Regional Variation in Scope of Practice by Family Physicians

Alyssa Lambert; Sarah E. Fleischer; Omer Atac; Andrew Bazemore; Lars E. Peterson

doi:10.3122/jabfm.2024.240201R1

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Figure 1.
Divisional variation from mean scope of practice score for early career and mid to late career family physicians.
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Figure 2.
Adjusted associations between scope of practice score and division controlling for clinician, practice, community, and health care market characteristics for early career and mid to late career family physicians.
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Table 1.

Divisional Variation of Clinician, Practice, Community, and Healthcare Market Characteristics of Early Career Family Physicians, 2017 to 2022

	East North Central	East South Central	Middle Atlantic	Mountain	New England	Pacific	South Atlantic	West North Central	West South Central	Full Population
Scope of practice score Mean (SD)	15.99 (2.68)	15.53 (2.91)	15.22 (2.84)	17.10 (2.81)	16.05 (2.76)	16.23 (2.81)	15.40 (2.88)	17.51 (2.56)	15.43 (3.09)	16.04 (2.90)
Domain 1: Clinician
Age Mean (SD)	34.74 (4.07)	35.43 (4.67)	34.92 (4.26)	35.19 (3.86)	35.51 (4.43)	35.68 (3.95)	35.48 (4.76)	34.48 (3.97)	35.38 (4.63)	35.23 (4.30)
Gender (percent)
Woman	860 (54.0%)	258 (49.1%)	624 (58.3%)	506 (51.6%)	296 (64.9%)	1,353 (59.7%)	1,106 (55.7%)	606 (57.6%)	681 (52.3%)	6,290 (56.0%)
Race (percent)
American Indian or Alaska Native	8 (0.5%)	5 (1.0%)	4 (0.4%)	12 (1.2%)	2 (0.5%)	29 (1.3%)	14 (0.7%)	9 (0.9%)	18 (1.4%)	101 (0.9%)
Asian	298 (19.3%)	70 (13.6%)	317 (30.0%)	132 (13.7%)	72 (16.6%)	700 (31.5%)	327 (16.7%)	105 (10.1%)	295 (23.2%)	2,316 (21.1%)
Black or African American	92 (5.9%)	50 (9.7%)	82 (7.8%)	17 (1.8%)	25 (5.8%)	90 (4.1%)	288 (14.7%)	32 (3.1%)	120 (9.4%)	796 (7.2%)
Native Hawaiian or Pacific Islander	6 (0.4%)	0 (0%)	1 (0.1%)	4 (0.4%)	2 (0.5%)	22 (1.0%)	10 (0.5%)	1 (0.1%)	6 (0.5%)	52 (0.5%)
White	1,110 (71.7%)	381 (74.0%)	610 (57.7%)	771 (80.1%)	320 (73.9%)	1,264 (56.9%)	1,265 (64.8%)	875 (84.5%)	800 (62.9%)	7,396 (67.3%)
Other	34 (2.2%)	9 (1.7%)	43 (4.1%)	27 (2.8%)	12 (2.8%)	116 (5.2%)	49 (2.5%)	14 (1.4%)	32 (2.5%)	336 (3.1%)
Ethnicity (percent)
