Family Physicians' Scope of Practice and American Board of Family Medicine Recertification Examination Performance

Lars E. Peterson; Brenna Blackburn; Michael Peabody; Thomas R. O'Neill

doi:10.3122/jabfm.2015.02.140202

Article Figures & Data

Tables

View popup

Table 1. Scope of Practice for Primary Care Scale Elements and the Percentage of Family Physicians taking the American Board of Family Medicine Maintenance of Certification for Family Physicians Examination Performing each Element (n = 10,978)

Element	Urban (n = 8,838)	Rural (n = 2,140)
School health	3.9	4.9^*
Emergency care	12.3	30.7^*
Geriatric medicine	96.5	98.6^*
Women's health	68.3	74.2^*
Hospital medicine	29.7	53.0^*
Occupational and industrial medicine	25.6	43.0^*
Adult medicine	98.2	98.7
Major surgery	1.0	4.6^*
Office surgery	50.2	64.9^*
Musculoskeletal problems	72.5	76.1^*
Pain management	42.7	53.2^*
Palliative care	28.2	52.1^*
Care for children	81.0	90.9^*
Adolescent medicine	87.5	93.2^*
Pre -operative care	54.2	63.9^*
Post-operative care	27.3	41.7^*
Mental health	58.0	66.9^*
Sports medicine	34.1	43.7^*
Urgent care	62.2	66.8^*
Deliveries	7.1	15.6^*
Care for newborns	54.0	67.4^*
Prenatal care	13.3	19.5^*

↵* P for Chi-Square test < .05.

View popup

Table 2. Characteristics of Family Physicians Seeking American Board of Family Medicine Recertification and Examination Results in 2013 (n = 10,978)

Characteristic	Urban (n = 8,838)	Rural (n = 2,140)
2013 primary exam score (SD)	495.4 (105.7)	516.7 (104.0)^*
Percent who passed the examination	86.8	90.7^*
Scope of practice for primary care score	14.3 (3.4)	16.1 (4.0)^*
Gender (% Female)	38.5	29.1^*
Age, years	51.0 (8.5)	51.9 (8.6)^*
Degree (% DO)	8.6	9.4
International medical school graduates	18.5	9.7^*
Medical school faculty	25.0	22.6^*
Hold other American Board of Medical Specialties certification	3.1	1.5^*
Practice organization
Group	39.0	38.3
Solo	12.8	12.4
Other	48.2	49.3

Values are percentage or mean (standard deviation).
↵* P for t test or Chi-Square test < .05.
SD, standard deviation; DO, doctor of osteopathic medicine.

View popup

Table 3. Adjusted Associations between American Board of Family Medicine Recertification Examination Score and Result with and without Scope of Practice for Primary Care (SP4PC) Scale

	Linear Regression: Examination Score: Beta Estimate of Change in Examination Score		Logistic Regression: Passing Examination: OR of Passing (95% CI)
	Without SP4PC	With SP4PC	Without SP4PC	With SP4PC
SP4PC		4.9^*		1.09 (1.07–1.11)
Urban	−15.6^*	−5.8^*	0.73 (0.62–0.87)	0.86 (0.73–1.02)
Female	−9.4^*	−7.8^*	0.81 (0.72–0.92)	0.83 (0.72–0.94)
Age	−1.0^*	−0.9^*	0.96 (0.95–0.96)	0.96 (0.95–0.96)
Degree (DO)	−57.5^*	−55.8^*	0.39 (0.33–0.47)	0.40 (0.33–0.48)
International medical school graduates	−71.5^*	−67.8^*	0.30 (0.26–0.34)	0.31 (0.27–0.36)
Medical school faculty	17.0^*	9.4^*	1.44 (1.24–1.68)	1.30 (1.11–1.52)
Hold other American Board of Medical Specialties certification	−3.4	6.4	1.20 (0.83–1.72)	1.37 (0.94–1.99)
Practice organization
Group	Reference	Reference	Reference	Reference
Solo	−40.8^*	−36.4^*	0.48 (0.41–0.56)	0.51 (0.43–0.60)
Other	3.9	11.7^*	1.11 (0.97–1.28)	1.31 (1.14–1.51)

↵* Beta estimate significantly different than zero at P < .05.
OR, odds ratio; DO, doctor of osteopathic medicine.

View popup

Table 4. Adjusted Associations between American Board of Family Medicine Recertification Examination Score and Result Stratified by Urban and Rural Status with and without Scope of Practice for Primary Care (SP4PC) Scale

	Urban				Rural
	Linear Regression: Examination Score Beta Estimate of Change in Examination Score		Logistic Regression: Passing Examination OR of Passing (95% CI)		Linear Regression: Examination Score Beta Estimate of Change in Examination Score		Logistic Regression: Passing Examination OR of Passing (95% CI)
	Without SP4PC	With SP4PC	Without SP4PC	With SP4PC	Without SP4PC	With SP4PC	Without SP4PC	With SP4PC
SP4PC		5.6^*		1.08 (1.06–1.11)		3.2^*		1.11 (1.07–1.16)
Female	−10.8^*	−9.1^*	0.78 (0.68–0.90)	0.79 (0.69–0.91)	−3.0	−1.7	0.99 (0.70–1.14)	1.04 (0.73–1.48)
Age	−1.0^*	−1.0^*	0.95 (0.95–0.96)	0.95 (0.95–0.96)	−1.0	−0.8	0.97 (0.95–0.99)	0.97 (0.96–0.99)
Degree (DO)	−57.2^*	−55.1^*	0.39 (0.32–0.49)	0.40 (0.32–0.50)	−58.5^*	−57.7^*	0.39 (0.25–0.61)	0.40 (0.26–0.63)
International medical school graduates	−71.5^*	−67.2^*	0.31 (0.27–0.36)	0.32 (0.27–0.37)	−69.9^*	−66.8^*	0.25 (0.17–0.37)	0.27 (0.18–0.39)
Medical school faculty	19.5^*	11.5^*	1.48 (1.26–1.75)	1.35 (1.14–1.61)	5.7	−0.5	1.25 (0.85–1.83)	1.02 (0.68–1.51)
Hold other American Board of Medical Specialties certification	−2.1	9.1	1.28 (0.87–1.89)	1.47 (0.98–2.21)	−18.2	−13.2	0.64 (0.23–1.78)	0.71 (0.25–1.99)
Practice organization
Group	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
Solo	−41.7^*	−37.1^*	0.45 (0.98–0.54)	0.47 (0.40–0.57)	−37.5^*	−33.8^*	0.68 (0.44–1.05)	0.77 (0.50–1.19)
Other	4.6^*	13.3^*	1.11 (0.95–1.28)	1.31 (1.12–1.52)	0.5	5.2	1.18 (0.84–1.64)	1.41 (0.99–1.99)