RESUMO
PURPOSE: A family physician's ability to provide continuous, comprehensive care begins in residency. Previous studies show that patterns developed during residency may be imprinted upon physicians, guiding future practice. The objective was to determine family medicine residency characteristics associated with graduates' scope of practice (SCoP). METHOD: The authors used (1) residency program data from the 2012 Accreditation Council for Graduate Medicine Education Accreditation Data System and (2) self-reported data supplied by family physicians when they registered for the first recertification examination with the American Board of Family Medicine (2013-2016)-7 to 10 years after completing residency. The authors used linear regression analyses to examine the relationship between individual physician SCoP (measured by the SCoP for primary care [SP4PC] score [scale of 0-30; low = small scope]) and individual, practice, and residency program characteristics. RESULTS: The authors sampled 8,261 physicians from 423 residencies. The average SP4PC score was 15.4 (standard deviation, 3.2). Models showed that SCoP broadened with increasing rurality. Physicians from unopposed (single) programs had higher SCoP (0.26 increase in SP4PC); those from major teaching hospitals had lower SCoP (0.18 decrease in SP4PC). CONCLUSIONS: Residency program characteristics may influence family physicians' SCoP, although less than individual characteristics do. Broad SCoP may imply more comprehensive care, which is the foundation of a strong primary care system to increase quality, decrease cost, and reduce physician burnout. Some residency program characteristics can be altered so that programs graduate physicians with broader SCoP, thereby meeting patient needs and improving the health system.
Assuntos
Internato e Residência/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Âmbito da Prática , Adulto , Fatores Etários , Feminino , Médicos Graduados Estrangeiros/estatística & dados numéricos , Geografia , Prática de Grupo/estatística & dados numéricos , Hospitais de Ensino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Prática Privada/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Sexuais , População Urbana/estatística & dados numéricosRESUMO
We found substantial gaps between preparation for, and practice of, early career family physicians in nearly all clinical practice areas. With reported intentions of graduates for a broad scope of practice, gaps between practice and preparation suggest family physicians early in their careers may not be finding opportunities to provide comprehensive care.
Assuntos
Escolha da Profissão , Medicina de Família e Comunidade/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Lacunas da Prática Profissional/estatística & dados numéricos , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/organização & administração , Humanos , Internato e Residência , Médicos de Família/organização & administração , Médicos de Família/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Estados UnidosRESUMO
The U.S. physician workforce is struggling to keep pace with the demand for health care services, a situation that may worsen without efforts to enhance team-based care. More than half of family physicians work with nurse practitioners, physician assistants, or certified nurse midwives, and doing so helps ensure access to health care services, particularly in rural areas.