Last Updated on August 28, 2023
The Duke Family Medicine Residency Curriculum represents a comprehensive plan designed to develop the knowledge, skills, and attitudes needed for independent primary care practice. The mission of the curriculum is to educate residents to become new leaders in our ever-changing health care system.
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Duke Family Medicine Residency Curriculum
Duke Family Medicine Center
Type:Duke University Hospital Outpatient Department, Primary Care*Hospital-based clinics are an extension of Duke Health hospitals and have additional facility charges. Some insurance companies process bills with a deductible and coinsurance rather than as a co-pay as for an office visit. This may impact the amount of the bill you are responsible for after payment from your insurance plan. Check with your insurance company before your visit to determine what your responsibility will be.
The Duke Family Medicine Center in Durham offers comprehensive care to every member of your family. Our family medicine providers see you at every stage of your life, from prenatal care and well-baby visits to senior care. As an LGBTQ+ medical home, our providers are trained to offer a range of culturally sensitive, knowledgeable, medical services to the LGBTQ+ community.
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Marshall I. Pickens Building
2100 Erwin Rd
Durham, NC 27705-3941Get DirectionsAppointments919-823-7357Office919-823-7357Fax919-681-7085Family Medicine
Family medicine providers include family doctors, physician assistants, and nurse practitioners. They establish relationships with you and your family to keep you healthy and help you prevent illness.Learn More
Family Medicine Care in Durham
Family doctors, physician assistants, and nurse practitioners at the Duke Family Medicine Center provide routine and sick medical care to children, teens, adults, and seniors. As a teaching practice, many of the providers you will meet are residents and fellows in several different specialties. The comprehensive care we provide includes:
- Annual physicals, sports, and school physicals
- Medicare annual wellness visits
- Age-appropriate health screenings throughout life, including hearing, vision, and developmental screenings for children
- Well-baby visits, newborn circumcision at four weeks, well-child care, and sick visits
- Immunizations, including newborn, school-age vaccinations, annual flu, and other vaccinations
- Sick visits for flu, cold, sinus infections, sore throats, and other concerns
- Ongoing management for conditions such as allergies, asthma, and high blood pressure
- Vasectomies can be performed in the office
Women’s Health Care
Our family doctors and providers offer family planning and regular gynecological screenings such as breast exams, pap smears, and screening for sexually transmitted diseases/infections.
We also perform selected women’s health procedures including pap smears, insertion/removal of implantable contraceptives, colposcopy, and endometrial biopsies.
Our prenatal care program, CenteringPregnancy®, is available to eligible women in their first three months of pregnancy. This program provides prenatal care to eight to 12 pregnant women who are due at about the same time, during two-hour visits. Moms have a one-on-one assessment with their provider and time for group sharing and discussion. Watch a video about this program.
Menopause care is available for women who experience symptoms related to perimenopause and menopause.
LGBTQ+ Culturally Sensitive and Knowledgeable Care
Duke Family Medicine Center offers a range of culturally sensitive and knowledgeable medical services for LGBTQ+ patients. We provide and work with specialists throughout Duke to offer:
- Adult gender care
- PrEP for people at high risk for HIV infection
- Gender affirming hormone therapy
- Gynecological care, including birth control and STD testing
Comprehensive Care Beyond Family Medicine
Many of our providers are board certified in additional specialties, which allow us to provide care beyond the realm of traditional family medicine. For example, we provide:
- Mental illness care, including treatment for depression and anxiety
- Endocrine and hormone concern management
- Care for rheumatologic and autoimmune conditions
- Smoking cessation efforts
- Diabetes education and nutrition counseling
- Multiple prescriptions management to prevent negative interactions
- Opioid use disorders
- Obesity management
- Treatment for sports medicine conditions and injuries that do not require surgery
- Specialized elder care
- Social work services
- Home-bound patient visits when needed
- INR monitoring for patients on warfarin treatment
- Selected skin procedures such as mole removal and ingrown toenail treatment
If you need specialty care, your primary care doctor can connect you with the Duke Health network of doctors who are ranked among the nation’s best. Our specialists have access to the latest research, technology, and medical advances, many of which are discovered at Duke Health. Because our electronic medical records system is accessible to every doctor and every facility at Duke, your medical record will be easily shared with your entire care team.
Manage Your Health Online
As a Duke patient, you’ll have access to Duke MyChart, an online patient portal that makes it easier than ever to manage your health care online. Duke MyChart allows you to see your test results, request prescription refills, schedule appointments, and communicate with your provider.
Lab Tests and X-rays
Blood work and X-rays can be done right in our clinic.
family medicine residency requirements
Training Requirements for Family Physicians
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.
Family Medicine Residency
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.
Requirements During Residency
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 »
Advanced / Additional Training
Combined Programs in Family Medicine
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):
- FM-emergency medicine
- FM-internal medicine
- FM-preventive medicine
- FM-osteopathic neuromusculoskeletal medicine
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:
- Addiction medicine
- Faculty development
- Preventive medicine
- Sports medicine
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.
