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Carek PJ, Cheng Y, Bazemore AW, Peterson LE. Variation in Practice Patterns of Early- and Later-Career Family Physicians. J Am Board Fam Med 2024; 37:35-42. [PMID: 38012011 DOI: 10.3122/jabfm.2023.230176r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Understanding how physicians' practice patterns change over a career is important for workforce and medical education planning. This study examined trends in self-reported practice activity among early- and later-career stage family physicians (FPs). METHODS Data on early career FPs came from the American Board of Family Medicine's National Graduate Survey (NGS) and on later career FPs from its Continuous Certification Questionnaire (CCQ). Both cohorts could complete the Practice Demographic Survey (PDS) 3 years later. Longitudinal cohorts were from 2016 to 2019 and 2017 to 2020, respectively. All surveys included identical items on scope of practice, practice type, organization, and location. We characterized physicians as outpatient continuity only, outpatient and inpatient care (mixed practice), and no outpatient continuity (for example, hospitalist). We conducted repeated cross-sectional and longitudinal analysis of practice type. RESULTS Our sample included 8,492 NGS and 30,491 CCQ FPs. In both groups, the vast majority provided outpatient continuity of care (77% to 81%). Approximately 25% of NGS had a mixed practice compared with approximately 16% of the CCQ group. The percent of FPs who had a mixed practice declined in both groups (34.21% to 27.10% and 23.88% to 19.33%). In both groups, physicians with higher odds of leaving mixed practice were in metropolitan counties or changed practice types. CONCLUSION Although early-career FPs more frequently reported providing both inpatient and outpatient care and serving as hospitalists compared with later-career FPs, both groups had a decline in frequency of providing mixed practice. This change after only 3 years in practice has significant implications for patient care and medical education.
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Affiliation(s)
- Peter J Carek
- From the Department of Family Medicine, Prisma Health - Upstate and USC School of Medicine Greenville (PJC); Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY (YC); American Board of Family Medicine, Lexington, KY (AWB, LEP); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
| | - Yue Cheng
- From the Department of Family Medicine, Prisma Health - Upstate and USC School of Medicine Greenville (PJC); Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY (YC); American Board of Family Medicine, Lexington, KY (AWB, LEP); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
| | - Andrew W Bazemore
- From the Department of Family Medicine, Prisma Health - Upstate and USC School of Medicine Greenville (PJC); Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY (YC); American Board of Family Medicine, Lexington, KY (AWB, LEP); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
| | - Lars E Peterson
- From the Department of Family Medicine, Prisma Health - Upstate and USC School of Medicine Greenville (PJC); Institute for Pharmaceutical Outcomes and Policy (IPOP), Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, Lexington, KY (YC); American Board of Family Medicine, Lexington, KY (AWB, LEP); Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
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Wang T, O'Neill TR, Peterson LE, Newton WP. COVID-19 Impact on Family Medicine Residents Exam Performance. Fam Med 2024; 56:163-168. [PMID: 38467034 DOI: 10.22454/fammed.2024.719362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic began interrupting family medicine residency training in spring 2020. While a decline in scores on the American Board of Family Medicine In-Training Examination (ITE) has been observed, whether this decline has translated into the high-stakes Family Medicine Certification Examination (FMCE) is unclear. The goal of this study was to systematically assess the magnitude of COVID-19 impact on medical knowledge acquisition during residency, as measured by the ITE and FMCE. METHODS A total of 19,101 initial certification candidates from 2017 to 2022 were included in this study. Annual ITE scores and FMCE scores were reported on the same scale (200-800) and served as the outcome measure. We conducted multilevel regression analysis to determine ITE score growth and FMCE scores compared to cohorts prior to COVID-19. RESULTS During COVID-19, the increase in ITE scores from postgraduate year 2 (PGY-2) to PGY-3 was 25.5 points less, representing a 57.6% relative decrease; and from PGY-3 ITE to FMCE, it was 8.6 points less, a 12.7% relative decrease, compared with cohorts prior to COVID-19. FMCE scores were 6.6 points less during COVID-19, representing a 1.2% relative decline from the average FMCE score prior to COVID-19. CONCLUSIONS This study found nonsubstantive COVID-19 impact on FMCE scores, but a considerable knowledge acquisition decline during residency, especially during the PGY-2 to PGY-3 period. While COVID-19 impacted learning, our findings indicated that residencies were largely able to remediate knowledge deficits before residents took the FMCE.
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Affiliation(s)
- Ting Wang
- American Board of Family Medicine, Lexington, KY
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, KY
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
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Sand J, Morgan ZJ, Peterson LE. Addressing Social Determinants of Health in Family Medicine Practices. Popul Health Manag 2024; 27:26-33. [PMID: 37903238 DOI: 10.1089/pop.2023.0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Primary care practices are under pressure to address patients' social determinants of health (SDOH). However, the extent to which these practices have this ability remains unknown. The objective of this study was to examine the association between physician, practice, and community characteristics and the ability of family medicine practices to address patients' SDOH. This cross-sectional study used data from the American Board of Family Medicine Continuing Certification Questionnaire from 2017 to 2019, with a 100% response rate. Respondents rated their practice's ability to address SDOH, which was dichotomized as high or low. Sequential multivariate logistic regression determined the association of the reported ability to address SDOH with physician, practice, and community characteristics. Among 19,300 respondents, 55.6% reported a high ability to address patients' SDOH. Across models controlling for different groups of variables, characteristics persistently positively associated with ability to address SDOH included employment at a federally qualified health center (Odds Ratios [OR] = 2.111-3.012), federally funded clinic (OR = 1.999-2.897), managed care organization (OR = 2.038-2.303), and working collaboratively with a social worker (OR = 2.000-2.523) or care coordinator (OR = 1.482-1.681). Characteristics persistently negatively associated with the ability to address SDOH were practicing at an independently owned (OR = 0.726-0.812) or small practice (OR = 0.512-0.863). While results varied across models, these findings are important for developing evidence-based policies and recommendations for resource sharing and allocation in clinics and communities. Ensuring availability and access to allied health professionals and community resources may be key components in Family Medicine clinics addressing SDOH.
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Affiliation(s)
- Jessica Sand
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky, USA
- Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky, USA
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Patterson DG, Shipman SA, Pollack SW, Andrilla CHA, Schmitz D, Evans DV, Peterson LE, Longenecker R. Growing a rural family physician workforce: The contributions of rural background and rural place of residency training. Health Serv Res 2024; 59:e14168. [PMID: 37161614 PMCID: PMC10771894 DOI: 10.1111/1475-6773.14168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To determine the distinct influences of rural background and rural residency training on rural practice choice among family physicians. DATA SOURCES AND STUDY SETTING We used a subset of The RTT Collaborative rural residency list and longitudinal data on family physicians from the American Board of Family Medicine National Graduate Survey (NGS; three cohorts, 2016-2018) and American Medical College Application Service (AMCAS). STUDY DESIGN We conducted a logistic regression, computing predictive marginals to assess associations of background and residency location with physician practice location 3 years post-residency. DATA COLLECTION/EXTRACTION METHODS We merged NGS data with residency type-rural or urban-and practice location with AMCAS data on rural background. PRINCIPAL FINDINGS Family physicians from a rural background were more likely to choose rural practice (39.2%, 95% CI = 35.8, 42.5) than those from an urban background (13.8%, 95% CI = 12.5, 15.0); 50.9% (95% CI = 43.0, 58.8) of trainees in rural residencies chose rural practice, compared with 18.0% (95% CI = 16.8, 19.2) of urban trainees. CONCLUSIONS Increasing rural programs for training residents from both rural and urban backgrounds, as well as recruiting more rural students to medical education, could increase the number of rural family physicians.
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Affiliation(s)
- Davis G. Patterson
- Department of Family MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Scott A. Shipman
- Department of Clinical Research and Public HealthCreighton UniversityOmahaNebraskaUSA
| | - Samantha W. Pollack
- Department of Family MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - C. Holly A. Andrilla
- Department of Family MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - David Schmitz
- School of Medicine and Health SciencesUniversity of North DakotaGrand ForksNorth DakotaUSA
| | - David V. Evans
- Department of Family MedicineUniversity of Washington School of MedicineSeattleWashingtonUSA
| | | | - Randall Longenecker
- Heritage College of Osteopathic MedicineOhio UniversityBridgewaterVirginiaUSA
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Dai M, Morgan ZJ, Russel K, Bortz BA, Peterson LE, Bazemore AW. Physician-Level Continuity of Care and Patient Outcomes in All-Payer Claims Database. J Am Board Fam Med 2024; 36:976-985. [PMID: 38171580 DOI: 10.3122/jabfm.2023.230119r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Being one of the few existing measures of primary care functions, physician-level continuity of care (Phy-CoC) is measured by the weighted average of patient continuity scores. Compared with the well-researched patient-level continuity, Phy-CoC is a new instrument with limited evidence from Medicare beneficiaries. This study aimed to expand the patient sample to include patients of all ages and all types of insurance and reassess the associations between full panel-based Phy-CoC scores and patient outcomes. METHODS Cross-sectional analysis at patient-level using Virginia All-Payer Claims Database (VA-APCD). Phy-CoC scores were calculated by averaging patient's Bice-Boxerman Index scores and weighted by the total number of visits. Patient outcomes included total cost and preventable hospitalization. RESULTS In a sample of 1.6 million Virginians, patients who lived in rural areas or had Medicare as primary insurance were more likely to be attributed to physicians with the highest Phy-CoC scores. Across all adult patient populations, we found that being attributed to physicians with higher Phy-CoC was associated with 7%-11.8% higher total costs, but was not associated with the odds of preventable hospitalization. Results from models with interactions revealed nuanced associations between Phy-CoC and total cost with patient's age and comorbidity, insurance payer, and the specialty of their physician. CONCLUSIONS In this comprehensive examination of Phy-CoC using all populations from the VA-APCD, we found an overall positive association of higher full panel-based Phy-CoC with total cost, but a non-significant association with the risk of preventable hospitalization. Achieving higher full panel-based Phy-CoC may have unintended cost implications.
