The process of ACGME program requirement revision typically engenders healthy debate on how best to train a family physician. The diversity of 750+ residency programs with different mission statements, serving different types of communities, a clinical-educational environment changing more rapidly than at any time in the history of family medicine GME, are all embedded in a stressed healthcare system. Family medicine is a specialty still grappling with defining its identity. If leaders are engaged—and family medicine program directors are—then controversies are inevitable. This chapter reviews some of the major hot button issues in family medicine education and provides some evidence-based guidance on how a program can decide what approach is right for them. Curricular controversies include—what should be the standard length of required training? Should all residents spend precious training time learning maternity care when only a small minority will most likely attend deliveries after graduation? Should the residency’s continuity clinic experience be prioritized over all other training sites? What are new controversies in professionalism and how best to teach it? How should the program director approach ACGME program requirements if they have different ideas about what their residents should be required to learn?