Factors Influencing Family Physician Scope of Practice:

Abstract

Background and Objectives: Despite the efforts of many organizations to increase the volume of rural health care providers, rural communities continue to experience a shortage of physicians. To address this shortage, more information is needed as to how specific factors contribute to family physicians’ choice to purse rural full-spectrum practice. Methods: Interviews with 21 key informants guided a grounded theory analysis around the question of “What factors contribute to the decision to, and maintenance of, practicing full-spectrum rural medicine?” Results: Analysis revealed two categories of factors that influenced choice of scope and maintenance of scope across a career: contextual and developmental factors. Contextual factors included the national health care landscape, the local setting, and personal factors. The developmental factors pertained to the point in the physician’s career, and include preprofessional envisioned scope, current scope, and ideal future scope of practice. Conclusions: Results describe how a rural physician’s scope of practice generally narrows as her/his career progresses. The results elaborate on how the larger health care landscape, local community, and personal factors all intersect to inform a physician’s decision to pursue and/or continue practice. Results of the study were consistent with preexisting literature, but provide additional depth and suggest a theoretical relationship among factors.

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

“…Recent literature exploring the narrowing scope of family physicians has focused on personal, local, and health system factors that influence scope of practice. 3 Our conceptual model adds population factors to the existing understanding of influences on scope of practice. Further, we expanded on local and health system factors described by Reitz and colleagues 3 to highlight workplace factors that can be influenced by organizational leaders.…”

“…Consistent with previous studies, most participants highlighted the importance of personal factors in influencing their desired scope of practice. 3 Each physician brings life circumstances, personal qualities, training, and skills with them to the workplace. Multiple participants highlighted how family circumstances, desired place of residence, and work-life balance caused them to narrow their scope.…”

“…T here is a trend towards an increased scope of practice in the field of family medicine as a whole but individual family physicians' scope of practice has been decreasing over time with fewer family physicians providing basic primary care services, such as hospital, pediatric, and prenatal care. [1][2][3] Concurrently, research shows that new family medicine graduates intend to provide a broader scope of practice than current family physicians provide. 1,2 Reasons hypothesized for the discrepancy between family medicine residents' intentions and the realities of practice are employer constraints and limited practice support.…”

“…4,5 Given the value of a broader scope of practice, researchers have called for further examination of the causes for the decline in the scope of practice. 1 Reitz and colleagues 3 recently produced a conceptual model to understand scope of practice decisions for family physicians who originally intended to practice rural, full-spectrum medicine. They identified personal, local, and health care system factors which influenced changes from the original desired scope to the eventual actual scope of rural practice.…”

Como se relacionam o escopo de práticas profissionais, a formação e a titulação de médicos de Família e Comunidade?

“…Estudos em que foi possível se observar influências desses fatores sobre o escopo de práticas, maior tempo de atuação e formação atrelada à APS não se relacionou a um escopo ampliado 9,[26][27][28][29] . É preciso, contudo, contextualizar a realidade brasileira quando se estabelece comparação a estudos internacionais no que tange à formação em MFC 30 e entender que não é necessariamente ruim haver um escopo de prática menor que o padrão mais abrangente 9 , desde que se dialogue com as necessidades reais da comunidade em que se pretende prestar atendimento 31 .…”