RT Journal Article
SR Electronic
T1 Regional Variation in Scope of Practice by Family Physicians
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 28
OP 45
DO 10.3122/jabfm.2024.240201R1
VO 38
IS 1
A1 Lambert, Alyssa
A1 Fleischer, Sarah E.
A1 Atac, Omer
A1 Bazemore, Andrew
A1 Peterson, Lars E.
YR 2025
UL http://www.jabfm.org/content/38/1/28.abstract
AB 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 health care market.Methods: We utilized 2 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 health care 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 health care market characteristics did not attenuate divisional variation in SOP.Discussion: Significant geographic variation in FP SOP was not explainable by adjustment for clinician, practice, community, and health care market characteristics. This suggests that health care variation is multifactorial and will require more multifaceted interventions to ameliorate.