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 ABFM approval, 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.
TIME AWAY FROM TRAINING ALLOWANCES
Residency Training Requirements for Board Certification Eligibility
Candidates for certification are required to complete 36 months of graduate medical education in an ACGME accredited Family Medicine residency program. In some situations, the training may be extended for additional time to meet the minimum requirements. All residents must have core clinical training that includes the breadth and depth of Family Medicine. These include, but are not limited to:
- Residents are required to spend their PGY-2 and PGY-3 training in the same residency program’s teaching practice, in order to provide sustained continuity of care to their patients.
- Each year of residency must include a minimum of 40 weeks of continuity clinic experience (exceptions may apply if the residency program has received a waiver of this requirement in connection with pilot projects assessing intentional variation in training requirements)
- Residents are required to complete a minimum of 1650 in-person patient encounters in the continuity practice site to be eligible for ABFM certification.
The Program Director is expected to sign, on behalf of the program, that the resident has met all requirements for board eligibility and is ready for autonomous practice.
Family Leave Policy and Time Away from Training
For the purpose of this policy:
- Academic/training years will be referred to as PGY1, PGY-2, PGY-3, and, when relevant, PGY-4.
- Family Leave of Absence from the residency program will be referred to as Family Leave.
- Time off allotted by programs for vacation, sick leave, holiday, PTO will be referred to as Other Leave.
Family Leave provided under this new policy is intended to address leave that related to:
- The birth and care of a newborn, adopted, or foster child, including both birth- and non-birth parents of a newborn.
- The care of a family member with a serious health condition, including end of life care
- A resident’s own serious health condition requiring prolonged evaluation and treatment
This policy does not apply to other types of personal leave and/or interruptions from a residency (e.g., prolonged vacation/travel, unaccredited research experience, unaccredited clinical experience, military or government assignment outside the scope of the specialty, etc.). This policy likewise does not apply to periods of time for which a resident does not qualify for credit by reason of resident’s failure to meet academic, clinical, or professional performance standards.
ABFM policy only provides guidance about the maximum time away from training allowable for a resident to be away from their program and remain board eligible without having to extend their training. It does not replace local human resource policies for resident leave. It is also distinct and separate from, and should not be confused with, family leave as permitted by the Family and Medical Family Leave Act (FMLA), or specific leave policies as defined by your sponsoring institution human resource department. Additionally, this policy is not intended to prescribe decisions regarding time of resident graduation. At any point, a Program Director and the CCC can make a decision to extend a resident’s training based on their assessment that the resident is not ready for attestation of meeting ACGME requirements and enter autonomous practice.
Time Allowed for Family Leave of Absence
Family Leave Within a Training Year: ABFM will allow up to (12) weeks away from the program in a given academic year without requiring an extension of training, as long as the Program Director and CCC agree that the resident is ready for advancement, and ultimately for autonomous practice. This includes up to (8) weeks total attributable to Family Leave, with any remaining time up to (4) weeks for Other Leave as allowed by the program.
There is no longer a requirement to show 12 months in each PGY-year for the resident to be board-eligible; however, by virtue of the allowable time, a resident must have at least 40 weeks of formal training in the year in which they take Family Leave. This policy also supplants the previous 30 day limit per year for resident time away from the program.
Total Time Away Across Training: A resident may take up to a maximum of 20 weeks of leave over the three years of residency without requiring an extension of training. Generally speaking, 9–12 weeks (3–4 weeks per year) of this leave will be from institutional allowances for time off for all residents; programs will continue to follow their own institutional or programmatic leave policies for this.
If a resident’s leave exceeds either 12 weeks away from the program in a given year, and/or a maximum of 20 weeks total, (e.g. second pregnancy, extended or recurrent personal or family leave) extension of the resident’s training will be necessary to cover the duration of time that the individual was away from the program in excess of 20 weeks.
- ABFM will allow Family Leave to cross over two academic years. In this circumstance, the Program Director and sponsoring institution will be the ones to decide when the resident is advanced from one PGY-year to the next.
- Other Leave time may be utilized as part of approved Family Leave, or in addition to approved Family Leave. ABFM encourages programs to preserve a minimum of one week of Other Leave in any year in which a resident takes Family Leave. Consideration should be given to the importance of preserving some time away for resident well-being outside of a period of Family Leave.
- Residents are expected to take allotted time away from the program for Other Leave according to local institutional policies. Foregoing this time by banking it in order to shorten the required 36 months of residency or to retroactively “make up” for time lost due to sickness or other absence is not permitted.
- Time missed for educational conferences does not count toward the time away from training under the Family Leave time allowed in this policy.
ABFM Family Leave Policy [PDF, 239KB]
FAQ for Family Leave Policy [PDF, 277KB]
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.