Financing the fourth year: Experiences of required 4-year family medicine residency programs

Abstract

The optimal length of family medicine training has been debated since the specialty’s inception. Currently there are four residency programs in the United States that require 4 years of training for all residents through par-ticipation in the Accreditation Council for Graduate Medical Education Length of Training Pilot. Financing the additional year of training has been perceived as a barrier to broader dissemination of this educational innovation. Utilizing var-ied approaches, the family medicine residency programs at Middlesex Health, Greater Lawrence Health Center, Oregon Health and Science University, and MidMichigan Medical Center all demonstrated successful implementation of a required 4-year curricular model. Total resident complement increased in all pro-grams, and the number of residents per class increased in half of the programs. All programs maintained or improved their contribution margins to their spon-soring institutions through additional revenue generation from sources including endowment funding, family medicine center professional fees, institutional col-laborations, and Health Resources and Services Administration Teaching Health Center funding. Operating expense per resident remained stable or decreased. These findings demonstrate that extension of training in family medicine to 4 years is financially feasible, and can be funded through a variety of models.