Duke retooling, reopening family medicine training

The overhauled program will focus on getting residents into community clinics.

By Myrle Croasdale, AMNews staff. June 11, 2007.

In a phoenix-like rebirth, Duke's family medicine residency is rising from the ashes.

Duke University Medical Center in Durham, N.C., announced in May that it plans to re-open its family medicine program in July 2008. The school closed the program in 2006 because of a lack of applicants.

The revitalized program has jettisoned its former hospital-based curriculum for one that focuses on clinical care at community sites. Training will have a heavy emphasis on team-based care, leadership skills and quality improvement. When residents finish the three-year program, there will be a fellowship option for a master's degree in clinical leadership.

"Morale here is fantastic," said Brian Halstater, MD, Duke's family medicine program director. "We are alive and well and stronger than ever."

Such optimism is in contrast to some family medicine numbers. In six years the specialty has seen 10% of its residencies close, said Perry Pugno, MD, MPH, director of medical education for the American Academy of Family Physicians. Not only does this generation of medical students favor subspecialties over primary care, but family medicine does not generate big revenues for teaching hospitals. Low reimbursements and a disproportionate number of poor and uninsured patients often make these programs a drain on sponsoring institutions.

So why Duke's change of heart? It may be the tenacity of family physicians themselves. Physicians from around the country and those within Duke's halls voiced concern over the decision to shutter the residency.