Rural Family Physicians Have a Broader Scope of Practice Than Urban Family Physicians
The objective of this research was to determine differences in scope of practice and procedural care between rural and urban family physicians.
We used data from the American Board of Family Medicine practice demographic questionnaire completed by family physicians in 2014 and 2015 when registering for the Certification Examination. Data captured include practice organization, size, features, address, and care team members; performance of clinical services; and sites of care. One in four family physicians also answered questions about whether they performed specific procedures. Rurality was determined using four categories derived from the Rural Urban Continuum Codes grouping by population size: metropolitan, large rural, small rural, and frontier. Differences in scope and procedures were determined using t-tests and Chi-Square tests.
We found significant variation in scope of practice between urban and rural family physicians. Rural family physicians were more likely to provide obstetrical deliveries, newborn care, pediatric care, occupational medicine, palliative care, and mental health care than urban family physicians. They were also more likely to see patients in the hospital and nursing home and to conduct home visits. The percentage of family physicians providing these services was greater with increasing rurality.
Rural family physicians generally have a broader scope of practice than urban family physicians, and the scope of practice expands with increasing rurality. Despite prior research that the scope of practice of family physicians has been shrinking, we found that rural family physicians are maintaining a broad scope of practice, which is likely necessary in rural areas where there are fewer options to access more specialized medical services.