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Affiliation(s)
- Mingliang Dai
- From the American Board of Family Medicine (MD, ZJM, LEP, AWB); Virginia Health Information (KR); Virginia Center for Health Innovation (BAB); Department of Family and Community Medicine at the University of Kentucky (LEP); Center for Professionalism and Value in Health Care (AWB).
| | - Zachary J Morgan
- From the American Board of Family Medicine (MD, ZJM, LEP, AWB); Virginia Health Information (KR); Virginia Center for Health Innovation (BAB); Department of Family and Community Medicine at the University of Kentucky (LEP); Center for Professionalism and Value in Health Care (AWB)
| | - Kyle Russel
- From the American Board of Family Medicine (MD, ZJM, LEP, AWB); Virginia Health Information (KR); Virginia Center for Health Innovation (BAB); Department of Family and Community Medicine at the University of Kentucky (LEP); Center for Professionalism and Value in Health Care (AWB)
| | - Beth A Bortz
- From the American Board of Family Medicine (MD, ZJM, LEP, AWB); Virginia Health Information (KR); Virginia Center for Health Innovation (BAB); Department of Family and Community Medicine at the University of Kentucky (LEP); Center for Professionalism and Value in Health Care (AWB)
| | - Lars E Peterson
- From the American Board of Family Medicine (MD, ZJM, LEP, AWB); Virginia Health Information (KR); Virginia Center for Health Innovation (BAB); Department of Family and Community Medicine at the University of Kentucky (LEP); Center for Professionalism and Value in Health Care (AWB)
| | - Andrew W Bazemore
- From the American Board of Family Medicine (MD, ZJM, LEP, AWB); Virginia Health Information (KR); Virginia Center for Health Innovation (BAB); Department of Family and Community Medicine at the University of Kentucky (LEP); Center for Professionalism and Value in Health Care (AWB)
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Sanders K, Phillips J, Fleischer S, Peterson LE. Early-Career Compensation Trends Among Family Physicians. J Am Board Fam Med 2023; 36:851-863. [PMID: 37704388 DOI: 10.3122/jabfm.2023.230039r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE Family medicine incomes are often cited as a key reason for shortages of family physicians. The purpose of this study was to identify family physician income trends and to test how income varies among early-career family physicians. METHODS We used data from the 2016 to 2020 American Board of Family Medicine National Graduate Survey (NGS) collected from early-career family physicians (n = 9566; response rate = 63.9%). The NGS asked practice income, practice activities, practice site, and setting. We performed an income trend analysis and conducted multivariate regression to test for associations of personal and workplace characteristics with income. RESULTS Average income across the full sample of early-career family physicians (after inflation adjustments) was $224,292. Overall, income growth outpaced inflation from 2016 to 2020. There are significant differences in income based on personal and work characteristics, and income growth varied dramatically. Notably, women respondents reported earnings of $33,522 below those of men respondents in adjusted models. In addition, the incomes of several groups lagged behind inflation, including those practicing geriatrics (-0.67%), employed by the Indian Health Service (-1.72%), and respondents who identified as Black or African American (-0.85%). Greatest increases in inflation-adjusted incomes were observed among those in palliative care (4.61%) and at nonfederal government clinics (4.46%). CONCLUSIONS Though income is only one factor physicians consider in deciding where and how to work, it is concerning to see lower incomes among groups that traditionally experience shortages (eg, geriatrics and government-associated practice sites). Differences in expected income among family physicians choosing different work may exacerbate workforce challenges.
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Affiliation(s)
- Kaplan Sanders
- From the Utah Tech University, Department of Accounting, Finance, and Data Analytics, St. George, UT (KS); Michigan State University, Department of Family Medicine, Lansing, MI (JP); American Board of Family Medicine, Lexington, KY (SF, LEP); University of Kentucky, Department of Family and Community Medicine, Lexington, KY (LEP).
| | - Julie Phillips
- From the Utah Tech University, Department of Accounting, Finance, and Data Analytics, St. George, UT (KS); Michigan State University, Department of Family Medicine, Lansing, MI (JP); American Board of Family Medicine, Lexington, KY (SF, LEP); University of Kentucky, Department of Family and Community Medicine, Lexington, KY (LEP)
| | - Sarah Fleischer
- From the Utah Tech University, Department of Accounting, Finance, and Data Analytics, St. George, UT (KS); Michigan State University, Department of Family Medicine, Lansing, MI (JP); American Board of Family Medicine, Lexington, KY (SF, LEP); University of Kentucky, Department of Family and Community Medicine, Lexington, KY (LEP)
| | - Lars E Peterson
- From the Utah Tech University, Department of Accounting, Finance, and Data Analytics, St. George, UT (KS); Michigan State University, Department of Family Medicine, Lansing, MI (JP); American Board of Family Medicine, Lexington, KY (SF, LEP); University of Kentucky, Department of Family and Community Medicine, Lexington, KY (LEP)
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Carroll JK, Hester CM, Lutgen CB, Callen E, Hunt S, Lanigan AM, Bartlett-Esquilant G, Irwin G, Jones WA, Loskutova N, Mabachi NM, Okuyemi KS, Peterson LE, Smith RE, Tabel C, Weidner A. Research interests of family physicians applying for research training. BMC Med Educ 2023; 23:617. [PMID: 37644437 PMCID: PMC10466687 DOI: 10.1186/s12909-023-04562-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 07/31/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND There is an ongoing need for research to support the practice of high quality family medicine. The Family Medicine Discovers Rapid Cycle Scientific Discovery and Innovation (FMD RapSDI) program is designed to build capacity for family medicine scientific discovery and innovation in the United States. Our objective was to describe the applicants and research questions submitted to the RapSDI program in 2019 and 2020. METHODS Descriptive analysis for applicant characteristics and rapid qualitative analysis using principles of grounded theory and content analysis to examine the research questions and associated themes. We examined differences by year of application submission and the applicant's career stage. RESULTS Sixty-five family physicians submitted 70 applications to the RapSDI program; 45 in 2019 and 25 in 2020. 41% of applicants were in practice for five years or less (n = 27), 18% (n = 12) were in in practice 6-10 years, and 40% (n = 26) were ≥ 11 years in practice. With significant diversity in questions, the most common themes were studies of new innovations (n = 20, 28%), interventions to reduce cost (n = 20, 28%), improving screening or diagnosis (n = 19, 27%), ways to address mental or behavioral health (n = 18, 26%), and improving care for vulnerable populations (n = 18, 26%). CONCLUSION Applicants proposed a range of research questions and described why family medicine is optimally suited to address the questions. Applicants had a desire to develop knowledge to help other family physicians, their patients, and their communities. Findings from this study can help inform other family medicine research capacity building initiatives.
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Affiliation(s)
- Jennifer K Carroll
- Department of Family Medicine, University of Colorado, 12631 East 17th Ave Box F496, Aurora, CO, 80045, USA.
| | | | - Cory B Lutgen
- American Academy of Family Physicians, Leawood, KS, USA
| | | | - Sharon Hunt
- American Academy of Family Physicians, Leawood, KS, USA
| | | | | | - Gretchen Irwin
- University of Kansas School of Medicine, Wichita, KS, USA
| | - Warren A Jones
- University of Mississippi School of Medicine, Jackson, MS, USA
- The Jones Group of Mississippi, Jackson, MS, USA
| | | | | | - Kolawole S Okuyemi
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | | | - Cheri Tabel
- American Academy of Family Physicians, Leawood, KS, USA
| | - Amanda Weidner
- Association of Departments of Family Medicine, Leawood, KS, USA
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Tong ST, Morgan ZJ, Bazemore AW, Eden AR, Peterson LE. Maternity Access in Rural America: The Role of Family Physicians in Providing Access to Cesarean Sections. J Am Board Fam Med 2023; 36:565-573. [PMID: 37385721 DOI: 10.3122/jabfm.2023.230020r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/17/2023] [Accepted: 03/27/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION As an increasing number of rural hospitals close their maternity care units, many of the approximately 28 million reproductive-age women living in rural America do not have local access to obstetric services. We sought to describe the characteristics and distribution of cesarean section-providing family physicians who may provide critical services in maintaining obstetric access in rural hospitals. METHODS Using a cross-sectional study design, we linked data from the 2017 to 2022 American Board of Family Medicine's Continuting Certification Questionnaire on provision of cesarean sections as primary surgeon and practice characteristics to geographic data. Logistic regression determined associations with provision of cesarean sections. RESULTS Of 28,526 family physicians, 589 (2.1%) provided cesarean sections as primary surgeon. Those who provided cesarean sections were more likely to be male (odds ratio (OR) = 1.573, 95% confidence limits (CL) 1.246-1.986), and work in rural health clinics (OR = 2.157, CL 1.397-3.330), small rural counties (OR = 4.038, CL 1.887-8.642), and in counties without obstetrician/gynecologists (OR = 2.163, CL 1.440-3.250). DISCUSSION Although few in number, family physicians who provide cesarean sections as primary surgeon disproportionately serve rural communities and counties without obstetrician/gynecologists, suggesting that they provide access to obstetric services in these communities. Policies that support family physician training in cesarean sections and facilitate credentialing of trained family physicians could reverse the trend of closing obstetric units in rural communities and reduce disparities in maternal and infant health outcomes.
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Affiliation(s)
- Sebastian T Tong
- From the Department of Family Medicine, University of Washington, Seattle, WA (STT), American Board of Family Medicine, Lexington, KY (ZJM, AWB, ARE, LEP), Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
| | - Zachary J Morgan
- From the Department of Family Medicine, University of Washington, Seattle, WA (STT), American Board of Family Medicine, Lexington, KY (ZJM, AWB, ARE, LEP), Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
| | - Andrew W Bazemore
- From the Department of Family Medicine, University of Washington, Seattle, WA (STT), American Board of Family Medicine, Lexington, KY (ZJM, AWB, ARE, LEP), Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
| | - Aimee R Eden
- From the Department of Family Medicine, University of Washington, Seattle, WA (STT), American Board of Family Medicine, Lexington, KY (ZJM, AWB, ARE, LEP), Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
| | - Lars E Peterson
- From the Department of Family Medicine, University of Washington, Seattle, WA (STT), American Board of Family Medicine, Lexington, KY (ZJM, AWB, ARE, LEP), Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY (LEP)
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Davis CS, Meyers P, Bazemore AW, Peterson LE. Impact of Service-Based Student Loan Repayment Program on the Primary Care Workforce. Ann Fam Med 2023; 21:327-331. [PMID: 37487722 PMCID: PMC10365874 DOI: 10.1370/afm.3002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/15/2023] [Accepted: 03/15/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE As the average level of medical education indebtedness rises, physicians look to programs such as Public Service Loan Forgiveness (PSLF) and National Health Service Corps (NHSC) to manage debt burden. Both represent service-dependent loan repayment programs, but the requirements and program outcomes diverge, and assessing the relative uptake of each program may help to inform health workforce policy decisions. We sought to describe variation in the composition of repayment program participant groups and measure relative impact on patient access to care. METHODS In this bivariate analysis, we analyzed data from 10,677 respondents to the American Board of Family Medicine's National Graduate Survey to study differences in loan repayment program uptake as well as the unique participant demographics, scope of practice, and likelihood of practicing with a medically underserved or rural population in each program cohort. RESULTS The rate of PSLF uptake tripled between 2016 and 2020, from 7% to 22% of early career family physicians, while NHSC uptake remained static at 4% to 5%. Family physicians reporting NHSC assistance were more likely than those reporting PSLF assistance to come from underrepresented groups, demonstrated a broader scope of practice, and were more likely to practice in rural areas (23.3% vs 10.8%) or whole-county Health Professional Shortage Areas (12.5% vs 3.7%) and with medically underserved populations (82.2% vs 24.2%). CONCLUSIONS Although PSLF supports family physicians intending to work in public service, their peers who choose NHSC are much more likely to work in underserved settings. Our findings may prompt a review of the goals of service loan forgiveness programs with potential to better serve health workforce needs.
