December 11, 1992
Regarding the Four Year Program for Family Practice Residents
I recently joined the Department of Family Practice as Director of Rural Health Education and Research. I held a similar position at East Tennessee State University. ETSU was one of the first to implement the accelerated program for students. The impact on the Family Practice Department was great.
Prior to implementation, ETSU was attracting two or three (out of 18) of its medical school graduates into the department's family medicine residencies. In the past two years this has tripled. Before the accelerated program, four to eight slots were open and only a few of these had late fills. Now all slots are filled with good quality residents. This is critical because candidates look for programs with a good fill rate. It is a time when the "haves" (those who match) will do better and the "have nots" will do worse. Implementation of the four year program has stabilized recruitment. It has been my experience at ETSU that resident recruitment efforts overshadow all activities of the department. Weak recruitment years have far-reaching impacts throughout the department, requiring much extra time and effort that could be better utilized in program development, advising students and residents, or other areas.
Another impact has been the retention of candidates who would have left Tennessee for other states. The one accelerated resident who dropped out realized this effect soon after beginning and opted out so that he could go to Ohio to train and eventually practice. Since program location is a critical factor in choice of a practice site, the state stands a much better chance of retaining some or all of its $1,000,000 investment in each trainee.
The accelerated student/interns who applied for the accelerated program were more mature. Almost all have had previous professional training and careers such as nursing and allied health. They were among the best students in their classes.
When I interviewed for my position, I was excited to hear about this program. I believe that Nebraska could set an example for the nation. Other accelerated programs only include six years of medical education. This one has seven. None of the others emphasize the procedural and practice preparation of this program. The Nebraska program will improve the family practice residency, it will assist the department's rural programs, it will better prepare students and residents for rural practice, and it will provide needed physicians for rural practice.
Sincerely, RCB
Note from 2002 - Interestingly this program was adopted despite some opposition from AAFP leaders who feared that this might imply the need for a 4 year FP residency program. Now it appears that this program trains leaders and facilitates the ability of residents to find their special town and place in practice in that town.
Accelerated Program Outcomes as of July 2002 (most already signed contracts)
| Total in program since 1992 | 35 | |
| Number from rural communities | 25 | 71% |
| Graduates of the program in practice | 24 | |
| Completing 4th year fellowship | 18 | 75% |
| Number in Nebraska | 20 | 83% |
| Number in towns of less than 8000 | 14 | 58% |