Study finds substantial minority of family medicine residents support extending residency training from three to four years


Sept. 1, 2004

WASHINGTON-- In a survey of third-year family medicine residents, researchers found that while most favored a three-year residency program (63 percent), a substantial minority supported lengthening the three-year training to four years (37 percent). The research from the Robert Graham Center: Policy Studies in Family Medicine and Primary Care in Washington, D.C., was published in the September edition of the Journal of the American Board of Family Practice.

A total of 997 first-year residents were surveyed in 2000, representing approximately one-third of first-year family medicine residents that year. For the second survey in 2002, the researchers sought out the same group of residents who were now third-year residents. A total of 280 surveys were used for this analysis. The researches compared the residents' responses to the two surveys.

"The structure of family medicine residency programs remains essentially unchanged from the model first proposed more than 35 years ago," said lead author Marguerite Duane, M.D., M.H.A., a researcher for the Graham Center and a practicing family physician in Washington, D.C. "Advances in medical technology and knowledge combined with increasing restrictions on resident work hours and decreasing medical student interest invite reconsideration of how family physicians are trained."

"Given the contemporary concerns about the adequacy of medical education for new models of practice that are needed to enhance care for all Americans, an opportunity for experimentation is at hand. Our findings indicate that consideration should be given to longer training programs with more emphasis on selected content areas," continued Duane.

When supporting change to a four-year residency, responders listed several factors, including the broad scope of family medicine, particularly when compared with training in other specialties, and more exposure to procedures and specialty training. A new factor in support of extended residency that showed up in the second survey was the effect of new regulations limiting residents' working hours and the resulting decreased learning time.

The most frequently cited barrier to a four-year residency was the time commitment of an extra year and related funding issues, including doubt about federal funding for a fourth year, residencies' host institutions reluctance to fund fourth year positions, residents' fears about continued low salaries combined with large student loans, and the perception that even after completing a fourth year their income as practicing family physicians would be low compared to other medical specialties.

The authors identified two policy implications:

If residency programs are changed to four years instead of three, it is likely to attract some students and repel others with a small net effect. Of greater threat to family medicine residencies are poorly organized programs, curricula inhibited by uncommitted leadership and inadequate education components, and inertia when action is needed.

If experimentation is pursued, consideration should be given to longer programs with greater emphasis on selected content areas, while duty hours are limited and attention is given to anticipated new models of family medicine. Consideration should be given to the recommendations from the Future of Family Medicine Project, principles articulated in the Institute of Medicine's report Crossing the Quality Chasm, and potential collaboration with general internal medicine where reconsideration of residency programs is also under way.


# # #

Note to journalists: To interview Dr. Duane, or to obtain a copy of the article, please contact Maureen Maxwell at (202) 232-9033, (800) 274-2237, or

The Journal of the American Board of Family Practice can be access at The primary purpose of the journal is to publish original papers about clinical investigations and case reports and review articles pertinent to the specialty of family medicine. It also serves as a forum for the specialty of family medicine and as a medium for information about the activities of the American Board of Family Practice.

Information about the Future of Family Medicine Project can be viewed at The Institute of Medicine's report Crossing the Quality Chasm can be accessed at

The Robert Graham Centerconducts research and analysis that brings a family medicine perspective to health policy deliberations in Washington. Founded in 1999, the Center is an independent research unit working under the personnel and financial policies of the AmericanAcademyof Family Physicians. For more information, please visit

The information and opinions contained in research from the RobertGrahamCenterdo not necessarily reflect the views or policy of the AAFP.

September 01, 2004