Are family physicians providing more comprehensive care more motivated to continue board certification?

Context. While six in ten FPs reported both extrinsic and intrinsic reasons for continuing board certification, it is unclear whether FPs with a larger scope of practice (SOP) would be more intrinsically motivated compared to those with a more limited SOP. As FPs employed by large health systems had narrower SOP, it is important to investigate whether practice setting modifies any association between SOP and motivation.

Objective. 1) To determine whether FPs with a larger SOP would be more intrinsically motivated to continue their board certification, and 2) to investigate the potential influence of practice setting on the association between SOP and motivation.

Study design. Cross-sectional.

Dataset. ABFM continuing certification questionnaire

Population. FPs registering for the ABFM continuing certification examination from 2017 to 2022 who provided primarily outpatient continuity care.

Outcome Measure. The primary outcome was individual SOP score, a scaled score based on 22 items of each individual FPs provision of services and procedures. The SOP score ranges from 0 to 30, with higher scores reflecting a broader SOP.

Analysis. We first analyzed reasons for continuing certification. We classified FPs who reported only extrinsic reasons as extrinsically motivated and otherwise intrinsically motivated and then examined the distribution of motivation by practice setting. In adjusted analysis, we investigated whether broader SOP was associated with greater odds of being intrinsically motivated.

Results. While over 80% of FPs reported both intrinsic and extrinsic reasons, there was not a dominant reason that motivated FPs to continue certification. Medical knowledge (54.3%) was the top intrinsic reason and hospital privilege requirement (53.4%) the top extrinsic reason. In adjusted analysis, FPs with a large (>16) or medium SOP (13-16) had 30% and 27% higher odds of having intrinsic motivation respectively compared to FPs with a small SOP (p<0.05). FPs in hospital owned clinics had 54% lower odds of reporting any intrinsic reasons compared to independent practices.

Conclusions. Larger SOP was associated with intrinsic motivation to continue board certification. The findings support the relevance of board certification to physicians with a broad scope. Lower intrinsic motivation by FPs employed by large health systems may be caused by increasing employer requirements to maintain certification.