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Affiliation(s)
- Caitlin S Davis
- Fairfax Family Medicine Program, Fairfax, VA, and a past postdoctoral fellow at the American Board of Family Medicine, Washington, DC
| | - Peter Meyers
- The University of Minnesota Medical School, Minneapolis, Minnesota
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Longenecker R, Oster NV, Peterson LE, Andrilla CHA, Schmitz DF, Evans DV, Morgan ZJ, Pollack S, Patterson DG. A Match Made in Rural: Interpreting Match Rates and Exploring Best Practices. Fam Med 2023; 55:426-432. [PMID: 37099387 PMCID: PMC10622069 DOI: 10.22454/fammed.2023.106345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Although rural family medicine residency programs are effective in placing trainees into rural practice, many struggle to recruit students. Lacking other public measures, students may use residency match rates as a proxy for program quality and value. This study documents match rate trends and explores the relationship between match rates and program characteristics, including quality measures and recruitment strategies. METHODS Using a published listing of rural programs, 25 years of National Resident Matching Program data, and 11 years of American Osteopathic Association match data, this study (1) documents patterns in initial match rates for rural versus urban residency programs, (2) compares rural residency match rates with program characteristics for match years 2009-2013, (3) examines the association of match rates with program outcomes for graduates in years 2013-2015, and (4) explores recruitment strategies using residency coordinator interviews. RESULTS Despite increases in positions offered over 25 years, the fill rates for rural programs have improved relative to urban programs. Small rural programs had lower match rates relative to urban programs, but no other program or community characteristics were predictors of match rate. Match rates were not indicative of any of five measures of program quality nor of any single recruiting strategy. CONCLUSIONS Understanding the intricacies of rural residency inputs and outcomes is key to addressing rural workforce gaps. Match rates likely reflect challenges of rural workforce recruitment generally and should not be conflated with program quality.
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Affiliation(s)
| | | | - Lars E. Peterson
- American Board of Family MedicineLexington, KY
- College of Medicine, University of KentuckyLexington, KY
| | | | - David F. Schmitz
- University of North Dakota School of Medicine and Health SciencesGrand Forks, ND
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Fouladvand S, Talbert J, Dwoskin LP, Bush H, Meadows AL, Peterson LE, Mishra YR, Roggenkamp SK, Wang F, Kavuluru R, Chen J. A Comparative Effectiveness Study on Opioid Use Disorder Prediction Using Artificial Intelligence and Existing Risk Models. IEEE J Biomed Health Inform 2023; PP. [PMID: 37037255 DOI: 10.1109/jbhi.2023.3265920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Opioid use disorder (OUD) is a leading cause of death in the United States placing a tremendous burden on patients, their families, and health care systems. Artificial intelligence (AI) can be harnessed with available healthcare data to produce automated OUD prediction tools. In this retrospective study, we developed AI based models for OUD prediction and showed that AI can predict OUD more effectively than existing clinical tools including the unweighted opioid risk tool (ORT). Data include 474,208 patients' data over 10 years; 269,748 were females with an average age of 56.78 years. Cases are prescription opioid users with at least one diagnosis of OUD or at least one prescription for buprenorphine or methadone. Controls are prescription opioid users with no OUD diagnoses or buprenorphine or methadone prescriptions. On 100 randomly selected test sets including 47,396 patients, our proposed transformer-based AI model can predict OUD more efficiently (AUC=0.742 ±0.021) compared to logistic regression (AUC=0.651 ±0.025), random forest (AUC=0.679 ±0.026), xgboost (AUC=0.690 ±0.027), long short-term memory model (AUC=0.706 ±0.026), transformer (AUC=0.725 ±0.024), and unweighted ORT model (AUC=0.559 ±0.025). Our results show that embedding AI algorithms into clinical care may assist clinicians in risk stratification and management of patients receiving opioid therapy.
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12
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Pollack SW, Andrilla CHA, Peterson LE, Morgan ZJ, Longenecker R, Schmitz D, Evans D, Patterson DG. Rural Versus Urban Family Medicine Residency Scope of Training and Practice. Fam Med 2023; 55:162-170. [PMID: 36888670 PMCID: PMC10622018 DOI: 10.22454/fammed.2023.807915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Little is known about how rural and urban family medicine residencies compare in preparing physicians for practice. This study compared the perceptions of preparation for practice and actual postgraduation scope of practice (SOP) between rural and urban residency program graduates. METHODS We analyzed data on 6,483 early-career, board-certified physicians surveyed 2016-2018, 3 years after residency graduation, and 44,325 later-career board-certified physicians surveyed 2014-2018, every 7 to 10 years after initial certification. Bivariate comparisons and multivariate regressions of rural and urban residency graduates examined perceived preparedness and current practice in 30 areas and overall SOP using a validated scale, with separate models for early-career and later-career physicians. RESULTS In bivariate analyses, rural program graduates were more likely than urban program graduates to report being prepared for hospital-based care, casting, cardiac stress tests, and other skills, but less likely to be prepared in some gynecologic care and pharmacologic HIV/AIDS management. Both early- and later-career rural program graduates reported broader overall SOPs than their urban-program counterparts in bivariate analyses; in adjusted analyses this difference remained significant only for later-career physicians. CONCLUSIONS Compared with urban program graduates, rural graduates more often rated themselves prepared in several hospital care measures and less often in certain women's health measures. Controlling for multiple characteristics, only rurally trained, later-career physicians reported a broader SOP than their urban program counterparts. This study demonstrates the value of rural training and provides a baseline for research exploring longitudinal benefits of this training to rural communities and population health.
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Affiliation(s)
- Samantha W. Pollack
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - C. Holly A. Andrilla
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Lars E. Peterson
- American Board of Family MedicineLexington, KY
- Family and Community Medicine, College of Medicine, University of KentuckyLexington, KY
| | | | | | - David Schmitz
- Department of Family and Community Medicine, School of Medicine and Health Sciences, University of North DakotaGrand Forks, ND
| | - David Evans
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Davis G. Patterson
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
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13
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Peterson LE, Morgan ZJ, Andrilla CHA, Pollack SW, Longenecker R, Schmitz D, Evans DV, Patterson DG. Academic Achievement and Competency in Rural and Urban Family Medicine Residents. Fam Med 2023; 55:152-161. [PMID: 36888669 PMCID: PMC10622012 DOI: 10.22454/fammed.2023.656489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES The quality of training in rural family medicine (FM) residencies has been questioned. Our objective was to assess differences in academic performance between rural and urban FM residencies. METHODS We used American Board of Family Medicine (ABFM) data from 2016-2018 residency graduates. Medical knowledge was measured by the ABFM in-training examination (ITE) and Family Medicine Certification Examination (FMCE). The milestones included 22 items across six core competencies. We measured whether residents met expectations on each milestone at each assessment. Multilevel regression models determined associations between resident and residency characteristics milestones met at graduation, FMCE score, and failure. RESULTS Our final sample was 11,790 graduates. First-year ITE scores were similar between rural and urban residents. Rural residents passed their initial FMCE at a lower rate than urban residents (96.2% vs 98.9%) with the gap closing upon later attempts (98.8% vs 99.8%). Being in a rural program was not associated with a difference in FMCE score but was associated with higher odds of failure. Interactions between program type and year were not significant, indicating equal growth in knowledge. The proportions of rural vs urban residents who met all milestones and each of six core competencies were similar early in residency but diverged over time with fewer rural residents meeting all expectations. CONCLUSIONS We found small, but persistent differences in measures of academic performance between rural- and urban-trained FM residents. The implications of these findings in judging the quality of rural programs are much less clear and warrant further study, including their impact on rural patient outcomes and community health.
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Affiliation(s)
- Lars E. Peterson
- American Board of Family MedicineLexington, KY
- Family and Community Medicine, College of Medicine, University of KentuckyLexington, KY
| | | | - C. Holly A. Andrilla
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Samantha W. Pollack
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Randall Longenecker
- The RTT Collaborative and Ohio University Heritage College of Osteopathic MedicineAthens, OH
| | - David Schmitz
- Department of Family and Community Medicine, School of Medicine and Health Sciences, University of North DakotaGrand Forks, ND
| | - David V. Evans
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
| | - Davis G. Patterson
- Department of Family Medicine, University of Washington School of MedicineSeattle, WA
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Tong ST, Morgan ZJ, Stephens KA, Bazemore A, Peterson LE. Characteristics of Family Physicians Practicing Collaboratively With Behavioral Health Professionals. Ann Fam Med 2023; 21:157-160. [PMID: 36973057 PMCID: PMC10042557 DOI: 10.1370/afm.2947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 11/15/2022] [Accepted: 12/01/2022] [Indexed: 03/29/2023] Open
Abstract
Integrating behavioral health into primary care can improve access to behavioral health and patient health outcomes. We used 2017-2021 American Board of Family Medicine continuing certificate examination registration questionnaire responses to determine the characteristics of family physicians who work collaboratively with behavioral health professionals. With a 100% response rate, 38.8% of 25,222 family physicians reported working collaboratively with behavioral health professionals, with those working in independently owned practices and in the South having substantially lower rates. Future research exploring these differences could help develop strategies to support family physicians implement integrated behavioral health to improve care for patients in these communities.
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Affiliation(s)
- Sebastian T Tong
- University of Washington, Department of Family Medicine, Seattle, Washington
| | | | - Kari A Stephens
- University of Washington, Department of Family Medicine, Seattle, Washington
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky
- Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
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15
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Davis C, Krishnasamy M, Morgan ZJ, Bazemore AW, Peterson LE. On the Topic of Academic Achievement, Professionalism, and Burnout in Family Medicine Residents. Fam Med 2023; 55:131. [PMID: 36689453 PMCID: PMC10614532 DOI: 10.22454/fammed.2022.148454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Caitlin Davis
- Inova/Fairfax Family Medicine Residency Program, Fairfax, VA
| | - Meenu Krishnasamy
- Inova Children's Hospital Pediatrics Residency Program, Falls Church, VA
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16
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Borders TF, Morgan ZJ, Peterson LE. Colorectal Cancer Screening in Rural and Urban Primary Care Practices Amid Implementation of the Medicare Access and CHIP Reauthorization Act. J Prim Care Community Health 2023; 14:21501319231177552. [PMID: 37282606 DOI: 10.1177/21501319231177552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
PURPOSE The Medicare Access and CHIP Reauthorization Act (MACRA) incentivized primary care practices to improve colorectal cancer screening rates. This study examined if colorectal screening rates improved among rural and urban primary care practices amid implementation of MACRA. METHODS Colorectal cancer screening data are from a national registry of 139 primary care practices. Repeated measures regression tested for rural/urban differences and changes in screening rates between 2016 and 2020, adjusting for county demographic factors and social deprivation. RESULTS Screening rates were 64% in both rural and urban practices in the first quarter of 2016 and increased to 80% and 83% in rural and urban practices, respectively, in the last quarter of 2020. In adjusted analyses, screening rates increased by 4% per year and there were no rural/urban differences. Lower screening rates were associated with higher county proportions of persons who were 45 to 74 years of age and Hispanic. Higher screening rates were associated with higher county proportions of persons who were White, Black, and Asian and higher social deprivation. CONCLUSIONS Colorectal screening rates improved among rural and urban primary care practices during implementation of MACRA, but disparities persist among practices serving county populations that are relatively older, more Hispanic, and have higher social deprivation.