Certificates of Added Qualification (CAQ)
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:
- Adolescent medicine
- Geriatric medicine
- Hospice and palliative medicine
- Pain medicine
- Sleep medicine
- Sports medicine
family medicine residency length
The duration of family medicine residency training in the United States has been 3 years since the inception of the discipline in 1969. Family medicine training around the world ranges from 2 to 5 years, with varying approaches to undergraduate and predoctoral education. Much has changed in US medicine since 1969, yet the core values of family medicine have remained consistent. While adjustments in curricula, structure, and sequence may be warranted, 3 years remains the appropriate length of training for family medicine residents. A longer duration of training poses significant challenges at the same time that learners need more choice and flexibility. Innovation in training requires creative thought, reforms, and adaptability, without increasing the length of training.
The 3-year family medicine residency experience allows for a graded exposure to key elements of training while also ensuring ready access to care for patients and communities. This is validated by sustained demand for the graduates of 3-year programs and the demand for additional training slots. In 2020, the physician recruiting firm of Merritt Hawkins identified family medicine as “the most in-demand specialty” by employers for 14 consecutive years.1 The Medical Group Management Association has shown a 15% increase in family physician salaries to a median of $250,000 for outpatient practice in 2020.2 At the same time, to meet the demand of trainees, the number of 3-year family medicine residencies has grown at approximately 3.5% per year, adding 99 new programs since 2018.3
The current infrastructure is built with resources and funding to support 3 years of family medicine residency. Increasing the duration would result in a longer pipeline and a delay in graduating family physicians prepared to serve their communities. A 1-year increase in training would result in approximately 4,500 fewer family medicine graduates. Even if spread over several years, that would represent a significant loss of new graduates at a time when the United States is projected to have a shortage of 55,000 family physicians.4
For community-based family medicine residencies, the increase in unfunded requirements and staffing needs of additional training would prove to be a significant burden. At the national average of $150,000 per year per resident, even small programs could see a large increase in expenses.5 Although some 4-year programs have reported financial stability, most depend on increased clinical volume or novel funding sources.6
Beyond the financial barriers, adequate clinical experiences and patient volumes, along with the concern for availability of clinical faculty, all pose significant hurdles. Accreditation Council for Graduate Medical Education data already shows declines in the number of continuity visits, pediatric visits, and continuity obstetrical deliveries managed by family medicine residents.7 Additional teaching needs would further exacerbate the existing challenges of recruiting new faculty to community-based and rural programs.
A change in length of training may also result in an overall decrease in the number of medical school seniors seeking family medicine residency positions. The existing structure maintains medical student interest and acknowledges the paradigm of educational debt. The Association of American Medical Colleges reported a median medical student debt burden of $200,000 in 2020.8 An increase in residency length would mean a delay to full income potential. Although family medicine salaries have risen steadily, the discipline remains among the lowest paid, and a nearly $200,000 pay differential between resident and attending physician, balanced against an average $200,000 educational debt is significant. The path to becoming a physician, already a long and expensive journey, could lead some students to choose a 3-year training program in a different specialty.
The discipline should emphasize the quality of training rather than the quantity of time. A recent survey of family medicine faculty and residents showed a clear preference for maintaining 3 years of training with 74% of faculty and 77% of residents preferring 3 years or 3 years with an optional fourth year of training.9 Longer length of training does not necessarily lead to increased knowledge. A recent study comparing emergency medicine residents in 3- or 4-year programs found no difference in board exam scores.10
There is a need for reexploration of the contents of the 3 years of family medicine training. While comprehensiveness remains a hallmark of family medicine, the current breakdown of training time is not reflective of the practice patterns for the majority of family physicians.11 A strategic decrease in the time required in experiences such as inpatient pediatrics, and a refocus on high-functioning outpatient clinics would more closely reflect the future needs of graduates. Only 24.1% of respondents to a recent survey felt that it was still important to teach inpatient pediatrics to family medicine residents.12 Use of “selective” or “area of concentration” opportunities could provide more cohesive learning experiences in important areas such as health equity and advocacy. This calls for a change in specific rotation requirements, different approaches to teaching and evaluation, and more flexibility in the overall curriculum, but it does not require an increase in length of training. Ultimately, flexibility should remain with the learner. There are ample fellowship and advanced degree opportunities for those who desire additional time for structured learning. The number of family medicine residents who choose to pursue fellowships is relatively small.13
Three years of family medicine residency is producing well-trained family physicians. Keeping the needs of patients, communities, and physicians at the forefront, learners should be able to determine for themselves the type and timing of any additional training. Ultimately, flexibility and autonomy will provide a consistent pipeline of well-trained, satisfied, and engaged family physicians to serve their patients and communities for generations to come.