The Association of Family Medicine Residency Directors (AFMRD) biannually conducts a Salary Survey of membership as a member benefit. The survey invites program directors (PDs) to report compensation considerations for themselves, associate program directors, core faculty, program coordinators/administrators, and behavioral health faculty. Full survey reports are available to AFMRD members on its website.
The most recent survey was open between February and April 2024 and circulated to 589 family medicine (FM) PDs in the United States with 201 (34.1%) respondents. Participants were also surveyed as to additional training or certifications, length of practice, and scope of practice, and 57.5% of respondents reported being graduates of AFMRD’s National Institute for Program Director Development. Key demographics of PD respondents and their programs are listed in Table 1.
Table 1.
Program Director Demographics
| Program sponsor | Count | Percent |
|---|---|---|
| Health care system (non-medical school–based) | 138 | 68.7 |
| Medical school | 45 | 22.4 |
| FQHC/Teaching health center | 7 | 3.5 |
| Military | 1 | 0.5 |
| Consortium | 8 | 4.0 |
| Other | 2 | 1.0 |
| Gender | ||
| Male | 105 | 52.2 |
| Female | 86 | 42.7 |
| Choose not to disclose | 10 | 4.9 |
| Race/Ethnicity | ||
| Asian | 16 | 8.0 |
| Black/African American | 10 | 5.0 |
| Hispanic/Latino/Spanish | 6 | 3.0 |
| Middle Eastern/North African | 3 | 1.5 |
| White | 149 | 74.1 |
| Choose not to disclose | 17 | 8.5 |
| Degree | ||
| MD | 152 | 78.8 |
| DO | 41 | 20.7 |
DO = doctor of osteopathic medicine; FQHC = Federally Qualified Health Center; MD = doctor of medicine. -LC
The mean, standard deviation, and median annual taxable income by role within program are summarized in Table 2. Mean PD income among respondents increased from $268,500 in 2021. Income varied by program type, region of the country, and years of PD experience. Additionally, while the proportion of respondents reporting clinical or educational incentives as a portion of their compensation increased from 45.1% in 2021 to 51.6% in 2024, the mean dollar amount varied. The mean dollar amount associated with clinical incentives decreased 31% in 2024 compared to 2021 while the mean dollar amount for educational incentives increased by 17%.
Table 2.
Residency Program Taxable Income (US Dollars) in 2024 by Role
| Role | n | Mean | SD | Median |
|---|---|---|---|---|
| Program director | 187 | $288,073 | $64,343 | $280,000 |
| Associate program director | 157 | $252,062 | $44,821 | $250,000 |
| Medical director | 126 | $247,191 | $71,241 | $250,000 |
| Rural training track site director | 17 | $212,598 | $99,123 | $237,000 |
| Director of osteopathic education | 40 | $217,834 | $73,177 | $239,325 |
| Full-time core faculty – outpatient only base/beginning | 125 | $224,876 | $36,225 | $225,000 |
| Full-time core faculty + inpatient base/beginning | 134 | $230,540 | $36,485 | $230,000 |
| Full-time core faculty + maternity base/beginning | 97 | $235,113 | $37,756 | $235,000 |
| Full-time core faculty + inpatient + maternity base/beginning | 91 | $234,505 | $34,958 | $233,000 |
| Behavioral health faculty, PhD level | 69 | $124,317 | $32,516 | $125,000 |
| Behavioral health faculty, non-PhD level | 35 | $110,315 | $49,638 | $100,000 |
| PharmD faculty | 26 | $124,147 | $29,904 | $120,000 |
| Coordinator | 139 | $69,212 | $23,105 | $64,000 |
Program Director Considerations
The AFMRD Board of Directors noted trends in the 2024 report compared to 2021 that may warrant further study. First, unlike recent previous surveys, the 2024 survey did not demonstrate a significant difference in salary based on gender. Future surveys will be important to understand if this represents permanent closure of a pay gap.1
Second, the mean years of total reported PD experience decreased from 6.98 in 2021 to 6.08 years in 2024. AFMRD continues to study PD tenure, noting reasons for departure most often reflect pursuit of new positions within the same institution or moving aside to allow growth for new leaders.2,3
Next, Table 3 describes scope of practice for PDs compared to 2021. The proportion of PDs practicing in different areas of scope decreased overall, particularly in inpatient pediatrics and newborn nursery care. Recent revisions by the Accreditation Council for Graduate Medical Education (ACGME) adjusted the volume and type of care related to pregnancy, infants, and children care programs must offer to maintain accreditation.4 Further assessment may determine whether the decrease in PD scope is related to sample demographics, ACGME revisions, health care systems characteristics, or other related factors.
