title: Community size and organization of practice predict family physician recertification success.
abstract: OBJECTIVE
  Health disparities exist between rural and urban areas. Rural physicians may lack sufficient medical knowledge, which may lead to poor quality of care. Therefore, we sought to determine whether medical knowledge differed between family physicians (FPs) practicing in rural areas compared with those practicing in metropolitan areas.
  
  
  METHODS
  We studied 8361 FPs who took the American Board of Family Medicine maintenance of certification (MOC) examination in 2009. Data sources were examination results and data from a demographic survey of practice structure and activities, completed as part of the examination application process. FPs' location of practice was categorized as either rural or metropolitan using a moderate and conservative definition based on reported community size. Univariate statistics assessed differences in FP characteristics between rural and metropolitan areas. Logistic regression analyses determined the adjusted relationship between rural status and the odds of passing the MOC examination.
  
  
  RESULTS
  Metropolitan FPs were less likely than their rural counterparts to pass the MOC examination using both the moderate (odds ratio, 0.67; 95% confidence interval, 0.54-0.83) and conservative (odds ratio, 0.56; 95% confidence interval, 0.42-0.74) definitions. Physicians in solo practice were less likely to pass the examination than physicians in group practice.
  
  
  CONCLUSIONS
  Rural physicians were more likely to pass the MOC examination, suggesting that rural health disparities do not result from a lack of provider knowledge.
authors.affiliation: the Department of Family and Community Medicine, College of Medicine, and the Departments of Epidemiology and Preventive Medicine and Environmental Health, College of Public Health, University of Kentucky, Lexington; the Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill; and the American Board of Family Medicine, Lexington, KY.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Schulte
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Royal
authors.forename: Sabrina L
authors.initials: SL
authors.lastname: Brown
authors.forename: Lars E
authors.initials: LE
authors.lastname: Peterson
authors.forename: James C
authors.initials: JC
authors.lastname: Puffer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002568:Certification / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000458:organization & administration* / Q000706:statistics & numerical data; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: Certification; Community; Organizational Structure; Rural Health; Specialty Boards