Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians

Peterson, Lars E.; Fang, Bo; Puffer, James C.; Bazemore, Andrew

doi:10.3122/jabfm.2018.02.170359

Cited by 35 publications

(39 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Survey research suggests that comprehensiveness is declining in the United States despite prior evidence suggesting numerous benefits. This decline is not the inevitable result of advances in modern medicine, but is largely a consequence of flawed incentives .…”

Section: Introductionmentioning

confidence: 99%

New approaches to measuring the comprehensiveness of primary care physicians

O’Malley

Rich

Shang

et al. 2019

Health Services Research

View full text Add to dashboard Cite

Objective To develop claims‐based measures of comprehensiveness of primary care physicians (PCPs) and summarize their associations with health care utilization and cost. Data Sources and Study Setting A total of 5359 PCPs caring for over 1 million Medicare fee‐for‐service beneficiaries from 1404 practices. Study Design We developed Medicare claims‐based measures of physician comprehensiveness (involvement in patient conditions and new problem management) and used a previously developed range of services measure. We analyzed the association of PCPs’ comprehensiveness in 2013 with their beneficiaries’ emergency department, hospitalizations rates, and ambulatory care‐sensitive condition (ACSC) admissions (each per 1000 beneficiaries per year), and Medicare expenditures (per beneficiary per month) in 2014, adjusting for beneficiary, physician, practice, and market characteristics, and clustering. Principal Findings Each measure varied across PCPs and had low correlation with the other measures—as intended, they capture different aspects of comprehensiveness. For patients whose PCPs’ comprehensiveness score was at the 75th vs 25th percentile (more vs less comprehensive), patients had lower service use (P < 0.05) in one or more measures: involvement with patient conditions: total Medicare expenditures, −$17.4 (−2.2 percent); hospitalizations, −5.5 (−1.9 percent); emergency department (ED) visits, −16.3 (−2.4 percent); new problem management: total Medicare expenditures, −$13.3 (−1.7 percent); hospitalizations, −7.0 (−2.4 percent); ED visits, −19.7 (−2.9 percent); range of services: ED visits, −17.1 (−2.5 percent). There were no significant associations between the comprehensiveness measures and ACSC admission rates. Conclusions These measures demonstrate strong content and predictive validity and reliability. Medicare beneficiaries of PCPs providing more comprehensive care had lower hospitalization rates, ED visits, and total Medicare expenditures.

show abstract

Section: Introductionmentioning

confidence: 99%

New approaches to measuring the comprehensiveness of primary care physicians

O’Malley

Rich

Shang

et al. 2019

Health Services Research

View full text Add to dashboard Cite

show abstract

“…To the Editor: Peterson et al 1 have published a stimulating piece that leaves the reader wanting more analysis, which will probably show up in future articles. For all the years since residency education began, a family medicine residency graduate faces a "buyers' market" relative to job opportunities that match one's desired practice.…”

Section: Re: Wide Gap Between Preparation and Scope Of Practice Of Eamentioning

confidence: 99%

Response: Re: Wide Gap between Preparation and Scope of Practice of Early Career Family Physicians

Peterson

2018

J Am Board Fam Med

Self Cite

View full text Add to dashboard Cite

“…A study of family physicians registering for the American Board of Family Medicine initial and continuing certification examinations found that 51.9% of initial certifiers intended to provide palliative care, and there was an increase in the provision of palliative care by physicians in practice with the percentage rising from 44.9% to 61.5% from the first 10 years in practice to over 30 years in practice . A survey of 2013 family medicine residency graduates done in 2016 found that 83% reported being prepared to provide “end‐of‐life care” with 64% providing the service . My own analysis of data provided by 2017 American Board of Family Medicine continuing certification candidates found that 0.8% (71 of 9408) primarily worked in a hospice setting, with 74.7% of these currently being HPM certified.…”

mentioning

confidence: 99%