If you’ve reached the point in your medical journey when it’s time to rank your top family medicine programs, the decision can be tough. Rest assured, all family medicine residency programs will provide you with the training you’ll need to successfully navigate the complex field of primary care.

Still, not all programs are alike. The training you’ll receive as an FM resident varies greatly from one program to another, including the amount of prenatal care you’ll provide, how you’ll manage your ICU patients, and even the number of procedures you’ll perform in the clinic.

The differences among family medicine residency programs exist largely because they come in two main flavors: opposed and unopposed. An opposed program is one in which other specialty programs are present in the same institution, whereas an unopposed program means the institution focuses solely on family medicine. In this post, we’ll examine opposed vs unopposed family medicine residency programs, explore their pros and cons, and help you understand each one, so you can decide which might be the right choice for you.

First, let’s ask an obvious question: does it really matter if you chose one or the other? The answer is yes! Let’s dig a bit deeper and see why.

Opposed vs Unopposed Family Residency Programs: Why the Difference Matters

Have you heard of having too many cooks in the kitchen? The phrase is often used metaphorically to caution against overcrowding or overcomplicating a situation by involving too many people, each with their own ideas or opinions. It implies that collaboration and teamwork are beneficial, but there’s a limit to how many individuals can effectively contribute without causing problems.

In medicine, the amount of residents and specialties can affect the training and exposure each individual receives. For example, will you manage the interesting inpatient case, or will it be transferred to a different service? Will teaching, evaluation, and overall attitudes towards you be different because you’re an off-service resident? How much will you have to fight for deliveries and knee injections?

Perhaps you’ve already decided which type of program you’ll train at prior to applying. If not, as you progress along your interview journey, you’ll likely interview at both opposed and unopposed programs. Embrace each interview and get a feel for each of them. Before eliminating any programs from your rank list, give the rest of this post a read to learn more about opposed vs unopposed family medicine residency programs.

Opposed Family Medicine Residency Programs

We’ve already given you a general idea as to what an opposed family residency program is, but let’s define it a bit more for you. Opposed family medicine residency programs are those that exist in a hospital or medical institution alongside several other specialty residency programs, such as internal medicine, surgery, and pediatrics, to name a few. Residents in opposed programs often have the opportunity to rotate and collaborate with trainees, fellows and attendings in various specialties.

Advantages of Opposed Programs

Due to the nature of opposed programs, there are some obvious advantages to them. Here are the big three:

1. Exposure to Other Specialties

In opposed programs, residents have the benefit of working with and learning alongside residents from various medical specialties. This exposure can provide a more comprehensive understanding of the various healthcare specialties, enabling family medicine residents to appreciate the interconnectedness of different medical fields.

One can easily see how a family medicine resident who rotates through an emergency medicine service, alongside EM residents, fellows, and attendings, will have a more holistic EM experience. Having other residencies in-house exposes you to other mindsets and further broadens your education, not to mention that you would learn EM during that rotation from masters in the field. 

Furthermore, having residents and fellows teach you, as well as attendings, may be beneficial as they’re closer to your academic level. This results in less formality, awkwardness, and a greater understanding of your level of training.

Lastly, training in such a setting can demonstrate to primary care docs the process patients navigate in order to go from primary care to specialist(s), which can lead to empathy and understanding. You’ll get a better sense of how difficult it can be for a patient with a common ailment such as diabetes to have to see their FM physician, in addition to their ophthalmologist, endocrinologist, nephrologist, and neurologist.

2. Collaboration and Networking

The presence of multiple specialty programs fosters collaboration and networking opportunities. Residents can work closely with peers from various backgrounds, creating a valuable professional network. This network can be an asset for referrals, consultations, and multidisciplinary care in the future. You’ll make new friends and meet people in various specialties.

Furthermore, you’ll be able to see how specialists do workups and manage certain issues. For instance, rotating on the rheumatology service will likely provide better insight and training for you on the appropriate diagnostic workup to initiate as a primary care provider for patients with rheumatoid arthritis. You can also see how the condition is managed and learn some clinical pearls of wisdom from specialists in the field.

3. Robust Academics

Having a number of specialties within an institution often results in a robust and stimulating academic environment. This can encourage you to engage in research opportunities you may not have otherwise had and pursue academic goals. Having access to experts from different fields can also facilitate mentorship and academic growth.

Disadvantages of Opposed Programs

Of course, no situation is perfect, and while opposed residencies can be great, they also present certain problems. Here’s three of them:

1. Competition for Resources

With multiple specialties vying for the same resources, such as clinical cases and faculty attention, all residents, including FM trainees, will face increased competition. This can make it more challenging to secure the experiences and mentorship you desire. You may have to fight for deliveries with OB, or sports medicine patients with PM&R.

2. A Lack of Focus on Family Medicine

In opposed programs, family medicine may not always receive the same level of emphasis as the larger, specialized departments. You may need to be proactive in seeking family medicine experiences, or assert yourself to ask for rotations tailored to your training.

3. Equality

Do off-service attendings treat all residents equally? Everything from teaching and training to feedback and evaluations are supposed to be fair and equitable, but unfortunately, that’s not always the case. I won’t go into too much detail over this, but ask the current FM residents during your interviews how they’re treated. They’ll let you know what’s up.

Unopposed Family Medicine Residency Programs

Now let’s have a look at unopposed FM programs. These can be defined as those in which the sole residency program at a hospital or medical institution has a primary focus on family medicine training. This means that family medicine residents have the institution’s resources and faculty dedicated to their specialty and education. This can yield certain positives, but as you might expect, there are downsides to these programs as well. Let’s take a look at each.

