Family Medicine Residency: How to Match

What is Family Medicine?

If you’re one of the medical students for whom the term “non-traditional applicant” simply doesn’t apply, you likely spent a fair bit of time daydreaming about being a doctor when you were a child. Close your eyes for a moment and go back to that early, simpler vision of medicine. What do you see? Interviewing a familiar face about what ails them? Working in your own office surrounded by medical tomes on a wide variety of subjects? Odds are that your earliest ideas of being a physician approximate one of the most consistently popular specialties: Family Medicine.

Family Medicine specialists are in many ways the captains of an individual’s—or family’s—medical care, and they are often considered the easiest doctor to become compared to other specialties. They see people of all ages and health conditions and provide a range of medical services including, but not limited to, diagnosis, treatment, screening, preventive care, risk assessments, immunization, and counseling. They are in many ways the “Swiss army knife” of physicians, and while their focus may be wide it is in no way superficial. Rather, the Family Medicine specialty includes numerous subspecialties, and moreover requires continuous learning and research to be practiced optimally. It is in every way a specialty of lifelong learning, and in many cases of lifelong relationships—an aspect of Family Medicine that the American Association of Family Physicians (AAFP) has referred to as providing care “from the cradle to the grave".

This emphasis on interpersonal skills and relationships is one of the major draws to the specialty. Unlike, say, neurosurgery residency, Family Medicine physicians (or simply Family Physicians) are typically the first point of contact for individuals and families when they require medical assistance, or even simply have a medical question. Family physicians are masters of data—they must track patients over sometimes long periods of time, adapting their strategies and services to meet their needs, and setting health goals based on this data. A good family physician is then also a kind of counselor, serving as an intermediary between patient and specialists, or between the community and the medical institutions which exist to serve it.

Curious about the residency process and MATCH? Check out our video for a helpful overview of how it all works

Family Medicine is also an especially balanced specialty. Family physicians don’t work on-call shifts for the most part, and while they strive to make themselves available to their patients, they often don’t work especially long or odd hours. A recent profile conducted by the AAFP and referred to by the AMA found that family physicians spend about 34 hours per week in direct patient care, work about 47 weeks per year, and see about 78 patients per week in office-based settings. As a result, Family Physicians often report high job satisfaction and a great sense of work-life balance.

Family Physicians aren’t among the highest paid doctors, but that’s an extremely relative factor. An average income of $234K may be significantly eclipsed by the $479K enjoyed by Plastic Surgeons, but compared to most other occupations it’s a very comfortable life, even with the millstone of repaying six-figure medical school debt factored in. Of course, there are many other factors involved in determining how to choose a medical specialty, but for medical students seeking to have a balanced, challenging, and diverse career, Family Medicine remains an extremely popular option.

Check out most competitive and least competitive residencies:

Family Medicine Residency: Structure

To become a practicing Family Physician, medical students must complete a residency program in Family Medicine, and pass one or more certifying examinations before being able to practice independently. While there’s much shared between Family Medicine residency programs in the US and Canada, it’s worth looking at each country’s programs individually to better understand how they work.

Family Medicine Residency in the US

The best Family Medicine residency programs in the US typically last 3 years. One of the most striking details in Family Medicine residency programs in the US (as opposed to those of other specialties) is the lack of a dedicated post-graduate general year (PGY1). In most residency programs, work in the specialty doesn’t truly begin until the second or even third year (PGY2/PGY3), with PGY1 being reserved for general clinical training in a related but less specific specialty. For example, neurosurgery residencies begin with PGY1 and even PGY2 being dedicated to general surgery rotations and study, with this aimed at building foundational skills necessary for proficiency in more the specialized surgery in the specialty. Family Medicine, on the other hand, is not so specialized, and involves significant variety throughout the entire program in order to train new doctors to become the masters of adaptability demanded by the specialty. PGY1 may usually focus on less discrete specialties like surgery or dermatology, but the central structure for Family Medicine residency programs is nonetheless continuous variety.