Hispanic or Latino	60 (3.9%)	14 (2.7%)	69 (6.5%)	84 (8.7%)	17 (3.9%)	272 (12.2%)	213 (10.9%)	31 (3.0%)	201 (15.8%)	961 (8.7%)
International medical graduate status (percent)
International medical graduate	507 (31.8%)	149 (28.4%)	448 (41.8%)	194 (19.8%)	127 (27.9%)	622 (27.4%)	726 (36.6%)	181 (17.2%)	480 (36.9%)	3,434 (30.6%)
Degree type, MD versus DO (percent)
DO degree	323 (20.3%)	109 (20.8%)	220 (20.5%)	221 (22.5%)	73 (16.0%)	486 (21.4%)	330 (16.6%)	277 (26.3%)	205 (15.7%)	2,244 (20.0%)
Residency location (percent)
Small rural	1 (0.1%)	12 (2.4%)	2 (0.2%)	0 (0%)	1 (0.2%)	4 (0.2%)	2 (0.1%)	0 (0%)	11 (1.0%)	33 (0.3%)
Large rural	65 (4.4%)	55 (11.0%)	21 (2.0%)	22 (2.4%)	30 (6.7%)	64 (3.0%)	80 (4.4%)	48 (4.8%)	38 (3.3%)	423 (4.0%)
Urban	1,419 (95.6%)	431 (86.5%)	1,020 (97.8%)	879 (97.6%)	416 (93.1%)	2,097 (96.9%)	1,755 (95.5%)	952 (95.2%)	1,099 (95.7%)	10,068 (95.7%)
Domain 2: Practice
Practice type (percent)
Academic health center	230 (16.7%)	42 (10.1%)	148 (17.1%)	88 (10.4%)	57 (14.5%)	182 (9.1%)	207 (13.1%)	91 (9.9%)	128 (12.4%)	1,173 (12.4%)
Federally qualified health center	130 (9.4%)	43 (10.3%)	120 (13.8%)	144 (17.0%)	96 (24.5%)	373 (18.7%)	151 (9.6%)	45 (4.9%)	73 (7.0%)	1,175 (12.5%)
Federal military	14 (1.0%)	29 (7.0%)	16 (1.8%)	51 (6.0%)	7 (1.8%)	108 (5.4%)	155 (9.8%)	23 (2.5%)	57 (5.5%)	460 (4.9%)
Rural health center	50 (3.6%)	28 (6.7%)	10 (1.2%)	54 (6.4%)	5 (1.3%)	73 (3.7%)	37 (2.3%)	120 (13.0%)	60 (5.8%)	437 (4.6%)
Independently owned	133 (9.7%)	83 (19.9%)	128 (14.7%)	119 (14.0%)	36 (9.2%)	192 (9.6%)	243 (15.4%)	104 (11.3%)	193 (18.6%)	1,231 (13.1%)
Managed care/HMO	32 (2.3%)	8 (1.9%)	15 (1.7%)	50 (5.9%)	12 (3.1%)	364 (18.2%)	128 (8.1%)	10 (1.1%)	39 (3.8%)	658 (7.0%)
Hospital/Health system	732 (53.2%)	163 (39.1%)	394 (45.4%)	277 (32.7%)	165 (42.1%)	524 (26.2%)	570 (36.2%)	482 (52.3%)	408 (39.4%)	3,715 (39.4%)
Other	56 (4.1%)	21 (5.0%)	37 (4.3%)	65 (7.7%)	14 (3.6%)	181 (9.1%)	85 (5.4%)	46 (5.0%)	78 (7.5%)	583 (6.2%)
Principal practice ownership (percent)
Not owner	1,042 (92.5%)	240 (81.1%)	636 (92.8%)	459 (86.0%)	258 (95.6%)	962 (76.2%)	1,000 (87.1%)	608 (88.5%)	671 (87.4%)	5,876 (86.7%)
Owner	85 (7.5%)	56 (18.9%)	49 (7.2%)	75 (14.0%)	12 (4.4%)	300 (23.8%)	148 (12.9%)	79 (11.5%)	97 (12.6%)	901 (13.3%)
Practice size (percent)
