Effects of the scope of practice on family physicians: a systematic review

Abstract

Background Family medicine is a branch of medicine that manages common and long-term illnesses in children and adults. Family physicians in particular play a major role and their scope of practice is expected to impact patient and population. However, little is known about its impact on physicians. We aimed to assess the effects of scope of practice on family physician outcomes. Methods We performed a systematic review that we reported using PRISMA guidelines. For the inclusion criteria, any study exploring an association between the scope of practice and physician outcomes was considered. Three bibliographic databases Medline, Embase, and ERIC were consulted through OVID interface from their respective inceptions to November, 2020. Two reviewers independently selected studies, extracted data and assessed the risk of bias of studies using appropriate tools. We conducted data synthesis using a narrative form. GRADE was used for evaluating quality of cumulative evidence. Results In total, we included 12 studies with 38,732 participants from 6927 citations identified. Eleven of them were cross-sectional, and one was a cohort study with acceptable methodological quality. We found that: 1) family physicians with diverse clinical and nonclinical activities significantly improve their job satisfaction (p<0.05); 2) family physicians with a variety of clinical practices significantly improve their competences and health status (p<0.05); 3) family physicians who perform clinical procedures (mainly extended to gynecological procedures) significantly improve their psychosocial outcomes (e.g., job satisfaction) (p<0.05); and 4) some associations are not statistically significant (e.g., relation between variety of practice settings and outcomes). We observed that the evidence available has a very low level. Conclusions Our findings suggest that the scope of practice may be favorably associated with some family physician outcomes but with a very low level of evidence available. Based on these findings, healthcare system managers could monitor the scope of practice among family physicians and encourage future research in this field. Systematic review registration Our protocol was registered under the number CRD42019121990 in PROSPERO.

Inquiry Into Physicians’ Scope of Practice in Japanese Rural Hospitals During the COVID-19 Pandemic: A Serial Cross-Sectional Study

“…There are some successful examples of rural-oriented medical schools, such as Jichi Medical University in Japan, James Cook University in Queensland, Australia, and Memorial University in St. John's, Canada [28][29][30]. Although these efforts contribute to the maintenance of rural healthcare to a certain degree, there is a need for additional incentives such as a scholarship.…”

“…Furthermore, Japan is implementing various strategies for rural healthcare maintenance such as providing scholarships in exchange for postgraduate rural services [ 27 ]. There are some successful examples of rural-oriented medical schools, such as Jichi Medical University in Japan, James Cook University in Queensland, Australia, and Memorial University in St. John’s, Canada [ 28 - 30 ]. Although these efforts contribute to the maintenance of rural healthcare to a certain degree, there is a need for additional incentives such as a scholarship.…”

“…Conversely, a study indicated that family physicians who provide a broader SoP reported significantly lower rates of burnout [ 29 ]. One of the systematic reviews on family physicians’ SoP revealed that those with diverse clinical activities have significantly higher job satisfaction [ 30 ]. In a recent study, it was further indicated that the defining factors for choosing rural practice include previous experience, preference for a rural lifestyle, desire for autonomy, a comprehensive SoP, and close relationships with patients [ 16 ].…”

Family Physicians Working at Hospitals: A 20-Year Nationwide Trend Analysis in Taiwan

“…This suggested that 9% of all family physicians practicing in hospitals stayed in practice because they oversaw inpatient hospice and palliative care. Some family physicians may have a passion for teaching, research, or management [29], which is not possible in a clinic setting. Some family physicians stay in hospitals for continuing education credits.…”

A Canadian model for providing high-quality, timely and relevant evidence to meet health system decision-maker needs: the SPOR Evidence Alliance

“…When appropriate, the SPOR Evidence Alliance research team collaborates with other SPOR entities to respond to a query. For example, the Ministère de la Santé et des Services sociaux (Québec Ministry of Health and Social Services) reached out to the SPOR Evidence Alliance in April 2018 seeking evidence on the scope of family physician practice to inform a position statement on the nature of family practice in Quebec (Zomahoun et al 2021). To respond to this query, the SPOR Evidence Alliance partnered with the knowledge synthesis platform of the Québec SUPPORT Unit, which is the provincial research service centre funded by the SPOR enterprise.…”