Family Medicine at Duke: An In-Depth Look at the History
Read a series of stories in-depth stories about the history of family medicine at Duke. This seven-part series explores the history of the program and the struggles it faced with the medical center in its early years, and looks at the recent curriculum re-design that has taken the residency to another level of training and patient care.
The Early Years: 1972-1984
The Duke Family Medicine Residency began in 1972 as the Duke-Watts Family Medicine Residency Program, a joint effort between Duke University Medical Center and the former Watts Hospital in Durham. It was a very successful program, training 13 residents in each three years and sending graduates all over the United States with almost 50% remaining in North Carolina.
Lyndon Jordan, M.D., served as the first program director, succeeded by William J. "Terry" Kane, M.D. Kane and his administrator, David Hunter, were effective in gaining financial support from available state and foundation sources, in addition to attracting superb residents.
In 1976 the program relocated to a new, state-of-the-art facility on the grounds of Durham County General Hospital — the Duke-Watts Family Medicine Center. The practice was thriving with about 50,000 patient visits in a year. Faculty and residents saw patients at the center and were not granted privileges at Duke University Hospital, which became the touchstone of a struggle between the program and Duke University Medical Center in the years to come.
The Middle Years: 1985-1999
In the April 1985, then-chancellor of health affairs for Duke University William Anlyan, M.D., announced that both the family medicine clinical practice and residency program would be phased out over four years. The decision came on the heels of an external review of the Division of Family Medicine, which was in favor of further integrating the practice and residency into the medical center.
In opposition to this decision, E. Harvey Estes, M.D., then-chairman of the Department of Community and Family Medicine, resigned his post. He later became director of the residency program. What followed was a very public struggle between Duke University Medical Center, Durham County General Hospital, family physicians from across the nation, Duke medical students and alumni, and national family medicine organizations.
By June 1985, the message had shifted and small steps were being made to repair the damage that had been done with Anlyan’s April announcement. The clinical practice and residency program continued and were not phased out.
In 1991, the program cut ties with Durham Regional Hospital and consolidated with Duke University Hospital with selected rotations at the community hospital, Durham VA Medical Center and Wake Medical Center in Raleigh. The compliment of residents began to shrink as national interest in family medicine began to decline.
The Later Years: 2000-Present
In May 2006, the program announced that it would suspend accepting new residents. The reasons behind the decision included issues with the applicant pool, resident attrition, and frustration of the faculty with training residents in a model of family medicine they themselves no longer practiced. The announcement led to considerable national reaction.
In the fall of 2006, Dr. Lloyd Michener, former chair of the Duke Department of Community and Family Medicine, commissioned a team to evaluate the RRC requirements for family medicine residency training, the needs of the Durham community, the scope of practice of family physicians, and the resources available at Duke to produce an innovative family medicine educational program. The team, with input from residents, alumni, and an expert advisory panel convened by Duke’s chancellor, created a new design for the Duke Family Medicine Residency Program. That program is designed to meet the needs of Durham and similar communities, and to prepare physicians for leadership roles promoting health in their communities.
The key aspects of the redesigned residency program include:
- Ambulatory care as the core focus, with reduced in-hospital training
- Prevention, early intervention, and systematic chronic disease management
- Team training
- Team-based care, in the office, and with community partners
- Nearly daily office hours in the second and third years
- Community engagement and participation including weekly sessions in innovative community-based clinics and programs of Duke's Division of Community Health. These programs provide services in neighborhoods, schools, and low income housing to patients who would otherwise have difficulty accessing care
- Community-engaged health research
- Quality measurement and improvement, with direct resident involvement in all levels of the process
- Clinical leadership training
In 2017, the program received a ranking of #9 from U.S. News & World Report.