Drivers of Scope of Practice in Family Medicine: A Conceptual Model

Abstract

PURPOSE The purpose of this study was to explore family medicine graduates' attitudes and perspectives on modifiable and unmodifiable factors that influenced their scope of practice and career choices. By understanding how these factors intersect to influence desired and actual scope of practice decisions, we hope to inform strategies to address training and health care workforce needs.METHODS During 5 focus group discussions, comprised of a total of 32 family physicians who either resided in or attended a residency program in western North Carolina, we explored family physicians' attitudes and perspectives on their desired and actual scope of practice. We used thematic analysis to identify patterns in the qualitative data. RESULTSWe created a conceptual framework to understand the complex factors which influence family physicians' scope of practice. Personal factors were found to impact desired scope, while workplace, environmental, and population factors influenced actual scope of practice. Stressors in each of these 4 categories often caused family physicians to narrow their scope of practice. Our study highlights specific supports that, if in place, enable physicians to maintain their desired broad scope of practice.CONCLUSIONS Our study indicates that the national trend toward family physicians narrowing their scope of practice can be addressed by providing specific supports during training, residency, and mid-career. Understanding personal, workplace, environmental, and population factors that influence scope of practice can inform specific interventions that create desirable jobs for family physicians and improve their ability to meet changing population needs.

Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review

“…The lack of literature on the factors influencing scope of practice of medical practice in Australia is in contrast to international jurisdictions. For example, Russell et al [ 64 ] discovered that four categories of influencers on scope of practice of medical practice exist within the US context: personal (e.g. training, work/life balance, mentoring); workplace (e.g.…”

Insights for New and Developing Rural Family Medicine Residency Programs

“…42 Studies indicate the underlying reasons for the change in a narrower scope are multifactorial, such as the national and regional health care demands, practice setting, local demographics and cultural norms, personal preferences, and more. 43,44 Narrowing the scope of family practice may have serious consequences on population health as greater continuity of care has been associated with lower mortality 45 and lower rates of patient hospitalizations and health care costs. 46 There is a need for further research into identifying and devising solutions to address health disparities attributed to change in rural family medicine practice scope.…”

Rural Versus Urban Family Medicine Residency Scope of Training and Practice

“…9,10 Conceptual modeling and theory behind family physician SOP point to the influence of personal (physician age, gender, education and training, career stage), workplace (health system administration, work culture), environmental (rural location, geographical location), and population factors (patient demographics, social barriers to care). 11,12 Narrowing SOP was found to be influenced at specific career points, including residency education. 12 The context of training in residency can influence SOP, with broader SOP for graduates with more rural training and from singleresidency institutions.…”