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17
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Davis CS, Roy T, Peterson LE, Bazemore AW. Evaluating the Teaching Health Center Graduate Medical Education Model at 10 Years: Practice-Based Outcomes and Opportunities. J Grad Med Educ 2022; 14:599-605. [PMID: 36274770 PMCID: PMC9580311 DOI: 10.4300/jgme-d-22-00187.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/13/2022] [Accepted: 07/08/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since 2011, the Teaching Health Center Graduate Medical Education (THC GME) program has sought to expand access to care by training residents in safety net settings. OBJECTIVE To examine impact on physician scope, location, and patient population served using a unique data set. METHODS Using 2017-2020 data from the American Board of Family Medicine National Graduate Survey, we compared demographics, practice location, populations served, and scope of practice between graduates of THC GME programs and graduates of other family medicine programs. RESULTS Our sample comprised 8608 (out of 13 465) eligible family medicine graduates 3 years after completion of residency training, for a response rate of 63.9%. THC graduates were significantly more likely than other graduates to practice in a rural location (17.9% to 11.8%), within 5 miles of their residency program (18.9% to 12.9%), and to care for medically underserved populations (35.2% to 18.6%). Their scope of practice was wider than other graduates and more likely to comprise services like buprenorphine prescribing, behavioral health care, and outpatient gynecological procedures. Regression results suggest that THC training is independently correlated with a broader scope of practice. CONCLUSIONS Graduates of THC programs were significantly more likely than graduates of other programs to practice close to their training sites and in rural areas, and to care for underserved patients while maintaining a broader scope of practice than other graduates.
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Affiliation(s)
- Caitlin Smith Davis
- Caitlin Smith Davis, MD, MSc, is a Resident, INOVA-Fairfax Family Medicine Residency Program
| | - Tuhin Roy
- Tuhin Roy, MD, MPH, is Program Faculty, Greater Lawrence Family Health Center
| | - Lars E. Peterson
- Lars E. Peterson, MD, PhD, is Senior Physician Scientist, American Board of Family Medicine, and Professor, Department of Family and Community Medicine, University of Kentucky
| | - Andrew W. Bazemore
- Andrew W. Bazemore, MD, MPH, is Senior Vice President of Research and Policy, American Board of Family Medicine
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18
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Wang T, O'Neill TR, Eden AR, Taylor MK, Newton WP, Morgan ZJ, Peterson LE. Authors' Reply. Fam Med 2022; 54:746-747. [PMID: 36219437 DOI: 10.22454/fammed.2022.954112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Ting Wang
- American Board of Family Medicine, Lexington, KY
| | | | - Aimee R Eden
- American Board of Family Medicine, Lexington, KY
| | | | | | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, KY.,and Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
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19
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Casalino LP, Li J, Peterson LE, Rittenhouse DR, Zhang M, O’Donnell EM, Phillips RL. Relationship Between Physician Burnout And The Quality And Cost Of Care For Medicare Beneficiaries Is Complex. Health Aff (Millwood) 2022; 41:549-556. [PMID: 35377764 PMCID: PMC9934398 DOI: 10.1377/hlthaff.2021.00440] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Despite reports of a physician burnout epidemic, there is little research on the relationship between burnout and objective measures of care outcomes and no research on the relationship between burnout and costs of care. Linking survey data from 1,064 family physicians to Medicare claims, we found no consistent statistically significant relationship between seven categories of self-reported burnout and measures of ambulatory care-sensitive admissions, ambulatory care-sensitive emergency department visits, readmissions, or costs. The coefficients for ambulatory care-sensitive admissions and readmissions for all burnout levels, compared with never being burned out, were consistently negative (fewer ambulatory care-sensitive admissions and readmissions), suggesting that, counterintuitively, physicians who report burnout may nevertheless be able to create better outcomes for their patients. Even if true, this hypothesis should not indicate that physician burnout is beneficial or that efforts to reduce physician burnout are unimportant. Our findings suggest that the relationship between burnout and outcomes is complex and requires further investigation.
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Affiliation(s)
| | - Jing Li
- Weill Cornell Medical College
| | - Lars E. Peterson
- American Board of Family Medicine, Washington, D.C., and University of Kentucky, Lexington, Kentucky
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20
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Peterson LE, Johannides J, Phillips RL. Physicians' Choice of Board Certification Activity Is Unaffected by Baseline Quality of Care: The TRADEMaRQ Study. Ann Fam Med 2022; 20:110-115. [PMID: 35346925 PMCID: PMC8959743 DOI: 10.1370/afm.2770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 06/24/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Physicians' use of self-assessment to guide quality improvement or board certification activities often does not correlate with more objective measures, and they may spend valuable time on activities that support their strengths instead of addressing gaps. Our objective was to study whether viewing quality measures, with peer comparisons, would affect the selection of certification activities. METHODS We conducted a cluster-randomized controlled trial-the Trial of Data Exchange for Maintenance of certification and Raising Quality (TRADEMaRQ)-with 4 partner organizations during 2015-2017. Physicians were presented their quality data within their online certification portfolios before (intervention) vs after (control) they chose board certification activities. The primary outcome was whether the selected activity addressed a quality gap (a quality area in which the physician scored below the mean for the study population). RESULTS Of 2,570 invited physicians, 254 physicians completed the study: 130 in the intervention group and 124 in the control group. Nearly one-fifth of participating physicians did not complete any certification activities during the study. A sizable minority of those in the intervention group, 18.4%, never reviewed their quality dashboard. Overall, just 27.2% of completed certification activities addressed a quality gap, and there was no significant difference in this outcome in the intervention group vs the control group in either bivariate or adjusted analyses (odds ratio = 1.28; 95% CI, 0.90-1.82). CONCLUSIONS Physicians did not use quality performance data in choosing certification activities. Certification boards are being pressed to make their programs relevant to practice, less burdensome, and supportive of quality improvement in alignment with value-based payment models. Using practice data to drive certification choices would meet these goals.
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Affiliation(s)
- Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky .,Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
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21
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Wang T, O'Neill TR, Eden AR, Taylor MK, Newton WP, Morgan ZJ, Peterson LE. Racial/Ethnic Group Trajectory Differences in Exam Performance Among US Family Medicine Residents. Fam Med 2022; 54:184-192. [DOI: 10.22454/fammed.2022.873033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background and Objectives: Racial/ethnic score disparities on standardized tests are well documented. Such differences on the American Board of Family Medicine (ABFM) certification examination have not been previously reported. If such differences exist, it could be due to differences in knowledge at the beginning of residency or due to variations in the rate of knowledge acquisition during residency. Our objective was to examine the residents’ mean initial scores and score trajectories using the In-Training Examination (ITE) and certification examination.
Methods: A total of 17,275 certification candidates from 2014 to 2019 were included in this study. Annual ITE scores and certification examination scores are reported on the same scale and serve as the outcome. We conducted multilevel longitudinal regression to determine initial knowledge and growth in knowledge acquisition during residency by race/ethnicity categories.
Results: The mean postgraduate year 1 (PGY-1) ITE score was 393.3, with minority residents scoring 16.2 to 36.0 points lower compared to White residents. The mean increase per year in exam performance from PGY-1 ITE to the certification exam was 39.9 points (95% CI, 38.7, 41.1) with additional change among race/ethnicity categories per year of -3.2 to 1.9 points.
Conclusions: This study found that there were initial score disparities across race/ethnicity groups in PGY-1, and these disparities continued at the same rate throughout residency training, suggesting equality in acquisition of knowledge during family medicine residency training but with a persistent gap throughout training.
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Affiliation(s)
- Ting Wang
- American Board of Family Medicine, Lexington, KY
| | | | | | | | | | | | - Lars E. Peterson
- American Board of Family Medicine, Lexington, KY
- and Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
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22
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Fouladvand S, Talbert J, Dwoskin LP, Bush H, Meadows AL, Peterson LE, Roggenkamp SK, Kavuluru R, Chen J. Identifying Opioid Use Disorder from Longitudinal Healthcare Data using a Multi-stream Transformer. AMIA Annu Symp Proc 2022; 2021:476-485. [PMID: 35308960 PMCID: PMC8861731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Opioid Use Disorder (OUD) is a public health crisis costing the US billions of dollars annually in healthcare, lost workplace productivity, and crime. Analyzing longitudinal healthcare data is critical in addressing many real-world problems in healthcare. Leveraging the real-world longitudinal healthcare data, we propose a novel multi-stream transformer model called MUPOD for OUD identification. MUPOD is designed to simultaneously analyze multiple types of healthcare data streams, such as medications and diagnoses, by attending to segments within and across these data streams. Our model tested on the data from 392,492 patients with long-term back pain problems showed significantly better performance than the traditional models and recently developed deep learning models.
