Family physicians’ scope of practice and American Board of Family Medicine recertification examination performance

PURPOSE: Previous research indicated that rural family physicians were more likely to pass the American Board of Family Medicine (ABFM) Maintenance of Certification for Family Physicians (MC-FP) examination. One possible explanation is that rural family physicians may have a broader scope of practice. METHOD: This was a cross-sectional study of family physicians taking the ABFM MC-FP examination in 2013. Examination results were linked with the Scope of Practice for Primary Care (SP4PC) scale. Linear and logistic regression models, with and without SP4PC score, determined associations between scope of practice and examination results. RESULTS: Among 10,978 examinees, rural physicians had a higher passing rate (90.7% vs 86.8%, P < .05) and higher SP4PC score (16.1 vs 14.3 P < .05) compared with urban physicians. Regression models without SP4PC score confirmed that urban physicians were less likely to pass (OR = 0.73; 95% CI, 0.62-0.87) and scored lower, -15.6 points, compared with rural physicians. Including SP4PC score completely attenuated the relationship between practice location and passing (OR = 0.86; 95% CI, 0.73-1.02) and decreased the relationship between score and practice location (-5.8 points). Each point increase on the SP4PC score was associated with 9% higher odds of passing (OR = 1.09; 95% CI, 1.07-1.11) and 4.9 more points. CONCLUSION: A broader scope of practice rather than rural or urban practice location, was associated with increased likelihood of passing the MC-FP examination. If higher board scores are associated with providing higher quality of care, then maintaining a broad scope of practice may enable the delivery of higher quality primary care.