Rural Family Physicians in Patient Centered Medical Homes Have a Broader Scope of Practice
The objective of this research was to determine whether rural family physicians who work in a Patient Centered Medical Home (PCMH) practice have a broader scope of practice than those not in PCMH practices.
We used data from the American Board of Family Medicine (ABFM) practice demographic questionnaire completed by family physicians in 2014 and 2015 when registering for the Family Medicine Certification Examination. Data captured include practice organization, size, features, address, and care team members; and PCMH status. Scope of practice was measured for all respondents by performance of clinical services and sites where care was delivered. Additionally, one in four respondents also answered questions regarding whether they performed specific procedures.
Our sample included 18,846 family physicians who sought to continue their ABFM certification in 2014 and 2015. Rurality was determined using four categories derived from the Rural Urban Continuum Codes grouping by population size: metropolitan, large rural, small rural, and frontier. Of the total sample, 83.4% were in metropolitan areas, 6.6% in large rural, 8.5% in small rural, and 1.4% in frontier areas. Respondents in rural areas were generally older, male, and U.S. medical graduates. As we were interested in differences within rural areas by PCMH status, we characterized differences in scope of practice and procedural care between physicians in a PCMH in the same rural category.
We found evidence that the PCMH model is, in general, associated with rural family physicians providing more services and procedures. The main diverging finding was that rural family physicians practicing in PCMHs reported lower rates of providing inpatient care and inpatient-related procedures.
The PCMH model appears to be increasing the scope of ambulatory healthcare services available to rural patients. Supporting rural practices that wish to transform to the PCMH model to improve care and access will be essential to meeting patient needs. With strong evidence that overall healthcare costs and hospitalization rates are lower when physicians have a broader scope of practice, including inpatient care, determining how to best structure care by rural family physicians in all care settings will be essential.