Article Figures & Data
Figures
- Figure 1.
Probability of failing recertification examination on first attempt, by motivation subgroup.
Tables
- Table 1.
American Board of Family Physician Recertification Survey Questions Used in This Study (2017–2021)
Why are you seeking to continue your ABFM certification at this time? a. Maintain professional image
b. Personal preference
c. Professional advancement
d. Maintain or improve patient satisfaction
e. Patients prefer being treated by board certified physicians
f. Certification program helps me update my medical knowledge
g. Certification program helps me monitor or improve the quality of my patient care
h. Required by my employer
i. Required for hospital privileges/credentialing
j. Required by one or more payer/insurance company
k. Other (please specify)
Which of the following describes your principal practice site: a. Academic health center / faculty practice (residency or university teaching environment)
b. Federal (Military, Veterans Administration/Department of Defense)
c. Federally Qualified Health Center or Look-Alike
d. Government clinic, non-federal (eg, state, county, city, maternal and child health, public health center, etc.)
e. Hospital-/health system-owned medical practice (not including managed care or HMO)
f. Independently owned medical practice
g. Indian Health Service
h. Managed care / HMO practice
i. Other, please specify:
j. Rural Health Clinic (federally qualified) Indian Health Service
k. Worksite clinic
Which of the following best describes your role in the ownership of your principal practice a. No official ownership stake (100% employed)
a. Sole owner
b. Partial owner or shareholder
c. Self-employed as a contractor (including locums)
d. Other, please specify:
Which of the following describes your principal practice size: a. Solo practice
b. 2 to 5 providers
c. 6 to 20 providers
d. >20 providers
- Table 2.
Percentage of Recertification Diplomates (2017–2021) within Each ML Cluster or Human Generated Group Who Endorsed Each Motivation
Machine learning clusters Cluster Description N (%) Image Personal Professional Patient satisfaction Patient preference Medical knowledge Patient care Employer Credential Payer Other 1 Credential + payer 2895 (19.3) 36 24 15 6 22 22 13 15 65 62 3 2 Employer 3208 (21.4) 32 29 17 6 16 25 15 70 27 10 3 3 Mainly extrinsic 2491 (16.6) 33 25 11 2.5 18 28 16 86 92 73 1 4 Broadly motivated 3553 (23.7) 88 86 75 70 83 93 86 73 77 66 1 5 Mainly intrinsic 2821 (18.8) 74 84 39 25 30 83 71 13 20 13 2 Human classification Extrinsic only 2626 (17.5) 0% 0% 0% 0% 0% 0% 0% 62% 64% 50% 2% Intrinsic only 3067 (20.5) 59% 70% 39% 25% 29% 57% 49% 0% 0% 0% 3% Mixed 9275 (62.0) 68% 60% 41% 31% 48% 65% 52% 66% 72% 58% 2% Shaded cells indicate major representative objects that different a cluster from others. Underlined cells indicate the allowed motivations for the Extrinsic Only and Intrinsic Only groups; all other combinations of motivations (ie, those that included at least one extrinsic motivation and at least one intrinsic motivation) were assigned to the Mixed group.
- Table 3.
Breakdown of % of 2017–2021 Recertification Diplomates Within Each Practice Site/Ownership/Size Category Assigned to Each Cluster
Cluster 1 (Credential + Payer) 2 (Employer) 3 (Mainly extrinsic) 4 (Broadly motivated) 5 (Mainly intrinsic) Variable: Type of Site Academic (1046) 2% 29% 33% 30% 7% Federal (570) 3% 37% 13% 20% 28% FQHC (951) 3% 26% 26% 24% 21% Govt, non-federal (230) 2% 36% 15% 18% 28% Hospital/health system (5258) 5% 27% 28% 30% 9% Independently Owned (4908) 48% 4% 2% 17% 29% Indian Health Service (91) 3% 26% 19% 27% 24% Managed care/ HMO (894) 8% 47% 7% 24% 14% Other (448) 10% 32% 13% 19% 27% Rural health clinic (345) 17% 20% 19% 21% 22% Work site clinic (227) 10% 35% 7% 18% 30% Site Ownership Employee (9584) 5% 28% 25% 27% 15% Other (186) 22% 28% 5% 20% 26% Partial owner /stakeholder (2863) 44% 13% 2% 20% 21% Self-employed [contractor] (427) 32% 15% 8% 18% 26% Sole owner (1908) 51% 1% 0% 16% 32% Site size Solo practice (1687) 42% 8% 3% 18% 29% 2-to-5 (5068) 26% 18% 9% 21% 27% 6-to-20 (4687) 11% 15% 33% 28% 13% >20 (3526) 11% 42% 12% 25% 10% Shaded cells for each variable indicate the major practice characteristics of each cluster (column).
Abbreviation: FQHC, federally qualified health center.
- Table 4.
Percent of 2017–2021 American Board of Family Medicine Diplomates Failing Initial Attempt at Recertification Exam, by Endorsement of Motivation
Motivation Endorses motivation Does not endorse motivation P (χ2) Intrinsic Image 6.8 (547/8093) 7.6 (524/6875) 0.041* Medical knowledge 7.3 (569/7760) 7.0 (502/7208) 0.383 Monitor/improve patient care 7.8 (492/6334) 6.7 (579/8634) 0.013* Patient preference 6.1 (327/5366) 7.8 (744/9602) <0.001*** Patient satisfaction 8.5 (308/3617) 6.7 (763/11,351) <0.001*** Personal preference 7.1 (548/7679) 7.2 (523/7289) 0.927 Professional advancement 8.2 (413/5035) 6.6 (658/9923) <0.001*** Extrinsic Credentialing 5.6 (464/8325) 9.1 (607/6643) <0.001*** Employer 4.5 (349/7772) 10.0 (722/7196) <0.001*** Payer 5.6 (374/6665) 8.4 (697/8303) <0.001*** Other 9.2 (26/283) 7.1 (1045/14,685) 0.181 ↵* P < .05, **P < .01, ***P < .001.
Bold figures indicate a higher probability of failure.