Applying to a Family Medicine Residency Program as an International Medical Graduate (IMG)? Check out our video guide for tips on how to match!

In the United States, medical residency programs are accredited by the Accreditation Council for Graduate Medical Education (ACGME), who have provided some general guidelines for the structure of Family Medicine residency programs. They include:

As this chart shows, Family Medicine residency is rooted in a tremendous variety of specialties, but they all share the common thread of being...well, common! Being able to carefully direct care for each patient “from the cradle to the grave” is a primary virtue of a skilled family physician, and so residency programs seek to help new doctors develop proficiencies covering the phases and events common to most human lives. This includes various aspects of disease common to each age group and sex, as well as common emergencies, injuries, and mental health issues.

The ACGME also certifies a number of combined training programs:

This last combined program, as you may suspect, is especially geared toward Doctors of Osteopathy (DO). Family Medicine residency programs are in general quite hospitable to DO students, with recent numbers indicating that about 33% of residency positions offered in Family Medicine were filled by MD students and 29.9% filled by DO students. To students mulling over the decision between DO vs MD programs, Family Medicine residency programs offer an inviting post-graduate education (PGE) option regardless of which route you take.

Family Medicine Residency in Canada

The 17 Family Medicine residency programs in Canada are accredited by, and structured based on guidelines from, the College of Family Physicians in Canada (CFPC). The CFPC sites four major principles necessary for effective Family Medicine PGE:

1. The Family Physician is a skilled clinician.
2. Family Medicine is a community-based discipline.
3. The Family Physician is a resource to a defined practice population.
4. The patient-physician relationship is central to the role of the Family Physician.

This emphasis on community in Family Medicine education is not surprising, as polls have repeatedly shown that the majority of Canadians view their family doctor as the most important person in their medical care. In Canada, family physicians truly embody all 7 of the CanMEDS roles.

Canadian Family Medicine residency programs range from 2-3 years in length and vary somewhat more than US programs do, with the amount of required clinical hours sometimes ranging from 30/week to 45/week depending on school and PGY in question. Teaching and research time also varies significantly from program to program, but in general these two dimensions are a part of every program. Each program also differs slightly in how they organize their variety of rotations, but the overall range and number of specialties experienced during a Canadian Family Medicine residency mirrors that of US programs quite a bit. Additionally, each site of residency training—hospitals for the most part, but sometimes other environments like smaller clinics, etc.—demands a unique or site-specific daily workload. Generally speaking though, Family Medicine Residencies in Canada utilize PGY1 for more generalized rotations like Internal Medicine, General Surgery, and Pediatrics, while PGY2 is specifically dedicated to establishing proficiency in the CFPC’s assessment objectives. Many Canadian Family Medicine Residencies now have resident practices, meaning that resident doctors have their own roster of patients for whom they are the primary physician. This is, as one resident notes, a substantial responsibility, and again puts into focus the importance of Family Medicine specialists acting as a community physician.

Family Medicine Fellowships and Certifications

Following the final year of their residency program, many—even most—family physicians choose to undertake additional training via subspecialty fellowship or certification programs. These fellowship options include, but are not limited to:

It’s important to note that Rural Medicine or Rural Family Medicine is now in many cases considered its own specialty. Most Family Medicine residency programs are located in or near cities, and so are able to utilize a great wealth of additional resources found in larger hospitals funded by large and dense populations. Rural settings are of course quite different, and range from smaller towns to truly isolated locations, the common thread of course being less access to specialists and sophisticated equipment. While fellowships in Rural Family Medicine still exist, the Rural Training Track Collaborative notes 42 medical schools with specific rural training programs, and 99 active rural Family Medicine Residencies.

Matching for Family Medicine Residency Programs

Medical students apply to Family Medicine residency programs using either ERAS in the United States or CaRMS in Canada. Matching—the process by which applicants and programs rank one another and are then “matched” using this data—is then done by the National Resident Matching Program (NRMP) in the US, and CaRMS in Canada.

