Variation in Scope of Practice and Medical Services Available at Family Physician Practices within Rural Areas
The scope of practice of family physicians has been shrinking over the last decade; however, patients of family physicians with a broader scope of practice have lower health care costs and odds of hospitalization. The variation of scope of practice and practice features in family physicians’ offices within rural and rural/disadvantaged areas is poorly understood. Family physicians are the predominant providers of medical care in rural America, and understanding personal, practice, and health care market characteristics associated with providing a broad scope is essential to ensuring access to high-quality health care for rural Americans. Our objective is to characterize scope of practice and practice features of rural family physicians and determine predictors of broad scope at the physician, practice, and health care market level.
To conduct this study, we will utilize data collected by the ABFM during its recertification examination registration process. For more than 30 years, the ABFM has required its Diplomates to complete a practice demographic survey in order to track the care their Diplomates provide and study outcomes of its certification program. Annually, between 11,000 and 12,000 family physicians apply for the examination. Data from this questionnaire will be used to create measures of scope of practice individually and in summary using the Scope of Practice for Primary Care Scale. Additionally, practice features will be determined from the survey. We will link the primary practice addressed to area level information on rurality, social deprivation, and health care resources from the U.S. Census and Area Resource File. We will create multilevel generalized linear models to determine associations between broad scope of practice and physician, practice, and health care market variables.