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Family Physicians and Scope of Practice What We Know, Why It Matters…

This article discusses the importance of the broad scope of practice for family physicians, its impact on residency education, the social contract, and the support it provides for outpatient, chronic, preventive, and acute care. It also explores data on family physicians providing maternity care, care for children, and EHR adoptions. The implications of scope of practice changes, including payment/advocacy, residency training redesign, and health system consolidation, are discussed, as well as the key questions regarding the changes and their impact on population health. Next steps and the importance of role modeling are also highlighted, along with the scope of practice of ABFM chairs.

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Family Physicians and Scope of Practice What We Know, Why It Matters…

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  1. Family Physicians and Scope of PracticeWhat We Know, Why It Matters… Warren P. Newton, MD, MPH Chair, ABFM February 25, 2012 American Board of Family Medicine

  2. Why does broad scope of practice matter? • FPs as quintessential generalists • Drives residency education • Social contract- then and now • Supports triple aim: outpatient care to include chronic care, preventive care and acute care; inpatient across the continuum

  3. What do we know?The ABFM Demographic Page • Required for All Candidates • Mandatory completion • Y/N questions + diplomates’ estimate of time***** • Questions have evolved--new categories added 2005/2006 • Sample skewed after 2009 skewed because of shift to MOC; after 2013 return to steady state

  4. Selection Bias • Board Certifying (>85% FPs) • Not perfect random sample • Physician’s labels and estimates • Does not capture gradations well • 2006-2009 Cleanest

  5. 2006-2008 cohort

  6. Figure: Proportion of Family Physicians providing maternity care

  7. Figure: Proportion of FPs providing care of children

  8. Figure: ABFM and NAMCS reports of EHR adoptions Data Source: National Ambulatory Medical Care Survey; American Board of Family Medicine Diplomate Database.

  9. Implications • Payment/Advocacy • PPACA Supplement • State Medicaid reductions • Residency Training Redesign • Health System Consolidation • Changes in JCAHO credentialing rules

  10. Key Questions • How is our scope of practice changing? How does this vary by age, region and patient population? • Why the changes? How can we influence? • How does scope relate to improving the health of the population?

  11. Next Steps • Part of ABFM Research Enterprise • Finish publications on current data • New demographic page July 2013 • Ongoing reports to the discipline • Other ideas?

  12. How important is role modeling?Chairs’ Scope of Practice • ½ days of continuity care/week • 0 = 9%, 1=16%, 1-2=43%, 2-3=19% • ½ days of precepting/week • 0=34%, 1=54%, 1-3=11% • Weeks of hospital work/year • 0=37%, 1-4=38%, 5-8=19%, 9-12=4% • Deliver babies = 22%

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