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 was 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 utilized data collected by the American Board of Family Medicine (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 was used to create measures of scope of practice individually and in summary using the Scope of Practice for Primary Care Scale. Additionally, practice features were determined from the survey. We linked 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 created multilevel generalized linear models to determine associations between broad scope of practice and physician, practice, and health care market variables.

Publications

• Declining Endoscopic Care by Family Physicians in Both Rural and Urban Areas
  Journal Article
  Rural and Underserved Health Research Center
  Date: 07/2019
  This paper explores the decline in the percentage of family physicians providing endoscopic services overall and in urban and rural areas. This has implications on the availability of colonoscopies, endoscopies, and flexible sigmoidoscopies in areas that lack specialists who perform such services.
• The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas
  Journal Article
  Rural and Underserved Health Research Center
  Date: 11/2020
  The scope of practice for family medicine physicians has decreased in recent years. Using survey data, researchers compared family medicine physicians' scope of practice scores based on rural-urban status and other variables. Researchers found statistically significant decreases in scope of practice scores in urban settings.
• Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 02/2018
  While the scope of practice of family physicians has been shrinking, they still practice broadly, often due to fewer health care resources in rural areas. Using data from family physicians seeking continued board certification in 2014 and 2015, we found that a high percentage of rural family physicians provide nearly every clinical service queried.
• Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
  Policy Brief
  Rural and Underserved Health Research Center
  Date: 02/2018
  The Patient Centered Medical Home (PCMH) is supposed to provide accessible and comprehensive care. Using data from family physicians seeking to continue their American Board of Family Medicine certification in 2014 and 2015, we found that rural family physicians in PCMH practices generally provide more services than those in non-PCMH practices.