Scope of Practice Affected by Residency Program and Physician Characteristics

July 16, 2019

Family physicians with rural exposure during residency training or who graduate from stand-alone, community-based residency programs are more likely to provide broad scope care associated with better outcomes according to a recent study published in Academic Medicine. The study also finds that family physicians practicing in the Midwest and West provide broader scope than those practicing in the South and Northeast. These findings update previous research and are made more important by recent studies showing that patients of primary care physicians who practice broad scope care have 15% lower overall healthcare costs and 25% less likely to be hospitalized. The study is also relevant to increasing focus on the outcomes of residency training and what the public should get for nearly $16 billion in annual funding. The authors also cite another recent study that found that family physicians who have the broadest scope of practice are also less likely to be burned out.

This study builds on existing evidence that practice patterns learned during residency training are predictive of future practice. The authors are careful to point out that the students who choose stand-alone residencies or those with rural exposure may be different from students who choose academic and large training programs, but still conclude that, “Increasing exposure to rural locations and establishing more community-based training experiences may increase the likelihood of producing a family physician with a broad scope of practice who can better serve the patient population.”

Individual characteristics also affected scope of practice in this study. Female physicians, osteopathic physicians, and International Medical Graduates (IMG) had a smaller scope of practice, consistent with prior studies using similar data. The authors suggest that since osteopathic physicians and IMGs provide a large amount of primary care in rural settings, and female physicians are a growing percentage of the overall workforce, designing residency training experiences to influence broader scope in later practice may be important.

The researchers used residency program data from the 2012 Accreditation Council for Graduate Medical Education Accreditation Data System and self-reported data from family physicians as they registered for their first certification examination between 2013–2016. The Scope of Practice for Primary Care score for each individual was based on physicians’ responses about the clinical activities and sites where they deliver care. The study sample included 8,261 family physicians who trained in 423 residency programs and were applying for their first continuing certification examination nearly a decade after completing training. The study is part of a larger effort by the American Board of Family Medicine and the Association of Family Medicine Residency Directors to understand training outcomes and experiences with the aims of improving training outcomes and to support better graduate medical education policy.

The complete article can be found in Academic Medicine.

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