Graduate medical education in family medicine faces many challenges and opportunities. During the development of the Accreditation Council on Graduate Medical Education Program Requirements for family medicine, effective July 1, 2024, seven competency themes that family medicine residency graduates should demonstrate were identified. These themes are community focused population health care, comprehensive clinically competent care, lifelong adaptive learning, relationship-based communication, collaborative team-based care, technology integration, and values-driven professionalism. A highly functioning model family medicine residency practice is essential to train family medicine residents in these competencies, leading to the educational axiom that “the practice is the curriculum.” Challenges faced in family medicine graduate medical education include medical student interest, diversity of the workforce to meet needs of a diverse patient population, health care disparities, variation in scope of practice, and corporatization of health care and funding. These challenges create opportunities. Integration of information technology, research-in-practice, competency-based medical education, and innovative educational practices offer many opportunities for physician and practice improvement. It is critical that the graduate medical education system produce competent, conscientious well-trained family physicians because family medicine, as a specialty, is foundational to an accessible, safe, effective, efficient, well-functioning, affordable, and equitable health care system.