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Residency Program Characteristics and Individual Physician Practice Characteristics Associated With Family Physician Scope of Practice

Coutinho, Anastasia J. MD, MHS; Levin, Zachary; Petterson, Stephen PhD; Phillips, Robert L. Jr MD, MSPH; Peterson, Lars E. MD, PhD

doi: 10.1097/ACM.0000000000002838
Research Reports

Purpose A family physician’s ability to provide continuous, comprehensive care begins in residency. Previous studies show that patterns developed during residency may be imprinted upon physicians, guiding future practice. The objective was to determine family medicine residency characteristics associated with graduates’ scope of practice (SCoP).

Method The authors used (1) residency program data from the 2012 Accreditation Council for Graduate Medicine Education Accreditation Data System and (2) self-reported data supplied by family physicians when they registered for the first recertification examination with the American Board of Family Medicine (2013–2016)—7 to 10 years after completing residency. The authors used linear regression analyses to examine the relationship between individual physician SCoP (measured by the SCoP for primary care [SP4PC] score [scale of 0–30; low = small scope]) and individual, practice, and residency program characteristics.

Results The authors sampled 8,261 physicians from 423 residencies. The average SP4PC score was 15.4 (standard deviation, 3.2). Models showed that SCoP broadened with increasing rurality. Physicians from unopposed (single) programs had higher SCoP (0.26 increase in SP4PC); those from major teaching hospitals had lower SCoP (0.18 decrease in SP4PC).

Conclusions Residency program characteristics may influence family physicians’ SCoP, although less than individual characteristics do. Broad SCoP may imply more comprehensive care, which is the foundation of a strong primary care system to increase quality, decrease cost, and reduce physician burnout. Some residency program characteristics can be altered so that programs graduate physicians with broader SCoP, thereby meeting patient needs and improving the health system.

A.J. Coutinho was, when this research occurred, a third-year family medicine resident, Santa Rosa Family Medicine Residency Program, Santa Rosa, California.

Z. Levin was, when this research occurred, research assistant, Robert Graham Center, Washington, DC.

S. Petterson is research director, Robert Graham Center, Washington, DC.

R.L. Phillips Jr is executive director, Center for Professionalism and Value in Health Care, Washington, DC.

L.E. Peterson is vice president of research, American Board of Family Medicine, Lexington, Kentucky.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: Peterson LE, Levin Z, Coutinho AJ. Residency program characteristics and individual resident characteristics influence family physician scope of practice. AcademyHealth Annual Research Meeting, Seattle, Washington, June 2018.

Correspondence should be addressed to Anastasia J. Coutinho, Santa Rosa Family Medicine Residency, 3569 Round Barn Circle, Suite 200, Santa Rosa, California 95403; telephone: (859) 538-7180; email:; Twitter: @TheABFM.

Copyright © 2019 by the Association of American Medical Colleges