Shrinking Scope of Practice Reflects Trends in Family Physician Employment, Hospital Privileges

FOR IMMEDIATE RELEASE: Tuesday, November 12, 2019

Contact:
Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224
lchampli@aafp.org 

Shrinking Scope of Practice Reflects Trends in Family Physician Employment, Hospital Privileges

WASHINGTON, DC — All family physicians train to treat patients in both their offices and in hospitals. But once they launch their careers, they discover they’re limited or denied the ability to provide hospital care.

Those are the results of Robert Graham Center research, which found that the proportion of family physicians reporting they provide inpatient care fell by 26% between 2013 and 2017. Only one in four family physicians practiced hospital medicine in 2017.

“Policymakers, payers, and leaders in medical education should closely track the impact of these trends, given previous evidence associating better cost and utilization outcomes with broader scope of practice,” write Anuradha Jetty, MPH, and her colleagues in “The Declining Presence of Family Physicians in Hospital-Based Care.” The policy brief was published in the November-December issue of the Journal of the American Board of Family Medicine.

Jetty reviewed data from the 2013-2017 ABFM certification examination application questionnaire to identify trends in hospital care. Over that time, the share of family physicians who reported providing hospital care fell from 34% to 25%.

“As observed in other domains (prenatal care, home visits, nursing home care, and obstetric care), this study adds to the evidence demonstrating contracting scope of practice among family physicians,” she writes.

The data signal two trends in health care, according to Jetty. “Not providing inpatient care is not bad,” she said. “It reflects that scope of practice is shaped by the shifting needs of patients and communities. With the changing composition of ambulatory care with large patient panels and patients with increased complexity, family physicians provide a high volume of care in ambulatory settings and seek assistance of hospitalists to take of care of inpatients.”

The data also indicate the outcome of a second trend: Despite the expansion of training in full-scope family medicine, fewer new family physicians can find positions that allow them to use all their expertise. According to the 2018 AAFP Practice Profile report, four in 10 family physicians have full hospital privileges, down from 56% in 2012. At the same time, AAFP Practice Profile data show more than six in 10 AAFP members—and more than eight in 10 new family physicians—are employed and do not own their practice. Many work in large, often multispecialty practices or in hospital systems. Some of these employers dictate scope of practice, limiting family physicians to coordinating outpatient care and relying on subspecialists or hospitalists to provide inpatient care.