Scope of Practice and ABFM Recertification Exam Performance
Scope of Practice and ABFM Recertification Exam Performance
Our final sample included 10,978 family physicians, with 2,140 (19.5%) located in rural areas. Rural physicians were less likely to have taken the examination twice (9.4% vs 12.4%, P < .05) in 2013. In bivariate analyses, rural family physicians had significantly higher examination scores, passing rates, and SP4PC scores (Table 2) and were also more likely to be male, slightly older, and a US medical school graduate. Rural family physicians were significantly more likely to report performing every element in the SP4PC scale except adult medicine (Table 1). The individual elements demonstrating the biggest differences between rural and urban family physicians were palliative care (52.1% of rural physicians vs 28.2% of urban physicians), hospital medicine (53% vs 29.7%), and emergency care (30.7% vs 12.3%).
The results of regression models without the SP4PC scale matched previously reported findings (Table 3). Specifically, we found that physicians in urban areas scored 15.6 points lower than rural physicians on the examination and were 27% less likely to pass the examination (OR = 0.73; 95% CI, 0.62–0.87). When the SP4PC scale was added to the regression models, the relationship between urban location and examination score was reduced 66% to 5.8 points but was still statistically significant. Inclusion of the SP4PC scale improved model fit (R increased 12–16%) in the linear models. Inclusion of the SP4PC score completely attenuated the relationship between urban location and passing the examination (OR = 0.86; 95% CI, 0.73–1.02). In the full model, each point increase on the SP4PC scale was associated with an examination score increase of 4.9 points and a 9% increase in the odds of passing (OR = 1.09; 95% CI, 1.07–1.11). Other findings of interest from the adjusted analyses were that physicians who work in solo practices score 36.4 lower points than physicians who work in group practices and were nearly 50% less likely to pass (OR = 0.51; 95% CI, 0.43–0.60). Similar to linear regression, model fit in logistic regression improved with addition of the SP4PC score.
Regression models stratified by rural/urban status were largely consistent with the results using all physicians. Specifically we found that the association between SP4PC and examination score was slightly larger in urban areas (5.6 vs 3.2 points) than in rural areas but the size of the association was small (Table 4). Similarly, the odds of passing the examination were nearly identical between rural physicians (OR = 1.11; 95% CI, 1.07–1.16) and urban physicians (OR = 1.08; 95% CI, 1.06–1.11) and to the full model.
Results
Our final sample included 10,978 family physicians, with 2,140 (19.5%) located in rural areas. Rural physicians were less likely to have taken the examination twice (9.4% vs 12.4%, P < .05) in 2013. In bivariate analyses, rural family physicians had significantly higher examination scores, passing rates, and SP4PC scores (Table 2) and were also more likely to be male, slightly older, and a US medical school graduate. Rural family physicians were significantly more likely to report performing every element in the SP4PC scale except adult medicine (Table 1). The individual elements demonstrating the biggest differences between rural and urban family physicians were palliative care (52.1% of rural physicians vs 28.2% of urban physicians), hospital medicine (53% vs 29.7%), and emergency care (30.7% vs 12.3%).
The results of regression models without the SP4PC scale matched previously reported findings (Table 3). Specifically, we found that physicians in urban areas scored 15.6 points lower than rural physicians on the examination and were 27% less likely to pass the examination (OR = 0.73; 95% CI, 0.62–0.87). When the SP4PC scale was added to the regression models, the relationship between urban location and examination score was reduced 66% to 5.8 points but was still statistically significant. Inclusion of the SP4PC scale improved model fit (R increased 12–16%) in the linear models. Inclusion of the SP4PC score completely attenuated the relationship between urban location and passing the examination (OR = 0.86; 95% CI, 0.73–1.02). In the full model, each point increase on the SP4PC scale was associated with an examination score increase of 4.9 points and a 9% increase in the odds of passing (OR = 1.09; 95% CI, 1.07–1.11). Other findings of interest from the adjusted analyses were that physicians who work in solo practices score 36.4 lower points than physicians who work in group practices and were nearly 50% less likely to pass (OR = 0.51; 95% CI, 0.43–0.60). Similar to linear regression, model fit in logistic regression improved with addition of the SP4PC score.
Regression models stratified by rural/urban status were largely consistent with the results using all physicians. Specifically we found that the association between SP4PC and examination score was slightly larger in urban areas (5.6 vs 3.2 points) than in rural areas but the size of the association was small (Table 4). Similarly, the odds of passing the examination were nearly identical between rural physicians (OR = 1.11; 95% CI, 1.07–1.16) and urban physicians (OR = 1.08; 95% CI, 1.06–1.11) and to the full model.