Family Medicine

What are some important statistics around the specialty?

Family Medicine is arguably the most diverse of all medical specialties, providing care to patients of all ages from newborn to geriatrics, as well as obstetrical services. Family Medicine physicians practice in a wide range of practice environments ranging from office-based practice to hospital settings, from urgent care centers to skilled nursing facilities. Family Medicine Residents receive training in six major medical disciplines: pediatrics, obstetrics and gynecology, internal medicine, psychiatry and neurology, surgery, and community medicine.

What activities should I pursue if I am interested in this field?

Family Medicine is arguably the most diverse of all medical specialties, providing care to patients of all ages from newborn to geriatrics, as well as obstetrical services. Family Medicine physicians practice in a wide range of practice environments ranging from office-based practice to hospital settings, from urgent care centers to skilled nursing facilities. Family Medicine Residents receive training in six major medical disciplines: pediatrics, obstetrics and gynecology, internal medicine, psychiatry and neurology, surgery, and community medicine.

What are some important statistics around the specialty? 

Unlike other specialties that are limited to a particular organ or disease, family physicians are the only specialists qualified to treat most ailments and provide comprehensive health care for people of all ages — from newborns to seniors. This looks like: 

* Caring for patients regardless of age or health condition, sustaining an enduring and trusting relationship * Understanding community-level factors and social determinants of health 

* Serving as a patient's first contact for health concerns 

* Navigating the health care system with patients, including specialist and hospital care coordination and follow-up 

* Using data and technology to coordinate services and enhance care 

* Considering the impact of health on a patient's family. 

I recommend that you get your FREE student membership (it costs practicing physicians close to $1000 annually) to American Academy of Family Physicians here: https://www.aafp.org/membership.html. You will find lots more resources on that website--including information just for students.

What general advice do you have for someone choosing this specialty?

Family Medicine can be many things: clinic, hospital, emergency, labor and delivery, procedural--or all of them. Especially in rural areas where there tends to be much broader scope of practice. My own career has taken me from "full spectrum" family medicine, to hospitalist medicine, to director of a clinic for unhoused people, to correctional health, to academia, to a leprosy clinic--in other words there are an enormous variety of opportunities.

What are the top three areas that students can focus on to help prepare themselves for a successful residency application and a successful transition to residency? 

I believe a record of service in the community is one of the best ways to prepare (e.g. volunteering in CHIP programs). Rotations that provide lots of hands-on training are best. Amazing immersive experiences in rural, border, tribal health such as experienced in the Year 3 Longitudinal Integrated Clerkship (LIC) are recommended. Website is here: https://phoenixmed.arizona.edu/clerkships/year-3/lic

What resources would you share with a student who is just starting to research their interest in this specialty and/or wants to learn more specifics of this specialty?

First and foremost, I recommend visiting the AAFP website and getting that free membership. Explore the student section. Consider attending the annual conference sponsored by AAFP for students and residents. Feel free to reach out to me and other family physicians for opinions/recommendations. 

What subspecialties exist with this specialty?

*There are "Added Qualifications" in: 

Adolescent Medicine Geriatric Medicine HALM (Health Care Administration, Leadership, and Management), Hospice and Palliative Medicine Pain Medicine, Sleep Medicine Sports Medicine

 *Certifications through other medical boards include: ]

Addiction Medicine, Brain Injury Medicine, Clinical Informatics, and Emergency Medical Services.  Check out this page at the American Board of Family Medicine web site for more info: https://www.theabfm.org

What does a typical workday or work week look like?

Such variety in family medicine, it is impossible to generalize. This depends completely on your practice interests

What are the important traits, qualities, and/or considerations recommended for physicians in this specialty?

1) Desire to understand the big picture. How component parts --of a person, health system, community --make up the whole. 2) A desire to put patients first and foremost--ahead of technology, testing, disease labels. 3) An interest in getting to know patients over time--their families, kids, parents, grandparents and appreciating the value that these relationships have in making you a more effective physician.

How does the specialty work differ in various settings?

Private practice: this is a rarer option but does certainly exist.  Requires managing a business (hiring/firing/contracts with insurances/billing/watching revenue/managing expenses/making payroll) in addition to that incidental thing called practicing medicine.  In a sole provider practice, this can be exhausting, though I know doctors who wouldn’t have it any other way.  They love the independence and the freedom to negotiate directly for contracts. Group practice, if the goals and the chemistry are aligned, can be a way to share the operations load and also have more leverage in negotiations with insurance companies.

Community Practice: I interpret this to mean working for a large health system (a la Banner or Honor Health or ValleyWise) in a practice often located some distance from the mother ship hospital(s).  In this scenario, the health system runs the practice and, depending on the corporate culture, include the physician staff in varying levels of decision making, like the hiring MAs, practice partners, etc.  The position is typically salaried with extra incentives for hitting quality measures.   