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Affiliation(s)
| | - Jeffery Talbert
- Institute for Biomedical Informatics
- Department of Internal Medicine
| | | | | | | | - Lars E Peterson
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY, USA
- American Board of Family Medicine, Lexington, KY, USA
| | | | - Ramakanth Kavuluru
- Institute for Biomedical Informatics
- Department of Computer Science
- Department of Internal Medicine
| | - Jin Chen
- Institute for Biomedical Informatics
- Department of Computer Science
- Department of Internal Medicine
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23
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Dai M, Chung Y, Peterson LE, Petterson S, Phillips RL. Family Practices in Transforming Clinical Practice Initiative Showed No Changes in Medicare Costs or Utilization. Med Care 2022; 60:50-55. [PMID: 34739412 DOI: 10.1097/mlr.0000000000001662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services proposed that the Transforming Clinical Practice Initiative (TCPI) would improve health outcomes for patients, reduce utilization of institutional services, and generate significant savings for payers by the end of September 2019. OBJECTIVE The objective of this study was to investigate whether participation in TCPI's Practice Transformation Networks (PTNs) was associated with improved cost and utilization outcomes for Medicare patients of family medicine-based practices in the first 2 years, that is, 2016-2017, of the Initiative. STUDY DESIGN A quasi-experimental design with a longitudinal cohort of family medicine-based practices and a propensity-matched comparison sample. SUBJECTS A total of 761 PTN practices and 3451 non-PTN practices. MEASURES To measure practice-level patient outcomes, we attributed patients to practice based on the plurality of office visits. We obtained Medicare claims from 2011 to 2017 to assess PTN participation effects for Medicare Part A and B costs, hospital admission, and emergency department visit rates using a Difference-in-Differences design, adjusting for baseline characteristics. RESULTS The differences in Medicare Part A and B costs (-1.71%, P=0.25), annual rates of hospitalization (-0.59%, P=0.12) and emergency department visit (-0.29%, P=0.46) were not significantly lower among PTN practices (N=761) than among propensity score-matched non-PTN practices (N=3541). CONCLUSIONS TCPI's transforming efforts, such as the outcomes examined in the study, might need a longer time frame to manifest and require evaluation after the full 4-year participation period. The indistinguishable effect of PTN participation may also be attributed to the fact that non-PTN practices might have participated in other initiatives that changed their care and curbed health care utilization and costs consequently.
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Affiliation(s)
| | - Yoonkyung Chung
- Robert Graham Center of American Academy of Family Physicians, Washington, DC
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, KY
- Department of Family and Community Medicine, University of Kentucky, Lexington, KY
| | - Stephen Petterson
- Robert Graham Center of American Academy of Family Physicians, Washington, DC
| | - Robert L Phillips
- American Board of Family Medicine, Lexington, KY
- Center for Professionalism and Value in Health Care, Washington, DC
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24
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Sonoda K, Morgan ZJ, Peterson LE. HIV Care by Early-Career Family Physicians. Fam Med 2021; 53:760-765. [PMID: 34624123 DOI: 10.22454/fammed.2021.415039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Antiretroviral treatment has transformed human immunodeficiency virus (HIV) infection into a chronic disease. Prior research demonstrated a discrepancy between preparation to provide HIV care and current provision among recent residency graduates. Our study aimed to describe characteristics related to preparedness and provision of HIV care, and to identify the associations between physician and practice characteristics with current provision of HIV care among those prepared. METHODS We obtained data from the 2016 through 2019 American Board of Family Medicine (ABFM) National Family Medicine Graduate Survey. Our main outcome was self-reported provision of HIV care. Bivariate statistics compared differences in personal and practice characteristics with self-reported preparation for HIV care, then among those prepared, provision of HIV care. We used logistic regression to determine associations between HIV care, among those prepared, with practice and personal characteristics. RESULTS The response rate was 68.7% and our final sample size was 6,740 respondents. Only 25% of respondents reported preparedness in residency, and 44% of them reported current provision. Among those prepared, female gender (OR=0.604; 95% CI, 0.494-0.739) was associated with lower odds of practicing HIV care. Those working in high HIV prevalence areas (OR=1.718; 95% CI, 1.259-2.344) and in Northeast census region (OR=1.557; 95% CI, 1.137-2.132) had higher odds of providing HIV care. CONCLUSIONS Fewer than half of those prepared in residency reported currently providing HIV care. Working in a high HIV prevalence area was associated with higher odds of providing HIV care, which suggests early-career family physicians are responding to community needs.
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Affiliation(s)
- Kento Sonoda
- Department of Family Medicine, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, KY.,and Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
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25
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Abstract
BACKGROUND AND OBJECTIVES Physician burnout has been shown to have roots in training environments. Whether burnout in residency is associated with the attainment of critical educational milestones has not been studied, and is the subject of this investigation. METHODS We used data from a cohort of graduating family medicine residents registering for the 2019 American Board of Family Medicine initial certification examination with complete data from registration questionnaire, milestone data, in-training examination (ITE) scores, and residency characteristics. We used bivariate and multilevel multivariate analyses to measure the associations between four professionalism milestones ratings and ITE performance with burnout. RESULTS Our sample included 2,509 residents; 36.8% met the criteria for burnout. Multilevel regression modeling showed a correlation between burnout and failure to meet only one of four professionalism milestones, specifically professional conduct and accountability (OR 1.41, 95% CI 1.07-1.87), while no statistically significant relationship was demonstrated between burnout and being in the lowest quartile of ITE scores. Other factors negatively associated with burnout included international medical education (OR 0.60, 95% CI 0.48-0.76) and higher salary compared to cost of housing (OR 0.62, 95% CI 0.46-0.82). CONCLUSIONS We found significant association between self-reported burnout and failing to meet expectations for professional conduct and accountability, but no relationship between burnout and medical knowledge as measured by lower ITE performance. Further investigation of how this impacts downstream conduct and accountability behaviors is needed, but educators can use this information to examine program-level interventions that can specifically address burnout and development of physician professionalism.
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Affiliation(s)
- Caitlin Davis
- University of Maryland/Sheppard Pratt Psychiatry Residency Program, Baltimore, MD
| | | | | | - Andrew W Bazemore
- American Board of Family Medicine, Lexington, KY.,and the Center for Professionalism and Value in Healthcare, Washington, DC
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, KY.,and Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
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Abstract
BACKGROUND AND OBJECTIVES Family physicians (FPs) are well positioned to increase abortion access given their broad scope and diverse geographic practice regions. Previously published studies focus on physicians who received formal abortion training but do not include the full landscape of FPs performing abortions in the United States. This secondary data analysis presents a unique opportunity to examine characteristics of early-career FPs who provide abortions, including practice locations and if they received abortion training during residency. METHODS We analyzed data from the 2016-2018 Family Medicine National Graduate Survey to generate descriptive statistics about respondents who report providing pregnancy termination, uterine aspiration/dilation and curettage, or both. We evaluated associations between physician and/or practice characteristics and providing pregnancy termination using bivariate statistics. RESULTS Of the 6,319 survey respondents, 3% reported providing pregnancy termination. Nearly three-quarters of this subset reported graduating residency feeling prepared to provide pregnancy termination. Most respondents completed residency in the West or Northeast US geographic regions, and 3 years later were practicing in the West or South regions. Additional characteristics associated with providing pregnancy termination include female gender, providing continuity care, and practicing in either an academic medical center or a federally qualified health center. CONCLUSIONS FPs are well positioned to address gaps in abortion access, and those who provide pregnancy termination practice in various US geographic regions. This is the first discussion of its kind about the scope of family physicians providing abortion care. Future research should continue to characterize FPs who provide abortions to determine where they train and practice and what type of abortions they provide.
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Affiliation(s)
- Payal Patel
- Department of Family and Social Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Sumathi Narayana
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Aleza Summit
- Reproductive Health Education in Family Medicine, Bronx, NY
| | - Marji Gold
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | | | | | - Allison Paul
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
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Abstract
BACKGROUND AND OBJECTIVES The capacity for research within family medicine has historically been low despite its importance. The aim of this study was to learn more about the perceptions of family medicine department chairs regarding research and its role in their departments and institutions. METHODS We analyzed a 2016 cross-sectional survey with responses from 109/142 (77% response) US chairs of allopathic departments of family medicine (DFMs) regarding departmental research capacity, research experience, and perceptions of research in the department and institution. RESULTS Most chairs agreed that research is important (91%, n=92) and raises the prestige of the DFM (90%, n=91), though perceptions differ by chair research experience and DFM capacity for research. The mean ideal focus on research (21%, 8% SD) is greater than the actual (12%, 8% SD). Compared to the mean of all departments, those in DFMs with a high capacity for research estimated a higher actual (76% vs 26% and 7%, P<.0001) and ideal (73% vs 30% and 18%, P<.0001) departmental focus on research, as well as a higher ideal institutional focus on research (69% vs 35% and 28%, P=.001), significantly more often than chairs in moderate or minimal capacity DFMs. Those in lower capacity DFMs estimated a greater ideal research focus for their departments than they perceived their institution have. CONCLUSIONS Research is important to chairs of DFMs. DFMs that do not currently have major research enterprises may have the will and training required of their leader to grow. With the right support and resources, these DFMs may increase their research capacity, and subsequently their research productivity to support the needs of the discipline for more family medicine research.
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Affiliation(s)
- Amanda Weidner
- Department of Family Medicine, University of Washington, Seattle, WA
| | | | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida.,and Department of Community Health and Family Medicine, University of Florida, Gainesville, FL
| | - Bernard Ewigman
- NorthShore University HealthSystem, Department of Family Medicine, Evanston, IL
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Dai M, Peterson LE, Phillips RL. Quality Changes Among Primary Care Clinicians Participating in the Transforming Clinical Practice Initiative. J Healthc Qual 2021; 43:e64-e69. [PMID: 33229941 DOI: 10.1097/jhq.0000000000000287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The Transforming Clinical Practice Initiative (TCPI) was designed to provide technical assistance to clinicians and prepare practices to participate in value-based payment arrangements. In this longitudinal cohort study, we assessed whether clinician's participation in TCPI practice transformation networks (PTNs) was associated with changes in quality of care from 2016 to 2018. We extracted quarterly measure performance data from 2016 to 2018 on two NQF-endorsed measures, one for outcome (Controlling High Blood Pressure) and one for process (Use of Imaging Studies for Low Back Pain), from 1,981 primary care clinicians enrolled in the PRIME Registry. Clinicians participating in PTNs were identified and compared with their counterparts who did not participate in PTNs. We found that the performance of PTN clinicians on controlling high blood pressure and use of imaging studies for low back pain was equivalent to that of non-PTN clinicians during the first 3 years of the TCPI. Although PTNs provided assistance to help practices achieve their clinical outcomes, these findings suggest that the changes in quality of care, for the measures studied, among PTN clinicians in the first 3 years of the TCPI were attributable to temporal trends rather than participation in PTNs.
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Affiliation(s)
- Lars E Peterson
- American Board of Family Medicine, Lexington, KY.,and Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, KY
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Bakhtiarydavijani A, Khalid G, Murphy MA, Johnson KL, Peterson LE, Jones M, Horstemeyer MF, Dobbins AC, Prabhu RK. A mesoscale finite element modeling approach for understanding brain morphology and material heterogeneity effects in chronic traumatic encephalopathy. Comput Methods Biomech Biomed Engin 2021; 24:1169-1183. [PMID: 33635182 DOI: 10.1080/10255842.2020.1867851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chronic Traumatic Encephalopathy (CTE) affects a significant portion of athletes in contact sports but is difficult to quantify using clinical examinations and modeling approaches. We use an in silico approach to quantify CTE biomechanics using mesoscale Finite Element (FE) analysis that bridges with macroscale whole head FE analysis. The sulci geometry produces complex stress waves that interact with one another to create increased shear stresses at the sulci depth that are significantly larger than in analyses without sulci (from 0.5 to 18.0 kPa). Sulci peak stress concentration regions coincide with experimentally observed CTE sites documented in the literature. HighlightsSulci introduce stress localizations at their depth in the gray matterSulci stress fields interact to produce stress concentration sites in white matterDifferentiating brain tissue properties did not significantly affect peak stresses.
