Practice Patterns of Family Physicians With and Without Addiction Medicine Board Certification

Sebastian T. Tong; Zachary J. Morgan; Andrew W. Bazemore; Aimee R. Eden; Ruchi M. Fitzgerald; Lars E. Peterson

doi:10.3122/jabfm.2021.04.200456

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Table 1.

Personal and Practice Characteristics of Family Physicians With and Without Addiction Medicine Board Certification From 2017–2019 ABFM Continuing Certification Examination Registration Questionnaire and 2016–2019 National Graduate Survey

Characteristics	National Graduate Survey 2016–2019			Continuing Certification 2017–2019
	ADM Certified	Not ADM Certified	P value^*	ADM Certified	Not ADM Certified	P value^*
	n (%)	n (%)		n (%)	n (%)
Total	47	8,816		139	24,991
Age, y
Under 40	40 (85.1)	7,712 (87.5)	.144^{^†}	11 (7.9)	2,255 (9.0)	.295
40–49	4 (8.5)	939 (10.7)		57 (41.0)	9,338 (37.4)
50–59	3 (6.4)	147 (1.7)		50 (36.0)	8,084 (32.3)
60 and over	0 (0.0)	18 (0.2)		21 (15.1)	5,313 (21.3)
Sex
Male	23 (48.9)	3,880 (44.0)	.498	81 (58.3)	14,288 (57.2)	.794
Female	24 (51.1)	4,936 (56.0)		58 (41.7)	10,702 (42.8)
IMG
Yes	8 (17.0)	2,960 (33.6)	.016	26 (18.7)	5,588 (22.4)	.299
No	39 (83.0)	5,856 (66.4)		113 (81.3)	19,378 (77.6)
Race^{^†^‡}
Asian		--		14 (10.1)	3,744 (15.0)	.221
Black or African American		--		5 (3.6)	1,459 (5.8)
White	--	--		110 (79.1)	17,985 (72.0)
Other	--	--		10 (7.2)	1,803 (7.2)
Ethnicity^{^‡}
Hispanic or Latino	--	--		11 (7.9)	1,692 (6.8)	.593
Not Hispanic or Latino	--	--		128 (92.1)	23,299 (93.2)
Faculty at medical school or residency^§
Yes, core/salaried	10 (24.4)	812 (12.1)	.004	14 (10.1)	2,312 (9.3)	.106
Yes, volunteer/clinical	13 (31.7)	1,354 (20.1)		38 (27.3)	5,106 (20.4)
No	18 (43.9)	4,563 (67.8)		87 (62.6)	17,572 (70.3)
Principal practice size
Solo practice	1 (2.2)	263 (3.6)	.439	29 (22.7)	2,544 (11.9)	<.001
2–5 providers	18 (40.0)	2,622 (35.6)		46 (35.9)	7,146 (33.5)
6–20 providers	20 (44.4)	2,795 (38.0)		33 (25.8)	6,541 (30.7)
>20 providers	6 (13.3)	1,675 (22.8)		20 (15.6)	5,097 (23.9)
Principal practice site
Hospital/health system owned medical practice	9 (20.0)	2,856 (38.8)	.003	21 (16.4)	7,219 (33.8)	<.001
Independently owned	7 (15.6)	1,082 (14.7)		56 (43.8)	6,813 (31.9)
Managed care/HMO	2 (4.4)	532 (7.2)		7 (5.5)	1,245 (5.8)
Academic health center/faculty practice	8 (17.8)	813 (11.0)		6 (4.7)	1,558 (7.3)
FQHC or look-alike	13 (28.9)	858 (11.7)		11 (8.6)	1,256 (5.9)
Other	6 (13.3)	1,223 (16.6)		27 (21.1)	3,238 (15.2)
Specialty mix of principal practice
Family medicine only	16 (35.6)	3,213 (43.7)	.030	34 (38.2)	10,193 (51.5)	<.001
Primary care specialty mix	11 (24.4)	2,430 (33.0)		20 (22.5)	5,310 (26.8)
Multiple specialties	18 (40.0)	1,713 (23.3)		35 (39.3)	4,292 (21.7)
Rurality
Urban	44 (95.7)	7,178 (84.6)	.038	122 (87.8)	20,924 (84.5)	.289
Rural	2 (4.3)	1,310 (15.4)		17 (12.2)	3,836 (15.5)

Abbreviations: ABFM, American Board of Family Medicine; ADM, addiction medicine; HMO, health maintenance organization; FQHC, federally qualified health center, IMG, International Medical Graduate.
↵* Unless otherwise noted, χ² test was to calculate the P value.
↵† Fisher exact test was used to calculate this P value.
↵‡ Race and ethnicity data were not available for National Graduate Survey respondents.
2016 National Graduate Survey responses were excluded because the question about faculty differed
from the 2017-2019 National Graduate Survey.

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Table 2.

Scope of Practice of Family Physicians With and Without Addiction Medicine Board Certification From 2017–2019 ABFM Continuing Certification Examination Registration Questionnaire and 2016–2019 National Graduate Survey

Characteristics	National Graduate Survey 2016–2019			Continuing Certification 2017–2019
	ADM Certified	Not ADM Certified	P value^*	ADM Certified	Not ADM Certified	P value^*
	n (%)	n (%)		n (%)	n (%)
Prenatal care	^{^†}			18 (12.9)	2,805 (11.2)	.521
Delivering babies	7 (14.9)	1,194 (13.7)	.806	12 (8.6)	1,637 (6.6)	.323
Newborn hospital care	10 (21.3)	2,101 (24.0)	.665	14 (10.1)	3,169 (12.7)	.356
Pediatric hospital care (not newborn)	8 (17.0)	1,714 (19.6)	.661	8 (5.8)	2,286 (9.1)	.166
Pediatric outpatient care	28 (59.6)	6,704 (76.5)	.006	43 (30.9)	13,812 (55.3)	<.001
Adult inpatient medicine	19 (40.4)	3,445 (39.4)	.885	41 (29.5)	6,079 (24.3)	.157
Intensive care/ICU-CCU	8 (17.0)	1,953 (22.3)	.386	11 (7.9)	2,316 (9.3)	.583
Behavioral health care	44 (93.6)	7,693 (87.8)	.224	99 (71.2)	8,962 (35.9)	<.001
Integrative medicine	8 (17.0)	1,648 (18.8)	.754	14 (10.1)	1,132 (4.5)	.002
End of life care	20 (42.6)	5,354 (61.1)	.009	22 (15.8)	7,071 (28.3)	.001
Buprenorphine treatment	44 (93.6)	886 (10.1)	<.001	26 (83.9)	285 (5.7)	<.001^{^‡}
Pharmacologic management of HIV/AIDS	15 (31.9)	1,554 (17.8)	.012	1 (3.2)	197 (3.9)	1.000^{^‡}
Pharmacologic management of hepatitis C	23 (48.9)	1,688 (19.3)	<.001	6 (19.4)	183 (3.6)	<.009^{^†}

ABFM, American Board of Family Medicine; ADM, addiction medicine; HIV/AIDS, human immunodeficiency virus/acquired immuno deficiency syndrome; ICU-CCU, intensive care unit-coronary care unit.
↵* Unless otherwise noted, χ² test was to calculate the P value.
↵† Data on prenatal care provision was not available for the National Graduate Survey.
↵‡ Fisher exact test was used to calculate this P value.