Group	1,335 (96.9%)	393 (94.2%)	834 (96.1%)	830 (97.9%)	387 (98.7%)	1,964 (98.3%)	1,518 (96.3%)	906 (98.4%)	978 (94.4%)	9,145 (97.0%)
Solo	42 (3.1%)	24 (5.8%)	34 (3.9%)	18 (2.1%)	5 (1.3%)	33 (1.7%)	58 (3.7%)	15 (1.6%)	58 (5.6%)	287 (3.0%)
Practice specialty mix (percent)
Family medicine only	690 (50.1%)	197 (47.2%)	411 (47.4%)	378 (44.6%)	159 (40.6%)	566 (28.3%)	741 (47.0%)	475 (51.6%)	434 (41.9%)	4,051 (42.9%)
Multiple specialties (Not only primary care)	321 (23.3%)	88 (21.1%)	195 (22.5%)	182 (21.5%)	81 (20.7%)	577 (28.9%)	316 (20.1%)	219 (23.8%)	266 (25.7%)	2,245 (23.8%)
Primary care specialty mix	366 (26.6%)	132 (31.7%)	262 (30.2%)	288 (34.0%)	152 (38.8%)	854 (42.8%)	519 (32.9%)	227 (24.6%)	337 (32.5%)	3,137 (33.3%)
Domain 3: Community
Social deprivation index (SD)	46.13 (28.70)	56.67 (22.49)	43.16 (30.91)	47.76 (26.57)	35.46 (27.24)	60.48 (24.61)	52.60 (26.94)	27.73 (21.56)	59.51 (24.74)	49.91 (28.04)
Rurality (percent)
Isolated	25 (1.6%)	16 (3.1%)	13 (1.2%)	33 (3.4%)	15 (3.3%)	29 (1.3%)	24 (1.2%)	77 (7.3%)	11 (0.8%)	243 (2.2%)
Small rural	142 (9.0%)	77 (14.8%)	57 (5.3%)	97 (9.9%)	39 (8.6%)	144 (6.4%)	124 (6.3%)	187 (17.8%)	118 (9.1%)	985 (8.8%)
Large rural	93 (5.9%)	59 (11.3%)	16 (1.5%)	87 (8.9%)	31 (6.8%)	83 (3.7%)	43 (2.2%)	160 (15.2%)	80 (6.2%)	652 (5.8%)
Urban	1,323 (83.6%)	370 (70.9%)	980 (91.9%)	758 (77.7%)	370 (81.3%)	2,003 (88.7%)	1,790 (90.4%)	626 (59.6%)	1,090 (83.9%)	9,310 (83.2%)
Premature death rate (percent)
High	22 (1.4%)	129 (24.9%)	2 (0.2%)	52 (5.3%)	0 (0%)	9 (0.4%)	204 (10.3%)	27 (2.6%)	96 (7.4%)	541 (4.8%)
Medium	787 (49.6%)	348 (67.1%)	469 (44.0%)	234 (24.0%)	96 (21.1%)	219 (9.7%)	785 (39.6%)	454 (43.2%)	488 (37.5%)	3,880 (34.7%)
Low	778 (49.0%)	42 (8.1%)	595 (55.8%)	690 (70.7%)	360 (78.9%)	2,028 (89.9%)	991 (50.1%)	570 (54.2%)	716 (55.1%)	6,770 (60.5%)
Domain 4: Healthcare market
Beds per hospital (percent)
High	1,128 (71.1%)	332 (64.0%)	919 (86.2%)	618 (63.3%)	353 (77.4%)	1,859 (82.3%)	1,550 (78.3%)	517 (49.2%)	881 (67.8%)	8,157 (72.9%)
Medium	387 (24.4%)	159 (30.6%)	123 (11.5%)	298 (30.5%)	99 (21.7%)	361 (16.0%)	336 (17.0%)	392 (37.3%)	323 (24.8%)	2,478 (22.1%)
Low	72 (4.5%)	28 (5.4%)	24 (2.3%)	60 (6.1%)	4 (0.9%)	39 (1.7%)	94 (4.7%)	142 (13.5%)	96 (7.4%)	559 (5.0%)
