Article Figures & Data
Tables
Characteristic 1996-1999 2010-2013 P Value Response rate, % (No.) 74 (293) 76 (408) .486 Male, % (No.) 48 (142) 41 (167) .048a Years since residency graduation, mean y 2.14 1.98 .657 Board certified by ABFM or AOBFP, % (No.) 93 (272) 94 (383) .584 Practice size, % (No.) Solo or 2 physician partnership 10 (28) 5 (19) .011a Single specialty group 35 (104) 29 (120) .090 Multispecialty group 28 (83) 39 (158) .005b Other (locums, military, residency, etc) 18 (53) 27 (111) .005b Practice community size, % (No.) <5,000 16 (47) 14 (59) .565 5,001-<25,000 22 (65) 23 (93) .849 25,001-<100,000 24 (70) 22 (91) .623 ≥100,000 & suburbs 32 (93) 40 (163) .027a - Table 2
Proportions of Cohorts Feeling More Than Adequately Prepared for Practice by Residency Training and Practicing Listed Services and Procedures at Time of Survey
Services and Procedures More Than Adequately Prepared for Practice Part of Practice at Time of Survey 1996-1999 Cohort, % (N) 2010-2013 Cohort, % (N) Change, % P Value 1996-1999 Cohort, % (N) 2010-2013 Cohort, % (N) Change, % P Value Women’s health Prenatal care 73 (215) 87 (356) 14 <.001 76 (222) 57 (232) −19 <.001 Deliveries 63 (185) 83 (337) 20 <.001 70 (205) 45 (182) −25 <.001 C-delivery, primary 9 (27) 11 (43) 2 .565 10 (30) 10 (41) 0 .935 C-delivery, assist 53 (156) 68 (278) 15 <.001 61 (180) 38 (155) −23 <.001 OB ultrasound 7 (20) 27 (112) 20 <.001 19 (55) 27 (112) 8 .008 Newborn CPR 24 (70) 40 (162) 16 <.001 70 (204) 62 (252) −8 .032 Colposcopy 28 (81) 52 (212) 24 <.001 52 (153) 47 (193) −5 .200 LEEP/LEETZ 7 (20) 17 (71) 10 <.001 12 (35) 9 (38) −3 .261 D&C 9 (25) 13 (53) 4 .065 23 (66) 10 (39) −13 <.001 Termination 6 (19) 13 (51) 7 .009 5 (14) 6 (25) 1 .443 Services Ambulatory care 70 (206) 91 (371) 21 <.001 95 (277) 97 (396) 2 .094 Inpatient medicine 63 (185) 88 (358) 25 <.001 78 (228) 46 (186) −32 <.001 Emergency care 37 (107) 54 (219) 17 <.001 64 (187) 38 (153) −26 <.001 Intensive/ICU-CCU 25 (72) 46 (186) 21 <.001 58 (170) 24 (96) −34 <.001 Nursing home care 27 (78) 59 (242) 32 <.001 52 (152) 33 (134) −19 <.001 End-of-life care 38 (111) 75 (308) 37 <.001 77 (225) 84 (342) 7 .020 Surgery/assist 40 (118) 48 (195) 8 .049 48 (140) 20 (82) −28 <.001 Disability evaluation 3 (8) 14 (59) 11 <.001 61 (179) 54 (219) −7 .052 Orthopedics 21 (61) 41 (169) 20 <.001 94 (274) 76 (309) −18 <.001 Procedures Sigmoidoscopy 24 (71) 7 (30) −17 <.001 42 (124) 4 (16) −38 <.001 Full colonoscopy 3 (10) 10 (39) 7 .002 5 (14) 6 (25) 1 .443 Treadmill stress test 16 (48) 12 (48) −4 .080 26 (75) 10 (40) −16 <.001 Intubation 19 (56) 24 (96) 5 .163 39 (113) 23 (92) −16 <.001 Manage ventilator 9 (25) 14 (57) 5 .028 25 (72) 14 (59) −11 .001 Central line 11 (31) 16 (66) 5 .035 20 (59) 16 (67) −4 .207 Interpret radiograph 23 (68) 51 (209) 28 <.001 91 (266) 85 (346) −6 .020 C-delivery = cesarean delivery; CCU = critical care unit; CPR = ccardiopulmonary resuscitation; D&C = dilation and curettage; ICU = intensive care unit; LEEP = loop electrosurgical excision procedure; LEETZ = loop electrosurgical excision of the transformation zone; OB = obstetrics
Additional Files
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.