Public Health/Population Health-Oriented/Underserved/Government: Veterans Administration settings, County Hospital System (ValleyWise), Correctional Health, Indian Health System (and Tribal-run health systems), Public Health Departments, Federally Qualified Health Centers (FQHC--like Wesley Community Health Center):  These are settings that are underappreciated by many future physicians.  Work in this setting can be highly rewarding as staff, nursing, and physicians tend to be “mission” driven.  Salaries, while plenty good, may be less than in the other settings. HOWEVER, state/federal loan repay options and generous benefits may in fact make the total package more generous.  They can include a pension plan, 401k (or similar) matching, generously subsidized health insurance, excellent malpractice with tail coverage. 

Academic:  This setting can be many things—medical practice in the settings described above or in a practice owned by the academic center plus academic duties. Academic responsibilities are varied, but as a broadly trained family physician, you would be uniquely prepared to collaborate with a wide range of specialists in developing novel educational programs, advancing research, and administering programs that require fluency in health systems and a wide range of specialty cultures.

What does training for this specialty look like (how many years, is a separate prelim year needed, etc.)?

3 years for family medicine. For Added Qualification, may require extra year.Is there a specialty interest group?  If not, what other networking options would you recommend?  Are there any specific national organizations or committees I should join?

FMIG exists at our medical school--Join it! :). Family Medicine Future Conference--look on AAFP Website.

What types of experiences might strengthen my future residency application, especially in areas of service, leadership, and research? 

Things that could help in order of importance: Community service--rotations and volunteer work that puts you where the need is greatest and where you may shoulder more responsibility as in the rural LIC (and soon urban LIC). Engaging in population health research; leadership in a medical student service organization; advocacy for evidence-based care (lobbying at the Capitol, for example) are other activities that will help show your dedication to working with patients and communities. 

What advice would you offer MS1s and MS2s who are interested in this specialty?

Get involved. Many of the faculty and deans on campus are family physicians. We love to talk about our specialty. The department, headed by Dr. Sharry Veres, is dynamic and creative. We have dozens of interesting initiatives (including research and community projects) going on at any given moment. Dr. Veres loves to support students interested in family medicine.

Is there anything else in addition to the suggestions above that could aid my future application, now that Step 1 is P/F?

Enjoy and learn as much as possible in every clinical rotation because this is education you will apply to your practice as a family physician!

How important are Step 2 scores to this specialty?

Somewhat Important

Are publications important to this specialty? Is there a general number of publications or presentations I should be aiming for?  How important is it for these to be within the specialty I am pursuing?

Perhaps at academic programs one or two publications would be helpful though not required. Community programs will not be expecting this. 

Are there any special considerations when applying for residency?

Deciding on these elements will be important:

1. Do I want an unopposed family medicine program?  Unopposed means family medicine is the only program in the medical system that hosts the residency (e.g. no pediatrics, surgery, EM etc).  Family medicine in a multi residency setting can feel like it has no primary ownership over any single domain of clinical setting.  In a training setting, it can mean rotating to other services and being treated as a ”visitor” or “guest” and not shouldering the same leadership and training opportunities as colleagues in the home specialty.  The degree to which this is an issue depends on the residency culture(s)and will require careful questioning.
2. Do I plan to practice full spectrum family medicine?  Full spectrum is “cradle to grave care.”  It is what would be needed in an underserved rural and urban setting where the family physician is the go-to doctor.  This is a relative term but includes acquiring proficiency in procedures like colonoscopy, exercise stress testing, obstetrics (possibly including c-sections), emergency medicine, family planning (including IUD insertions, fertility workup or pregnancy terminations).  Full spectrum could also include inpatient care of adults and pediatric patients, newborn resuscitations, and the level 2 newborn nursery.  Believe me when I say many family physicians are well prepared in all these areas and more.
3. What is the residency culture?  Are residents well supported? What if I have a personal/family emergency—how would the residency community react?  How does they support wellness?  How do they adapt to the inevitable surprises and challenges in the local health care landscape.  Some of these questions may not seem important now, but they can be crucial in a high stress residency training environment. 

What is a general recommendation for how many programs to apply to (recognizing that this may vary based on student situation)?

The average student applies to 20-25

What letters of recommendation are recommended for this specialty?

Faculty who have worked with you in the clinical space. 

If other disciplines are appropriate for letter of recommendation writers, are there specific specialties you would strongly recommend?

         Other primary care--IM, peds, OB. Also surgery could be helpful. 

How competitive are the residency programs in this specialty?

Some community and university programs are highly competitive, the majority of programs are reasonably attainable with good effort and preparation. 

When do programs typically offer interviews?

Typically September through January.

What is UA COM-P's history with matching in this specialty?

Excellent. We have many faculty ready to give you good advice.

Are away rotations required for this specialty and if so, when should I plan to do them?

No they are not necessary and could be helpful for a competitive out of state program.