Medicare cost per capita (percent)
High	461 (29.0%)	113 (21.8%)	507 (47.6%)	83 (8.5%)	246 (53.9%)	1,305 (57.8%)	664 (33.5%)	164 (15.6%)	748 (57.5%)	4,291 (38.3%)
Medium	864 (54.4%)	357 (68.8%)	443 (41.6%)	459 (47.0%)	130 (28.5%)	448 (19.8%)	1,098 (55.5%)	619 (58.9%)	521 (40.1%)	4,939 (44.1%)
Low	262 (16.5%)	49 (9.4%)	116 (10.9%)	434 (44.5%)	80 (17.5%)	506 (22.4%)	218 (11.0%)	268 (25.5%)	31 (2.4%)	1,964 (17.5%)
External reasons for not practicing OB or inpatient medicine (percent)
No	1,204 (75.6%)	368 (70.1%)	712 (66.5%)	684 (69.7%)	311 (68.2%)	1,546 (68.2%)	1,265 (63.7%)	790 (75.1%)	893 (68.6%)	7,773 (69.2%)
Yes	388 (24.4%)	157 (29.9%)	359 (33.5%)	297 (30.3%)	145 (31.8%)	720 (31.8%)	721 (36.3%)	262 (24.9%)	409 (31.4%)	3,458 (30.8%)
Ratio of primary care physicians
High	50 (3.2%)	47 (9.1%)	0 (0%)	43 (4.4%)	0 (0%)	34 (1.5%)	39 (2.0%)	162 (15.4%)	69 (5.3%)	444 (4.0%)
Medium	517 (32.6%)	212 (40.8%)	242 (22.7%)	326 (33.4%)	120 (26.3%)	743 (32.9%)	595 (30.1%)	492 (46.8%)	559 (43.0%)	3,806 (34.0%)
Low	1,020 (64.3%)	260 (50.1%)	824 (77.3%)	607 (62.2%)	336 (73.7%)	1,482 (65.6%)	1,346 (68.0%)	397 (37.8%)	672 (51.7%)	6,944 (62.0%)

*External reasons for not practicing OB and Internal Medicine includes selecting either “challenges with privileging” or “not available in the practice I joined”, as reasons for not practicing either inpatient medicine or obstetric care.
^±All tests have P-values of < 0.0001.
Abbreviation: SD, Standard deviation.

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Table 2.

Divisional Variation of Clinician, Practice, Community, and Healthcare Market Characteristics of Mid to Late Career Family Physicians, 2017 to 2022

	East North Central	East South Central	Middle Atlantic	Mountain	New England	Pacific	South Atlantic	West North Central	West South Central	Full Population
Scope of practice score Mean (SD)	13.68 (3.51)	12.63 (3.81)	12.59 (3.54)	13.42 (3.86)	13.20 (3.44)	12.26 (3.75)	11.49 (3.62)	14.95 (3.98)	12.20 (3.82)	12.77 (3.83)
Domain 1: Clinician
Age Mean (SD)	50.08 (9.39)	50.37 (9.65)	50.54 (9.72)	50.04 (8.94)	51.04 (9.45)	49.45 (9.06)	50.56 (9.39)	50.22 (9.29)	49.46 (9.09)	50.09 (9.31)
Gender (percent)
Female	2,588 (45.2%)	711 (37.1%)	1,683 (48.5%)	1,251 (42.2%)	832 (52.5%)	3,464 (50.5%)	3,002 (44.1%)	1,432 (43.0%)	1596 (38.8%)	16,559 (45.0%)