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Affiliation(s)
- A Bakhtiarydavijani
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | - G Khalid
- Middle Technical University, Baghdad, Iraq
| | - M A Murphy
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | | | - L E Peterson
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA
| | - M Jones
- Institute of Medical Engineering & Medical Physics, Cardiff University, Cardiff, Wales, UK
| | | | - A C Dobbins
- Department of Biomedical Engineering, University of Alabama at Birmingham, Birmingham, USA
| | - R K Prabhu
- Center for Advanced Vehicular Systems, Mississippi State University, Starkville, MS, USA.,Department of Agricultural and Biological Engineering, Mississippi State University, MS, USA
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Abstract
PURPOSE Physicians of all specialties are more likely to live and work in urban areas than in rural areas. Physician availability affects the health and economy of rural communities. This study aimed to measure and update the availability of physician specialties in rural counties. METHODS This analysis included all counties with a Rural-Urban Continuum Code (RUCC) between 4 and 9. Geographically identified physician data from the 2019 American Medical Association Masterfile was merged with 2019 County Health Rankings, the Census Bureau's 2010 county-level population data, and 2010 Topologically Integrated Geographic Encoding and Referencing shapefiles. Multivariate logistic regression was performed to assess the availability of physicians by specialty in rural counties. FINDINGS Of the 1,947 rural counties in our sample, 1,825 had at least 1 physician. Specialties including emergency medicine, cardiology, psychiatry, diagnostic radiology, general surgery, anesthesiology, and OB/GYN were less available than primary care physicians (PCPs) in all rural counties. The probability of a rural county having a PCP was the highest in RUCC 4 (1.0) and lowest in RUCC 8 (0.93). Of all primary care specialties, family medicine was the most evenly distributed across the rural continuum, with a probability of 1.0 in RUCC 4 and 0.88 in RUCC 9. CONCLUSIONS Family medicine is the physician specialty most likely to be present in rural counties. Policy efforts should focus on maintaining the training and scope of practice of family physicians to serve the health care needs of rural communities where other specialties are less likely to practice.
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Affiliation(s)
- Tyler Barreto
- Sea Mar Marysville Family Medicine Residency, Marysville, Washington
| | | | - Aimee R Eden
- American Board of Family Medicine, Lexington, Kentucky
| | | | - Andrew Bazemore
- American Board of Family Medicine, Lexington, Kentucky.,Center for Professionalism & Value in Healthcare, Washington, DC
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky.,Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
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Abstract
PURPOSE Scope of practice of family physicians (FPs) has been decreasing overall. Our objective was to determine if the distribution of declining scope occurs across urban and rural settings. METHODS We used secondary data from practicing FPs collected on the American Board of Family Medicine examination registration demographic questionnaire from 2014 to 2016 on scope of practice merged with county-level data from the Area Health Resources File. Rurality was assigned using 4 population-based groupings from the Rural Urban Continuum Codes. Outcome measures were scope of practice score (0-30, higher score reflecting broader scope) and provision of specific types of care/procedures. Bivariate statistics assessed changes in scope of practice over time. Adjusted regression models tested associations between time, physician, practice, and county characteristics with scope of practice score. FINDINGS Our sample was 27,343 practicing FPs. Overall, the scope score decreased from 15.5 to 15.0 (P value < .05) but was significant only for urban settings. Regression analysis found that scope decreased each year (β = -0.15), broader scope for rural FPs, and no interaction between year and rural. CONCLUSIONS The decrease in FP scope of practice is largely an urban phenomenon. FPs in rural areas have a broad scope of practice, which may ensure access to care in rural areas that rely on FPs to provide a large portion of health care services. However, county characteristics like persistent poverty and the presence of nurse practitioners, physician assistants, and other physicians were associated with changes in scope that may modify the gains associated with rurality.
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Affiliation(s)
- Urooj Nasim
- Department of Political Science, College of Arts & Sciences, University of Kentucky, Lexington, Kentucky
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky.,Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
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Rittenhouse DR, Wiley JA, Peterson LE, Casalino LP, Phillips RL. Meaningful Use And Medical Home Functionality In Primary Care Practice. Health Aff (Millwood) 2020; 39:1977-1983. [DOI: 10.1377/hlthaff.2020.00782] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Diane R. Rittenhouse
- Diane R. Rittenhouse is a senior fellow in Health at Mathematica in Oakland, California
| | - James A. Wiley
- James A. Wiley is a professor in the Philip R. Lee Institute for Health Policy Studies at the University of California San Francisco, in San Francisco, California
| | - Lars E. Peterson
- Lars E. Peterson is vice president of research at the American Board of Family Medicine, in Lexington, Kentucky
| | - Lawrence P. Casalino
- Lawrence P. Casalino is the Livingston Farrand Professor and chief of the Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medicine, in New York, New York
| | - Robert L. Phillips
- Robert L. Phillips Jr. is the founding executive director of the American Board of Family Medicine Foundation Center for Professionalism and Value in Health Care, in Washington, D.C
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Abstract
PURPOSE Burnout affects about half of family physicians (FPs). Minimal research exists which examines the impact of urban and rural practice settings on FP burnout. In this study, we examined whether rural practice is associated with FP burnout. METHODS Data from the 2017 and 2018 American Board of Family Medicine Family Medicine Certification examination registration questionnaire were used. We limited our sample to FPs in continuity care in the United States. The questionnaire is a mandatory component of registration, resulting in a 100% response rate. Burnout was measured via 2 questions validated against the Maslach Burnout Inventory. We used logistic regression to determine associations between burnout and rural location, controlling for practice and personal characteristics. FINDINGS Of the FPs surveyed, 2,740 met our inclusion criteria. Rural FPs were older, more likely to be male, and had a broader scope of practice than urban FPs. Rural FPs had a nonsignificantly higher burnout rate than urban FPs (45.1% vs 43.0%). Burnout was more common in younger and female FPs. We found no rural/urban differences between job satisfaction, practice environment, workload, and job stress; however, all of these characteristics were associated with burnout. In adjusted analyses, rural location was not associated with burnout (odds ratio = 1.15, 95% CI: 0.87-1.52). CONCLUSION In a large national sample, we found no difference in burnout between rural and urban FPs. This suggests there is nothing unique about rural practice that predisposes to burnout and that a common pathway to reduce burnout may exist.
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Affiliation(s)
- Zachary D Ward
- Department of Health Administration, University of Southern Indiana, Evansville, Indiana
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky.,Department of Family and Community Medicine, College of Medicine, University of Kentucky, Lexington, Kentucky
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35
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Peterson LE, Boulet JR, Clauser B. Associations Between Medical Education Assessments and American Board of Family Medicine Certification Examination Score and Failure to Obtain Certification. Acad Med 2020; 95:1396-1403. [PMID: 32271228 DOI: 10.1097/acm.0000000000003344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Family medicine residency programs can be cited for low pass or take rates on the American Board of Family Medicine (ABFM) certification examination, and the relationships among standardized medical education assessments and performance on board certification examinations and eventual board certification have not been comprehensively studied. The objective of this study was to evaluate the associations of all required standardized examinations in medical education with ABFM certification examination scores and eventual ABFM certification. METHOD All graduates of U.S. MD-granting family medicine residency programs from 2008 to 2012 were included. Data on ABFM certification examination score, ABFM certification status (as of December 31, 2014), Medical College Admission Test (MCAT) section scores, undergraduate grade point average, all United States Medical Licensing Examination (USMLE) Step scores, and all ABFM in-training examination scores were linked. Nested logistic and linear regression models, controlling for clustering by residency program, determined associations between assessments and both certification examination scores and board certification status. As many international medical graduates (IMGs) do not take the MCAT, separate models for U.S. medical graduates (USMG) and IMGs were run. RESULTS The study sample was 15,902 family medicine graduates, of whom 92.1% (14,648/15,902) obtained board certification. In models for both IMGs and USMGs, the addition of more recent assessments weakened the associations of earlier assessments. USMLE Step 2 Clinical Knowledge was predictive of certification examination scores and certification status in all models in which it was included. CONCLUSIONS For family medicine residents, more recent assessments generally have stronger associations with board certification score and status than earlier assessments. Solely using medical school admissions (grade point average and MCAT) and licensure (USMLE) scores for resident selection may not adequately predict ultimate board certification.
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Affiliation(s)
- Lars E Peterson
- L.E. Peterson is vice president of research, American Board of Family Medicine, and associate professor, Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky; ORCID: http://orcid.org/0000-0003-4853-3108
| | - John R Boulet
- J.R. Boulet is vice president, Research and Data Resources, Foundation for Advancement of International Medical Education and Research, Philadelphia, Pennsylvania
| | - Brian Clauser
- B. Clauser is vice president, Center for Advanced Assessment, National Board of Medical Examiners, Philadelphia, Pennsylvania
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Basu S, Phillips RS, Phillips R, Peterson LE, Landon BE. Primary Care Practice Finances In The United States Amid The COVID-19 Pandemic. Health Aff (Millwood) 2020; 39:1605-1614. [DOI: 10.1377/hlthaff.2020.00794] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sanjay Basu
- Sanjay Basu is vice president of research and population health at Collective Health, in San Francisco, California, and director of research at the Center for Primary Care, Harvard Medical School, in Boston, Massachusetts
| | - Russell S. Phillips
- Russell S. Phillips is director of the Center for Primary Care and the William Applebaum Professor of Medicine and professor of global health and social medicine, Harvard Medical School
| | - Robert Phillips
- Robert Phillips is the executive director of the Center for Professionalism and Value in Health Care, American Board of Family Medicine, in Lexington, Kentucky
| | - Lars E. Peterson
- Lars E. Peterson is vice president of research at the American Board of Family Medicine
| | - Bruce E. Landon
- Bruce E. Landon is a professor of health care policy, Department of Health Care Policy, Harvard Medical School, and a professor of medicine and practicing internist at Beth Israel Deaconess Medical Center, in Boston
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37
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Dai M, Peterson LE. Characteristics of Family Medicine Residency Graduates, 1994-2017: An Update. Ann Fam Med 2020; 18:370-373. [PMID: 32661040 PMCID: PMC7358018 DOI: 10.1370/afm.2535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The purpose of this study was to characterize graduates of family medicine (FM) residencies from 1994 to 2017 and determine whether they continue to practice family medicine after residency. METHOD We sampled physicians who completed FM residency training from 1994-2017 using 2017 American Medical Association (AMA) Physician Masterfile linked with administrative files of the American Board of Family Medicine (ABFM). The main outcomes measured were characteristics of FM residency graduates, including medical degree type (Doctor of Medicine, MD vs Doctor of Osteopathic Medicine, DO), international medical school graduates (IMGs) vs US graduates, sex, ABFM certification status, and self-designated primary specialty. Family medicine residency graduates were grouped into 4-year cohorts by year of residency completion. RESULTS From 1994 to 2017, 66,778 residents completed training in an ACGME accredited FM residency, averaging 2,782 graduates per year. The number of FM residency graduates peaked in 1998-2001, averaging 3,053 each year. The composition of FM residents diversified with large increases in DOs, IMGs, and female graduates over the past 24 years. Of all the FM residency graduates, 91.9% claimed FM as their primary specialty and 81% were certified with ABFM in 2017. FM/sport medicine (2.1%), FM/geriatric medicine (0.9%), internal medicine/geriatrics (0.8%), and emergency medicine (0.7%) were the most common non-FM primary specialties reported. CONCLUSIONS DOs, IMGs, and female family medicine residency graduates increased from 1994 to 2017. With 9 in 10 graduates of family medicine residencies designating FM as their primary specialty, FM residency programs not only train but supply family physicians who are likely to remain in the primary care workforce.
