Program Directors are responsible for conducting their residency training programs in compliance with the Accreditation Council for Graduate Medical Education (ACGME) Institutional Requirements and the Program Requirements for Graduate Medical Education in Family Medicine.
Your program director should periodically review these requirements with faculty, staff, and residents. Any variance from the Program Requirements for Residency Education in Family Medicine, or failure to comply with ABFM requirements for Family Medicine Certification, places your ability to qualify for the Family Medicine Certification Examination at risk. If you have any questions regarding compliance with these requirements, please discuss with your program director, ACGME or ABFM.
Advanced Placement Credit: United States & Canada
You may be eligible to enter training with up to 12 months of advanced placement credit toward certification if you are transferring from a program that is:
- An ACGME-accredited family medicine training program
- Another ACGME-accredited specialty training program
- An American Osteopathic Association (AOA) approved training program
- A Canadian training program approved by the College of Family Physicians of Canada
This is accomplished through entry into the online RTM system by residency program staff. However, some advanced placement credits will require prior approval from the ABFM, including:
- Requests for credit that exceeds 12 months
- Transfers associated with the closing of a program
- Transfers involving hardship circumstances
- Advanced placement credit for international training.
Maximum Amount of Advanced placement credit
The amount of credit normally recognized for each curricular area is listed in the table below.
- Ambulatory Medicine/Subspeciality
- 6 months
- 1 month
- 1 month
- 8 months
Diagnostic Imaging & Nuclear Medicine
Maternity & Gynecologic Care
- Gynecologic Care
- Maternity Care
- 1 month
- 2 months
- General Surgery
- Surgical Subspecialities
- 1 month
- 2 month
Human Behavior & Mental Health
Care of Neonates, Infants, Children & Adolescents
- 4 months
- 2 months
Musculoskeletal & Sports Medicine
Community Medicine & Population Health
Before you begin your training, your residency program must advise ABFM of advanced placement credit authorized for prior training through ABFM's Residency Training Management (RTM) system. Once you begin your training at a defined level, with a specified amount of credit, no additional credit toward certification for previous training will be authorized.
If it is the intention of your program to use a portion of your previous ACGME, AOA, or College of Family Physicians of Canada (CFPC)-accredited postgraduate education to meet residency program requirements, but you will still be completing a full 36 months of education (e.g., applying the prior training to requirements to permit a greater amount of elective time), your program is not required to obtain authorization of credit from ABFM.
If your program recruits you for an entry level PGY-1 position, and you begin training at that level, you will be expected to complete the full residency program of 36 months regardless of the amount of prior training or your performance after entry.
Transfer from one accredited Family Medicine residency program to another after the beginning of the PGY-2 year will be considered only when your program closes or when there is evidence of a hardship. A hardship is defined as a medical condition or injury of an acute but temporary nature, or the existence of a threat to the integrity of the resident's family, which impedes or prohibits the resident from making satisfactory progress toward the completion of the residency program's requirements. In considering such transfers, ABFM is concerned primarily with the requirements for continuity of care during your second and third years of training as stipulated in the ACGME Program Requirements. All requests must demonstrate the nature and extent of the hardship.
Any change that has not been approved by ABFM and does not meet the requirement for continuity may affect your eligibility for the certification examination.
Advanced Placement Credit: International
If you are an internationally-trained physician with postgraduate training outside of the U.S. or Canada, you may be admitted to an ACGME-accredited Family Medicine program with advanced placement credit of 12 months or less. However, your program must obtain approval from ABFM prior to your entry. Advanced placement credit up to 12 calendar months may be awarded to your PGY-1 year of residency training. ABFM may award credit only for experiences which are equivalent to training in Family Medicine and only in the amount compatible with the ACGME program requirements.
You must have completed a minimum of three years of international graduate medical education after receiving your medical degree to be considered for any credit. Requests for international advanced placement credit must include all of the following verifiable supporting documentation:
- Licensure in the state, province, and/or country of practice
- The medical school diploma (World Health Organization approved)
- Documentation of internship and residency training or equivalent including a description of the clinical rotation schedule or the number of months of specialty training completed
- Specialty and subspecialty certification
- Receipt of a currently valid Standard ECFMG Certificate from the Educational Commission for Foreign Medical Graduates
Part Time Residency in family medicine
ABFM requires prior approval for part-time or reduced training schedules. Your residency program director must submit a description of the curriculum outlining how your part-time schedule complies with the ACGME Program Requirements and the specific conditions described below. Any subsequent changes must be approved by ABFM in advance. Your curriculum design must meet the following guidelines:
- A satisfactory reason for your part-time status must be communicated.
- Your educational needs must be assured.
- Your continuity of care experience must occur in a Family Medicine Practice site approved by the Residency Review Committee and must occur in the same Family Medicine Practice site in the PGY-2 and PGY-3 years of training. During the PGY-2 and PGY-3 years, you will be required to complete comprehensive continuity of care for patients in the Family Medicine Practice site on a full-time equivalent basis. Clinical rotations/experiences and continuity clinic time will be integrated during the part-time schedule. Block clinic time without concurrent clinical rotations/experiences does not reduce the continuity of care requirement or the length of training time but can serve to assure compliance with the continuity of care requirement. You will need to complete the same minimum number of continuity patient visits as required of full-time residents.
- Fairness to other residents in the program has been considered and addressed.