Race (percent)
American Indian or Alaska Native	31 (0.5%)	12 (0.6%)	12 (0.3%)	44 (1.5%)	8 (0.5%)	62 (0.9%)	48 (0.7%)	35 (1.1%)	59 (1.4%)	311 (0.8%)
Asian	881 (15.4%)	179 (9.3%)	657 (19.0%)	277 (9.3%)	201 (12.7%)	1,867 (27.2%)	1,028 (15.1%)	261 (7.8%)	775 (18.8%)	6,126 (16.7%)
Black or African American	277 (4.8%)	188 (9.8%)	225 (6.5%)	66 (2.2%)	51 (3.2%)	223 (3.3%)	854 (12.6%)	93 (2.8%)	320 (7.8%)	2,297 (6.2%)
Native Hawaiian or Pacific Islander	20 (0.3%)	1 (0.1%)	12 (0.3%)	17 (0.6%)	5 (0.3%)	85 (1.2%)	28 (0.4%)	9 (0.3%)	17 (0.4%)	194 (0.5%)
White	4,222 (73.7%)	1,464 (76.4%)	2,347 (67.7%)	2,388 (80.5%)	1,254 (79.1%)	3,943 (57.5%)	4,423 (65.0%)	2,823 (84.8%)	2,696 (65.5%)	25,560 (69.5%)
Other	298 (5.2%)	71 (3.7%)	214 (6.2%)	174 (5.9%)	66 (4.2%)	673 (9.8%)	419 (6.2%)	109 (3.3%)	248 (6.0%)	2,272 (6.2%)
Ethnicity (percent)
Hispanic or Latino	239 (4.2%)	39 (2.0%)	180 (5.2%)	232 (7.8%)	61 (3.8%)	641 (9.4%)	642 (9.4%)	92 (2.8%)	542 (13.2%)	2,668 (7.3%)
International medical graduate status (percent)
International medical graduate	1,367 (24.2%)	331 (17.4%)	1,056 (31.1%)	439 (14.9%)	303 (19.3%)	1,721 (25.4%)	1,926 (28.7%)	401 (12.1%)	1,112 (27.3%)	8,656 (23.8%)
Degree type, MD versus DO (percent)
DO degree	610 (10.6%)	188 (9.8%)	480 (13.8%)	447 (15.1%)	191 (12.1%)	740 (10.8%)	559 (8.2%)	466 (14.0%)	412 (10.0%)	4,093 (11.1%)
Residency location (percent)
Small rural	2 (0.0%)	27 (1.5%)	3 (0.1%)	1 (0.0%)	0 (0%)	1 (0.0%)	8 (0.1%)	0 (0%)	8 (0.2%)	50 (0.2%)
Large rural	161 (3.1%)	175 (9.8%)	51 (1.6%)	78 (3.0%)	110 (7.4%)	123 (1.9%)	219 (3.6%)	153 (5.2%)	105 (3.0%)	1,175 (3.5%)
Urban	5,026 (96.9%)	1,580 (88.7%)	3,191 (98.3%)	2,524 (97.0%)	1,368 (92.6%)	6,202 (98.0%)	5,839 (96.3%)	2,803 (94.8%)	3,382 (96.7%)	31,915 (96.3%)
Domain 2: Practice
Practice type (percent)
Academic health center	426 (8.7%)	106 (7.0%)	292 (9.7%)	186 (7.3%)	101 (7.4%)	351 (5.9%)	405 (7.1%)	226 (8.2%)	280 (8.3%)	2,373 (7.6%)
Federally qualified health center	254 (5.2%)	64 (4.2%)	211 (7.0%)	221 (8.7%)	201 (14.6%)	590 (9.8%)	271 (4.8%)	91 (3.3%)	124 (3.7%)	2,027 (6.5%)
Federal military	86 (1.8%)	83 (5.5%)	69 (2.3%)	112 (4.4%)	24 (1.7%)	223 (3.7%)	411 (7.2%)	83 (3.0%)	174 (5.2%)	1,265 (4.1%)
