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Ventura County Family Medicine
is now a four-year program

Ventura County Medical Center's Family Medicine Residency Program has added a fourth year of training after being chosen as one of a select few to participate in the AIRE program by the ACGME and ABFM.


We are eager for the opportunity to create new space for the growing range of skills that a Family Doctor must master, compensate for the ongoing decline in actual training time, and promote resident well-being.


With the fourth year of training, we will be able to:

  • Preserve our ability to train in full spectrum of care, producing Family Medicine physicians empowered to serve in all settings.

  • Continue to recruit top-tier candidates who aspire to be personal physicians for the marginalized.

  • Incorporate new program requirements that encompass the breadth of primary care without sacrificing a robust inpatient experience.

  • Lead the specialty of Family Medicine in preserving our traditional breadth and quality of training, actively resisting a diminishing scope of practice.


Please read on below to learn more about our plans.  While they are subject to change as we grow into the transition, VCMC has been training Family Physicians for more than 50 years and is committed to carrying forward the legacy of full spectrum training that has always set our program apart.


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  • How will this improve our training?
    Time available to gain clinical experience has declined as work hours restrictions have been implemented and electronic health records and other administrative responsibilities have pulled residents away from the bedside. At the same time, the breadth of Family Medicine training has continued to expand. Consider fields such as Palliative Care or Addiction Medicine that had little to no presence a decade ago, or the growing recognition of the need for robust behavioral health and geriatrics training. An additional year of training will allow us to cover all the necessary topics while maintaining a hearty exposure to the elements of Family Medicine that are not as commonplace in modern training programs, such as inpatient medicine, surgery, intensive care, emergency medicine and surgical obstetrics. It will allow us to do so in a more relaxed fashion, with room in the curriculum to preserve and respect both the inpatient and outpatient elements of training. It will allow for more flexibility and customization to enable residents to cater their training to meet the needs of their future practice setting.
  • Are you collaborating with other programs?
    The OHSU Family Medicine Residency Program is our consortia partner in the AIRE project. They have extensive experience as a four-year program via the Length of Training pilot program dating back to 2015 and share our goal of training physicians that reach the maximum potential of Family Medicine's scope of practice. We're learning a lot from their experience. In addition, there are several other programs and consortia enrolling in the AIRE waiver program that will all share research and ideas. The ACGME has set a goal of enrolling 10% of the nation's Family Medicine programs in this endeavor.
  • What about the opportunity cost? How will I afford another year of residency salary?
    4 years of training will satisfy an additional year of PSLF income based repayment, deferring loan repayment expenses. You'll also have the opportunity to apply for loan repayment scholarships at conclusion of residency focused on the under served: Cal Health Cares scholarship for increasing medical care access for MediCal (Medicaid) patients Steven Thompson Award for physicians with disadvantaged history who care for under served National Health Service Corps Loan repayment National Health Service Corps Substance Use Disorder for physicians practicing addiction medicine.
  • Are 4-year programs allowed?
    The ABFM and ACGME have worked together to open applications to the Advancing Innovation in Residency Education (AIRE) program. They’ve shared a goal of recruiting 10% of the nation’s family medicine programs to experiment with a 4th year of training using the AIRE framework. This is the next step in more than a decade of research around the benefits of a longer training program in Family Medicine, first via the Preparing the Personal Physician for Practice (P4) program and then the Length of Training pilot that began in 2013. VCMC’s application to the AIRE program has been approved by the AIRE committee of the ABFM and ACGME. This is not a new concept - Emergency Medicine residency training has long included 3-year and 4-year training programs in recognition of the diversity of future practice settings.
  • Will you be able to retain a class size of 15 residents per year?
    Yes! Thanks to careful planning and forward-thinking support from our institutional partners in the Ventura County Health Care Agency, we will be able to continue to match 15 residents per academic year, ultimately growing the program size from 45 to 60 residents.
  • When will the transition occur?
    Classes of 2024 & 2025 will graduate after 3 years. Those who choose to stay for fellowships will have a traditional stand-alone 4th year fellowship experience. Those who began as interns in July 2023 will be given the option to stay for a 4th year and complete a fellowship, or to graduate after 3 years in June of 2026. Those who begin as interns in July 2024 will stay for 4 years and graduate in 2028.
  • What about wellness? Won't 4 years of training be even more exhausting than 3?
    While residency will always be a taxing experience, one of the benefits of an extended length of training will be to intersperse more flexible and ambulatory-based experiences in between the more intense inpatient rotations. A 4th year will allow us to spread the intensity out. Some of the rotations that require more autonomy can be moved later in the curriculum so residents feel fully prepared for them.
  • What about equity? Could the opportunity cost of a 4th year of resident income dissuade those from marginalized backgrounds from applying?
    This is a real concern that has not been definitively studied in the 4-year program pilots. We expect that the added benefit of better training will outweigh the financial concerns, particularly for those who aspire to work in resource-limited settings. Graduates with more comprehensive skill sets will be sought after, particularly for leadership positions with opportunities to transform health care delivery. Our Equity and Inclusion committee will remain engaged in the planning process and inform its design.
