Posted by: notdeaddinosaur | February 9, 2012

The Terminology of Conflict

A 4th year medical student friend of mine tells me he has decided to apply for “Family Medicine unopposed”.


My first thought was that this was the opposite of hedging ones bets, where one ranks programs in other specialties along with Family Medicine and leaves one’s fate in the hands of the Match Gods, while  “Family medicine unopposed” means ranking only programs in Family Medicine. But no. It turns out to mean specifically applying to Family Medicine residencies in hospitals where there are no training programs in other specialties.

As with so many other life decisions, there are pros and cons. The major advantages in this case are indeed the greater autonomy and respect often found in a single specialty training hospital, plus having the run of the hospital, including first crack at ER patients, procedures, codes, and so on. There are downsides, though: the programs tend to be in smaller hospitals, with possibly lower degrees of patient acuity (less sick or complex patients). There are fewer peers in training nearby for socialization, commiseration, etc.

Personally, I feel the advantages far outweigh the disadvantages, and in fact I trained at such a program myself.

But this terminology is new to me: “unopposed.” The implication is that family doctors-in-training are “opposed” by all the other specialties when working together in large tertiary centers. I find it sad that this is a largely accurate perception, sadder still that the idea of conflict is incorporated into the terminology. Granted, we in Primary Care are due more respect than we often receive from other specialties, but still: words have power. We need to stop fighting among ourselves in order to put our patients first.

I propose using the term “Solo Family Medicine programs” for hospitals with no other trainees, and let the word “unopposed” fall by the wayside. The first step in making peace is to stop picking a fight.




  1. Don’t know if it really matters what you call it, but I agree that a regional medical center with only a family practice residency affords the best and most well-rounded training. It’s the only place you don’t have to fight the internal medicine residents (and fellows) for the interesting cases, the pediatrics residents for the kids and the OB residents (or in some places, the midwives, for heaven’s sake) for deliveies. Besides, most family practice graduates don’t go to bigger hospitals after graduation due to the lack of respect you already stated.

  2. …Life is a series of choices, each with its own rewards and consequences…(and) the world really doesn’t lie before us like a land of dreams. At best—at the very best—it can only offer us choices between two good things, and as we grasp at one, we lose the other forever. – Caitlin Flanagan

  3. I think “Exclusive Family Practice” would be a better term; it doesn’t suggest that the intern would be alone and it has a certain cachet.

  4. @101598: I like that.

  5. I wish I’d paid a little more attention to the difference when making my list. I love where I’m at, but it is true, too many consults and hands in the pot. I have heard the term “community” family med programs which usually is “unopposed” in other words.

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