Rural health center	123 (2.5%)	57 (3.8%)	19 (0.6%)	82 (3.2%)	28 (2.0%)	101 (1.7%)	61 (1.1%)	148 (5.4%)	97 (2.9%)	716 (2.3%)
Independently owned	1,231 (25.2%)	596 (39.4%)	993 (32.8%)	829 (32.6%)	329 (23.9%)	1,418 (23.7%)	1,987 (35.0%)	606 (22.0%)	1,295 (38.4%)	9,284 (29.8%)
Managed care/HMO	83 (1.7%)	8 (0.5%)	23 (0.8%)	139 (5.5%)	14 (1.0%)	1,239 (20.7%)	278 (4.9%)	64 (2.3%)	81 (2.4%)	1,929 (6.2%)
Hospital/Health system	2,354 (48.2%)	470 (31.1%)	1,189 (39.3%)	699 (27.5%)	582 (42.4%)	1,363 (22.7%)	1,734 (30.5%)	1,369 (49.6%)	964 (28.6%)	10,724 (34.4%)
Other	324 (6.6%)	128 (8.5%)	228 (7.5%)	276 (10.8%)	95 (6.9%)	710 (11.8%)	529 (9.3%)	172 (6.2%)	356 (10.6%)	2,818 (9.1%)
Principal practice ownership (percent)
Not owner	3,807 (78.0%)	970 (64.2%)	2,249 (74.4%)	1,809 (71.1%)	1,113 (81.0%)	3,766 (62.8%)	4,064 (71.6%)	2,202 (79.8%)	2,266 (67.2%)	22,246 (71.4%)
Owner	1,074 (22.0%)	542 (35.8%)	775 (25.6%)	735 (28.9%)	261 (19.0%)	2,229 (37.2%)	1,612 (28.4%)	557 (20.2%)	1,105 (32.8%)	8,890 (28.6%)
Practice size (percent)
Group	4,369 (89.5%)	1,296 (85.7%)	2,601 (86.0%)	2,341 (92.0%)	1,263 (91.9%)	5,480 (91.4%)	4,923 (86.7%)	2,614 (94.7%)	2,804 (83.2%)	27,691 (88.9%)
Solo	512 (10.5%)	216 (14.3%)	423 (14.0%)	203 (8.0%)	111 (8.1%)	515 (8.6%)	753 (13.3%)	145 (5.3%)	567 (16.8%)	3,445 (11.1%)
Practice specialty mix (percent)
Family medicine only	2,488 (54.3%)	790 (55.9%)	1,590 (56.8%)	1,162 (49.4%)	621 (49.7%)	1,914 (34.6%)	2,774 (53.1%)	1,344 (52.1%)	1,623 (51.5%)	14,306 (49.5%)
Multiple specialties (Not only primary care)	958 (20.9%)	245 (17.3%)	486 (17.4%)	505 (21.5%)	222 (17.8%)	1,728 (31.2%)	931 (17.8%)	690 (26.7%)	643 (20.4%)	6,408 (22.2%)
Primary care specialty mix	1,136 (24.8%)	379 (26.8%)	721 (25.8%)	684 (29.1%)	406 (32.5%)	1,888 (34.1%)	1,522 (29.1%)	546 (21.2%)	883 (28.0%)	8,165 (28.3%)
Health care professional collaboration in practice
Physician assistant	2,183 (38.1%)	629 (32.8%)	1,575 (45.4%)	1,769 (59.6%)	786 (49.6%)	3,645 (53.2%)	3,139 (46.2%)	1,907 (57.3%)	1,588 (38.6%)	17,221 (46.8%)
Domain 3: Community
Social deprivation index (SD)	41.88 (28.14)	53.47 (22.74)	38.71 (29.35)	44.58 (26.76)	31.01 (24.59)	58.82 (24.23)	49.09 (27.09)	27.51 (20.89)	59.81 (25.15)	47.11 (27.83)
Rurality (percent)
Isolated	147 (2.6%)	52 (2.7%)	49 (1.4%)	91 (3.1%)	100 (6.3%)	73 (1.1%)	88 (1.3%)	180 (5.4%)	47 (1.1%)	827 (2.3%)