Family Medicine residency programs in the US utilize the standard ERAS timeline, i.e. are not early match programs. This means, generally, that students begin assembling their application materials throughout their third year, begin the application process proper in June of this same year, and then begin interviewing in October of their 4th year. Students complete Rank Order Lists (ROL) in January-February of this 4th year following interview season, and main match results are made available in mid-March. It’s a long process, but matching for residency programs is careful, painstaking work that demands a great deal of forethought and calculus to make sure the right students are picked for each coveted residency spot.

Preparing for interview season? Check out our video on 10 common Residency Interview Questions

CaRMS utilizes an almost identical timetable, though interview season typically begins quite a bit later, in January or February of the 4th year. Matching results—aka “match day”—are still posted in March.

Each program has slightly different requirements for their ERAS application materials, so you should always check their exact guidelines before beginning your application materials. However, common to all are the CV, Personal Statement, and Letters of Recommendation.

Tips for Matching in Family Medicine

While it would be exhaustive and exceed our space here to fully lay out the ideal path to a Family Medicine residency=, there are some specific points of importance when it comes to optimizing your time in medical school and, therefore, your application materials.

Personal Statement & CV

Crafting a strong residency personal statement is crucial for any residency program, but for Family Medicine residency programs especially. Why? Think of the many points above stressing the importance of communication, community, and relationship-building. A good personal statement for Family Medicine programs needs to show that the applicant not only understands these points, but has dedicated significant time to honing their skills in them.

Your interest and passion for Family Medicine should be prominent and well-explained. Try to incorporate the ways in which you've experienced the specialty so far, while similarly communicating your desire to continue on within it and learn more. It's vital to emphasize your commitment to Family Medicine, so make sure it's evident throughout—the desire to commit to the specialty is often seen as just as important as having begun to develop its proficiencies. Given the importance of strong doctor-patient relationships in Family Medicine, illustrating this kind of commitment effectively should be a major goal for any Family Medicine personal statement.

These aspects should, of course, be presented in an honest and highly personal story. Personal statements that simply list facts are seldom attention-grabbing, so no matter how extensive your experiences are, focus on giving the people reading your statement a narrative that takes them on a succinct version of your own journey. Don’t try to “sell yourself” so much as be honest and engaging. Tell your story, but don’t strain to continuously point out how unique you are. The things that truly move you, and have moved you in the direction of a Family Medicine residency, will stand out without much added emphasis from you.

The residency CV is a similar challenge in that it asks you to tell a convincing story, although this time it’s not a narrative as such, but rather a story created implicitly through the items and descriptions you provide. Think of the Personal Statement and CV as two complementary pieces—the personal statement is your chance to speak directly and be explicitly narrative. The CV is the skeleton of this story and should strive to clearly summarize many of the major experiences and achievements that have occurred along the journey described in your Personal Statement. As such, a good CV will cover basic sections like personal information, education, and research and clinical experiences, while also providing additional explanation/description on volunteer experiences, research projects, and awards. Although residency programs will typically give you a specific set of criteria for what else to include, most will invite you to offer short descriptions of other personally relevant information like your extracurricular interests, non-medical skills, professional memberships, and leadership experiences.

The way these two elements in your application work together can be of great benefit as your craft them. Consider beginning with your CV, outlining your achievements and path to the present, and after laying all of this down in a concise manner you can begin thinking about the emotional and psychological resonance of each of these experiences, and begin drafting your statement to convey this richer, fuller narrative.

