Changes in Preparation and Practice Patterns Among New Family Physicians

The Article in Brief

Changes in Preparation and Practice Patterns Among New Family Physicians

Amanda K.H. Weidner , and colleagues

Background The decline in family physicians' scope of practice in the United States over the last few decades has been well-documented, with fewer family physicians practicing obstetrics, pediatrics, hospital care, and house calls. This study looked at the difference between preparation for practice and scope of practice among new family medicine residency graduates at two points in time.

What This Study Found Recent family medicine residency graduates feel better prepared to provide a variety of procedures and clinical services than their predecessors but report a narrower scope of practice. These findings are the result of a University of Washington survey of family medicine graduates in affiliated programs in five states, with a focus on two cohorts: those who graduated residency between 2010 and 2013 (n=408) and an earlier cohort who graduated between 1996 and 1999 (n=293). The survey addressed 26 services and procedures that graduates might provide in their practice and how prepared they feel to provide those services. Researchers found that the earlier cohort had a similar or significantly higher proportion of graduates practicing almost all listed procedures and services compared to the later cohort; only OB ultrasound and end-of-life care were more common among more recent graduates. The pattern of findings was reversed when comparing graduates who felt more than adequately prepared for practice; a greater proportion of those in the later cohort reported feeling prepared in most areas compared to earlier graduates. For example, 52 percent of the earlier cohort reported providing nursing home care, compared to 33 percent of the later cohort, but 59 percent of the later cohort felt more than adequately prepared to provide such care, compared to 27 percent of earlier graduates.

Implications

• According to the authors, these findings suggest that training has improved over the last decade, but that scope of practice is declining for reasons unrelated to training. Changes are likely due to a variety of factors, including the evolution of clinical practice and differences in practice size and type, including a trend toward larger, multispecialty groups in which family physicians may not be required (or allowed) to practice a wide array of procedures.
• The decline in scope of practice, the authors state, has negative implications for the breadth and richness of physician practice and for patients' access to and quality of care. Family medicine educators may need to adapt their training to a new generation of practice realities and physician preferences.