Small rural	414 (7.2%)	180 (9.4%)	89 (2.6%)	193 (6.5%)	103 (6.5%)	152 (2.2%)	162 (2.4%)	396 (11.9%)	210 (5.1%)	1,899 (5.2%)
Large rural	567 (9.9%)	317 (16.6%)	192 (5.5%)	295 (10.0%)	147 (9.3%)	337 (4.9%)	424 (6.2%)	518 (15.6%)	313 (7.6%)	3,110 (8.5%)
Urban	4,591 (80.3%)	1,364 (71.3%)	3,130 (90.5%)	2,381 (80.4%)	1,231 (77.9%)	6,280 (91.8%)	6,111 (90.1%)	2,228 (67.1%)	3,536 (86.1%)	30,852 (84.1%)
Premature death rate (percent)
High	138 (2.5%)	479 (26.2%)	18 (0.5%)	117 (4.0%)	10 (0.6%)	37 (0.6%)	649 (9.9%)	89 (2.7%)	315 (7.9%)	1,852 (5.2%)
Medium	2,805 (49.9%)	1,145 (62.6%)	1,353 (40.5%)	631 (21.8%)	385 (25.0%)	515 (7.7%)	2,627 (40.0%)	1,174 (35.9%)	1,368 (34.3%)	12,003 (33.6%)
Low	2,676 (47.6%)	206 (11.3%)	1,968 (58.9%)	2,151 (74.2%)	1,146 (74.4%)	6,139 (91.8%)	3,288 (50.1%)	2,005 (61.4%)	2,309 (57.8%)	21,888 (61.2%)
Domain 4: Healthcare market
Beds per hospital (percent)
High	3,651 (65.0%)	1,175 (64.2%)	2,819 (84.4%)	1,891 (65.2%)	1,035 (67.2%)	5,571 (83.2%)	5,073 (77.3%)	1,766 (54.0%)	2,834 (71.0%)	25,815 (72.2%)
Medium	1,670 (29.7%)	555 (30.3%)	435 (13.0%)	874 (30.1%)	487 (31.6%)	1,035 (15.5%)	1,138 (17.3%)	1,152 (35.3%)	932 (23.3%)	8,278 (23.2%)
Low	298 (5.3%)	100 (5.5%)	85 (2.5%)	134 (4.6%)	19 (1.2%)	88 (1.3%)	353 (5.4%)	350 (10.7%)	226 (5.7%)	1,653 (4.6%)
Medicare cost per capita (percent)
High	1,440 (25.6%)	316 (17.3%)	1,438 (43.1%)	220 (7.6%)	756 (49.1%)	3,847 (57.5%)	2,000 (30.5%)	365 (11.2%)	2,443 (61.2%)	12,825 (35.9%)
Medium	3,173 (56.5%)	1,280 (69.9%)	1,540 (46.1%)	1,339 (46.2%)	449 (29.1%)	1,430 (21.4%)	3,797 (57.8%)	2,074 (63.5%)	1,468 (36.8%)	16,550 (46.3%)
Low	1,006 (17.9%)	234 (12.8%)	361 (10.8%)	1,340 (46.2%)	336 (21.8%)	1,417 (21.2%)	767 (11.7%)	829 (25.4%)	81 (2.0%)	6,371 (17.8%)
External reasons for not practicing OB or Inpatient Medicine (percent)
No	3,906 (68.2%)	1,290 (67.4%)	2,158 (62.2%)	1,870 (63.0%)	952 (60.1%)	4,136 (60.4%)	4,121 (60.6%)	2,292 (68.8%)	2,720 (66.1%)	23,445 (63.8%)
Yes	1,823 (31.8%)	625 (32.6%)	1,310 (37.8%)	1,096 (37.0%)	633 (39.9%)	2,717 (39.6%)	2,679 (39.4%)	1,039 (31.2%)	1,396 (33.9%)	13,318 (36.2%)

*All tests have P-values of < 0.0001.
Abbreviation: SD, Standard deviation.

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Table 3.

