Scope of Practice and Location of 3-Versus 4-Year Family Medicine Residency Graduates

BACKGROUND AND OBJECTIVES: The John Peter Smith (JPS) Family Medicine Residency Program participated in two national experiments: Preparing the Personal Physician for Practice (P4, 2007-2012) and the Length of Training Pilot, which began in 2013. In these experiments, JPS created optional integrated 4-year areas of emphasis (AOE). The objective of this study was to examine the career outcomes of JPS graduates differentiated by those who completed a 4-year AOE, versus traditional fourth-year fellowship, vs 3-year only. METHODS: We surveyed each graduate who started residency from 2007-2016 on their scope of practice. We also searched each graduate via Google to identify each of their practice sites and ascertain their status as a Health Professional Shortage Area (HPSA) or Medically Underserved Area for primary care (MUA-P). RESULTS: Of the 220 residents who entered the program as interns, 70 completed an integrated AOE (31.8%), 54 completed 3 years of training with a traditional fourth-year fellowship (24.5%, 40 at JPS, 14 at another location), and 93 completed only 3 years of training (42.3%). The overall percentage of JPS graduates who work in the United States (n=201) in HPSAs or MUA-Ps is similar to national numbers (45.3% vs 43.5% for HPSAs, 35.3% vs 33.3% for MUA-Ps). Graduates of a JPS integrated AOE track were more likely to work in a HPSA or MUA-P than other graduates (81.4% vs 38.5% traditional fellowship vs 45.6% 3-year only, P<.001; US practice sites only). Graduates of sports medicine fellowships were particularly less likely to work in HPSAs/MUA-Ps than other graduates (26.1%). Graduates of integrated AOEs provided much broader scopes of cognitive and procedural services than fellowship or 3-year graduates. CONCLUSIONS: In JPS graduates, 4 years of training with an integrated AOE had a large association with serving vulnerable populations, and providing broader cognitive and procedural services.

Automated summary

This study found a significant association between completing a 4-year integrated area of emphasis (AOE) training program and serving vulnerable populations as well as providing broader cognitive and procedural services among graduates of the John Peter Smith Family Medicine Residency Program.