ORIGINAL RESEARCH
Alyssa Lambert, MD; Sarah E. Fleischer, MS; Omer Atac, MD, PhD; Andrew Bazemore, MD, MPH; Lars E. Peterson, MD, PhD
Corresponding Author: Lars Peterson, MD, PhD; American Board of Family Medicine; Department of Family and Community Medicine, College of Medicine, University of Kentucky
Email: lpeterson@theabfm.org
DOI: 10.3122/jabfm.2024.240201R1
Keywords: Delivery of Health Care, Family Medicine, Family Physicians, Health Workforce, Primary Health Care, Scope of Practice, Secondary Data Analysis
Dates: Submitted: 05-21-2024; Revised: 07-17-2024; Accepted: 07-22-2024
Status: In production for ahead of print.
INTRODUCTION: Geographic variation in physician scope of practice (SOP) has been documented but the causes remain unknown. We examined whether geographic variation in family physician (FP) SOP is explained by differences in the characteristics of the FPs, their practices, practice environment, or healthcare market.
METHODS: We utilized two datasets from the American Board of Family Medicine (ABFM) from 2017 to 2022. The National Graduate Survey captures early career FPs while the Continuous Certification Questionnaire is administered to mid to late career FPs. We used a SOP score that ranges from 0 to 30 with a larger score reflecting a broader SOP. Bivariate analyses assessed for differences by Census division in clinician, practice, community, and healthcare market characteristics. A series of multilevel linear regression analyses tested if geographic differences in SOP were attenuated by the aforementioned characteristics.
RESULTS: Our analytic included 9,378 early career FPs and 28,832 mid to late career FPs in the unadjusted regression model. We found significant differences in clinician characteristics by division and cohort. In unadjusted results, SOP score differed by division and career stage within division (range 11.49 to 14.95 for later career FPs and 15.22 to 17.51 for early career FPs). Adjusting for clinician, practice, community, and healthcare market characteristics did not attenuate divisional variation in SOP.
DISCUSSION: Significant geographic variation in FP SOP wasn’t explainable by adjustment for clinician, practice, community, and healthcare market characteristics. This suggests that healthcare variation is multifactorial and will require more multifaceted interventions to ameliorate.