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Affiliation(s)
- Mingliang Dai
- American Board of Family Medicine, Lexington, Kentucky
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky.,Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
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Gliklich RE, Leavy MB, Cosgrove L, Simon GE, Gaynes BN, Peterson LE, Olin B, Cole C, DePaulo JR, Wang P, Crowe CM, Cusin C, Nix M, Berliner E, Trivedi MH. Harmonized Outcome Measures for Use in Depression Patient Registries and Clinical Practice. Ann Intern Med 2020; 172:803-809. [PMID: 32422056 DOI: 10.7326/m19-3818] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Major depressive disorder is a common mental health condition that affects an estimated 16.2 million adults and 3.1 million adolescents in the United States. Yet, a lack of uniformity remains in measurements and monitoring for depression both in clinical practice and in research settings. This project aimed to develop a minimum set of standardized outcome measures relevant to both patients and clinicians that can be collected in depression registries and clinical practice. Twenty-nine depression registries and related data collection efforts were identified and invited to submit outcome measures. Additional measures were identified through literature searches and reviews of quality measures. A multistakeholder panel representing clinicians; payers; government agencies; industry; and medical specialty, health care quality, and patient advocacy organizations categorized the 27 identified measures using the Agency for Healthcare Research and Quality's supported Outcome Measures Framework. The panel identified 10 broadly relevant measures and harmonized definitions for these measures through in-person and virtual meetings. The harmonized measures represent a minimum set of outcomes that are relevant to clinicians and patients and appropriate for use in depression research and clinical practice. Routine and consistent collection of these measures in registries and other systems would support creation of a national research infrastructure to efficiently address new questions, improve patient management and outcomes, and facilitate care coordination.
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Affiliation(s)
| | | | - Lisa Cosgrove
- University of Massachusetts Boston, Boston, Massachusetts (L.C.)
| | - Gregory E Simon
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (G.E.S.)
| | - Bradley N Gaynes
- University of North Carolina School of Medicine, Chapel Hill, North Carolina (B.N.G.)
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky (L.E.P.)
| | | | - Collette Cole
- MN Community Measurement, Minneapolis, Minnesota (C.C.)
| | - J Raymond DePaulo
- Johns Hopkins University School of Medicine, Baltimore, Maryland (J.R.D.)
| | - Philip Wang
- American Psychiatric Association, Cambridge, Massachusetts (P.W.)
| | - Chris M Crowe
- Veterans Health Administration Office of Mental Health and Suicide Prevention, Washington, DC (C.M.C.)
| | - Cristina Cusin
- Massachusetts General Hospital, Boston, Massachusetts (C.C.)
| | - Mary Nix
- Agency for Healthcare Research and Quality, Rockville, Maryland (M.N., E.B.)
| | - Elise Berliner
- Agency for Healthcare Research and Quality, Rockville, Maryland (M.N., E.B.)
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Eden AR, Chesluk BJ, Hansen ER, Brock A, Bernabeo EC, Peterson LE. The Role of Gender in the Experience and Impact of Recertification Exam Preparation: A Qualitative Study of Primary Care Physicians. J Womens Health (Larchmt) 2020; 29:1401-1409. [PMID: 32212996 DOI: 10.1089/jwh.2019.8033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about how physicians experience preparing for board recertification examinations. As women make up a growing proportion of the primary care physician workforce, we aimed to explore how primary care physicians experience the personal and professional impacts of recertification examination preparation activities, and whether these impacts differ by gender. Materials and Methods: We conducted exploratory qualitative semistructured interviews with 80 primary care physicians, who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine recertification examination and who practice outpatient care. We used an iterative recruitment approach to obtain a representative sample. We applied a team-based constant comparative analytic approach to identify and categorize themes related to how preparing for the recertification examination impacted their personal or professional lives, and then compared these themes by physician gender. Results: We interviewed 41 male and 39 female participants. Physicians most frequently described taking time from personal rather than professional activities to study, but often said this was "no big deal." Physicians described impacts on personal life such as missing out on family or leisure time, conflicts with parenting responsibilities, and an increased reliance on their spouse for domestic and childcare duties. Female physicians more frequently described parenting and leisure time impacts than males did. Conclusions: Recertification examination preparation impacts physicians' personal lives in a variety of ways and are sometimes experienced differently along gendered lines. These findings suggest opportunities for employers, payers, and specialty boards to help physicians ease potential burdens related to maintaining board certification.
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Affiliation(s)
- Aimee R Eden
- American Board of Family Medicine, Department of Research, Lexington, Kentucky, USA
| | - Benjamin J Chesluk
- American Board of Internal Medicine, Department of Assessment and Research, Philadelphia, Pennsylvania, USA
| | | | - Audrey Brock
- American Board of Family Medicine, Department of Research, Lexington, Kentucky, USA
| | - Elizabeth C Bernabeo
- American Board of Internal Medicine, Department of Assessment and Research, Philadelphia, Pennsylvania, USA
| | - Lars E Peterson
- American Board of Family Medicine, Department of Research, Lexington, Kentucky, USA.,Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky, USA
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40
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Louis JS, Eden AR, Morgan ZJ, Barreto TW, Peterson LE, Phillips RL. Maternity Care and Buprenorphine Prescribing in New Family Physicians. Ann Fam Med 2020; 18:156-158. [PMID: 32152020 PMCID: PMC7062488 DOI: 10.1370/afm.2504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 06/25/2019] [Accepted: 08/13/2019] [Indexed: 11/09/2022] Open
Abstract
The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5.1%) respondents both provide maternity care and prescribe buprenorphine. Family physicians who care for pregnant women and also prescribe buprenorphine represented 50.4% of all buprenorphine prescribers. The family physicians in this group were trained in a small number of residency programs, with only 15 programs producing at least 25% of graduates who do this work.
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Affiliation(s)
- Joshua St Louis
- Greater Lawrence Family Health Center, Lawrence, Massachusetts
| | - Aimee R Eden
- American Board of Family Medicine, Lexington, Kentucky
| | | | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky
- Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
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Phillips WR, Dai M, Frey JJ, Peterson LE. General Practitioners in US Medical Practice Compared With Family Physicians. Ann Fam Med 2020; 18:127-130. [PMID: 32152016 PMCID: PMC7062491 DOI: 10.1370/afm.2503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/28/2019] [Accepted: 08/16/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE General practitioners (GPs) are part of the US physician workforce, but little is known about who they are, what they do, and how they differ from family physicians (FPs). We describe self-identified GPs and compare them with board-certified FPs. METHODS Analysis of data on 102,604 Doctor of Medicine and Doctor of Osteopathy physicians in direct patient care in the United States in 2016, who identify themselves as GPs or FPs. The study used linking databases (American Medical Association Masterfile, American Board of Family Medicine [ABFM], Area Health Resource File, Medicare Public Use File) to examine personal, professional, and practice characteristics. RESULTS Of the physicians identified, 6,661 self-designated as GPs and 95,943 self-designated as FPs. Of the self-designated GPs, 116 had been ABFM certified and were excluded from the study. Of the remaining 102,488 physicians, those who self-designated as GPs but were never ABFM certified constituted the GP group (n = 6,545, 6%). Self-designated FPs that were ABFM certified made up the FP group (n = 79,449, 78%). The remaining self-designated FPs not ABFM certified constituted the uncertified group (n = 16,494, 16%). GPs differed from FPs in every characteristic examined. Compared with FPs, GPs are more likely to be older, male, Doctors of Osteopathy, graduates of non-US medical schools, and have no family medicine residency training. GPs practice location is similar to FPs, but GPs are less likely to participate in Medicare or to work in hospitals. CONCLUSIONS GPs in the United States are a varied group that differ from FPs. Researchers, educators, and policy makers should not lump GPs together with FPs in data collection, analysis, and reporting.
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Affiliation(s)
- William R Phillips
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Mingliang Dai
- American Board of Family Medicine, Lexington, Kentucky
| | - John J Frey
- Department of Family Medicine, University of Wisconsin, Madison, Wisconsin
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky.,Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
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Creager J, Coutinho AJ, Peterson LE. Associations Between Burnout and Practice Organization in Family Physicians. Ann Fam Med 2019; 17:502-509. [PMID: 31712288 PMCID: PMC6846281 DOI: 10.1370/afm.2448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/22/2019] [Accepted: 04/12/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Burnout has been reported to be as high as 63% among family physicians and has negative effects on physicians, patients, and the medical system. There are likely structural causes of burnout, but little is known about the relationship between practice organization and burnout. Our objective was to study this association in family physicians. METHODS This cross-sectional study uses secondary data supplied by practicing physicians from the 2017 American Board of Family Medicine (ABFM) Family Medicine Certification examination registration questionnaire, a mandatory component of registration, yielding a 100% response rate. Burnout was measured as a positive response to either of 2 validated questions measuring emotional exhaustion and depersonalization. Practice environment was measured with questions on work stressors and teamwork. Logistic regression determined independent associations between burnout and individual and practice characteristics. RESULTS Of the 1,437 physicians included, the burnout rate was 43.7%; 33.7% worked in hospital-owned practices and 65.5% reported no ownership stake in their practice. Controlling for personal characteristics and practice organization, being in a hospital-owned practice (odds ratio (OR) = 1.68; 95% CI, 1.14-2.46) and being a partial owner (OR =1.67; 95% CI, 1.13-2.46) were positively associated with burnout. When also controlling for practice environment, no practice organization variable remained associated with burnout. CONCLUSION Burnout in family physicians should not be attributed solely to practice organization. No single practice type or ownership status was independently associated with burnout, which indicates that any practice can attempt to mitigate burnout.
