What Services Do Family Physicians Provide in a Time of Primary Care Transition?

The Future of Family Medicine Report envisioned a new model of practice “committed to providing the full basket of clinical services offered by Family Medicine.”¹ In actuality, variation in that basket is considerable and may influence patients' access to care as much as supply and distribution of physicians does in the wake of health care reform.

The Institute of Medicine defines primary care as “…the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs.”² The actual scope of a primary care provider, however, varies widely and has changed over time. Trained with perhaps the widest scope among primary care providers, family physicians' scope of practice is thought to be changing as well.^3,4

When applying for Part III of Maintenance of Certification (cognitive examination), all family physicians must identify areas of practice on a mandatory (100% response rate) questionnaire included in the online application. We analyzed 3 years of responses (2006–2008) to assess what percentage of family physicians reported any service delivery across service type, all of which fall within the realm of family physician training. Specifically, we used data from a cohort applying for the Part III examination during the years 2006 to 2008 (n=26,355). Variation in services provided is considerable, and less than 40% of family physicians reported offering any services in more than half of the areas of scope considered (Figure 1).

• Download figure
• Open in new tab

Figure 1.

Percent of family physicians offering various services.

To preserve access to services already deficient in rural and urban underserved areas, policymakers will need to consider not only workforce supply, distribution, and composition but also desirable scope of practice. Specifically, they will need to adapt policies that influence provider scope of practice to allow visions of comprehensive care within a patient-centered medical home for all Americans to be realized. These include, but are not limited to, provider payment, certification and credentialing, and undergraduate, graduate, and continuing education.

• Received for publication December 31, 2010.
• Revision received March 29, 2011.
• Accepted for publication April 6, 2011.