experiences around the diverse needs of the population and community within which residents learn. Such a structure builds on what many residents already bring when they start their training — an ever-growing understanding of the impact of diversity and equity initiatives and the social determinants of health on patient care.
Well-being in residency is critically important for residents to successfully complete a three- or four-year training program. In Medscape’s 2021 Physician Burnout and Suicide Report, 47% of family physicians reported burnout, which was higher than many other specialties. Burnout can negatively affect patient care and physician health, contributing to the primary care workforce shortage. The ACGME proposal would mandate consistent evaluation of residents’ work environments, ensuring physical and psychological well-being. To prevent burnout, programs should create safe environments where residents can promptly recognize their burnout signs and then seek services through a readily available list of well-being resources. We strongly support inclusion of specific guidelines regarding well-being in the new ACGME requirements.
If approved by the ACGME, the new family medicine residency requirements will be implemented in July 2022. We anticipate an overhaul in all residency programs as they examine how they address their populations’ needs while supporting individual resident career trajectories. For program faculty and leadership, this is a valuable opportunity to shape curricular missions, affirm and build on program strengths and identify and address weaknesses.
For resident trainees, we encourage developing career interests early in order to seek valuable clinical opportunities, effectively shape individual learning plans and take advantage of the expanded elective time. By increasing curriculum flexibility and reducing total resident and faculty minimums, we also anticipate that the proposal has potential for creating new family medicine residency programs. This would directly improve the shortage of primary care physicians and open opportunities for a more diverse family medicine workforce. Due to variable experiences depending on populations served and overall program values, we advise future family medicine applicants to reflect on their interests and goals when applying to residency. It will be important to actively engage and inquire how certain programs will align with one’s passions and aspirations.
The future of family medicine is bright, and we look forward to the changes to come. Spend some time the next few weeks reading the new recommendations or viewing the ACGME webinar that summarizes the proposed new requirements.
We urge you to provide feedback as we shape our futures together.
Emmeline Ha, M.D., is a health policy fellow with the Center for Professionalism and Value in Health Care and George Washington University. Victoria Boggiano, M.D., M.P.H. is a chief resident at University of North Carolina Family Medicine Residency. Kento Sonoda, M.D., A.A.H.I.V.S. is an addiction medicine fellow at the University of Pittsburgh Medical Center. The opinions expressed in this post are their own.