- Your total curriculum equates to the sum of clinical experiences and responsibilities of that of a resident with a normal full-time schedule.
- Documentation regarding how your continuity of care responsibilities will be assured throughout the term of your training experience.
Family Medicine combined residencies are residency programs sponsored by a single institution that provides residents with all of the curricular elements of a categorical ACGME-accredited family medicine residency as well as the required ACGME curricular elements of a second discipline. They are specifically designed to enable residents to complete and become eligible to take the certification examination in both specialties one year earlier than if they were to have completed the two residencies in a sequential fashion. Combined residencies involving family medicine are not accredited by the ACGME— they are approved by ABFM and the second ABMS specialty board involved. At the present time, ABFM has approved combined residency training programs in conjunction with the American Board of Internal Medicine, the American Board of Emergency Medicine, the American Board of Preventive Medicine, and the American Board of Psychiatry.
ABSENCE FROM THE RESIDENCY
Continuity of Care
ACGME program requirements define continuity of care as providing care to a panel of patients in a continuous fashion. This is a foundational aspect of family medicine and is required in your residency program. To accomplish this, you are expected to be assigned to one Family Medicine Practice site for all three years but required to do so at least throughout the second and third years of training. You will need to meet the defined minimum patient visits in the Family Medicine Practice site and must be scheduled to see patients in that site for a minimum of 40 weeks during each year of your training.
VACATION, ILLNESS, AND OTHER SHORT-TERM ABSENCES
Time away from your training program for vacation, illness, or other special circumstances is important to support your personal health. Maintaining wellness while also remaining in compliance with ABFM requirements is critical to your future as a board-certified family physician. As a resident, you are expected to perform your duties for a minimum period of eleven months each calendar year. As such, absence from your program for vacation, illness, personal business, leave, etc., must not exceed a combined total of one month each academic year. ABFM defines one month as 21 working days or 30 calendar days.
Vacation periods may not accumulate from one year to another. Annual vacations must be taken in the year of the service for which the vacation is granted. No two vacation periods may be concurrent (e.g., last month of the PGY-2 year and first month of the PGY-3 year in sequence), so that disruptions in continuity of care are limited. Reducing the total time required for residency (36 calendar months) may not occur by relinquishing vacation time.
ABFM recognizes that vacation/leave policies vary from program to program and are the prerogative of your program so long as you do not exceed ABFM's time restriction.
Time away from your residency program for educational purposes, such as workshops or continuing medical education activities, is not counted in the general limitation on absences but should not exceed five days annually.
LONG TERM ABSENCE
Absence from your residency program, in excess of one month within the academic year (PGY-1, PGY-2 or PGY-3 year) must be made up before you advance to the next training level and the time must be added to the projected date of completion of the required 36 months of training. Absence from your residency program, exclusive of the one-month vacation/sick time, may interrupt continuity of patient care for a maximum of three months in each of the PGY-2 and PGY-3 years of training. Leave time may be interspersed throughout the year or taken as a three-month block.Following a leave of absence of less than three months you are expected to return to the program and maintain care of your panel of patients for a minimum of two months before any subsequent leave. Leave time must be made up before the resident advances to the next training level and the time must be added to the projected date of completion of the required 36 months of training. Residents will be permitted to take vacation time immediately prior to or subsequent to a leave of absence.
In cases where a resident is granted a leave of absence by the program, or must be away because of illness or injury, the Program Director is expected to inform ABFM promptly by electronic mail of the date of departure and expected return date. It should be understood that the resident may not return to the program at a level beyond that which was attained at the time of departure. All time away from training in excess of the allocated time for vacation and illness should be recorded in the RTM system.
Leaves of absence in excess of 3 months are considered a violation of the continuity of care requirement. Programs must be aware that ABFM may require the resident to complete additional continuity of care time requirements beyond what is normally required to be eligible for ABFM board certification.
WAIVER OF CONTINUITY OF CARE REQUIREMENTS FOR HARDSHIP
While reaffirming the importance of continuity of care in Family Medicine residency training, ABFM recognizes that hardships occur in the personal and professional lives of residents. Accordingly, a waiver of the continuity of care requirement or an extension of the leave of absence policy may be granted if your residency program closes during your training period, or when a resident experiences a substantial hardship. A hardship is defined as a debilitating illness or injury of an acute but temporary nature, or the existence of a threat to the integrity of the resident's family, which impedes or prohibits the resident from making satisfactory progress toward the completion of the requirements of the residency program.
A request for a waiver of the continuity of care requirement or an extension of the leave of absence policy on the basis of hardship must demonstrate:
- The nature and extent of the hardship
- Assurance that disruption on continuity of care does not exceed 12 months
- That the annual vacation/sick time permissible by ABFM and the program has been reasonably exhausted
- That a medical condition causing absence from training is within the Americans with Disabilities Act (ADA) definition of disability.
If the necessary absence is less than 12 months, the amount of the 24-month continuity of care requirement that the resident completed prior to the absence will be considered a significant factor in the consideration of the request.
When the break in continuity exceeds 12 months, it is highly unlikely that waivers of the continuity of care requirement will be granted.
The Residency Program Director should indicate what criteria will be used to determine the point at which the resident is expected to re-enter. This re-entry may not be granted a level beyond that which the resident had attained at the time of departure. Given that these circumstances are uncommon and fluid, the resident may re-enter the program pending a final decision by ABFM on the amount of additional training, if any, that will be required of the resident.