Scope of Practice Score by Clinician, Practice, Community, and Healthcare Market Characteristics for Early Career (NGS) and Mid to Late Career (CCQ) Family Physicians, 2017 to 2022

	Scope of Practice Score
	NGS	CCQ
	Mean (SD)	Mean (SD)
Clinician
Gender
Female	15.79 (2.87)	12.56 (3.76)
Male	15.86 (2.76)	13.04 (3.87)
Race
American Indian or Alaska Native	15.85 (2.43)	13.15 (3.67)
Asian	14.88 (2.86)	11.28 (3.43)
Black or African American	15.01 (2.81)	11.47 (3.62)
Native Hawaiian or other Pacific Islander	16.32 (2.57)	11.87 (3.42)
Other	15.25 (2.86)	13.38 (3.79)
White	16.20 (2.73)	11.94 (3.80)
Ethnicity
Hispanic or Latino	15.25 (3.24)	11.40 (3.77)
Not Hispanic or Latino	15.87 (2.78)	12.93 (3.81)
International medical graduates
US medical graduate	16.12 (2.70)	13.29 (3.79)
International medical graduate	15.07 (2.98)	11.29 (3.53)
Degree type
DO	15.96 (2.56)	13.00 (3.82)
MD	15.79 (2.89)	12.79 (3.82)
Residency location
Small rural residency	16.09 (3.00)	12.71 (4.57)
Large rural residency	14.33 (4.39)	13.59 (4.29)
Urban residency	15.82 (2.81)	12.79 (3.80)
Practice
Practice type
Academic health center	17.67 (2.76)	15.52 (4.05)
FQHC	̂	13.31 (3.52)
Federal military	̂	8.86 (3.80)
Hospital/health system	15.52 (2.64)	13.11 (3.39)
Independently owned Medical practice	15.59 (2.82)	12.85 (3.48)
Managed care/HMO	14.81 (2.66)	10.52 (3.35)
RHC	̂	16.22 (3.75)
Other practice type	̂	10.67 (3.86)
Practice ownership
Owns practice	15.16 (2.93)	12.78 (3.94)
Does not own practice	15.85 (2.82)	12.91 (3.53)
Practice size
Group practice	15.85 (2.82)	12.87 (3.85)
Solo practice	15.16 (2.93)	12.38 (3.54)
Practice specialties
Family medicine only	16.36 (2.76)	13.49 (3.74)
Multiple specialties (not just primary care)	15.30 (2.87)	12.18 (3.85)
Primary care specialty mix	15.38 (2.73)	12.13 (3.74)
Collaboration
Collaborates with PA	#	13.12 (3.87)
Does not collaborate with PA	#	12.58 (3.77)
Community
Rurality
Isolated	18.00 (2.26)	16.08 (3.66)
Small rural	16.83 (2.54)	16.15 (3.88)
Large rural	18.02 (2.53)	14.38 (3.88)
Urban	15.58 (2.79)	12.36 (3.62)
Premature death rate
High premature death	16.10 (2.25)	16.08 (3.66)
Medium premature death	16.04 (2.79)	16.15 (3.88)
Low premature death	15.69 (2.87)	14.38 (3.88)
Healthcare market
Beds per hospital
Beds per hospital - High	15.58 (2.81)	12.22 (3.66)
Beds per hospital - Medium	16.48 (2.75)	14.27 (3.83)
Beds per hospital - Low	16.92 (2.77)	14.82 (3.74)
Medicare cost per capita
Medicare cost per capita - High	15.24 (2.91)	11.85 (3.80)
Medicare cost per capita - Medium	15.92 (2.69)	13.06 (3.70)
Medicare cost per capita - Low	16.78 (2.70)	14.19 (3.69)
Reasons for not practicing OB or Inpatient Medicine
Yes	15.49 (2.46)	13.26 (3.97)
No	15.96 (2.95)	12.05 (3.42)
Ratio of primary care physicians
High	18.5 (2.7)	16.7 (3.9)
Medium	16.4 (2.9)	13.5 (3.7)
Low	15.7 (2.9)	12.2(3.7)

*Scope score ranges from 0–30.
̂Sample sizes were too small to produce a reliable regression model.
^#Data not available in NGS.
NGS is National Graduate Survey. CCQ is Continuous Certification Questionnaire.
Abbreviations: SD, Service delivery; MD, Doctor of Medicine; DO, Doctor of Osteopathic Medicine; FQHC, Federally qualified health center; HMO, Health maintenance organization; RHC, Rural health clinic; OB, Obstetrics; PA, Physician assistant.