Table 3.
Scope of Practice Comparisons from 2024 to 2021
| Scope of practice | 2024 Count (%) | 2021 Count (%) | Difference, % |
|---|---|---|---|
| Hospital care including ICU care | 69 (34.3%) | 62 (37.1%) | −2.8 |
| Hospital care, excluding ICU care | 69 (34.3%) | 70 (41.9%) | −7.6 |
| Maternity care, including deliveries | 51 (25.4%) | 50 (29.9%) | −4.5 |
| Operative obstetrics | 3 (1.5%) | 4 (2.4%) | −0.9% |
| Newborn nursery care | 102 (50.7%) | 104 (62.3%) | −11.6% |
| Inpatient pediatrics | 60 (29.9%) | 77 (46.1%) | −16.2% |
| Nursing home | 52 (25.9%) | 59 (35.3%) | −9.4% |
| Osteopathic manipulation | 35 (17.4%) | 26 (15.6%) | + 1.8% |
ICU = intensive care unit.
Faculty Considerations
Recent revisions by the ACGME also adjusted the amount of time programs must protect for faculty and curricular areas to maintain accreditation.4 The mean total number of full-time family medicine core faculty decreased by 6% (7.37 in 2024 compared to 7.85 in 2024), while the mean total number of paid part-time family medicine faculty increased by 28% (4.16 in 2024 compared to 3.26 in 2021). Whether this reflects cost-savings measures by institutions, work-life preferences by faculty candidates, an impact of revisions to program requirements for accreditation, sample characteristics, or other factors may be determined by further study.5,6 Regardless, the ratio of full-time to part-time faculty is an important trend to monitor in graduate medical education.
Program Considerations
More respondents reported sponsorship by health care system (non-medical school based) in 2024 (68.7% compared to 3% identifying in 2021). Fewer respondents reported FQHC/Teaching Health Center (THCs) (3.5% compared to 20.2% in 2021). Whether this represents a difference in sample demographics or a shift in the landscape of program funding will be important to monitor. The tenuous nature of GME THC funding may further impact those programs’ ability to respond to the salary survey. Stabilization of THC funding remains an important advocacy opportunity.7
One potential factor to consider in future surveys is geographic setting, such as urban, suburban, rural, and frontier. The mean salary reported for rural training track site directors decreased in 2024 ($212,598) from 2021 ($247,487). With many policymakers currently prioritizing access to rural health care and funding streams for rural graduate medical education (GME) programming, a salary gap could disincentivize qualified site directors.
In conclusion, the AFMRD Salary Survey can be a powerful tool for family medicine residency leaders to understand trends in family medicine GME and for individual PDs to advocate within their institutional landscape.
Acknowledgements
The authors extend appreciation to Tom Wasser for assistance with analysis and to AFMRD members for responding to the survey.
References
- 1.Kelly K, Barr WB.. A Description of the 2021 AFMRD Salary Survey and next steps. Ann Fam Med. 2022;20(3):284-285. doi: 10.1370/afm.2835 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Fernald D, Hester CM, Brown SR.. Why family medicine program directors leave their position. Fam Med. 2021;53(5):347-354. doi: 10.22454/FamMed.2021.746153 [DOI] [PubMed] [Google Scholar]
- 3.Fernald DH, Hester CM, Brown SR.. Departure decisions: exit survey of family medicine residency directors. PRiMER. 2024;21(8):46. doi: 10.22454/PRiMER.2024.770282 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.ACGME program requirements for graduate medical education in family medicine. Accessed Nov 9, 2024. https://www.acgme.org/globalassets/pfassets/programrequirements/2024-prs/120_familymedicine_2024.pdf
- 5.Mallon WT, Cox N.. Promotion and tenure policies and practices at U.S. medical schools: is tenure irrelevant or more relevant than ever? Acad Med. 99(7): 724-732. doi: 10.1097/ACM.0000000000005689 [DOI] [PubMed] [Google Scholar]
- 6.Maresh OK. Part-time practice: making it work. Fam Pract Manag. 2004;11(6): 45-50. [PubMed] [Google Scholar]
- 7.Chen C, Chong N, Luo Q, Park J.. Community health center residency training: improving staffing, service, and quality. Fam Med. 202;53(8):689-696. doi: 10.22454/FamMed.2021/843335 [DOI] [PubMed] [Google Scholar]