Family Medicine Residency Overview

Residency Application Specialists

Family Medicine’s physicians are generalists, trained to prevent, diagnose and treat conditions across age groups and systems. A good family physician must blend understanding of the biomedical and social sciences, and be aware of the importance of community care. Expect to receive training across surgery, psychiatry, internal medicine, obstetrics and gynecology, pediatrics and geriatrics during your residency. The median salary for a family physician is relatively lower than many other specialties, at $211,000 for a clinician (and a little under $200k for an academic).

Residency Core Requirements

Core requirements are three years of training in an ACGME-accredited training program. In the most recent available data there were 480 family Medicine residency programs, offering more than 4900 positions. Subspecialty training is much more limited than in many specialties, with only geriatric Medicine and Sports Medicine being available upon completion of the core Residency.

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Application Statistics & Competition

Family Medicine had 4935 positions available in the most recent data, which was an increase of 91 compared to the year before. In fact, this makes up 13.6% of the total number of positions offered across all specialties, showing the importance of this area of Medicine. 4470 medical students matched to family Medicine residency programs in 2022, with 1555 of these US MD Seniors, 1496 DO Seniors, 779 being US IMGs, 458 being foreign IMGs, and a little less than 200 being previous graduates of US MD and DO schools. The percentage of DO students matching to family Medicine has actually been decreasing in recent years, and the number of US MD seniors matching has also decreased, even more significantly. The number of US MD seniors hit a peak of 2340 in 1997 – this year, only 8.4% of matched US MD Seniors matched in family Medicine, and a quarter of US IMGs matched to family Medicine. This is something to be aware of – year-over-year declines in the number of US MD Seniors applying and matching. This reflects wider concerns with the attractiveness of the specialty to US MDs, and over whether the US medical system is correctly geared towards training physicians in the specialties that it most needs.

Sample Interview questions

A 72 year old woman has attended, needing a repeat prescription of 100 mcg levothyroxine daily. She has been taking this for the past 25 years. The last record of any blood test was five years ago. She describes an episode of severe back pain, with a dull ache around the L3 region. There are no neurological signs. What is the most likely diagnosis? Tell me more about the diagnosis.

The most likely diagnosis is osteoporosis. A patient who has replacement levothyroxine needs to be monitored regularly to make sure that the dose is correct. If the patient’s dose is too high, osteoporosis can result, making this the most likely diagnosis. Osteoporosis is a progressive, systemic skeletal disorder. It is characterised by disruption of bone microarchitecture and loss of bone tissue. This leads to bone fragility and thus an increased risk of fracture. It is especially associated with postmenopausal women.

What are some red flags for neck lumps? What might you look for on palpation?

Red flags for neck lumps include a hard and fixed mass, the presence of a mucosal lesion in the head or neck, a history of persistent hoarseness or dysphagia, the presence of trismus, unilateral ear pain, irregular borders, and being over 35 years old. On palpation, a hard lump is more likely to be a malignancy than a soft lump, and a tethered lump is likely to indicate a malignant tumour. If the lump is not fluctuant it is unlikely to be a cyst, and thus more likely to be sinister. We might also note the temperature of overlying skin and if there are any changes – warmth or a punctum might indicate a cyst, for example. Pulsatility suggests vascular origin, and tenderness is indicative of inflammation or infection , likely due to a ruptured or infected cyst.

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Important considerations

It’s worth considering the relative lack of US MD graduates in the field, and to a lesser extent the lack of US DO graduates. This is something that programs will be aware of, and it could therefore mean a smoother matching process as programs look to balance the numbers of IMGs vs US students.

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