  • What are the advantages of a fully-integrated 4-year program?
    Resiliency in the residency curriculum that allows for learner and program variations in training volumes and time needed for competency based education. Ongoing program and individual education innovations to address emerging community needs. Deeper longitudinal learning through an integrated fellowship benefits learners, increases faculty satisfaction, improves learning across the program through the presence of local experts More confident and competent 4th year residents become program assets and teachers The presence of integrated fellowships draws specialty-level attendings into the core teaching faculty. Substantial increases in clinic visits and continuity benefit everyone, and lead to increased confidence on the part of senior residents and graduates Increased opportunities for scholarship Increased opportunities for longitudinal community engagement, community and institutional leadership experiences, and advocacy development The skillsets 4 year graduates bring to practice ultimately increase program reputation in the community Wellness: spreading the intensity of full spectrum training over 4 years brings many benefits to resident well-being including more frequent breaks from inpatient work, more flexibility, and enhanced skills leading to greater practice satisfaction. Dr Alan Douglass makes a compelling Case for the 4-year Residency in the May 2021 edition of Family Medicine.
  • When will residents become board-eligible?
    As a 4-year training program, residents will be required to complete the entire four-year curriculum before the program director can designate them as eligible for ABFM certification. Per California Law, residents may apply for their full and unrestricted medical license after 12 months of training.
  • How will the broader County of Ventura benefit from this endeavor?
    Quality: additional senior residents with more flexibility in their areas of interest will mean more opportunities for improvement projects and clinical leadership. Local workforce: the program will improve retention by nesting continuity practices in ambulatory care clinics and becoming involved in more community outreach, while also producing residents more likely to take leadership roles,. Health of the training program: the County's flagship residency will be able to meet program requirements without the sacrificing rigor and training excellence that attracts top-tier medical students to the community. Finances: Clinical revenues and Medicare dollars will offset additional costs, not to mention savings in recruitment costs and many other ancillary financial benefits.
  • Will an integrated fellowship be as valuable as a stand-alone fellowship?
    Yes. The integrated addiction fellowship will remain ACGME-accredited, and graduates will be eligible for the addiction boards. The other fellowships will retain the same curricular content, just spread over 2y rather than 1y. Some data suggests that the longitudinal experience in the area of expertise may be even more effective than a concentrated experience in a shorter time; there is a clear educational advantage to spaced-repetition learning. OHSU’s experience is that graduates get the jobs they want rather than settling for a more limited scope of practice.
  • How will the 4th year be structured?
    The first two years of training will be structured similar to how they are now to ensure a broad base of clinical skills across the scope of venues. During the PGY-2 year, residents will apply for an integrated fellowship to track into for their 3rd and 4th years. During the PGY-3 and -4 years, residents will complete 12 months of core Family Medicine curriculum and 12 months of their integrated fellowship curriculum, alternating monthly.
  • When will I pick my integrated fellowship? What if I don't get my first choice?
    Residents will apply for their fellowship in their PGY-2 year. As much as possible we will accommodate residents' first choices. When there is more interest than a specific fellowship can accommodate, or if the fellowship curriculum is not sufficiently comprehensive for a resident's future needs, the Expert Generalist program to will provide plenty of opportunity to customize the experience. Are you planning a career in an inner-city setting? We could design you a curriculum with experiences in addiction medicine, HIV medicine, and public health outreach. Do you anticipate working in an agricultural community? Maybe you'd like to set up your primary care practice at the FQHC with a large Mixtec population, build in additional women's' health experiences, get some special expertise through our FM Diabetes specialty clinic, and arrange a community needs assessment project through the county's Farmworker Resource Program. Do you see yourself as the only doctor in a critical access hospital some day? Let's set up rotations at our small sister hospital in Santa Paula where you can work alongside other family doctors in the ER, ICU, and labor and delivery, all in the same shift. Residents will work with a dedicated faculty advisor to build a Generalist track that suits their needs, taking advantage of the breadth of opportunities offered by our large Health Care Agency with a long legacy of training physicians.
  • What will be the integrated fellowship options?
    Our longstanding fellowships will be integrated in the four-year curriculum: Addiction Medicine (ACGME-accredited) High-risk Obstetrics Maternal-Child Health Global Health New opportunities will also be developed: Hospital Medicine: including junior attending experience on inpatient medicine at VCMC, autonomous practice with indirect supervision at Santa Paula Hospital and ICU experience Expert Generalist: will include additional core family medicine curriculum plus dedicated time to an area of special interest to the resident, designed in collaboration with advisor to meet needs of future practice. With the extensive clinical opportunities under the umbrella of the Ventura County Health Care Agency, and our academic affiliation with Keck School of Medicine at USC, opportunities for focus areas are limitless. Ideas include ER/critical care, faculty development, HIV/infectious disease, Palliative Medicine, Sports Medicine, public health, informatics and many more.
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