Specialization and Scope-of-Practice for Family Physicians

A new study from the Annals of Family Medicine finds that while family physicians are better prepared today than before, their profession is becoming more specialized, with implications for regulatory scope-of-practice restrictions in the healthcare profession:

Family physicians’ scope of practice is declining despite being well prepared to provide a range of clinical services. [In this context, “scope of practice” refers to what treatments doctors provide, rather than the legal restrictions placed on providers.] To evaluate whether this is a new phenomenon, we compared the proportions of regional family medicine residency graduates who report practicing and those who report feeling more than adequately prepared to practice various procedures and clinical services from 2 points in time–a survey in 2000 of graduates from 1996-1999 (n = 293) and a survey in 2012 or 2014 of graduates from 2010-2013 (n = 408). The recent graduates felt better prepared, but reported a narrower scope of practice than those who graduated more than a decade earlier. These findings suggest that family medicine residency training has improved over time but the declining scope of practice is a concerning trend.

“Significant differences exist between the proportion of the earlier and later cohorts who report practicing various services and procedures at the time of the survey,” found the authors. “The earlier cohort [‘96-’99 graduates] had a similar or significantly higher proportion of graduates practicing almost all of the listed services and procedures than the later cohort; only obstetric ultrasound and end-of-life care were more common among the later cohort.”

Increased specialization in medicine is a problem if physicians become too “highly trained.” That is, if they learn far more than they need to in medical school and residency, the extra time and resources spent is wasted, or at least not used efficiently.

“[T]hese results suggest we may need to consider ways to adapt our current training to a new generation of practice realities and physician preferences,” say the authors, though they offer no specific policy solutions. One way to address this would be to expand scope-of-practice for non-MD healthcare providers, such as physician assistants or nurse practitioners.