title: Comparison of Intended Scope of Practice for Family Medicine Residents With Reported Scope of Practice Among Practicing Family Physicians.
abstract: OBJECTIVE
  Narrowing of the scope of practice of US family physicians has been well documented. Proposed reasons include changing practice patterns as physicians age, employer restrictions, or generational choices. Determining components of care that remain integral to the practice of family medicine may be informed by assessing gaps between the intended scope of practice of residents and actual scope of practice of family physicians.
  
  
  OBJECTIVE
  To compare intended scope of practice for American Board of Family Medicine (ABFM) initial certifiers at residency completion with self-reported actual scope of practice of recertifying family physicians.
  
  
  METHODS
  Cross-sectional data were collected from a practice demographic questionnaire completed by all individuals applying to take the ABFM Maintenance of Certification for Family Physicians examination. Initial certifiers reported intentions and recertifiers reported actual provision of specific clinical activities. All physicians who registered for the 2014 ABFM Maintenance of Certification for Family Physicians examination were included: 3038 initial certifiers and 10,846 recertifiers.
  
  
  METHODS
  Initially certifying physicians vs recertifying physicians.
  
  
  METHODS
  The Scope of Practice for Primary Care score (scope score), a psychometric scale, was calculated for each physician and ranged from 0 to 30, with higher numbers equating to broader scope of practice. Recertifiers were categorized by decades in practice.
  
  
  RESULTS
  The final sample included 13,884 family physicians and, because the questionnaire was a required component of the examination application, there was a 100% response rate. Mean scope score was significantly higher for initial certifier intended practice compared with recertifying physicians' reported actual practices (17.7 vs 15.5; difference, 2.2 [95% CI, 2.1-2.3]; P < .001). Compared with recertifiers, initial certifiers were more likely to report intending to provide all clinical services asked except pain management; this included obstetric care (23.7% vs 7.7%; difference, 16.0% [95% CI, 14.4%-17.6%]; P < .001), inpatient care (54.9% vs 33.5%; difference, 21.4% [95% CI, 19.4%-23.4%]; P < .001), and prenatal care (50.2% vs 9.9%; difference, 40.3 [95% CI, 38.5%-42.2%]; P < .001). Similar differences from initial certifiers were present when comparisons were limited to recertifiers in practice for only 1 to 10 years.
  
  
  CONCLUSIONS
  In this study of family physicians taking ABFM examinations, graduating family medicine residents reported an intention to provide a broader scope of practice than that reported by current practitioners. This pattern suggests that these differences are not generational, but whether they are due to limited practice support, employer constraints, or other causes remains to be determined.
authors.affiliation: College of Medicine, University of Vermont; now with Santa Rosa Family Medicine Residency, Santa Rosa, California.
authors.forename: Anastasia J
authors.initials: AJ
authors.lastname: Coutinho
authors.affiliation: American Board of Family Medicine, Lexington, Kentucky.
authors.forename: Anneli
authors.initials: A
authors.lastname: Cochrane
authors.affiliation: Department of Family Medicine and Community Health, University of Minnesota, Minneapolis.
authors.forename: Keith
authors.initials: K
authors.lastname: Stelter
authors.affiliation: American Board of Family Medicine, Lexington, Kentucky.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Phillips
authors.affiliation: American Board of Family Medicine, Lexington, Kentucky.
authors.forename: Lars E
authors.initials: LE
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000367:Age Factors; D002568:Certification; D017046:Cost Savings; D003430:Cross-Sectional Studies; D004651:Employment / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006801:Humans; D033182:Intention; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011594:Psychometrics; D058996:Quality Improvement; D011787:Quality of Health Care