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

Alan B. Douglass, Wendy Barr, Joe M. Skariah, Kelly Hill, Yadira Acevedo, Roger Garvin, Sasha Savage

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)195-199
Number of pages5
JournalFamily medicine
Issue number3
StatePublished - Mar 2021

ASJC Scopus subject areas

  • Family Practice


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