Training for family physicians is a process that begins with medical school, continues through residency, and lasts throughout a physician's career. Family doctors never stop acquiring new knowledge and skills in their drive to provide the best possible care for their patients.
All family physicians begin their training by graduating from an accredited school of medicine or osteopathic medicine. During medical school, students take board exams, either steps 1 and 2 of the United States Medical Licensing Examination (USMLE) or levels 1 and 2 of the Comprehensive Osteopathic Medical Licensing Examination of the United States, and complete core clerkships, or periods of clinical instruction. Passing both exams, core science courses, and the clerkships grants students the Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree, which entitles them to start full clinical training in a residency program.
After graduation from medical school, the next step is to complete a residency in family medicine. Students apply to and interview for residency program placement during the last year of medical school. Most residency programs in the United States enter the nationwide Match process to process applications and select residents.
Students who graduate from a medical school outside of the United States are considered International Medical Graduates (IMGs) and must meet certain criteria established by the Education Commission for Foreign Medical Graduates (ECFMG) and obtain ECFMG certification in order to apply to a US-based residency program.
Family medicine residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) require three years of training. Some family medicine residencies offer a four-year training plan, while others that combine family medicine training with another specialty, like psychiatry, require five years.
As with other specialties, family medicine residency programs have specific requirements including certain numbers of months in each training area that must be completed for board certification. Family medicine residencies are designed to provide integrated experiences in ambulatory, community, and inpatient environments during three years of concentrated study and hands-on training. Strolling Through the Match includes a table comparing family medicine residency requirements with requirements in other specialties, like pediatrics.
The first year of residency is called the internship year. 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. During intern year, most residents also study for and take their final USMLE or COMLEX-USA exam. 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 training, residents must meet the ACGME family medicine residency education accreditation requirements and eligibility requirements for Board certification by the American Board of Family Medicine (ABFM) or American Osteopathic Board of Family Physicians (AOBFP). Specific required educational experiences 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, emergency medicine, and inpatient hospital care (including critical care). Each resident spends a few nights per month “on call” and on rotation throughout the hospital.
After training is completed and all requirements are met, residents are eligible to take the certification exam by the ABFM or AOBFP. Toward the end of residency, physicians also apply for state licensure, which determines where they can practice as a board-certified family physician. Although each state has different requirements for initial medical licensure, all physicians must pass step 3 of the USMLE or level 3 of the COMLEX-USA.
To learn about specific residency programs, visit the AAFP’s Residency Directory »
Combined programs typically require five years of training. Upon graduation, residents are board-eligible for two specialty certifications. Currently, there are five types of combined-specialty residency programs for family medicine (FM):
Dual specialty programs are designed to provide residents who complete them with certifications from both boards; they also must recertify with each board.
After residency, additional opportunities are available to physicians who seek advanced training in areas of family medicine. However, fellowship training is not required to practice broad-scope family medicine or develop an area of interest. Family physicians may choose a fellowship as a post-residency option because the more concentrated training helps them meet a community need or professional goal. Some fellowship areas are:
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.
Family physicians can earn a subspecialization certificate in another select field if they complete additional training and exams. Family medicine uniquely requires that its physicians maintain certification in family medicine and the subspecializtion area. CAQs are valid for ten years, and physicians must apply for recertification to renew the certificate (in addition to recertifying in family medicine after ten years). The AAFP supports CAQs as a way to improve physicians’ academic and administrative development.
The ABFM currently offers CAQs in the following areas: