Newly Trained Family Physicians Want to Provide Broader Scope of Practice Compared to Practicing Physicians

Share Article

According to Lars Peterson, MD, PhD, research director at the American Board of Family Medicine (ABFM), and colleagues, findings published in a recent issue of JAMA show graduating family medicine residents intend to provide a broader scope of practice than what practicing family physicians provide.

Graduating family medicine residents intend to provide a broader scope of practice than what practicing family physicians provide. Their broader intentions include services such as maternity care, inpatient care, home visits, prenatal care, and inpatient care. The findings were published December 8 in the JAMA medical education theme issue.

As a medical specialty, family medicine is not bound by patient gender, age, site of care delivery, nor presenting symptom or illness. As such, family physicians are trained broadly to provide comprehensive health care. Past research shows that places where health systems support primary care have lower costs and better outcomes. Despite these known benefits, the scope of practice of family physicians has been shrinking. Possible reasons include employer restrictions, changing physician preferences based on lifestyle or generational choices, or changing practice patterns as physicians age.

The ABFM research department, and a visiting scholar, used data routinely collected by the ABFM during the certification examination application on reported scope of practice to conduct the study. The study sample included all physicians who signed up for the examination in 2014; 3,030 graduating residents and 10,846 practicing physicians. Graduating residents were asked intention to perform specific services while practicing physicians reported whether they provided the same services.

Graduating residents reported higher intentions to provide all services except pain management. Compared to practicing physicians, they were more likely to provide home visits (44% versus 9%), maternity care (24% versus 8%), nursing home care (38% versus 16%), inpatient care (55% vs 34%), and prenatal care (50% vs 10%). Compared to practicing physicians, graduating residents were also more likely to provide procedural care including neonatal circumcisions (44% versus 15%), intrauterine device insertion (74% versus 18%), and joint injections (93% versus 61%).

“The benefits of family physicians providing a broader scope of practice may include lower overall health care costs and reduced hospitalizations, as well as increased availability of services in physician shortage areas. These findings suggest that graduating family medicine residents intend to provide a broad array of care commensurate with their training.”

These findings have broader implications for reducing the costs of care. Medicare’s recent announcement to move the majority of payment to value-based, rather than fee-for-service will likely spur continued momentum towards paying for value rather than volume with the overall goal of shifting the cost curve. Value-based payment demands increased effectiveness of primary care, which will require supporting resources. Accountable Care Organizations and others in risk sharing or shared savings settings may rely on high functioning primary care teams to provide broad scope care to help meet these goals. This study’s findings indicate that graduating residents aspire to provide such broad scope care.

The researchers further note that the intentions of graduating residents need to be tracked into practice to see if the intentions become reality. If intentions are not being realized, it would be important to determine what barriers exist to providing value creating comprehensive care.

The American Board of Family Medicine (ABFM) is the second-largest medical specialty board in the United States. Founded in 1969, it is a voluntary, not-for-profit, private organization whose objective is to encourage excellence in medical care. The ABFM believes that its certified family physicians have successfully demonstrated their ability and have proven their commitment to the public, the specialty of Family Medicine and the profession.

Through its certification and recertification processes, the ABFM seeks to provide patients the assurance that its certified family physicians have completed the necessary training/experience to provide quality care to the individual and the family and that this commitment to excellence is maintained throughout the physician’s years of practice.

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Jane Ireland

Jane Ireland
Visit website