• David Killeen, Anuradha Jetty, Lars E Peterson, Andrew Bazemore, and Yalda Jabbarpour.
• From University of Pennsylvania, Philadelphia, PA (DK); Robert Graham Center, Washington, DC(AJ, YJ); American Board of Family Medicine, Lexington, KY(LEP, AB); and Center for Professionalism & Value in Health Care, Washington, DC (AB). davidkilleenmd@gmail.com.
• J Am Board Fam Med. 2023 Feb 8; 36 (1): 798779-87.

IntroductionComprehensiveness is a defining principle of primary care and Family Medicine but is declining in some settings. This study explores the relationship between practice setting and comprehensiveness among family physicians (FPs).MethodsUsing 2014 to 2016 American Board of Family Medicine survey data to generate scope of practice (SOP) scores (0 to 30) for FPs. We ran univariate and bivariate analyses for services by practice organization type. Our principal independent variable was practice organization type and dependent variable, the SOP score.ResultsAmong 25,117 total respondents, FPs at rural health centers (RHC) had the widest scope of practice (SOP score of 17.7) whereas FPs in federal, urgent care and other safety net clinics had the narrowest with mean SOP score of 14.0 or less. Higher rates of FPs practicing in Federally Qualified Health Centers and academic health centers were providing a women's health service, except for deliveries, whereas FPs in rural health centers were providing obstetric services (24%). The proportion of FPs providing newborn care was highest in RHCs and lowest in the urgent care setting (85%, vs 26%). A higher proportion of FPs in RHCs provided joint injections and skin procedures than FPs in other practice organizations.ConclusionsSignificant variation in FP comprehensiveness exists across different practice types. FPs in practice types commonly associated with large health systems had narrower breadth of practice, concerning amid increasing practice consolidation. Given associations between comprehensiveness and desirable health care outcomes, policy makers should encourage payment/accountability models that incentivize broader SOP.© Copyright by the American Board of Family Medicine.

20 keywords...

hide…