The Time Is Now: A Plan to Redesign Family Medicine Residency Education

Abstract

A new graduate medical education program in family medicine is urgently needed now. We propose an innovative plan to develop community-based, community-owned family medicine residency programs. The plan is founded on five guiding principles in which residencies will (1) transition to independent, community-owned organizations; (2) sustain comprehensiveness and generalism; (3) emphasize collaborative learning and interprofessional education; (4) develop local educators with national guidance; and (5) share resources, responsibilities, and learning. We describe actionable steps to begin the process of transforming residencies and strengthening primary care. As community-based and locally-run organizations, residencies will gain self-determination in how time is allocated, budgets are spent, and teams function. Building on the momentum of the National Academy of Medicine’s 2021 primary care implementation plan and recommendations by family medicine organization leaders, we propose a Decade of Family Medicine Residency Transformation. We encourage individuals and organizations spanning disciplines, health care systems, and communities, to join forces to reimagine and recreate the preparation of outstanding personal physicians dedicated to individual and community health and well-being.

The Role of Primary Care in Improving Population Health

“…Invest in primary care as a common good by doubling the current 6% of health care expenditure on primary care to 12% 11,154,206,207 and paying for primary care through capitation as the relationship‐centered frontlines for a more integrated, personalized health care system. Dramatically reduce administrative and documentation burden by revamping information systems to focus on clinically relevant rather than billing‐required information and focusing quality measurement on supporting the integrating, personalizing, and prioritizing functions of primary care, such as those assessed by the Person‐Centered Primary Care Measure 68 Invest in expanding the primary care workforce by redirecting graduate medical education and graduate nursing education support, including HRSA Title VII funding, toward primary care and community training settings 11,198 ; refocusing health care professional school admission processes so that trainees better reflect underserved populations 200 ; developing integrated training programs for members of the primary care team 11 ; and increasing HRSA Title VIII funding and loan forgiveness for those practicing in primary care, with additional incentives for those serving high‐need and underserved populations 201 …”

“…49,198 It also is vital to begin to invest in rebalancing toward 50% of the health care workforce serving in primary care, as is seen in more functional health care systems. 161,199 Currently, graduate medical and nursing training is hospital based, and the needs of the population would be better served by moving a substantial portion of that training to community settings and community ownership to better reflect population health needs. 198 Redirecting graduate medical education and graduate nursing education support, including Health Resources and Services Administration (HRSA) Title VII funding, toward primary care and community training settings 11 and refocusing health care professional school admission processes so that trainees better reflect underserved populations 200 are important first steps.…”

“…Valuing and supporting primary care have the potential to draw into the workforce those who want to care for whole people and to support that impulse in the entire workforce. Novel training approaches have been proposed for the individuals and teams needed for this work 49,198 …”

“…Novel training approaches have been proposed for the individuals and teams needed for this work. 49 , 199 …”

“… 161 , 200 Currently, graduate medical and nursing training is hospital based, and the needs of the population would be better served by moving a substantial portion of that training to community settings and community ownership to better reflect population health needs. 198 Redirecting graduate medical education and graduate nursing education support, including Health Resources and Services Administration (HRSA) Title VII funding, toward primary care and community training settings 11 and refocusing health care professional school admission processes so that trainees better reflect underserved populations 200 are important first steps. In addition, there is a growing need for training to better reflect the interprofessional practice setting and to develop integrated training programs to train other members of the primary care team.…”