Electives

As Family Medicine is a diverse specialty, your electives should reflect a great deal of variety. A good guide is the ACGME’s list of clinical guidelines above. Of course, Family Medicine-specific rotations will be extremely important, but they’re not the only criterion of note. If you can, take electives in your fourth year that include time in emergency medicine, internal medicine, family-centered maternity care, pediatrics, psychiatry, and inpatient/continuity care. The point is really to show that you’re interested in what your desired program will have you do, so it’s best to make your list from their program-specific guidelines if possible. Community-based research projects are also very attractive to residency programs, as are global health initiatives and teaching if at all possible. Use your elective slots to show that you’re engaged with your community and value building strong relationships and communication.

Extracurriculars

Similar to the elective guidelines above, your extracurricular activities should show a clear commitment to the people who make up your future patient base. Contact doctors in Family Medicine for shadowing experiences or even clerking if possible. For wholly non-medical activities, choose to showcase hobbies that illustrate your communication abilities like writing, student leadership activities, and volunteering. You also want to present a balanced picture of yourself, so discussing activities that you personally feel passionate about is crucial too, whether its art, sports, or simply other non-medical subjects of study you’ve been engaged with. Your ability to talk about yourself outside the bounds of purely academic and medical contexts is a crucial part of responding well to residency interview questions when the big day arrives, so think about how you might want to elaborate on the information in this section in person. Part of being a vital point of contact in a community is being approachable and personable, so making sure you seem like an actual human being and not just the sum of your academic achievements is crucial for Family Medicine residency extracurriculars.

ERAS Letter of Recommendation

Letters of Recommendation are super important for matching in residency, especially letters that can specifically address and support your candidacy for Family Medicine. Letters should nonetheless be standardized, so while emphasizing your suitability for Family Medicine is important, they should specifically not address why you’re a fit for a specific residency program.

One of the keys to ensuring good letters is to start early—our advice in many contexts, but especially true here. Starting early with your Letters doesn’t mean asking your first-year instructors to write them when you’re midway through your introductory biochem class, but rather focusing on performing as strongly as possible throughout medical school so that you have a plurality of options to choose from when it comes to procuring writers. Doing mediocre in a rotation might not seem like a big deal within the context of med school, but someone who feels tepid about your performance isn’t likely to write you a good letter when you start assembling materials for residency. This is less about networking or marketing yourself, but rather is more about proving you can create and maintain strong, positive relationships with the people you work with.

You also want diversity in your letters. You should have at least one letter from a mentor or other more authoritative figure attesting to your suitability for Family Medicine—which is far and away the most important—but you should also consider asking someone outside the field of medicine who can contextualize your abilities, personality, and so on from a different perspective than that of faculty or mentors. However, each residency program will have specific requirements in this regard, so always check your program’s specific guidelines before reaching out to potential letter-writers.

Medical Student Performance Evaluation (MSPE)

The MSPE is one of the last parts of your application for residency to be finalized, and while most of its contents are determined ahead of time, you will in most cases be able to meet with the faculty or dean/s tasked with writing yours before it’s completed. We cannot stress strongly enough how vital these meetings are to ensure you know what’s being transmitted to the residency programs to which you’re applying, as well as possibly being able to provide input on the document itself. Specifically, the Noteworthy Characteristics (NC) section is almost always given to the student to draft, and it’s the most contextual part of the MSPE. Each NC is summarized in 40 or fewer words, so making sure your MSPE writers capture your strengths in this extremely limited space is an important part of any meetings you have with them.

Lastly, you’ll want to discuss the six ACGME competencies during your MSPE meeting as well: patient care, medical knowledge, interpersonal and communication skills, professionalism, practice-based learning and improvement, and system-based practice. As should be evident, all of these are crucial competencies for the practice of Family Medicine, though the first four most of all. Making sure that these are well-evidenced in your MSPE is extremely important.

Conclusion

Family Medicine is exciting and challenging in equal measure, but its real uniqueness lies in its continual emphasis on community and relationships. For medical students with a desire to engage in long-term care and lifelong learning, it remains an extremely attractive option for specialization, and can provide a balanced, adaptable life.

FAQ

To your success,

Your friends at BeMo

BeMo Academic Consulting

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