Advantages of Unopposed Programs

1. Priority Access to Resources

In unopposed programs, family medicine residents are the primary focus. This priority ensures they have the best access to resources, including clinical cases, faculty guidance, elective opportunities, funding, and procedures.

2. Focused Education

Unopposed programs can provide a highly tailored education in family medicine. This allows residents to immerse themselves in the intricacies of primary care without the distractions of other specialties.

Furthermore, as the sole specialty in the hospital system, you’ll be able to train and practice full scope family medicine. You’ll diagnose, manage, treat, and provide screening plans for everyone, from obstetrics to newborns to geriatrics, or as the saying goes, “from cradle to grave.”

3. FM-Specific Opportunities

Due to the singular focus on family medicine, residents in unopposed programs may have more significant educational or leadership roles and responsibilities. This can be beneficial for their career development and future practice management.

Disadvantages of Unopposed Programs

Naturally, unopposed programs also have potential drawbacks, including the following:

1. Limited Exposure to Other Specialties

Unopposed family medicine residents might miss out on the broad exposure to various medical fields that opposed program residents receive. This could hamper your learning from other specialties and lead to decreased effectiveness when working with other specialists in the future.

2. Potential Isolation

The absence of other specialties in unopposed programs could lead to a more isolated training experience. You might not have as many opportunities for interdisciplinary collaboration or learning from other specialists.

A potential solution to the problems posed by unopposed residencies is referred to as a collaborative program, which is a term some residencies are using to describe their opposed, but positive or family medicine focused, training and culture.

FAQs About Opposed vs Unopposed Family Medicine Residency Programs

Before we wrap up, I’d like to answer some commonly asked questions about opposed and unopposed FM programs. This will help you ask insightful questions during interviews, and zone in on key factors when it comes to choosing one vs. the other.

Here they are, in no particular order:

For opposed programs, do FM residents get a chance to work with other residents during rotations?

Yes, most off-service rotations are done with residents of that service. For instance, on radiology, you will rotate with and learn from radiology residents/fellows/attendings, though there may be other off-service residents with you as well.

In some cases, you may complete a radiology rotation with a radiology intern and an IM resident. You may have a month-long EM rotation in the ED alongside EM, peds, and IM residents as an FM resident, which is awesome. FM, IM, peds, and EM residents all think differently, and we have a ton of stuff to teach each other.

How do I tell if a program is “too opposed”?

It varies. Sometimes, it’s very difficult to tell, and what’s too opposed for you may be just fine for your colleague. Occasionally, it’s obvious, as there are some institutions in the country that are not so FM friendly, despite having an FM residency.

You’ll hopefully get the hint during interview day, perhaps a feeling that the FM residents are the forgotten specialty, if you see signs of discrimination. For instance, a program that offers free parking for other residents, but not FM ones, or access to the physicians’ lounge for everyone except FM trainees, etc. The best way to discern this is to ask the current FM residents.

How do I choose between an opposed vs unopposed family medicine residency?

The decision is ultimately yours, but I can give you some advice. When struggling to decide between an opposed vs unopposed family medicine residency program, I think it’s important to keep the following things in mind: 

1. Your Career Goals

If you’re certain about a career in academic family medicine, train at a program that allows you to pursue that. If you want to practice sports medicine in addition to family medicine, train at a program that has good historical match rates for sports medicine.

In these cases, opposed or unopposed is less important. If you want to practice full-spectrum family medicine in a rural area, train in such a setting, which will often be unopposed anyway.

2. Interest in Diverse Experiences

If you wish to explore various medical specialties and build a broad medical foundation and network, an opposed program may be more appealing. Consider how important it is for you to establish connections with professionals in various specialties.

3. Program Size

The size of the residency program can affect the volume and variety of patients you’ll see. Smaller programs may offer more personalized attention, while larger programs can provide a broader clinical experience. Furthermore, more residents often equates to fewer calls, which is a nice perk. 

4. Patient Population

Think about the patient population you want exposure to and the cases you want to see. For the most part, opposed programs in large cities at level one trauma centers offer the greatest variety of patients, zebra medical cases, and newly discovered treatment options. 

5. Current Residents

Knowing how current residents at the program are doing is essential to helping you make a decision. Do they abhor the off-service rotations due to poor treatment and worse schedules compared to other trainees, or is it mostly equitable? What are the graduates of the program doing? Have they all departed the institution, or did some of them stay on as faculty because FM is valued and they liked training and working there?

It’s important to spend some time chatting with residents, alumni and ancillary staff to get answers to those questions. Don’t focus solely on the core faculty to judge the program’s reputation. 

If you feel like you need more help with this, check out this article about what it’s like to work with a residency counselor such as myself. And don’t hesitate to reach out!

Further Reading

Whether a program is opposed or unopposed is an important factor to consider when you’re choosing a family residency program. However, the quality of the program and the people, from residents to staff to core faculty, should be considered as well. 

Remember that an opposed and collaborative program can be a great place to train, and have benefits that are worth considering compared to a program you like simply because it’s unopposed. Opposed and unopposed family medicine residency programs each have their merits and drawbacks. The right choice depends on your career aspirations and personal preferences. 

Whichever path you choose, both types of programs offer valuable opportunities for becoming a skilled and compassionate family physician. Ultimately, the key is to select a program that aligns with your goals and will help you excel in your chosen medical specialty!

Looking for more (free!) tips to help you choose a residency program? Check out these other posts from Blueprint tutors on the Med School blog:

• How to Make A Residency Rank List That Puts Your Happiness First
• Can I Stop Zooming Now? How to Know You’re Done with Residency Interviews
• How to Choose a Residency Program: Top Factors to Consider for Your Rank List