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Affiliation(s)
- Jessica Creager
- University of Kentucky College of Medicine; Department of Family & Community Medicine, Lexington, Kentucky
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky .,Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
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Peabody MR, Peterson LE, Dai M, Eden A, Hansen ER, Puffer JC. Motivation for Participation in the American Board of Family Medicine Certification Program. Fam Med 2019; 51:728-736. [PMID: 31596931 DOI: 10.22454/fammed.2019.850799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Board certification programs have been criticized as not relevant to practice, not improving patient care, and creating additional burdens on already overburdened physicians. Many physicians may feel compelled to participate in board certification programs in order to satisfy employer, hospital, and insurer requirements; however, the influence of forces as motivators for physicians to continue board certification is poorly understood. METHODS We used data from the 2017 American Board of Family Medicine (ABFM) Family Medicine Certification Examination practice demographic registration questionnaire for those seeking to continue their certification, removing physicians who indicated they did not provide direct patient care. We utilized a mixed-methods design. For the quantitative analysis, a proportional odds logistic regression was used to examine the association between predictor variables and increasing levels of external motivation. For the qualitative analysis, we used a deductive approach to examine open-text responses. RESULTS Of the analytical sample of 7,545 family physicians, approximately one-fifth (21.4%) were motivated to continue their board certification solely by intrinsic factors. Less than one-fifth (17.3%) were motivated only by extrinsic factors, and the majority (61.2%) reported mixed motivations for continuing their board certification. Only 38 respondents (0.5%) included a negative opinion about the certification process in their open-text responses. CONCLUSIONS Approximately half of family physicians in this sample noted a requirement to continue their certification, suggesting that there has been no significant increase in the requirements from employers, credentialing bodies, or insurers for physicians to continue board certification noted in previously cited work. Furthermore, only 17.5% of our sample reported solely external motivation to continue certification, indicating that real or perceived requirements are not the primary driver for most physicians to maintain certification.
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Affiliation(s)
| | | | | | - Aimee Eden
- American Board of Family Medicine, Lexington, KY
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Coutinho AJ, Levin Z, Petterson S, Phillips RL, Peterson LE. Residency Program Characteristics and Individual Physician Practice Characteristics Associated With Family Physician Scope of Practice. Acad Med 2019; 94:1561-1566. [PMID: 31192802 DOI: 10.1097/acm.0000000000002838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
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.
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Affiliation(s)
- Anastasia J Coutinho
- 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
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Dai M, Ingham RC, Peterson LE. Scope of Practice and Patient Panel Size of Family Physicians Who Work With Nurse Practitioners or Physician Assistants. Fam Med 2019; 51:311-318. [PMID: 30973618 DOI: 10.22454/fammed.2019.438954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Little is known about how the presence of nurse practitioners (NPs) and physician assistants (PAs) in a practice impacts family physicians' (FPs') scope of practice. This study sought to examine variations in FPs' practice associated with NPs and PAs. METHODS We obtained data from American Board of Family Medicine practice demographic questionnaires completed by FPs who registered for the Family Medicine Certification Examination during 2013-2016. Scope of practice score was calculated for each FP, ranging from 0-30 with higher numbers equating to broader scope of practice. FPs self-reported patient panel size. Primary care teams were classified into NP only, PA only, both NP and PA, or no NP or PA. We estimated variation in scope and panel size with different team configurations in regression models. RESULTS Of 27,836 FPs, nearly 70% had NPs or PAs in their practice but less than half (42.5%) estimated a panel size. Accounting for physician and practice characteristics, the presence of NPs and/or PAs was associated with significant increases in panel sizes (by 410 with PA only, 259 with NP only and 245 with both; all P<0.05) and in scope score (by 0.53 with PA only, 0.10 with NP only and 0.51 with both; all P<0.05). CONCLUSIONS We found evidence that team-based care involving NPs and PAs was associated with higher practice capacity of FPs. Working with PAs seemed to allow FPs to see a greater number of patients and provide more services than working with NPs. Delineation of primary care team roles, responsibilities and boundaries may explain these findings.
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Weidner A, Ewigman B, Peterson LE, Mainous AG. Response to "The Importance of Support Staff to Research Capacity". Fam Med 2019; 51:619. [PMID: 31287911 DOI: 10.22454/fammed.2019.332787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Amanda Weidner
- Association of Departments of Family Medicine, Leawood, KS, and University of Washington School of Medicine, Family Medicine Residency Network
| | - Bernard Ewigman
- NorthShore University HealthSystem, Department of Family Medicine, Evanston, IL
| | | | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida.,and Department of Community Health and Family Medicine, University of Florida, Gainesville, FL
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Peabody MR, Young A, Peterson LE, O'Neill TR, Pei X, Arnhart K, Chaudhry HJ, Puffer JC. The Relationship Between Board Certification and Disciplinary Actions Against Board-Eligible Family Physicians. Acad Med 2019; 94:847-852. [PMID: 30768464 DOI: 10.1097/acm.0000000000002650] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Lack of specialty board certification has been reported as a significant physician-level predictor of receiving a disciplinary action from a state medical board. This study investigated the association between family physicians receiving a disciplinary action from a state medical board and certification by the American Board of Family Medicine (ABFM). METHOD Three datasets were merged and a series of logistic regressions were conducted examining the relationship between certification status and disciplinary actions when adjusting for covariates. Data were available from 1976 to 2017. Predictor variables were gender, age, medical training degree type, medical school location, and the severity of the action. RESULTS Of the family physicians in this sample, 95% (114,454/120,443) had never received any disciplinary action. Having ever been certified was associated with a reduced likelihood of ever receiving an action (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.30, 0.40; P < .001), and having held a prior but not current certification at the time of the action was associated with an increase in receiving the most severe type of action (OR = 3.71; 95% CI = 2.24, 6.13; P < .001). CONCLUSIONS Disciplinary actions are uncommon events. Family physicians who had ever been ABFM certified were less likely to receive an action. The most severe actions were associated with decreased odds of being board certified at the time of the action. Receiving the most severe action type increased the likelihood of physicians holding a prior but not current certification.
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Affiliation(s)
- Michael R Peabody
- M.R. Peabody is senior psychometrician, American Board of Family Medicine, Lexington, Kentucky. A. Young is assistant vice president, Research and Data Integration, Federation of State Medical Boards, Euless, Texas. L.E. Peterson is vice president of research, American Board of Family Medicine, and assistant professor, Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, Kentucky. T.R. O'Neill is vice president of psychometric services, American Board of Family Medicine, Lexington, Kentucky. X. Pei is senior research analyst, Federation of State Medical Boards, Euless, Texas. K. Arnhart is senior research analyst, Federation of State Medical Boards, Euless, Texas. H.J. Chaudhry is president and chief executive officer, Federation of State Medical Boards, Euless, Texas. J.C. Puffer is president and chief executive officer emeritus, American Board of Family Medicine, Lexington, Kentucky
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Abstract
BACKGROUND AND OBJECTIVES Capacity for conducting family medicine research has grown significantly since the specialty was founded. Many calls to increase this capacity have been published, but there has been no consistent, systematic, and longitudinal assessment. This survey was designed to gather baseline data with an easily replicable set of measures associated with research productivity that can guide and monitor the impact of efforts to build research capacity in US departments of family medicine (DFMs). METHODS We surveyed family medicine department chairs regarding departmental research capacity using well-established empirical measures of capacity (trained research faculty, infrastructure, research leadership, and funding) and a self-assessment. We used bivariate analyses to assess correlation between the empirical measures and the self-assessed stage of research capacity. RESULTS Self-assessed capacity was significantly associated with every empirical measure. High-capacity departments have more research-trained faculty, more faculty effort, utilize more research "laboratories," have more faculty serving on federal peer-review panels, more faculty as principal investigators, devote more internal funding to research, and garner larger amounts of funding from more external funding sources than moderate or minimal-capacity departments. CONCLUSIONS US DFMs have made great strides over the past half century in building research capacity. However, much more capacity in family medicine and primary care research is needed to produce new knowledge necessary to improve the health and health care of the nation. Periodic measurement using the simple, replicable, and valid minimum measures of this study provides an opportunity to establish longitudinal tracking of change in research capacity in US DFMs.
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Affiliation(s)
- Amanda Weidner
- Association of Departments of Family Medicine, Leawood, KS, and University of Washington School of Medicine, Family Medicine Residency Network
| | | | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Avisek Datta
- NorthShore University HealthSystem, Evanston, IL
| | - Bernard Ewigman
- NorthShore University HealthSystem, Department of Family Medicine, Evanston, IL
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Peterson LE. Palliative Care Champions Are a Promising Solution to Meeting Patient Needs. J Am Geriatr Soc 2019; 67:S468-S469. [DOI: 10.1111/jgs.15796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 12/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Lars E. Peterson
- American Board of Family Medicine Lexington Kentucky
- Department of Family and Community MedicineUniversity of Kentucky Lexington Kentucky
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Abstract
OBJECTIVES There are more than 7000 rare diseases in the USA, and they are prevalent in 8% of the population. Due to life-threatening risk and limited therapies, early detection and treatment are critical. The purpose of this study was to explore characteristics of visits for patients with rare diseases seen by primary care physicians (PCPs). DESIGN The study used a cross sectional study using a national representative dataset, the National Ambulatory Medical Care Survey for the years 2012-2014. SETTING Primary care setting. PARTICIPANTS Visits to PCPs (n=22 306 representing 354 507 772 office visits to PCPs). PRIMARY OUTCOME MEASURES Prevalence of rare diseases in visits of PCPs was the primary outcome. Bivariate analyses and logistic regression analyses were used to compare patients with rare diseases and those without rare diseases and examined characteristics of PCP visits for rare diseases and practice pattern. RESULTS Among outpatient visits to PCPs, rare diseases account for 1.6% of the visits. The majority of patients with rare diseases were established patients (93.0%) and almost half (49.0%) were enrolled in public insurance programmes. The time spent in visits for rare diseases (22.4 min) and visits for more common diseases (21.3 min) was not significantly different (p=0.09). In an adjusted model controlling for patient characteristics (age, sex, types of insurance, reason for this visit, total number of chronic disease, having a rare disease and established or new patient), patients with rare diseases were 52% more likely to be referred to another provider (OR 1.52, 95% CI, 1.01 to 2.28). CONCLUSIONS Visits for rare diseases are uncommon in primary care practice. Future research may help to explain whether this low level of management of rare diseases in primary care practice is consistent with a goal of a broad scope of care.
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Affiliation(s)
- Ara Jo
- Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Samantha Larson
- Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
| | - Peter Carek
- Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | | | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky, USA
- Family and Community Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Arch G Mainous
- Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
- Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
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