Although new family medicine graduates intend to provide a broader scope of practice than their senior counterparts, individual family physicians' scope of practice has been decreasing, with fewer family physicians providing basic primary care services, such pediatric and prenatal care. Russell et al conducted a study to explore family medicine graduates' attitudes and perspectives on modifiable and non-modifiable factors that influenced their scope of practice and career choices. The authors conducted five focus group discussions with 32 family physicians and explored their attitudes and perspectives on their desired and actual scope of practice. Using a conceptual framework to understand the influences on practice scope, the authors found that personal factors played a role on desired scope while workplace, environmental and population factors influenced actual practice scope. Stressors that occurred in these four categories often caused family physicians to narrow their scope of practice. Understanding personal, environmental, workplace and population factors that influence practice scope can inform specific interventions that create desirable jobs for family physicians and improve their ability to meet changing population needs. Supportive factors of a broader-scope practice include training and access to additional medical education after training; access to mentors; strong organizational leadership; and team-based care.
Drivers of Scope of Practice in Family Medicine: A Conceptual Model
Amy Russell, MD, et al
University of North Carolina Health Sciences at Mountain Area Health Education Center and HCA Healthcare, Asheville, North Carolina